ch 34 exam four (nur200)

All protatectomies carry a risk of what and why?

-risk of impotence because of potential damage to the pudendal nerves

Suprapubic prostatectomy

-A method of removing the prostate gland through an abdominal incision

Whats the BETTER Model

-A model use for assessing sexuality *B*-bring up the topic, ask questions *E*-explain you are concerned with quality of life *T*-tell patient you will find resources to help *T*-timing may not be appropriate now *E*-educate patient about med side effects *R*-record assessment and interventions in patient's medical record

Whats Priapism

-A persistent erection of the penis that causes penis to become large, hard, and painful(sometimes this can take hours to resolve -Its considered a urologic emergency -Causes: tumors, sickle cell disease, anti-hypertensive meds, injection substances into the penis *This can cause blood clot in the penis which can cause cellular death* -Treatments: Anticoagulant injection into corpora cavernosa of penis which can allow blood to be removed, or a shunt can be placed to remove blood

Erectile dysfunction(ED)

-Another term is impotence -Inability to achieve or maintain an erection sufficient for satisfactory sexual activity (have understanding of what individual considers satisfactory sexual activity) -Diagnosis: look at sexual history, medical history, look at analysis of symptoms, physical examination -Diagnostics: Nocturnal penile tumescence tests, and Rigiscan testing

Medications for Erectile Dysfunction(ED)

*Viagra, Levitra, Cialis* -Contraindications: don't take meds if taking nitrates, have high BP, coronary artery disease, if had heart attack in last 6 months, diagnosed with cardiac arrhythmia, kidney, or liver disease -Side Effects: Viagra (head aches, indigestion, nasal congestion, blue vision from blue dye in medication). Levitra (runny nose, head ache, indigestion, sinusitis). Cialis (back pain, muscle ache ) -When to take meds: Viagra (Take meds 30 minutes to 4 hours before intercourse), Levitra (take one hour before intercourse), Cialis (effects peak at 30m) *must be sexual stimulation to produce erection* -Treat underlining cause for erectile dysfunction-

Whats TURP

-Carried out through endoscopy -Surgical instrument is introduced via urethra to the prostate which can be viewed -The prostate gland is removed in small chips with an electrical cutting loop -Procedure usually require overnight stay at hospital -A foley catheter is used after procedure because urine is acidic which can cause more damage to urethra when going through. Foley can give tissue in urethra time to heal -Advantage of TURP: No abdominal incision, no destruction of muscle tissue, shorter hospitalization -Disadvantage: Can be bleeding involved, obstruction, urethra trauma, strictures can develop and cause obstruction of urine -Nursing interventions: Check urine for blood, urinary patterns

are the level of PSA in the blood which is proportional to the total prostatic mass, an indication of malignancy?

-No it doesn't indicate malignancy

Conditions Affecting the Testes and adjacent structures

Orchitis: An inflammation of the testes caused by a variety of factors -Causes: bacterial infection, viral infection, Epididymitis -Treatments: antibiotics if bacterial is the cause, if its viral then let infection run its course, avoid trauma, ice pack to scrotum, analgesics for pain,*elevate Scrotum* -Avoid lifting heavy objects, avoid sex, avoid straining *testes can be the size of a melon*

Testicular Cancer

-Most common in men ages 15 to 40 -Risk: Family history, undecended testicle -Manifestations: Lump on testies, painless enlargement of testes, heaviness in scrotal area -Should be doing testicular self exams in trying to find small pee like lump or any mass which would indicate a problem and provider should be contacted -Treaments: Orchiectomy(removal of testes), radiation, chemotherapy

A 58 year old patient had a prostatectomy. The nurse is preparing for discharge. What should be incorporated in the teaching plan?

-Note that spicy foods, alcohol, and coffee may cause bladder discomfort

Nursing Process: The patient undergoing Prostate surgery

-Nursing Interventions: preoperative assessments (reduce anxiety, Teach about prostate disorder), Postoperative assessment(identify fluid volume balance, relief of pain and discomfort, ability to perform self care activities, maintaining foley, educate patient about infection prevention, catheter obstruction from blood clot *at risk for sexual dysfunction hemorrhage, infections, catheter obstruction, DVT*

What are the immediate dangers after a prostate surgery?

-Bleeding and hemorrhagic shock

Prostate cancer can metastasize to where?

-Bones and lymph nodes

Benign Prostatic Hyperplasia (BPH)

-Enlargement of the prostate gland that obstruct the outflow of urine, enlargement of cervical neck or urethra, causes incomplete emptying of bladder and urinary retention *Biggest risk is infection* -Assess for urinary retention by using a bladder scan, looking at input and output -Risk: smoking, hypertension, diabetes, heart disease, -Manifestations: frequent urination, dribbling, straining to use bathroom, recurrent UTI's -Treatment: Alpha-adrenergic blockers, 5-alpha reductase inhibitors, herbal treatments(saw Palmetto) -If prostate is enlarged surgical option is recommended -Nursing interventions: evaluate Intake and outtake, do bladder scan, straight cath using coude catheter to empty bladder

A 60 year old patient is complaining of difficulty sustaining his erections, the nurse is aware that he suffered an MI about 3 months ago, what teaching is relevant to his concern?

-He is a candidate for a penile implant -He can use a vacuum erection device -Men with a heart attack in the proceeding 6 months cannot use certain medications

Treatments for Erectile Dysfunction

-Oral meds: Viagra, Levitra, Cialis -Penile injection: injecting penis with vasodilator to promote vasodilation inside penis and cause erection *teach patient how to give injection, proper disposal of needle, prevention of infection(wear condoms* -Urethral suppository: Medication inserted into urethra to cause smooth muscle relaxation and allow for erection *teach patient to wash hands, urinate before, how to insert, wear a condom so ejaculation can go into condom and not inside his partner* -Penile implant(semi-rigid rod, inflatable): when patient needs to use this, they re-position it or inflate or pump it, if its an inflatable penile implant -Negative pressure(vacuum device): device is put on shaft of penis, pump is squeezed which then suction out all the air, sucking blood into penis to create an erection *Don't leave on for too long, may cause tissue destruction*

What are the two reasons for erectile dysfunction?

-Psychogenic causes: anxiety, fatigue, depression and pressure to perform sexually -Organic causes: endocrine disease, cirrhosis, chronic renal failure, trauma to pelvic or genital area, medications(antidepressants, calcium channel blockers, antifungals, anti-psychotics )

Cancer of the Prostate

-Risk: family history, nutrition(high dairy fat, red meat) -Manifestations: rarely produce symptoms in early stages, later stages involve urinary obstruction, retention *monitor intake and intake, bladder scan* -metastasize to bones and lymph nodes -Screening: Digital rectal exam, Prostate specific antigen(PSA), if anything is suspected then a trans rectal ultrasound and Biopsy is done -Treatment: Radiation(prescribed amount of time by provider), radical prostatectomy(prostate, seminal vesicle, lymph node, nerves and fatty tissue removal

A 55 year old man has been diagnosed with prostate cancer. His treatment option depend on what?

-Staging of the tumor -His preference -His age

Radical Prostatectomy

-The complete surgical removal of the prostate gland, seminal vesicles, and often the surrounding fat, nerves, lymph nodes, and blood vessels

Surgeries For BPH and Prostate Cancer

-Transurethral resection of prostate -Suprapubic protatectomy -perineal prostatectomy -retropubic prostatectomy -Robotic or Laparoscopic prostatectomy