Unit 2: Men's Health. PDF

**Unit 2** 1. **Men** a. **RF for prostate cancer:** increasing age (\> 50 yrs old), genetics, tobacco use, environmental exposures, African Americans, diet high in red meat and high fat diet i. **Dx:** digital rectal exam and PSA, biopsies to confirm \[...

**Unit 2** 1. **Men** a. **RF for prostate cancer:** increasing age (\> 50 yrs old), genetics, tobacco use, environmental exposures, African Americans, diet high in red meat and high fat diet i. **Dx:** digital rectal exam and PSA, biopsies to confirm \[multiple quadrants/lobes\] ii. Post-op complications: bleeding & infections b. **Prostate enlargement/BPH:** iii. **Clinical manifestations \[also s/s urinary retention\]** 1. **Decrease in volume and force of stream** 2. Increased urinary frequency, urge, nocturia, hesitancy, dribbling 3. Incomplete bladder empty, impeded urine flow 4. Urinary retention, Recurrent UTIs, post void residual 5. Azotemia (accumulation of waste products in the blood) iv. **Tx:** **Transurethral resection (TURP):** endoscopy inserted into urethra and the inner part of prostate removed 6. **Continuous Bladder Irrigation for post prostate surgery \[3-way catheter system\]** a. Used after prostate surgery to help prevent blood clot formation to ensure the bladder stays clear of any blockages b. If there is bright red drainage after an hour: call surgeon c. Report frank blood \[not clots\] d. Mang: Monitor the flow, monitor I&O, note color of fluid in drainage bag v. **Medications**: 7. Alpha adrenergic blockers: alfuzosin, **terazosin, doxazosin (used most commonly)** e. **A/E**: **postural hypotension, sexual dysfunction (retrograde ejaculation), nasal stuffiness/rhinitis,** dizzy, H/A, and fatigue f. MOA: relaxes smooth muscle 8. 5-alpha-reductase inhibitors: **finasteride and dutasteride (Advodart)** g. **Finasteride is best used in combination w/ doxazosin to decrease prostate size** c. **Erectile dysfunction:** vi. **Patho**: Decreased frequency of erections, inability to achieve a firm erection, or rapid detumescence vii. **Causes**: 9. **Psychogenic (abrupt onset)** h. Anxiety, fatigue, depression i. Pressure to perform j. Absence of desire k. Negative body issues l. Relationship issues 10. **Organic (gradual onset)** m. Meds Chart 53-1, p. 4628 i. The main one that cause ED are Beta blockers and Statins n. CVD, Endocrine (uncontrolled diabetes and hypothyroidism), Cirrhosis, Chronic renal failure, Leukemia, Neuro disorders, ETOH and SMOKING viii. **S/s:** sexual dysfunction ix. **Tx:** **Sildenafil**, **tadalafil,** vardenafil (Table 53-3 p. 4651) 11. **A/E of sildenafil:** Nasal congestion 2. **Women** d. **Menopause:** x. **Patho**: Permanent physiologic cessation of menses associated with declining ovarian function evidenced **by 12 consecutive months with no menstrual bleeding** xi. **S/s of menopause**: 12. **Mood changes** may be due to **lack of sleep** from hot flashes 13. Breast tenderness (due to fluid retention) 14. **Increased risk for vaginal infections** 15. **Hot or warm flashes** due to vasomotor instability (can also cause palpitations), vaginal dryness, HA, thinning hair 16. **Increased bone loss** causes increased risk of osteoporosis. So they need calcium supplements, vitamin D, and weight-bearing exercise 17. **Sleep issues d/t all of these above issues (mainly hot flashes)** 18. **Entire GU system is changing: vaginal atrophy/fragile, decreased vaginal lubrication can lead to painful sex** 19. **Vasomotor s/s: Hot flashes, night sweats, dizziness, palpitations** 20. **Increase in vaginal pH causes increase in vaginal infections. Also b/c of thinning and atrophy of vaginal tissue and decrease in vaginal lubrication** xii. **Complications of menopause:** osteoporosis xiii. **Medical management: Hormone Replacement Therapy \[HRT\]:** prescribed to alleviate symptoms of menopause 21. Research shows they increase some health disorders such as breast cancer, heart attack, stroke and blood clots 22. **Contraindicated in the following: Hx of breast cancer, coronary heart disease, previous TIA/DVT/PE, unexplained vaginal bleeding, active liver disease** 23. **Tx if she has a uterus and ovaries: Estrogen/progesterone therapy (estradiol)** 24. **Tx if she does NOT have a uterus and ovaries: Estrogen therapy** e. **Perimenopause:** xiv. **Teaching for perimenopause:** 25. **USE CONTRACEPTION** until no menses for 12 consecutive months 26. **Oral contraception** is preferred as a contraception b/c provide **protection against uterine cancer and ovarian cancer, anemia, pregnancy, s/s of fibrocystic breast dz, and relief of perimenopausal s/s** (book) f. **Self-breast exam** xv. **The best time for self breast exam for women of childbearing age is 5-7 days after menses** xvi. **Abnormal inspection:** lumps, dimpling, P'deu orange, discharge from the nipple xvii. **Palpation**: **Tail of spence:** part of breast that goes up into the axilla; needs to be checked during exams bc it's a common spot for tumor xviii. **When to notify the provider?** 27. When there are abnormalities such as abnormal lumps, dimpling, and or notable erythema g. **Cervical cancer:** xix. **S/S:** 28. **Early:** thin, watery vaginal discharge after intercourse/douching 29. **Advanced/Late:** vaginal discharge, irregular bleeding, pain/bleeding with or after intercourse 30. **More Advanced**: dark-foul smelling discharge, irregular vaginal bleeding 31. **Most common symptom of cervical cancer is irregular bleeding** o. NOTE: In post-menopausal women: bleeding \[ALWAYS BAD\] xx. **Dx testing: Colposcopy:** allows the examiner to visualize the cervix and obtain a sample of abnormal tissue for analysis xxi. **Medical management:** 32. **Simple hysterectomy:** removal of the uterus only p. Used when not in child-bearing age 33. **LEEP**: thin wire loop is used to cut away tissue; removes abnormal cells h. **Trichomanissis:** xxii. **S/s**: itchy, yellow to yellow-green frothy copious & discharge, malodorous, burning, and irritation xxiii. **Dx:** inspection with a speculum often reveals vaginal and cervical erythema with **multiple small petechiae (strawberry spots),** pH greater than 4.5 i. **Vaginal fistula:** xxiv. **Patho**: Fistula is an abnormal opening b/t two internal hollow organs or internal organ and exterior of body xxv. **S/s**: 34. **Vesicovaginal fistula**: fistula b/t bladder & vagina causing urine to leak from bladder into vagina 35. **Rectovaginal fistula:** fistula b/t vaginal canal and rectum causing fecal incontinence & flatus passing through vagina q. **S/sx: pressure, fecal matter in the vagina** xxvi. **Pt teaching:** **Rectovaginal fistula: low fiber and low-residue diet for healing** j. Pt teaching for STI and prevention