Med-Surg Test 2 - Urinary/Reproductive/STDs
Terms in this set (81)
Transurethral Resection of the Prostate (TURP)
Most common treatment of BPH; prostate removed by endoscopy (no surgical incision is made), allowing for a short hospital stay
Pain from bladder spasms, bleeding, shock, clots, urine is reddish pink and should clear to pink in 24 hrs, and yellow in 4 days. Some clots in urine = normal. Watch drops in hemoglobin & hematocrit. Avoid straining.
Meds Used for Bladder Spasms
B&O suppository, Ditrapan
Bladder Irrigation TURP Post-Op
Sterile saline; 3 way catheter (CBI, Murphy Drip) - 1st for urine, 2nd for saline to go in balloon, 3rd for saline irrigation
Proscar, Flomax - watch BP because meds can drop it.
Urinary Calculi Diagnosis
Intravenous Pyelogram - An intravenous pyelogram (IVP) allows for visualization of the kidney and its associated structures via placement of radioactive contrast dye to visualize the stone and its location. **
Make sure px is not allergic to iodine.
Urinary Calculi Treatment
Lithotripsy or Extracorporeal Shock Wave Lithotripsy (ESWL); Stones over 1 cm may need surgery removal (cystoscopy); Morphine, Torodol, Phenergren, NSAIDs; high fluid intake; warm bath once stone has passed; strain urine to collect stones for lab
Urinary Calculi Prevention
Avoid intake of oxolate-containing foods (spinach, strawberries, rhubarb, tea, peanuts, wheat bran). Drink fluids every 1-2 hrs during the day (enough to excrete 3k-4k ml every 24 hrs). Avoid foods high in purine (shellfish, anchovies, asparagus, mushrooms, and organ meats).
Noninvasive; need informed consent; coordinated w/ heart beat; anesthesia used; monitor/teach about hematuria; pain control; KUB to see if stones are moving; high fluid intake
A needle or catheter is inserted through the skin into the calyx of the kidney. The stone may be dissolved by percutaneous irrigation w/ a liquid through the needle/catheter.
Major Complication of Any Renal Surgery
Paralytic Ileus; absent bowel sounds, nausea, vomiting, distention
Inflammation of the urinary bladder
Most Common Infectious Agent w/ UTI
Clean-catch; IVP to determine kidney functioning (know allergies to iodine); Cystogram to determine bladder functioning; Cystoscopy to determine bladder or urethral abnormalities;
Iodine Allergy w/ IVP Symptoms/Treatment
SOB, tingling in mouth, tightening in throat. Epi, Benadryl, steroids.
Fever, chills, frequency, urgency, dysuria, hematuria, pain at costovertebral angle, elevated serum WBCs (over 10,000)
Antibiotics, fluid intake of 3,000 ml/ day, I&O, administer mild analgesics (phenazopyridine/Pyridium, acetaminophen, aspirin), macrodantin, cypro, bactrim (sulpha allergies), void every 2-3 hrs,
Med for pain and burning associated w/ UTI; Turns urine orange/red. Stains clothing.
Flaccid/spastic bladder; can be cause of urinary obstruction
Routes of Infection for UTI
Transurethral (ascending from urethra - fecal contamination, most common)
Bloodstream (hematogous spread)
Fistula (direct extension)
What infection can glomerulonephritis arise from?
Mild to moderate edema (often confined to face - periorbital), irritability, HPTN, tea-colored urine due to hematuria, proteinuria, elevated ASO, elevated BUN/creatinine as urinary output decreases, azotemia (urea in blood), anemia
BUN & Creatinine
Measure renal function
Normal BUN 10-20
Normal Creatinine .5-1.1
Both elevated in renal dysfunction.
Antibiotics to prevent secondary infection, bedrest, protein & sodium restriction, I&O, daily weight, lung sounds
The kidneys are reduced to as little as 1/5 normal size (consisting largely of fibrous tissue). Can progress to renal failure & require renal replacement therapies.
Renal Cancer Risk Factors
Affects more men than women, tobacco use, occupational exposure to industrial chemicals, obesity, estrogen therapy, polycystic kidney disease.
Signs/Sx - Painless hematuria (usually the first sign px gets alarmed about, can be intermittent), pain, mass in flank
May metastasize early to the lungs, bone, liver, brain, and contralateral kidney.
Radical nephrectomy is the preferred treatment. Adrenal glands, surrounding fascia (connective tissue), and lymph nodes removed.
Leading cancer of women in US (1 in 8). Tumors tend to be located in the upper outer quadrant, and more often in the left than the right. Highest incidence in ages 40-49 and over 65.
Tumors less than 4 cm are deemed curable. Larger tumors are difficult to cure.
Breast Cancer Risk Factors
Family history, menarche before 12 and menopause after 50, nulliparous, bearing children after 30 yo, history of uterine cancer, daily alcohol intake
Breast Cancer Detection
BSE monthly, preferably as soon as menstrual bleeding ceases, or on the same day every month if postmenopausal
Mammography - baseline at 35-40 yo, every 1-2 yrs for women in 40s, anual for women over 50. No use of lotions, talc powder, or deoderant under arms prior to procedure (may mimic calcium deposits under radiograph).
Physical examination by a professional annually.
Definitive diagnosis is made by biopsy.
Med used to treat or prevent hormonally dependent breast cancer; suppresses estrogen.Side effects are hot flashes and vaginal dryness.
Common Sites of Breast Cancer Metastasis
Axillary, supraclavicular, and mediastinal lymph nodes, followed by lungs, liver, brain and spine.
Treatment of Breast Cancer
Adjuvant treatment consists of radiation (either external beams or implants), antineoplastic chemotherapy, and hormonal therapy. The prescence or absence of hormone receptors is paramount in selecting clients for adjuvant therapy.
Late Signs of Breast Cancer
Hard lump (not freely movable and not painful), dimpling of skin, retractions of nipple, alterations in contour of breast, change in skin color, change in skin texture (peau d'orange), discharge from nipple, pain and ulcerations
Monitor bleeding; check under dressing, Hemovac, and under client's back.
Position arm on operative side on a pillow, slightly elevated and abducted (away) from body (distal joint higher than proximal).
Lifetime protection of arm from BP, injections, and IV, especially if lymph node involved.
Encourage hand and arm activity/exercises.
Leading cause of cancer-related death in males 15-35. If detected early, there is a 90-100% chance of cure. Early signs are subtle and usually go unnoticed: feeling of heaviness or dragging sensation in lower abdomen and groin, lump or swelling (painless) on testicle. Late signs include low back pain, weight loss, and fatigue.
Men whose testes have not descended into the scrotum or whose testes descended after age 6 are at high risk for developing testicular cancer.
**The most common symptom is the appearance of a small, hard lump about the size of a pea on the front or side of the testicle. Swe
Testicular Self-Exam (TSE)
Should be done regularly at the same time every month by all males after age 14.
Testicular Cancer Treatment: Orchidectomy
Observe for hemorrhage, active movements may be contraindicated. Encourage genetic counseling (sperm banking). Counsel that sexual function is usually not affected because the remaining testis undergoes hyperplasia, producing sufficient testosterone to maintain sexual function. Although ejaculatory ability may be decreased, orgasm is still possible.
Infection of the epididymis, which usually spreads from an infected urethra, bladder, or prostate. Prevalance greatest in men 19-35 yo. Risk factors include recent surgery or procedure involving urinary tract, participation in high-risk sexual practices, personal history of an STD, past prostate infections or UTIs, and presence of a chronic indwelling urinary catheter. Usually caused by E.Coli, but may be a result of urinary obstruction in older men. Treated w/ rest, icepack, pain control, NSAIDs, and antibiotics.
Male sterilization; involves the surgical interruption of both vas deferens, which are the tubes that carry the sperm from the testicles and epididymis to the seminal vesicles to prevent fertilization of an egg after ejaculation; has no effect on sexual potency, erection, ejaculation, or production of male hormones and provides no protection against STDs. Still fertile 3-6 months post-op, carry sperm samples to lab. Sex may be resumed as desired, usually after 1 week.
Used to screen for prostate cancer; anually for all men over 50 (45 for high risk - blacks, family history)
Rarely produces symptoms in early stages. Symptoms that develop from urinary obstruction occur in later stages. Hematuria. Sexual dysfunction is common before the dx is made. Can spread to lymph nodes and bone. Symptoms of metastasis are backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urinary output), and spontaneous fractures. These may be the first signs of prostate cancer. If it's detected early, likelyhood of cure is high.
Prostate Cancer Diagnosis
Abnormal findings on DRE, serum PSA, and ultrasound-guided TRUS with biopsy.
Prostate Cancer Treatment
Radical prostatectomy for tumor confined to prostate. It is the complete removal of the prostate, seminal vesicles, tips of the vas deferens, and often surrounding fat, nerves, and blood vessels. Sexual impotence is common.
Teletherapy (external) and brachytherapy (internal)
Androgen Deprivation Therapy - estrogen to decrease testosterone
Cryosurgery of Prostate
For px who can't tolerate surgery or have recurrent prostate cancer
Inflammation of vagina, usually secondary to infection.
The vagina is protected against infection by its normally low pH (3.5-4.5).
Risk factors: premenarche, pregnancy, perimenopause, menopause, poor personal hygiene, tight undergarments, synthetic clothing, frequent douching, allergies, oral contraceptives, antibiotics, diabetes, low estrogen levels, oral-genital contact, HIV
Recurrent yeast infections may be sign of unknown diabetes.
Yeast Infection Signs/Sx
Discharge that causes pruritis and irritation. Discharge may be watery or thick but has a white, cottage cheese like appearance. Symptoms are usually more sever just before menstration and may be less responsive to treatment during pregnancy.
pH will be 4.5 or less.
Treatment of Vaginal Candidiasis
Antifungal suppository agents like Monistat, Mycostatin, Lotrimin, Terazol. **
Use at bedtime
** Oral Diflucan available in 1 pill dose. Relief should be noted within 3 days.
Caused by an overgrowth of Gardnella vaginalis and an absence of lactobacilli. Risk factors include douching after menses, smoking, multiple sex partners, STDs. Can occur throughout menstrual cycle and does not produce local discomfort or pain. Discharge, if noted, is heavier than normal and gray to yellowish white in color. It is characterized by a fishlike odor that is particularly noticable after sex or during menstration as a result of increase in vaginal pH (usually more than 4.7).
Metronidazole (Flagyl), Clyndamycin (Cleocin). Treat partner.
Common, usually sexually transmitted disease known as "trich."
Vaginal discharge that is thin (somtimes frothy), yellow to yellow-green, malodorous, and very irritating. Vulvitis may occur. Vaginal and cervical erythema. pH greater than 4.5
Metronidazole or tinidazole (Tindamax). Both partners receive a one-time loading dose or a smaller dose 3 times/day for a week.
Flagil (Anabuse) - Don't drink alcohol!
Surgical removal of uterus to treat cancer, dysfunctional uterine bleeding, endometriosis, non-malignant growths, persistent pain, pelvic relaxation and prolapse, and injury.
TAH - total abdominal hysterectomy involves removal of uterus and cervix
LAVH - Laproscopic Assisted Vaginal Hysterectomy; may complain of bloating or shoulder pain post-op
Discontinue anticoagulants, NSAIDs such as aspirin, and vitamin E to reduce risk of bleeding. Prophylactic antibiotics may be administered prior to surgery but discontinued the next day. May take heparin to prevent clots.
Major risk are infection and hemorrhage. Not a lot of vaginal drainage expected post op; three peripads saturated in 1 hr is too much bleeding.
Edema or nerve trauma may cause temporary loss of bladder tone (bladder atony), and catheter may be inserted.
If ovaries are removed, hormonal therapy may be needed.
Avoid straining/lifting and sex until okayed by dr.
Benign Uterine Tumors: Fibroids (Leiomyomas, Myomas)
Common; usually occur between 20-40 yo; grow slowly and may become quite large; common reason for hysterectomy because they often result in menorrhagia and metrorrhagia, which can be difficult to control. Medications (leurprolide/Lupron) induce a temporary menopause-like environment; side effects include hot flashes and vaginal dryness.
Profuse or prolonged bleeding (menorrhagia) is the most important factor relating to benign uterine tumors. Assess for signs of anemia.
Chronic disease; a benign lesion or lesions w/ cells similiar to the lining of the uterus grow anywhere in the pelvic cavity outside the uterus. Extensive endometriosis usually causes few symptoms, but an isolated region may produce severe symptoms. It is a major cause of chronic pelvic pain and infertility.
Has been diagnosed more frequently w/ laparoscopy. Risk factors include family history, few children, bearing children late in life, shorter menstrual cycle (less than 27 days), flow longer than 7 days, outflow obstruction, younger age at menarche. Characteristically found in nulliparous women between 25-35, and in adolescents particularly those w/ dysmenorrhea that does not respond to NSAIDs.
Oopharectomy - surgical removal of ovary
Salpingo-Oopharectomy - removal of an ovary and its fallopian tube
D&C (Dilation & Cutterage)
Used only in extreme cases of bleeding.
Treats benign tumors of the uterus (fibroids).
No sex, no douching, no tampons - until okayed by dr.
Downward displacement of the uterus
Relaxation of the anterior vaginal wall w/ prolapse of the bladder
Relaxation of the posterior vaginal wall w/ prolapse of the rectum
Uterine Prolapse, Cystocele, & Rectocele Treatment
Preventative Measures - postpartum perineal exercises, spaced pregnancies, weight control
Surgical Intervention - hysterectomy, anterior and posterior vaginal repair (A&P repair)
Nonsurgical Intervention (for uterine prolapse) - Kegels, knee-chest position, pessary use
Pelvic Inflammatory Disease (PID)
Signs/Sx - vaginal discharge, dyspareunia (painful intercourse), lower abdominal pelvic pain, and tenderness that occurs after menses. Pain may increase w/ voiding or defecation. Fever, general malaise, anorexia, nausea, headache, and possibly vomiting. On pelvic examination, intense tenderness may be noted on palpation of the uterus or movement. Sx may be acute or mild.
Pelvic or generalized peritonitis, abscesses, strictures, and fallopian tube obstruction may develop. Obstruction can cause an eptopic pregnancy in the future. Adhesions are common and often result in chronic pelvic pain; they may require removal of the uterus, fallopian tubes, and ovaries. Other complications include bacteremia w/ septic shock and thrombophlebtitis.
Manage pain w/ analgesics & warm sitz bath. Bed rest. Antibiotics.
Keep head of bed elevated to keep infection localized & promote drainage.
Stop spread of infection - careful handling of OB pads & handwashing.
Easily detected w/ Pap test.
Precurser is dysplasia (precancerous cell change).
Treatments include cryosurgery, elecrocauthery, laser, conization, hysterectomy, intracavity radiation, chemo.
Should begin w/in 3 yrs of having intercourse or no later than 21 yo, whichever comes first. Should be performed annually until age 29 and then may be done every 2-3 yrs if a woman has three consecutive normal results. After age 70, client may stop if she has three consecutive normals and no abnormals in the past 10 yrs. Women at high risk should have annual screenings. After age 30, women should be screened for HPV.
Brachytherapy; delivers high-dose radiation directly to affected tissue.
Do not allow anyone pregnant in room. Discourage visits by small children. Keep a lead-lined container in the room for disposal in case the implant falls out. Client should remain in bed w/ as little movement as possible. Wear latex gloves when handling potentially contaminated secretions. Wear a dosimeter when providing care; badge is not worn out and is checked by staff. Each contact should last no more than 30 min. Watch policies on laundering.
Uterine (Endometrium) Cancer
Treatment consists of total or radical hysterectomy and bilateral salpingo-oopharectomy (removal of fallopian tube and ovary).
Risk Factors: At least 55, median age 61, obesity that results in increased estrogen levels, nulliparity, truncal obesity, late menopause (after 52), and use of tamoxifen
Can occur at all ages. Early dx is difficult becaus eno useful screening tool exists. Leading cause of death from gynecologic cancers in US. Growth is insidious, so it's not recognized until advanced stage.
Advanced signs/sx: pelvic discomfort, low back pain, weight change, abdominal pain, increased abdominal girth, nausea, vomiting, constipation, urinary frequency.
Laparotomy - a surgical incision through the abdominal wall made to allow investigation of an abdominal organ or diagnosis of an abdominal disorder
Most prevelant communicable disease in US.
STD Risks to Newborn
Gonorrheal conjunctivitis, herpes, syphilis, oral candidiasis
Females: majority asymptomatic
Males: Dysuria, yellowish-green discharge, urinary frequency
Dx: smears, cultures
Often coexists w/ Chlamydia
Up to 90 days postexposure: chancre, highly infectious
6 weeks - 6 months: Flu-like symptoms, generalized rash that affects palms of hands & soles of feet, lesions contagious
10-30 years postexposure: cardiac & neurologic destruction
Diagnosed w/ VDLR (blood test)
Treated w/ penicillin
Most commonly reported communicable diseas in US
Females: Many asymptomatic, but may exhibit dysuria, urgency, vaginal discharge
Males: Leading cause of nongoncoccal urethritis
Dx: tissue culture, Chlamydiazyme, MicroTrak
Treatment: Doxycycline hyclate or Tetracycline HCl (take on empty stomach, avoid milk, dairy, iron, antacids)
Vesicles (blisters) in clusters that rupture & leave painful erosions that cause painful urination; initial infection usually very painful & lasts about 1 week; remissions & exacerbations that are often associated w/ stress, sunburn, dental work, or inadequate rest and nutrition; may be contagious even when asymptomatic; can be trasmitted from wet surfaces or by self-transmission (auto-innoculation); symptoms controlled w/ Acyclovir (Zovirax), lidocain topically paito ease pain, keep lesions clean & dry
Lesions may be small, wartlike, or clustered, flat or raised; paint on podophyllum resin; Trichloracetic acid (TCA); laser; cryotherapy
Caused by retrovirus that attacks CD4 T cells, lymphocytes, macrophages, and cells of the CNS.
Normal CD4 count is 600-1200, under 200 = at risk for opportunistic infection (pneumocystis Carinii, Kaposi's Sarcoma, TB, candidiasis of mouth/esophagus).
Symptoms of HIV
Extreme fatigue, loss of appetite, unexplained weight loss, swollen glands, leg weakness or pain, unexplained fever, night sweats, dry cough (may represent PCP), diarrhea, white spots in mouth (candidiasis), painful blisters (shingles), painless purple-blue lesions on skin, confusion, disorientation, recurrent vaginal infections that are resistant to treatment
Nursing Interventions for HIV
Boost immune system, respiratory, avoid infection, strict aspsis, frequent vitals, rest, elevate head of bed, nutritionist, small & frequent meals, high calorie & easily digested protein, daily weights, avoid fatty foods, skin care, oral hygiene; goal is to keep CD4 high and viral load down
Zidovudine (Retrovir, AZT) main drug; many antivirals taken at once (coctail, HAART - highly active antiretroviral therapy); take around the clock
Rapid HIV test for rape victims in ER
Screens for presence of HIV antibodies in the blood
Western Blot, confirms seropositivity
T Cell Less than 200
"Full Blown AIDs" & very susceptible to opportunistic infection