Test 4 Nur 114
S/S of BPH
- incomplete bladder emptying - nocturia - dribbling at the end of the urinary stream - incontinence, leakage of urine - weak urine stream -sudden urge to urinate -painful urination -UTI -Blood in urine - gland may be normal in size, or may feel symmetrically enlarged, smooth, and firm, though slightly elastic; there may be obliteration of the median sulcus and more notable protrusion into the rectal lumen.
Finasteride TEACHING
--Gynecomastia (Breast in men) --keep medication and semen of men taking medication away from pregnant or women of childbearing age --take the capsule whole (DO NOT open and sprinkle) irritates the throat
Colorectal Cancer Myelosuppression Tx
--Iron Rich Foods --Blood Transfusion Epoetin Alpha (Colony-stimulating factor) 50-150 units/kg 3 x week SQ / IV (Onset 7-10d) Contraindicated in uncontrolled HTN S.E. HTN, arthralgias, nausea, edema, fatigue, injection site reactions, rash diarrhea, ShOB
Prostate Cancer
-2nd most common 2nd leading cause of death -curable if caught early -most are adenocarcinoma's (when grow compress urethra) -normally arises in the periphery of the glad where BPH occurs in the center of the gland -men should start to be screened at 45 or 40 if family hx
Colorectal cancer
-3rd most common cancer, 3rd most deadly - Most are adenocarcinomas(polyp that it benign in early stages, if left untreated, the polyp will grow and malignancy increases) - Most often found in the rectosigmoid
Inflammation is associated with diseases such as
-Autoimmune diseases like rheumatoid arthritis -Cardiovascular diseases like high blood pressure and heart disease Gastrointestinal disorders like inflammatory bowel disease Lung diseases like asthma Mental illnesses like depression Metabolic diseases like Type 2 diabetes Neurodegenerative diseases like Parkinson's disease Some types of cancer, like colon cancer
Colon Cancer Expected Findings
-Change in stool consistency or shape (w/ or w/out noticeable blood) -Blood in stool -Abd cramps and/or gas -wt loss fatigue -Anemia -abd fullness,distention or pain -rectal pain, rectal bleeding -sensation of bowel fullness after defecation -high pitched tinkling bowel sounds ( indicative of obstruction)
Colorectal cancer Health Promotion/Disease Prevention
-Diet Rich in Ca ( Calcium binds to free fatty acids and bile salts in the lower GI tract) -Low Fat, Simple Carbs, High Fiber -Regular Screenings >45 or can be earlier if family hx -yearly fecal occult blood test -colonoscopy q 10yrs -flex sigmoidoscopy q 5yrs -Genetic testing -Regular exercise, no smoking, limit alcohol use
Colorectal Cancer: Care Coordination and Transition Management
-Normal appearance of stoma -Signs and symptoms of complications -Measurement of stoma -Choice, use, care, application of appropriate appliance to cover stoma -Measures to protect skin -Dietary measures to control gas and odor -Resumption of normal activities
Colorectal Cancer Risk Factors
50+ yrs genetics adenomatous polyps (family hx) IBD (ulcerative colitis, Crohn's ) smoking obesity alcohol sedentary lifestyle High Fat Diet
Risk Factors for BPH
>50 yo, Family Hx, Obesity, Type 2 Diabetes, ED, Sedentary lifestyle, alcohol, caffeine, smoking, Black men, Western Diet (high fat-protein-carbs-low fiber)
A 72-year old male client is brought to the emergency room by his son. The client is extremely uncomfortable and has been unable to void for the past 12 hours. He has known for some time that he has an enlarged prostate but has wanted to avoid surgery. The best method for the nurse to use when assessing for bladder distention in a male client is to check for: A. A rounded swelling above the pubis. B. Dullness in the lower left quadrant. C. Rebound tenderness below the symphysis. D. Urine discharge from the urethral meatus.
A. A rounded swelling above the pubis. The best way to assess for a distended bladder in either a male or female client is to check for a rounded swelling above the pubis. The swelling represents the distended bladder rising above the pubis into the abdominal cavity. Determine the condition of the skin in the perianal area. In patients with chronic neurogenic bladder, the skin typically shows areas of chronic irritation manifested by areas of excoriation and redness, usually superseded by fungal infection.
The client with BPH undergoes a transurethral resection of the prostate. Postoperatively, the client is receiving continuous bladder irrigations. The nurse assesses the client for signs of transurethral resection syndrome. Which of the following assessment data would indicate the onset of this syndrome? A. Bradycardia and confusion B. Tachycardia and diarrhea C. Decreased urinary output and bladder spasms D. Increased urinary output and anemia
A. Bradycardia and confusion Transurethral resection syndrome is caused by increased absorption of nonelectrolyte irrigating fluid used during surgery. The client may show signs of cerebral edema and increased intracranial pressure such as increased blood pressure, bradycardia, confusion, disorientation, muscle twitching, visual disturbances, and nausea and vomiting.
Because a client's renal stone was found to be composed of uric acid, a low-purine, alkaline ash diet was ordered. Incorporation of which of the following food items into the home diet would indicate that the client understands the necessary diet modifications? A. Milk, apples, tomatoes, and corn. B. Eggs, spinach, dried peas, and gravy. C. Salmon, chicken, caviar, and asparagus D. Grapes, corn, cereals, and liver.
A. Milk, apples, tomatoes, and corn. Because a high-purine diet contributes to the formation of uric acid, a low-purine diet is advocated. An alkaline ash diet is also advocated because uric acid crystals are more likely to develop in acid urine. Foods that may be eaten as desired in a low-purine diet include milk, all fruits, tomatoes, cereals, and corn. Food allowed on an alkaline ash diet include milk, fruits (except cranberries, plums, and prunes), and vegetables (especially legumes and green vegetables). Gravy, chicken, and liver are high in purine.
A client is complaining of severe flank and abdominal pain. A flat plate of the abdomen shows urolithiasis. Which of the following interventions is important? A. Strain all urine. B. Limit fluid intake. C. Enforce strict bed rest. D. Encourage a high calcium diet.
A. Strain all urine. Urine should be strained for calculi and sent to the lab for analysis. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of type of stone and influences choice of therapy.
Prostate Cancer Risk Factors
Advanced age, Black Man, family hx high fat diet Rapid growth of the prostate Exposure to environmental toxins such as arsenic
Medications that can affect the urinary system
Antidepressants Diuretics Antihistamines Sedatives
A client has a ureteral catheter in place after renal surgery. A priority nursing action for care of the ureteral catheter would be to: A. Irrigate the catheter with 30 ml of normal saline every 8 hours. B. Ensure that the catheter is draining freely. C. Clamp the catheter every 2 hours for 30 minutes. D. Ensure that the catheter drains at least 30 ml an hour.
B. Ensure that the catheter is draining freely. The ureteral catheter should drain freely without bleeding at the site. Ensure nephrostomy is secure at all times with drain fixation dressing (and secondary film dressing if required). Check drainage tubing is patent and not kinked/twisted. At night, the patient and/or carer should be taught to attach a larger-volume night drainage bag to ensure a comfortable night's sleep.
The client returns to the nursing unit following a pyelolithotomy for removal of a kidney stone. A Penrose drain is in place. Which of the following would the nurse include in the client's postoperative care? A. Sterile irrigation of the Penrose drain. B. Frequent dressing changes around the Penrose drain. C. Weighing the dressings. D. Maintaining the client's position on the affected side.
B. Frequent dressing changes around the Penrose drain. Frequent dressing changes around the Penrose drain is required to protect the skin against breakdown from urinary drainage. If urinary drainage is excessive, an ostomy pouch may be placed over the drain to protect the skin. Change the dressing 2 times every day and anytime it's wet or loose. It's best to change it around the same time every day.
Allopurinol (Zyloprim), 200 mg/day, is prescribed for the client with renal calculi to take home. The nurse should teach the client about which of the following side effects of this medication? A. Retinopathy B. Maculopapular rash C. Nasal congestion D. Dizziness
B. Maculopapular rash Allopurinol is used to treat renal calculi composed of uric acid. Side effects of allopurinol include drowsiness, maculopapular rash, anemia, abdominal pain, nausea, vomiting, and bone marrow depression. Clients should be instructed to report skin rashes and any unusual bleeding or bruising.
A client who has been diagnosed with calculi reports that the pain is intermittent and less colicky. Which of the following nursing actions is most important at this time? A. Report hematuria to the physician. B. Strain the urine carefully. C. Administer meperidine (Demerol) every 3 hours. D. Apply warm compresses to the flank area.
B. Strain the urine carefully. Intermittent pain that is less colicky indicates that the calculi may be moving along the urinary tract. Fluids should be encouraged to promote movement, and the urine should be strained to detect the passage of the stone. Strain all urine. Document any stones expelled and sent to the laboratory for analysis. Retrieval of calculi allows identification of the type of stone and influences choice of therapy.
The nurse is conducting a postoperative assessment of a client on the first day after renal surgery. Which of the following findings would be most important for the nurse to report to the physician? A. Temperature, 99.8°F B. Urine output, 20 ml/hour C. Absence of bowel sounds D. A 2×2 inch area of serosanguineous drainage on the flank dressing.
B. Urine output, 20 ml/hour The decrease in urinary output may indicate inadequate renal perfusion and should be reported immediately. Urine output of 30 ml/hour or greater is considered acceptable. There is a possibility that the kidney could become damaged during the surgical procedure. Every attempt will be made to minimize this risk.
Acute Phase of Postinfectious Glomerulonephritis Actions:
Bedrest - To conserve energy and assist in the healing process Fluid restriction - Only sensible fluid loss is replaced until the renal status is known. Protein restriction with azotemia
Transurethral Resection of the Prostate (TURP) POST-OP
Bladder Irrigation(CBI) for first 24 hrs to prevent mucous and blood clots Provide increased fluids Assess for complications: Hemorrhage(pallor, tachycardia, hypotension)bleeding, clot retention, dilutional, hyponatremia(due to irrigation fluids), retrograde ejaculation TEACH: diet of foods ^mg, ca, zinc, manganese kegel exercises bladder control can take up to a yr. dribbling and small clots normal after cath removed take meds as ordered: stool softener to prevent straining, antispasmodics(bladder spasms), analgesics(incisional discomfort), antibiotics(Prophylaxis) ambulate asap to prevent DVT monitor: vital signs urinary output obstructed catheter(bladder spasms, reduced irrigation outflow) check for kinks in tubing, turn off CB, and irrigate with 50 ml irrigation solution using large piston syringe Rate of CBI should be high enough to keep return pink or lighter, if bright red with clots observed notify provider may need to increase CBI rate
The client passes a urinary stone, and lab analysis of the stone indicates that it is composed of calcium oxalate. Based on this analysis, which of the following would the nurse specifically include in the dietary instructions? A. Increase intake of meat, fish, plums, and cranberries. B. Avoid citrus fruits and citrus juices. C. Avoid green, leafy vegetables such as spinach. D. Increase intake of dairy products.
C. Avoid green, leafy vegetables such as spinach. Oxalate is found in dark green foods such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolate, wheat bran, nuts, beets, and tea. The more oxalate that is absorbed from the digestive tract, the more oxalate in the urine. Often a combination of calcium from foods or beverages with meals and fewer high-oxalate foods is required.
The client is admitted to the hospital with BPH, and a transurethral resection of the prostate is performed. Four hours after surgery the nurse takes the client's VS and empties the urinary drainage bag. Which of the following assessment findings would indicate the need to notify the physician? A. Red bloody urine B. Urinary output of 200 ml greater than intake C. Blood pressure of 100/50 and pulse 130. D. Pain related to bladder spasms.
C. Blood pressure of 100/50 and pulse 130. A rapid pulse with low blood pressure is a potential sign of excessive blood loss. The physician should be notified. Class III of hemorrhagic shock includes a volume loss from 30% to 40% of total blood volume, from 1500 mL to 2000 mL. A significant drop in blood pressure and changes in mental status occurs. Heart rate and respiratory rate are significantly elevated (more than 120 BPM). Urine output declines. Capillary refill is delayed.
A client has passed a renal calculus. The nurse sends the specimen to the laboratory so it can be analyzed for which of the following factors? A. Antibodies B. Type of infection C. Composition of calculus D. Size and number of calculi
C. Composition of calculus The calculus should be analyzed for the composition to determine appropriate interventions such as dietary restrictions. Development of the stones is related to decreased urine volume or increased excretion of stone-forming components such as calcium, oxalate, uric acid, cystine, xanthine, and phosphate. Calculi may also be caused by low urinary citrate levels or excessive urinary acidity.
The nurse is taking the history of a client who has had benign prostatic hyperplasia in the past. To determine whether the client currently is experiencing difficulty, the nurse asks the client about the presence of which of the following early symptoms? A. Urge incontinence B. Nocturia C. Decreased force in the stream of urine D. Urinary retention
C. Decreased force in the stream of urine Decreased force in the stream of urine is an early sign of BPH. The stream later becomes weak and dribbling. The client then may develop hematuria, frequency, urgency, urge incontinence, and nocturia. If untreated, complete obstruction and urinary retention can occur. Men with BPH are likely to report predominant symptoms of nocturia, poor stream, hesitancy, or prolonged micturition.
A client has urge incontinence. Which of the following signs and symptoms would the nurse expect to find in this client? A. Inability to empty the bladder. B. Loss of urine when coughing. C. Involuntary urination with minimal warning. D. Frequent dribbling of urine.
C. Involuntary urination with minimal warning. A characteristic of urge incontinence is involuntary urination with little or no warning. Urge incontinence is a type of urinary incontinence in adults, which involves sudden compelling urges to void and results in involuntary leakage of urine. This is a serious and debilitating condition and has a social stigma attached to it. To avoid the huge socioeconomic burden and high morbidity associated with this condition, early diagnosis, treatment, and referral concepts must be widely practiced among clinicians.
The nurse is receiving in transfer from the postanesthesia care unit a client who has had percutaneous ultrasonic lithotripsy for calculuses in the renal pelvis. The nurse anticipates that the client's care will involve monitoring which of the following? A. Suprapubic tube B. Urethral stent C. Nephrostomy tube D. Jackson-Pratt drain
C. Nephrostomy tube A nephrostomy tube is put in place after percutaneous ultrasonic lithotripsy to treat calculuses in the renal pelvis. The client may also have a Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of these tubes and strains the urine to detect the elimination of the calculus fragments.
During a client's urinary bladder catheterization, the bladder is emptied gradually. The best rationale for the nurse's action is that completely emptying an overdistended bladder at one time tends to cause: A. Renal failure B. Abdominal cramping C. Possible shock D. Atrophy of bladder musculature
C. Possible shock Rapid emptying of an overdistended bladder may cause hypotension and shock due to the sudden change of pressure within the abdominal viscera. Previously, removing no more than 1,000 ml at one time was the standard of practice, but this is no longer thought to be necessary as long as the over distended bladder is emptied slowly.
A client is diagnosed with prostate cancer. Which test is used to monitor the progression of this disease? A. Serum creatinine B. Complete blood cell count (CBC) C. Prostate-specific antigen (PSA) D. Serum potassium
C. Prostate-specific antigen (PSA) The PSA test is used to monitor prostate cancer progression; higher PSA levels indicate a greater tumor burden. Elevated Prostate-Specific Antigen (PSA) levels (usually greater than 4 ng/ml) in the blood is how 80% of prostate cancers initially present even though elevated PSA levels alone correctly identify prostate cancer only about 25% to 30% of the time. We recommend at least 2 abnormal PSA levels or the presence of a palpable nodule on DRE to justify a biopsy and further investigation.
The client with urolithiasis has a history of chronic urinary tract infections. The nurse concludes that this client most likely has which of the following types of urinary stones? A. Calcium oxalate B. Uric acid C. Struvite D. Cystine
C. Struvite Struvite stones commonly are referred to as infection stones because they form in urine that is alkaline and rich in ammonia, such as with a urinary tract infection. Struvite stones are also known as triple-phosphate (3 cations associated with 1 anion), infection (or infection-induced), phosphatic, and urease stones.
Colorectal Cancer Myelosuppression Risk For Infection
Calculation of ANC(absoulte Neutrophil Count) normal 1.5-8.0 (1,500-8,000/mm3) <1,000—neutropenic precautions <500—infection Neutropenic precautions Filgrastim (CSF-colony stimulating factor) IV/SQ 5-10 mcg/kg once or twice a day S.E: N/V, skeletal pain, diarrhea, alopecia, rash, HA, Cough, CP, sore throat, constipation monitor temp for increase, monitor for thrush
Colorectal Cancer Nursing Care Myelosuppression
Cancer Induced Anemia Secondary to several factors including: *cancer *chemo *radiation Risk Factors --Platinum-based chemotherapy --Certain tumor types (such as lung or ovary tumors) -- Having a low hemoglobin level before you had cancer
Prostate Cancer CHEMO
Cisplatin- (alkylating agent) mylosuppressive SE N/V Adverse: nephrotoxic, ototoxic, hepatotoxic Etoposide- (plant alkaloid) mylosuppressive SE irritant, peripheral neuropathy Adverse: anaphylaxis Docetaxel -(plant alkaloid/taxane) mylosuppressive SE peripheral edema, hypersensitive( unpredictable adverse) reactions
A client had a transurethral prostatectomy for benign prostatic hypertrophy. He's currently being treated with a continuous bladder irrigation and is complaining of an increase in severity of bladder spasms. Which of the interventions should be done first? A. Administer an oral analgesic. B. Stop the irrigation and call the physician. C. Administer a belladonna and opium suppository as ordered by the physician. D. Check for the presence of clots and make sure the catheter is draining properly.
D. Check for the presence of clots and make sure the catheter is draining properly. Blood clots and blocked outflow of urine can increase spasms. Bladder irrigation helps remove and prevent blood clots in the bladder. The blood clots stop urine from flowing through the catheter. The urine collects in the bladder and causes pain that gets worse as the bladder fills.
The client who has a cold is seen in the emergency room with inability to void. Because the client has a history of BPH, the nurse determines that the client should be questioned about the use of which of the following medications? A. Diuretics B. Antibiotics C. Antitussives D. Decongestants
D. Decongestants In the client with BPH, episodes of urinary retention can be triggered by certain medications, such as decongestants, anticholinergics, and antidepressants. The client should be questioned about the use of these medications if the client has urinary retention. Retention can also be precipitated by other factors, such as alcoholic beverages, infection, bedrest, and becoming chilled.
The client has a clinic appointment scheduled 10 days after discharge. Which laboratory finding at that time would indicate that allopurinol (Zyloprim) has had a therapeutic effect? A. Decreased urinary alkaline phosphatase level B. Increased urinary calcium excretion C. Increased serum calcium level D. Decreased serum uric acid level
D. Decreased serum uric acid level By inhibiting uric acid synthesis, allopurinol decreases its excretion. The drug's effectiveness is assessed by evaluating for a decreased serum uric acid concentration. Allopurinol undergoes metabolism in the liver, where it transforms into its pharmacologically active metabolite, oxypurinol. The half-life of allopurinol is 1 to 2 hours, and oxypurinol is about 15 hours.
When providing discharge teaching for a client with uric acid calculi, the nurse should make an instruction to avoid which type of diet? A. Low-calcium B. Low-oxalate C. High-oxalate D. High-purine
D. High-purine To control uric acid calculi, the client should follow a low-purine diet, which excludes high-purine foods such as organ meats. To prevent uric acid stones, cut down on high-purine foods such as red meat, organ meats, and shellfish, and follow a healthy diet that contains mostly vegetables and fruits, whole grains, and low-fat dairy products.
A client is admitted with a diagnosis of hydronephrosis secondary to calculi. The calculi have been removed and post obstructive diuresis is occurring. Which of the following interventions should be done? A. Take vital signs every 8 hours. B. Weigh the client every other day. C. Assess for urine output every shift. D. Monitor the client's electrolyte levels.
D. Monitor the client's electrolyte levels. Post-obstructive diuresis seen in hydronephrosis can cause electrolyte imbalances; lab values must be checked so electrolytes can be replaced as needed. Obstructive uropathy is a hindrance to normal urinary flow that can be caused by a variety of structural and functional etiologies. This is a common and potentially serious condition that affects people across all ages and walks of life.
Prostate Cancer Dx Assessments
DRE PSA (prostate specific antigen)>4 indicates possible prostate disease EPCA (early prostate cancer antigen) TRUS(Transrectal ultrasonography) -visualization of lesion -educate pt extra fluids, no strenuous activities -enema
Chronic Glomerulonephritis:Assessment/Recognizing Cues
Diagnostic assessment Urinalysis GFR Serum creatinine BUN Sodium and phosphate levels ABGs
Colorectal Cancer Consider the Nursing Analysis
Diarrhea Impaired Oral Mucous Membranes Body Image Risk for Infection Acute Pain Imbalanced Nutrition Less than Body Requirements Anticipatory Grieving Risk for Ineffective Sexuality Pattern
Prostate Cancer Physical cues during assessment
Dx as part of your routine exam, hematuria (as a result of bladder irritation) weight changes pelvis,hips,spine,ribs DRE(hard prostate with palpable irregularities) bladder infection
BPH MEDS: Erectogenic Drugs PDE5 inhibitors- aFILS
Effectively reduces symptoms of BPH and ED by causing VASODILATION allowing for the ability to FILL afils FILL the penis Tadalafil (Cialis) Teach -No Grapefruit Juice(increases drug in the body) - No more than one in a day SE headache, flushing, muscle ache, back pain, GI irritation Condraindication: use of Nitro meds
Acute Glomerulonephritis-Interventions/Take Action ..cont'd
Excess fluid volume Daily consistent weights Intake & output Bedrest fluid restrictions Preventive skin care Diruetics BP Albumin Risk for infection Monitor temps Infection prevention Risk for Injury Confusion Elevated BUN Seizures Encephalopathy Fatigue Assist with ADLs Provide rest periods Limit visitors
BPH Med: 5a-Reductase Inhibitors
Finasteride ( Proscar) - shrinks prostate- takes 3-6 mos Lowers DHT which decreases the production of testosterone and reduces the size of the prostate
What is Glomerulonephritis?
Glomerulonephritis refers to inflammation of the glomeruli. It can be primary when the disease starts in the glomeruli, or secondary, when the glomeruli are affected by systemic disease. It can also be acute, when symptoms develop suddenly and resolve with treatment; or it can be chronic if acute disease is not treated, or when the disease process develops slowly,
Chronic Glomerulonephritis: Assessment/Recognizing Cues
History Other health problems, recent exposure to infection, fatigue, lethargy, elimination patterns Physical Assessment/Signs and Symptoms Systemic circulatory overload Lung crackles Uremic symptoms
Prostate Cancer Education
Home Care Management Self Management Education -foley care -walk short distances -use of stool softener is prescribed -shower don't soak
Side Effects of BPH medication Finasteride
Impotence decreased libido decreased volume of ejaculation ED
What is Inflammation
Inflammation is a normal part of the body's defense to injury or infection, and, in this way, it is beneficial. But inflammation is damaging when it occurs in healthy tissues or lasts too long. Known as chronic inflammation, it may persist for months or years.
Glomerlulonephritis - Other diagnostic assessment
Kidney biopsy Throat or skin cultures KUB abdominal x-ray Kidney scan
Colon Cancer Dx Procedures
Lab: FOBT (2 Positive stools in 3 days) -Do not use the stool from DRE to avoid false-pos results -Neg. results do not completely rule out CRC -Client should avoid Red Meat, anti-inflamatory meds, & vitamin C, iron, beets, 48 hrs prior to test CEA (Carcinoembryonic Antigen in the blood) -Denotes malignancy -Not specific to CRC -Positive CEA can be indicative of many other Cancers Other Diagnostic: Sigmoidoscopy and colonoscopy (definitive test)
Acute Glomerulonephritis-Interventions/Take Action
Managing infection Antibiotics Anti-inflammatories Preventing complications Immunosuppressives Antihypertensives Diet restrictions Providing appropriate patient education
Colon Cancer Matastasis
Metastasizes by direct extension or through lymph or blood spread Common metastasis sites: Lung Liver Brain Bone Kidney
BPH Diet to reduce Hypertrophy
Mg, Ca, Zinc
acute inflammation
Minimal and short-lasting injury to tissue. The response to sudden body damage, such as cutting your finger. To heal the cut, your body sends inflammatory cells to the injury. These cells start the healing process.
Colorectal Cancer Myelosuppression Risk for Bleeding
Monitor platelet count <50,000 bleed easily <10,000—risk for spontaneous bleed, administer platelets Bleeding precautions Omprevlekin (Thrombopoietic growth factor) SQ 50 mcg/kg daily 1st dose 6-24 hrs after chemo completion S.E: fluid retention, hypersensitivity reactions, A-fib
Side Effects of BPH med Alpha Blockers ---OSINS
Orthostatic Hypotension - dizziness ED Headache Nasal congestion weakness TEACH the client to change position slowly
Diagnosis of BPH
Patient History and Physical Labs (Urinalysis and culture, CBC (elevated WBC if infection present), BUN and Creatinine(indicate kidney damage) PSA,blood test --Prostate-specific antigen checks for cancer(should be < 2.5 in men 50 and under) DRE --> uniformly enlarged rubbery prostate Prostate Biopsy Cystoscopy interior of bladder neck and urethra, residual urine measurement TRUS Transrectal Ultrasonography (inside rectum to the prostate)
Prostate Cancer Surgical Management Radical Prostectomy (laproscopic or open)
Post op nursing care is the same Pain management Indwelling catheter (will always have a foley but duration Depends on type of surgery) Ambulate no later than same day may have ED or urge incontinence
a nurse caring for a pt with glomerulonephritis expects what lab values to be decreased?
RBC
Colorectal Cancer Non-surgical Treatment
Radiation Therapy Chemotherapy: 5-Fluorouracil (5-FU) with Leucovorin Advanced Disease Irinotecan (Topoisomerase inhibitor) Bevacizumab (vascular endothelial growth factor) Cetuximab (monoclonal antibody)
Prostate Cancer Treatment non surgical treatment
Radiation Therapy- Brachytherapy(internal) radiation seeds planted in prostate guided by rectal ultrasound External Beam 5 days a week for 6-9 weeks Low dose no harm to others, fatigue common can last months Report:rectal cramping, passing of mucous or blood Hormone Therapy Luteinizing hormone agonists-- Leuprolide, Goserelin, Tirptorelin SE hot flashes, gynecomastia, ED, decrease libido, osteoporosis Anti-androgen drugs Flutamide, Bicalutamide, Nilutamide SE hot flashes, Diarrhea, N/V, Loss of sexual function/interest Prostate Cancer Primarily treated with hormone therapy
BPH Med: Alpha- Adrenergic receptor antagonists (Alpha Blockers) most common choice for initial therapy
Relax smooth muscle in the prostate & the bladder neck, thus decreasing the blockage of urine OSINS "Alf! Oh Son, you are relaxing the prostate" Alfuzosin Doxazosin silodosin tamsulosin terazosin
Acute Glomerulonephritis: Interventions/Take Action ..cont'd
Risk for imbalanced nutrition: less than body requirements K+ restriction Renal failure oliguria Na restriction BP Or no added salt Protein restriction with azotemia Prevents increase in BUN & Uremia GFR reduced Knowledge Deficit Restrictions Diet Daily wt & BP Acute Pain Assess onset Provide comfort Analgesics Ineffective Breathing Pattern Deep breathing exercises Elevate HOB Encourage rest
Prostate Cancer Role of the Nurse
Surgical Care, Med administration, Teaching, advocacy, coordination
Transurethral Resection of the Prostate(TURP)
The most common SURGICAL procedure for BPH - Rectoscope is inserted down the urethra and is used to trim excess prostatic tissue and enlarge the passageway for urine. - Prostate can continue to grow bc only some tissue was removed -requires hospital stay -Must STOP ANTICOAGULANTS prior
Glomerulonephritis - Laboratory assessment
Urinalysis 24-hour urine collection Serum albumin Serum creatinine BUN GFR
Complications of BPH
Urinary Retention UTI Bladder Stones can cause infection, bladder irritation, blood in the urine and obstruction of urine flow Bladder Damage a bladder that hasn't emptied completely can stretch and weaken over time (incontinence) Kidney Damage pressure on bladder from urinary retention can directly damage the kidneys or allow bladder infection to reach the kidneys
chronic inflammation
Your body continues sending inflammatory cells even when there is no outside danger. Chronic inflammatory diseases contribute to more than half of deaths worldwide.
Prostate Cancer Psychosocial cues
anxiety, fear, grieving process, anger, concern regarding sexual function
What would be an appropriate choice for a client with Crohn's disease? Vanilla Milkshake buttered popcorn tossed green salad apple sauce and whole wheat bread
apple sauce and whole wheat bread --Doesn't contain large amounts of lactose, fiber, or fat
S/S of Turp Syndrome
caused by excessive absorption of electrolyte-free irrigation fluids Decreases Hct, hypertension, decreases heart rate, nausea, vomiting, confusion, dizziness, headache. SHob
a nurse caring for a client with suspected cholecystitis should expect the urine to be what color
dark and foamy which indicates the kidneys are filtering excess billirubin
Prostate Cancer Metastasizes
pelvic lymphnodes BONES(pelvis, sacrum, lumbar spine) Lungs Liver
Prostate Cancer Planning and Implementation
preventing metastasis by active surveillance , non-surgical management (radiation and drug therapy)
BPH Meds: Herbal: Saw Palmetto
successfulness varies can interact with NSAIDS & Anticoagulants
