M3 Exam Case Studies
What action should the RN implement?
Discontinue the infusion and restart another site Rationale: This intervention should be implemented when both subjective and objective data support the complication of infiltration
Acute Lymphocytic Leukemia (ALL)
Most common type of leukemia in children Abrupt: Fever & Bleeding Weakness, fatigue, bone and joint pain
Pelvic Exenteration
Removal of uterus, ovaries, fallopian tubes, vagina, bladder, urethra and pelvic lymph nodes Urinary and fecal diversions Onset symptoms of menopause
Modified Radical
Removes breast but saves pectoralis major muscles
Total or Simple Mastectomy
Removes entire breast
Mr. Sumo tells you that oral doxycycline sometimes upsets his stomach. Which administration guideline could reduce his upset stomach when he takes this medication?
Take the drug with food Rationale: Doxycycline can be administered with food or milk if stomach upset occurs. Doxycycline should not be taken with an antacid. Drug absorption would be decreased.
Immunotherapy & Targeted Therapy
Target cells w/altered genes HER-2 & Breast Cancers Trastuzumab (Herceptin)
Cystoscopy
used to visualize urethra and bladder
To evaluate the effectiveness of diphenhydramine, the RN should assess for which finding?
Absence of itching, urticaria, and flushing Rationale: Benadryl is given prophylactically to prevent these symptoms which are associated with a mild allergic response
While the Rn is reviewing instructions with the client, Mrs. Sanchez spouse arrives with a box of chocolates and a beautiful bouquet of long stem roses. What action should the RN take?
Advise the husband that fresh cut flowers are a source of infection Rationale: Chemotherapy causes neutropenia (an abnormal reduction in neutrophils) Then a client is neutropenic, there is a greater risk of infection from NML body flora and opportunistic organisms. The likelihood that the client will develop an infection is related to the duration of the neutropenia. Fresh flowers are contraindicated for this client b/c they are a source of bacteria and infectious material
Lobular Breast Cancer
Affecting milk producing glands
BPH Non-Modifiable Risk Factors
Age Family Hx
Inflammatory Breast Cancer
Aggressive & Fast Growing (warm, red, sore) Worse prognosis
Pancytopenia
All WBCs, RBCs and Platelets decrease S/S fever, fatigue, sob, swelling, bruising, bleeding
Mrs. Sanchez has a large family that is very concerned about her and come to visit. What action should the nurse implement?
Allow the grandchildren to visit from the doorway Rationale: Young children often carry infections, letting the grandkid visit from the doorway will facilitate continued bonding, while decreasing the client's risk for infection
Antacids
Aluminum hydroxide, Magnesium Hydroxide, Calcium Carbonate, and Sodium Bicarbonate Neutralizes excess acid and increase LES pressure Nursing Actions: Ensure there is no contraindication with other prescribed medications (levothyroxine) Evaluate kidney function in clients taking magnesium hydroxide
What is the effect of Proscar (Finasteride) in the treatment of BPH?
A reduction in the size of the prostate gland Rationale: Causes suppression of androgen formation by inhibiting testosterone and results in decrease in the size of the prostate gland
SLNB
(Sentinel Lymph Node Biopsy) Take out the primary lymph node and see if there is any cancer cells in it At least one lymph node removed
Acute Myelogenous Leukemia (AML)
80% of the acute leukemia in adults Serious infection or abnormal bleeding Hyperplasia of bone marrow
Immediately following the sigmoidoscopy, it is important for the nurse to assess for manifestation?
Abdominal guarding Rationale: Abdominal distention, tenderness, or guarding may indicate perforation of the intestine
Hyperplasia
Abnormal cell growth
Malignant Neoplasms
Abnormal cells that are capable of metastasis Malignant move from one body part to another Cancerous cell growth
Mrs. Sanchez returns to the clinical in 1 week at the time the HCP informs her that her Pap smear was abnormal and a repeated Pap smear is completed. When the client visits the clinical following weeks for the results of the Pap smear she is notified that the repeat test is abnormal. The HCP refers Mrs. Sanchez to a gynecologist for an endocervical biopsy. After the HCP leves the exam room, the client starts to cry and states "I do not understand the reason for the biopsy"
Ask the client about her understanding of the abnormal pap smear result Rationale: This therapeutic response allows the client to elaborate on her understanding of what an abnormal result means to her. The nurse then understands the client's baseline and can explain the meaning of abnormal results and correct any false information.
The nurse provides Jessica with a stool specimen container and instructs Jessica to obtain 3 specimens, one each day, for 3 consecutive days. Which instructions are important for the nurse to provide Jessica regarding food and fluid intake during the stool specimen collection?
Avoid red meat Don't take supplemental ascorbic acid (Vitamin C) Rationale: Ingestion of hemoglobin found in red meats may cause a false positive test result. Vitamin C intake is associated with false negative guaiac stool specimen results. NML diet is encouraged to ensure regular bowel movements, caffeine doesn't affect test findings.
Tony asks the nurse to explain the difference between benign prostatic hyperplasia (BPH) and prostate cancer. What is the best response by the RN?
BPH is a benign enlargement of the gland caused by an increase in the number of normal cells
Identify the major IMMEDIATE postoperative concern for Tony
Bleeding Pain
Estrogen Receptor Blocker
Blocks Estrogen --> Promotes Tumor Regression in ER + Breast Cancer Tamoxifen (Soltamox)
Prostate cancer is the most common occurring cancer in men. Early detection increases the chance of cure. What yearly screenings are recommended for early detection of prostate cancer?
Blood tests for Prostate-Specific (PSA) for all men over 50 years of age Digital rectal exam for all men over 50 years of age Rationale: The presence of PSA, which is secreted only by prostate tissue, suggest prostate disease. Levels are extremely high with advanced prostate cancer. The American Cancer Society recommends PSA blood tests yearly for all men over age of 50. Men high risk groups (African American and those with a first degree relative diagnosed with prostate cancer at an early age) should be tested earlier. The American Cancer Society recommends annual digital rectal exam for all men over age 50. Palpation of hard, irregular nodes on the prostate suggest cancer. Men in high risk groups should be tested earlier.
The nurse anticipates that Jessica will describe her diarrhea as
Bloody Rationale: Clients with UC may experience as many as 10-20 liquid, bloody stools per day
Nipple Sparing Mastectomy
Breast tissue removed, but nipple and areola are preserved
Which assessment findings would be the most concerning in the initial 24 hour period after surgery?
Bright red blood suddenly appears in the foley bag and tubing Rationale: Pinkish urine with small clots is expected directly after surgery, as is bladder spasms. The new appearance of bright red blood would be concerning and require evaluation
Chemotherapy
Cytotoxic drugs destroy cells rapidly Combination of chemotherapy drugs used in breast cancer Tx Given for 3-6 months, unless metastasis -->then lifetime
Noninvasive (In situ)
Cancer remains within the duct Right in place not gone anywhere
Acute Leukemia
Clonal proliferation of immature hematopoietic cells
Which order is the priority for the RN to implement?
Collect all specimens for culture Rationale: Cultures must be obtained prior to administration of ABX or the result may be compromised. The client will be started on a broad-spectrum ABX until the results have grown. The other interventions are also important but for this patient initiation of ABX the priority.
Thrombocytopenia
Decrease in platelets
Anemia
Decrease in red blood cells
Leukopenia
Decrease in white blood cells
Myelosuppression
Decrease production of bone and blood product (WBCs, platelets, red blood cells) Labs: CBC w/diff, CMP, INR, blood culture, bone marrow biopsy Causes: Genetics, Environmental Factors, Disease State
5a-Reductase Inhibitor
Decrease the size of the prostate gland but can take up to 6 months to be effective Finastrice (Proscar) Dutasteride (Avodart)
Which assessment finding indicates that the Lomotil is having desired effect?
Decreased number of bowel movements Rationale: This is an antidiarrheal medication so the best measure is effectiveness is assessment of the number of stools. This medication should be used with extreme caution for clients with UC b/c excessive use may result in colonic dilation causing problems such as toxic megacolon.
Cryotherapy (Cryoablation)
Destroys cancer cells by freezing w/liquid nitrogen
Because rectal bleeding is a common finding in ulcerative colitis (UC) which additional question is important for the nurse to ask Jessica?
Do you feel fatigued or light headed? Rationale: Continuous rectal bleeding will result in anemia, causing the client to feel fatigued, .dizzy, light headed and weak
What instruction should the nurse provide to a client who just completed a barium enema?
Drink extra fluids Rationale: Extra fluids are important to help flush out the barium and prevent constipation and bowel obstruction
Tony complains of bladder spasms and is given a dose of oxybutynin (Ditropan XL) The nurse will monitor for which adverse effects?
Dry mouth Dizziness Palpitations Rationale: Oxybutynin adverse effects include dry mouth and eyes, dizziness, drowsiness, anxiety, restlessness, constipation and palpitations.
Mr. Sumo complains of severe cramping and tightness in his abdomen. What actions should the nurse implement?
Encourage relaxation techniques the client learned pre-operatively Check the urinary catheter for kinks and clots Check and see if the client has orders for anti-spasmodic medication Rationale: Bladder spasms, due to surgical trauma are common 24-48 hours after TURP. Relaxation techniques can be helpful, in conjunction with other pain relief interventions. Obstruction to the flow of urinary drainage, from catheter kinks or clots can contribute to bladder spasms after TURP. To maintain urinary flow and avoid clots, bladder irrigation should be constant. Also, fluid intake should be high to promote urine flow. Ditropan (oxybutynin) (oral or transdermal) OR belladonna and opium rectal suppositories are prescribed to reduce bladder spasms.
Radical Prostatectomy
Entire prostate, seminal vesicles and part of the bladder neck are removed
What are two main long term consequences of prostatectomy?
Erectile dysfunction: If a patient has a low grade tumor that is small the urologist will try to spare the nerves that help provide erections Urinary Incontinence: The risk of incontinence is greatest just after catheter removal and continue over the first few months as internal healing occurs. Over time, most men regain control. Patients who have the laparoscopic radical prostatectomy have a lower incident of these problems
Hormonal Receptor Status
Estrogen + Vs - Progesterone + Vs - HER2 receptor proteins located on breast cells that control how healthy the breast cell growth/divides/repair itself
Estrogen Receptor Modulators
Estrogen Agonist Effects on bone & breast tissue Raloxifene (Evista)
Benign Neoplasms
Excessive growth of normal cells that are not capable of metastasis Does not move from one body part to another
Mr. Sumo states, I have to urinate. His urine appears to be flowing freely in the urinary catheter tubing. What should the nurse do?
Explain to the client that this is a common feeling Rationale: It is common for a patient with a urinary catheter to feel like he has to urinate. It is appropriate to tell Mr. Sumo this feeling is normal. However, Mr. Sumo should avoid trying to urinate around the catheter since this could increase pain and bladder spasms
Salpingectomy
Fallopian tube removal
The urologist you work for has asked you give Tony preoperative instructions. What should you tell him?
Follow a clear liquid diet the day before surgery Use a bowel preparation procedure to evacuate stool and clean the rectrum. He might be given a laxative to take the afternoon before surgery and a few doses of oral antibiotics preoperatively. This protocol might be practice specific, so check the protocol in your area. Take nothing by mouth (NPO) after midnight
Mr. Sumo needs instructions about signs and symptoms of complications of the TURP that should be reported to the HCP. What signs and symptoms should be reported?
Gross hematuria Rationale: Although some bleeding can continue for up to six weeks after surgery, gross hematuria should be reported. Urinary dribbling is expected after transurethral resection of the prostate (TURP) secondary to insufficient muscle tone. This does not need to be reported. Dribbling generally subsides as muscle tone improves with perineal exercises. With retrograde ejaculation, urine appears cloudy after intercourse. This does not need to be reported
Mrs. Sanchez asks if she could get the HPV quadrivalent vaccine to treat her cervical cancer instead of surgery. Which explanation by the RN is best to provide the client?
HPV vaccine does not treat cervical cancer Rationale: HPV vaccine does not TX cervical cancer, instead it is used in the prevention of certain types of HPV virus that can cause cervical cancer. This explanation is the most relevant for the client's situation
Ovarian Cancer
High Fatality Most common 55-65yr old women No accurate screening tests available
Da Vinci (Robotic-Assisted)
High resolution cameras & microsurgical instruments via computer Faster recovery time
Perineal
Higher chance of infection d/t location of the incision
The RN reviews the client's history and notes that Mrs. Sailor's last Pap Smear was 5 years ago. What information is most important for the RN to obtain to determine the client's risk for cervical cancer?
History of sexual patterns Age with first pregnancy Rationale: Most significant risk factor for cervical cancer is certain types of HPV. Risk Factors: HPV, Cigarette Use, Low Socioeconomic Status, Multiple Sexual partners, Hx of STD, High risk Male partner, Compromised Immune Status, Early First Pregnancy, African Americans & Hispanics
Aromatase Inhibitors
Hormone Therapy Blocks Estrogen by inhibiting Aromatase Anastrozole (Arimidex)
Which signs of shock would the nurse expect if hemorrhage occurred?
Hypotension Tachycardia Pallor Restlessness Rationale: Hypotension is a sign of compensated shock and occurs secondary to decreased circulating volume. SNS activation causes increased HR to compensate for decreased for decreased fluid volume. The SNS activation also causes peripheral vasoconstriction causing pallot and cool extremities. Cerebral hypoxemia d/t decreased oxygen can make pt's restless and confused
Hemorrhage is a possible complication of transurethral resection of the prostate (TURP) If hemorrhage occurred, shock could develop. What type of shock would you anticipate for Mr. Sumo?
Hypovolemic
Immunosuppression Vs. Myelosuppression
Immunosuppression is apart of myelosuppression is bigger because it has to do with bone marrow and red blood cells
Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do?
Increase the rate of the irrigation and take the patient's vital signs Rationale: Bleeding and clots are expected and CBO is used to keep clots from obstructing the urinary tract. The rate of irrigation may be titrated to keep the clots from forming, but the nurse also check the VS b/c hemorrhage is the most common complication of this surgery.
Phyllodes Tumor
Rare Develops in connective tissue Requires mastectomy
The client tells the RN that she is worried about having a mutually satisfying sexual relationship with her husband. Based upon the RN's assessment what is the priority nursing diagnosis for the client?
Ineffective sexuality pattern related to physiological limitations
TURP (Transurethral Resection of Prostate)
Inpatient Procedure Scope inserted through urethra Requires 3-way cath w/CBI for at least 24 hrs post operatively
The client's catheter has been removed and plan are made for discharge this evening, if the patient is able to void. How would you assess Mr. Sump to determine if he has urinary retention?
Inspect the suprapubic area for distention Palpate the surpapubic area for distention Rationale: Surprabubic distention is common with urine retention. It may be observed as "swelling" in the lower abdomen. Palpation over the suprapubic area will reveal distention of the bladder if urine is being retained
In responding to Jessica, the nurse recognizes that Jessica's remarks reflect which of Erikson's developmental stages?
Intimacy versus isolation Rationale: Young adulthood, between the ages of 18-35 is seen by Erikson as the developmental stage in which a priority concern is maturing relationship of oneself to surrounding social systems. A major life event can greatly impact how a young adult relates to others.
The RN should anticipate what would be ordered if the foley catheter were to become occluded with clots
Irrigation with normal saline Rationale: Normal saline irrigation is typically ordered to remove clots as well as lyse clots
Paget's Disease
Itching, burning, blood nipple discharge
5a-Reductase Inhibitor + A-Adrenergic Receptor Blocker
Jaylyn (Finasteride + Tamsulosin) Most effective
Leukostasis
LIFE THREATENING High WBC Greater than 100,000 Blood thickens & blocks circulating pathways
Which action is most important for the RN to implement to avoid blood related transfusion reaction when preparing to administer Mrs. Sanchez unit of PRBCs?
Match the label on the blood with the client's blood ID band Rationale: The is the priority safe practice guidelines to avoid blood related (Acute Hemolytic) transfusion reactions. It requires that 2 personnel verify the identity and match the label found on the blood to the client's blood ID band
Chronic Leukemia
Mature forms of WBC and onset is more gradual
Stage IV
Metastasis
What information about the side effects of Filgrastim should the RN include in the discharge teaching plan for Mrs. Sanchez?
Mild to moderate bone pain Rationale: Bone pain and some general muscle aches often occur, and can be lessened by non-narcotic pain relievers
Mr. Sumo verifies that he knows what transurethral resection of the prostate (TURP) involves and that three are possible complications. Which statement by Mr. Sumo indicates that he understands the implications of surgery on his sexual function?
My sexual relations should not be affect. I will be able to have an erection, but will ejaculate less semen. Rationale: TURP when done for treatment of symptomatic benign prostate hyperplasia (BPH) involves removal of some prostate tissue to reduce its size. When done for treatment of cancer, cancerous tissue is removed. TURP is done through the urethra. Abdominal incision is not required. It is unlikely that the nerves responsible for erection would be damaged or removed during TURP. Impotence (inability to have an erection) is not a side effect. However, ejaculate may contain less semen, and retrograde ejaculation may occur (discharge of semen into bladder and urine)
Mrs. Sanchez expresses concern about nausea and vomiting while taking chemotherapy, what information should the RN provide?
N/V are anticipated, so medications will be given to prevent them Rationale: This response addresses the client's concerns and gives accurate information. Anti-neoplstic drugs often stimulate the chemoreceptors trigger zone (CTZ) leading to N/V. N/V may also be caused by irritation of the GI tract. Provide antimetics before, during and after chemotherapy
Clean margins
No abnormal tissue in the cells they sent
Stage 0
Non-invasive
BPH Modifiable Risk Factors
Obesity Sedentary ETOH Smoking Diabetes
Laser Prostatectomy
Outpatient Procedure Laser used to kill tissue Cath for 24hrs
TUNA (Transurethral Needle Ablation)
Outpatient Procedure Low pain Quick Recovery Low wave frequency burns prostate tissue leading to necrosis Precise way to remove targeted tissue
TUMT (Transurethral Microwave Therapy)
Outpatient Procedure Microwave administ thru transurethral probe Heat causes tissue death Post Retention Common Discharge w/Cath Anticoagulants held prior to procedure
Oophorectomy
Ovarian removal If you remove the ovaries and fallopian tubes we through them in to surgical menopause d/t taking away hormones
Electrogenic Drugs
Reduces symptoms of BPH and ED Tadalafil (Cialis)
Tony wonders whether he has prostate cancer. What can you tell him about his PSA level?
PSA is glycoprotein produced by prostate cells. It is unique to the prostate and is not produced anywhere else in the body. Normally, prostate cells leak a small amount of PSA into the bloodstream; this small amount is what is measured when a PSA is down. An enlarged prostate naturally leaks more PSA and causes an elevated PSA level in the blood. When a prostate cell is damaged, it leaks more PSA; damage might be caused by infection, inflammation, or cancer. A.B's results of 11.9ng/mL reflects a moderate elevation. Further testing needs to be done.
Gastric Ulcer
Pain most commonly occurs 30 to 60 minutes after a meal Less often pain at night Pain exacerbated by ingestion of food Malnourishment Hematemesis
Duodenal Ulcer
Pain occurs 1.5 to 3 hour after a meal Awakening with pain during the night Pain relieved by ingestion of food or antacid Well-nourished Melena
Proton Pump Inhibitors (PPIs)
Pantoprazole, Omeprazole, Esomeprazole, Rabeprazole, and Lansoprazole Reduce gastric acid by inhibiting the cellular pump of the gastric parietal cells necessary for gastric acid secretion Nursing Actions: Monitor for electrolyte imbalances and hypoglycemia in clients who have diabetes mellitus Monitor for abdominal cramping, fever, and diarrhea. This can indicate presence of Clostridium Difficile
One hour after the initiation of the IV KCL the RN reassess Mrs. Sanchez. Which nursing assessment has the highest priority?
Patient complain of palpitations and heathy feeling in the chest Rationale: The complaint warrant further assessment b/c it may represent cardiac dysrhythmia that is life threatening
Based on the PSA and TRUS results, Tony is scheduled for prostate biopsy. He wonders what he needs to do to prepare for this test, Explain a prostate biopsy procedure and how to prepare for the procedure.
Patients preparing for a prostate biopsy should stop all medications that increase bleeding time: Warfarin (Coumadin) Clopidogrel (Plavix), Aspirin, Nonsteroidal Anti-Inflammatory Drugs (NSAIDS) such as Ibuprofen (Motrin, Advil) or Naproxen (Naprosyn, Aleve) Warfarin should be stopped 5 to 7 days prior; patients should talk to their provider before stopping this medication. Other Anticoagulants and Antiplatelet medications should be stopped 1 week prior. Patients can expect to find some blood in their bowel movement for up to 2 weeks after a biopsy. Herbal products that may cause increased bleeding, such a ginkgo biloba, ginger, ginseng, and St. John's wort, should also be stopped The patient will probably be sedated for this procedure and will need a driver to take him home. If sedation is used, he will need to fast before his procedure by can take his other medications as usual. If not allergic, he will be medicated with an antibiotic the day before, the day of, and the day after the procedure. In addition, he can have a Fleet enema the morning of the procedure. The pre-procedure treatment may vary with different facilities; check the patient in your area before instructing patients about medications A prostate biopsy is performed by inserting in a large ultrasound probe into the rectum. Because the prostate is located next to the rectum, the probe can be angled to visualize the prostate on the US screen. A biopsy needle is inserted through the wall of the rectrum into the prostate will usually get six tissue samples from each side of the prostate for a total of 12 samples.
Retropubic
Pelvic lymph nodes can be access with this procedure
Ductal Breast Cancer
Pertaining to a duct Affects Milk Ducts
When assessing Mr. Sumo's urine in the immediate postoperative period, what characteristics would you anticipate?
Pink to red Rationale: Bleeding is common immediately after transurethral resection of the prostate (TURP), since surgery has caused trauma. Bloody urine with close is not usual. Gradually, urine will fade to pink as bleeding diminished. Mr. Sumo's urinary drainage is reddish-pink with some small clots.
What additional information should the RN obtain on a client who is taking Cisplatin?
Presence of cough and productive sputum Dysuria Reports of malaise and chills Rationale: Different types of infection and all warrant immediate intervention
To which room should the RN admit Mrs. Sanchez
Private Room Rationale: The client should be in neutropenic precautions and requires protection from other client's infections
A-Adrenergic Receptor Blocker
Promotes smooth muscle relaxation in the prostate b/c they increase hyperplastic prostate tissue Tamsulosin (Flomax)
Which intervention should the RN include in Mrs. Sailor's plan of care?
Provide accurate and timely teaching regarding the client's sexual concerns Rationale: This information provides data about the impact that surgery has on the physiological responses
When developing a plan of care to reduce the risk of cervical cancer, the RN recognizes that primary prevention should include which intervention?
Provide community education
Histamine 2 Receptor Antagonist
Ranitidine, Famotidine, Cimetidine, and Nizatidine Reduce the secretion of acid Nursing Actions: Use cautiously in clients who have kidney disease
Lumpectomy
Removal of tissue
Which of the following is a priority client education based on today's findings?
Report a fever greater than 100.4 Rationale: Temperature greater than 100.4 may be a sign of infection and prompt antibiotic TX should be initiated. Remember the patient is on chemotherapy drugs that wipe out the immune response.
Sigmoidoscopy
Resection of diseases segments w/anastomoses of remaining intestine
BPH (Benign Prostatic Hyperplasia)
S/S difficulty urinating, nocturia, cannot empty bladder increase risk for infection, progressive condition, problems with incontinence, intraprostatic tissue growth BPH is not malignant it is overgrowth of tissue
Besides assessing Mr. Sumo for shock, it is also important to assess for TURP Syndrome. What blood test is done to monitor a client for TURP syndrome?
Serum Na Rationale: TURP syndrome occurs when irrigation fluid (usually sterile normal saline) is absorbed systemically. Na is monitored to detect TURP syndrome. Serum osmolality may also be monitored. Irrigation fluid may be absorbed rapidly (through the prostate venous plexus) or gradually (from retroperitoneal spaces) TURP syndrome can occur during TURP surgery or up to 24 hours after surgery. With TURP syndrome, a severe hypervolemic, hyponatremic state occurs. Neurologic and hypovolemic changes occur. Signs and symptoms vary greatly and may change. These include nausea and vomiting, confusion and hypotension, hypertension, bradycardia and visual disturbances. Treatment is symptomatic
TUIP (Transurethral Incision of Prostate)
Several incisions are made into prostate to expand urethra
Mrs. Sanchez is admitted to the hospital for surgery. During the pre-operative process the client begins to cry uncontrollably and states "I can never be a proper wife again". In response, to the client's statement, which concern is most important for the RN to explore in greater depth?
Sexual limitations as a result of surgery Rationale: Clients often worry about the ability to resume normal sexual activity after surgery.
Invasive
Spreading to other locations Most spread to bones, liver, lungs and brain
Tony asks the RN what he could have done to decrease his risk of prostate cancer. What should the RN teach hum about prostate cancer risks?
Substituting fresh fruits and vegetables for high fat foods in the diet may lower the risk for prostate cancer Rationale: Approximately 75% of cancers are considered sporadic. The only modifiable risk factor for prostate cancer is its associated with a diet high in red and processed meat and high fat dairy products along with a low intake of vegetables and fruits. Age, ethnicity, and family hx are risk factors of prostate cancer, but are not modifiable. Saw Palmetto has no benefit for BPH or prostate cancer.
What information should the nurse provide regarding prostate cancer risks?
Substituting fresh fruits and vegetables for high fat foods in the diet may lower the risk of prostate cancer Rationale: diets high in red and processed meat and high fat dairy products along with low intake of vegetables and fruits have been shown to increase the risk of prostate cancer. Simple, enlargement or hyperplasia of the prostate is not a risk factor.
Orchiectomy
Surgical removal of testes Gold standard androgen deprivation
Angiogenesis Inhibitors
TX for cervical and ovarian cancer Used for women w/BRCA mutations Interferes w/blood vessels that supply cancer cells Bevacizumab (Avastin)
When the client asks the RN where the bipsy will take place, how should the RN respond?
The gynecologist's office Rationale: This is an outpatient procedure, performed in the office d/t it's minimal risk of bleeding or complications
A teaching plan is developed for Mr. Sumo's immediate needs after discharge. Which needs should be included in pain?
The need for a high fluid intake Regular walking Avoiding heavy lifting Perineal exercises Rationale: A high fluid intake will ensure adequate urine output which will flush the bladder, keep it free of clots, and reduce risk for ascending urinary tract infection. Residual bleeding and clots may occur up to six weeks after surgery. Regular walking will promote venous return from the lower extremities. Walking is preferred over sitting, which puts pressure on the surgical area and can cause bleeding. Strenuous exercises should be initially avoided. Perineal exercises are often prescribed after TURP to improve muscle tone and promote continence. Post-void dribbling is common after TURP. This generally subsides as muscle tone improved with perineal exercises
What is the nurse's best response to Jessica?
This all seems very overwhelming right now Rationale: This is an open ended statement that acknowledges Jessica's expressed feelings, leaving an opportunity for her to continue to share her feelings and concerns.
Tony is scheduled for a transrectal ultrasound (TRUS) of the prostate. What is the purpose of this test?
This test is a good tool in the early diagnosis of prostate cancer combined with the PSA and digital rectal examination. The sound waves emitted by the ultrasound provide an image of the prostate gland. The TRUS can also be helpful in guiding a prostate biopsy.
Which treatment for BPH uses low wave radiofrequency to precisely destroy prostate tissue?
Transurethral needle ablation (TUNA) Rationale: Uses low-wave radiofrequency to heat the prostate, causing necrosis
The RN understands that cervical cancer causes the most death of cancer in women
True
Jessica has no other GI symptoms at the present time. She does report that her body is stiff and aching when she rises in the morning for which she takes NSAIDs to help relieve pain. What is the nurse's best response to this information?
Ulcerative Colitis can cause problems in areas other than the colon Rationale: Moderate to extensive UC can cause extra-intestinal complications. Some of the common manifestations affect the large joints with symptoms of arthritis and the eyes with symptoms such as blurred vision and photophobia. UC doesn't spread t/o the GI tract
Why is a patient with BPH at higher risk for UTI and kidney problems?
Urinary Retention Overdistention of the bladder with backflow of urine into the kidney Rationale: BPH does not cause injury to urethra or migration of prostate cells
When taking a nursing history from a patient with BPH, the nurse should expect the patient to report?
Urinary hesitancy, post-void dribbling, and weak urine stream Rationale: With benign prostate hyperplasia (BPH) the prostate gland enlarges. Since the prostate is situated area the urethra, problem with urination can occur secondary to urethral constriction. Symptoms of BPH can include hesitancy, intermittent voiding, urgency, nocturia, post-void leakage, and difficulty voiding.
In addition to bladder ultrasound, the extent of urinary obstruction caused by BPH can be determined by which diagnostic study?
Uroflowmetry Rationale: Uroflowmetry determines extent of urethral blockage and TX needed
Tony returns after his laparoscopic radial prostatectomy (LRP) Initial postoperative orders are written. Which orders are appropriate for Tony?
VS per hospital protocol Notify MD if urinary output is less than 30m/hr Oxybutynin (Ditropan XL) 100mg, PO every AM Docusate (Colace) 100mg PO, qd Morphine 4mg, IVP, q4hrs, PRN pain
Which laboratory finding would be the most important for the RN to report to the HCP?
WBC 1,700/mm3 Rationale: This result is critically low and requires immediate action
Which assessment data indicates to the RN that the desired outcome of the Filgrastim has been achieved?
WBC 3,500/mm3 Rationale: This medication is considered a WBC booster that helps your body increase more WBC to decrease the risk of infection or to help fight an infection. It can be given 24hrs after chemotherapy for patients at risk
Human Granulocyte Colony Stimulating Factor
WBC Booster 24hrs prior to chemo administration Filgrastim (Neupogen)
The urologist discusses possible treatment option with Tony. Identify three treatment options for prostate cancer.
Watchful waiting: this involves simple monitoring A.Bs condition and intervening if symptoms become troublesome Brachytherapy: Radioactive seeds are implanted in the prostate (these people have irritative voiding symptoms; frequency for moths after the procedure) or external beam radiation can be used Hormone therapy: A PSA is drawn and medications are given based on PSA levels. In some patients, medications are given to shrink the tumor before surgery Chemotherapy: Systemic cytotoxic chemotherapy might be done for patients whose cancer has metastasized Surgery: 1) Laparoscopic radical prostatectomy is a minimally invasive robot-assisted procedure. Benefits include a decreased hospital stay ( 1 to 2 days), smaller incision, less postoperative discomfort and faster recovery. In addition, there are neresparing advantages 2) Radical open prostatectomy the patient might have blood loss during surgery and incontinence and erectile dysfunction postoperatively
Jessica is scheduled for a flexible sigmoidoscopy and barium enema. Which explanation of the procedure for the barium enema should the nurse provide Jessica?
Xray is used to visualize the large intestine after barium is instilled Rationale: The barium enema involves a series of x rays taken to visualize the colon. The X-rays are taken after barium is instilled into the colon thru a rectal catheter.
The nurse identifies the priority outcomes for Jessica include control of her pain and diarrhea. Jessica receives prescription for Diphenoxylate (Lomotil) PRN, Prednisone (Deltasone), Sulfasalazine (Azulfidine) and Azathioprine (Imuran). Jessica's prescription for Sulfasalazine reads "Take 1gm 3 times per day" Jessica takes this medication a 0800, 1200 and 1800 which are her meal times. After 2 weeks she reports that her diarrhea has worsened and that she vomits frequently.
You need to increase the length of time between each dose of the medication Rationale: THe adverse GI manifestations can increase if the dose is too large or if the doses are taken too close together. Encourage every 8 hours dosing schedule, since the medication was ordered TID. This medication should be taken with meals to decrease GI upset
Transrectal US (TRUS)
differentirates BPH from prostate CA
