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EXAM 3 - MED SURG
BPH, ED, TURP, INCONTINENCE, KIDNEY STONES
| Question | Answer |
|---|---|
| Pharmacological Treatment of Pyelonephritis | Fluoroquinolones, Penicillin's, Trimethoprim-Sulfamethoxazole Combination |
| Fluoroquinolones | such as ciprofloxacin (Cipro), ofloxacin (Floxin), norfloxacin (Noroxin), and gatifloxacin (Zymar). |
| Penicillin's | such as ampicillin (Principen, Omnipen), and amoxicillin (Amoxil) |
| Trimethoprim-Sulfamethoxazole Combination | such as co-trimoxazole (Bactrim, Septra). |
| Benign Prostatic Hyperplasia (BPH) Definition | Noncancerous enlargement or hypertrophy of the prostate, and one of the most common diseases in aging men. |
| Benign Prostatic Hyperplasia (BPH) Signs & Symptoms for Diagnosis | Urinary frequency, urgency, nocturia, hesitancy in starting urination, decreased and intermittent force of stream and the sensation of incomplete bladder emptying. Large, rubbery, and nontender prostate gland. Urinalysis, urinary flow rate and measurement of post void residual urine. |
| Benign Prostatic Hyperplasia (BPH) Generalized Symptoms | Fatigue, anorexia, nausea, vomiting, and pelvic discomfort. |
| Benign Prostatic Hyperplasia (BPH) Plan of Care | Improve quality of life, improve urine flow, relieve obstruction, prevent disease progression, and minimize complications |
| Benign Prostatic Hyperplasia (BPH) Acute Interventions | Transurethral microwave thermotherapy (TUMT) which is the application of heat to prostatic tissue. High-Energy TUMT devices & low-energy devices. Transurethral needle ablation (TUNA) by radio frequency energy and the UroLume stent. |
| Catheter Usage in Benign Prostatic Hyperplasia (BPH) | If a patient is administered and unable to void. May require a thin wire stylet is introduced to prevent the collapse during insertion, and a longer Cath may be needed |
| Transurethral Resection of the Prostate (TURP) Definition | Most commonly used, and performed endoscopically. The prostate gland is removed in small chips with an electrical cutting loop. |
| Transurethral Resection of the Prostate (TURP) Post-Surgical Assessment Findings | Catheter is connected immediately after procedure to irrigate fluids to wash blood and blood clots from the bladder. When urine is clear, the irrigation will be slowed and eventually stopped. The procedure typically relieves symptoms quickly, and most men have a stronger urine soon after. |
| Transurethral Resection of the Prostate (TURP) Client Education | Ensure the patient understands the procedure, risks, and complications. Complications include incontinence and dribbling for the first year. |
| Transurethral Resection of the Prostate (TURP) Nursing Documentation | Color of the urine. BP, respirations. |
| Transurethral Resection of the Prostate (TURP) Nurse Monitoring | Drainage of catheter for bloody urine, or obstruction. Lower abdomen for swelling or an over distended bladder. BP, pulse, respirations, restlessness, diaphoresis, pallor, drop in BP, and increasing pulse rate. |
| Pharmacological Interventions & Therapeutic Effects of Drugs Used in Benign Prostatic Hyperplasia (BPH) | Alpha1-Adrenergic Antagonists & 5-Alpha-Reductase Inhibitors |
| Alpha1-Adrenergic Antagonists | Relax the smooth muscle of the bladder neck and prostate (sympathetic effects on the bladder and sphincters) Which improves urine flow and relieves symptoms. Side Effects include dizziness, headache, asthenia/fatigue, postural hypotension, rhinitis, and sexual dysfunction. Drug names include alfuzosin (Uroxatral), terazosin (Hytrin), doxazosin (Cardura), tamsulosin |
| 5-Alpha-Reductase Inhibitors | Block the body's production of a powerful androgen to prevent the conversion of testosterone to DHT and decreases prostate size. Side Effects include decreased libido, ejaculatory dysfunction, erectile dysfunction, gynecomastia (breast enlargement), and flushing. Drug names include finasteride (Proscar), dutasteride (Avodart) |
| 5-Alpha-Reductase Inhibitors are Most Appropriate for those with | Very Large Prostates (Mechanical Obstructions) |
| Alpha1-Adrenergic Antagonists are Most Appropriate for those with | Relatively Small Prostates (Dynamic Obstructions) |
| Erectile Dysfunction (ED) Definition | Persistent inability to achieve or sustain and erection suitable for satisfactory sexual performance |
| Erectile Dysfunction (ED) Lifestyle Modifications | Alcohol, smoking, drug abuse |
| Erectile Dysfunction (ED) Organic Causes | Certain Diseases/Disorders such as CV, Endocrine (diabetes, pituitary tumors, testosterone deficiencies, thyroid disfunction), cirrhosis, kidney diseases, urinary disease, hematologic conditions (leukemia, lymphoma), neurological disorders, trauma to pelvic or genital area |
| Erectile Dysfunction (ED) Psychogenic Causes | Anxiety, fatigue, depression, pressure to perform sexually, negative body image, absence of desire, privacy, as well as trust and relationship issues |
| Erectile Dysfunction (ED) Long-Term Management | Include Negative-Pressure (Vacuum) Devices and Penile Implants |
| Erectile Dysfunction (ED) Treatment Options | Oral Medications, Penile Injections, Penile Suppositories, Penile Implants, Negative-Pressure (Vacuum) Devices |
| Penile Implants for Erectile Dysfunction | Semirigid rod, inflatable, soft silicone. Surgically implanted into corpus cavernosum, reliable, healing takes up to 2 weeks, subsequent cryptoscopic surgery is difficult, semirigid od results in permanent semi-erection. Stays in place indefinitely. Inflatable prosthesis that saline returns from penile to receptable to reservoir |
| Least Invasive Measures to Most Invasive Measures for the Treatment of Erectile Dysfunction (ED) | Oral medications (PDE-5) --> injections, --> suppositories --> Vacuum --> Implants |
| Injections for Erectile Dysfunction | alprostadil, papaverine, phentolamine. Smooth muscle relaxants causing blood flow into the penis. Firm erections are achievable over 50% of the time. Pain at injection site is possible, plaque formation, risk of priapism. Injection should be done 20 minutes before intercourse. Erection can last up to 1 hour |
| Urethral Suppository for Erectile Dysfunction | Alprostadil. Smooth muscle relaxant that causes blood flow into the penis. May be used twice a day. Urethral and genital pain is possible, risk of hypertension and syncope, not recommended for those with pregnant partners. Inserted 10 minutes before intercourse. Erection can last up to 1 hour |
| Negative-Pressure (Vacuum) Devices for Erectile Dysfunction | Induction of an erection with a vacuum. Maintained with constricting band around the base of the penis. Cumbersome to use before intercourse. Vasocongestion of the penis can cause pain or numbness. To prevent penile injury, constriction band must not be left in place for more than 1 hour |
| Erectile Dysfunction (ED) Oral Medication Treatment with Phosphodiesterase Type-5 (PDE-5) Inhibitors | sildenafil (Viagra), vardenafil (Levitra), tadalafil (Cialis). Smooth muscle relaxants causing blood flow to the penis. Erections can last up to 1 hour |
| Erectile Dysfunction (ED) Treatment with Phosphodiesterase Type-5 (PDE-5) Inhibitors Client Education | Sildenafil interacts with grapefruit juice. Once medication or treatment plan is made, patients should attempt to engage in regular sexual activity 2-3 times per week which will help to overcome the inevitable performance anxiety and pressure to perform. Medications only work with sexual stimulation. Side effects are headaches, visual changes, dizziness, flushing, muscle pains, stuff nose |
| Co-morbidities to Monitor During Treatment with Phosphodiesterase Type-5 (PDE-5) Inhibitors | Should not be prescribed for those taking organic nitrates. Undiagnosed diabetes, hypertension, hypogonadism, etc. All will need a hormone, lipid and glucose assessment prior to treatment options, fitness for sexual activity will be established |
| Urge incontinence Definition | Involuntary loss of urine associated with a strong urge to void that cannot be suppressed. Aware they need to void, but cannot reach toilet in time |
| Urge incontinence Life-Style Changes | Loose weight if indicated, manage fluid intake, train bladder, perform Kegel Exercises, Encourage Biofeedback Method |
| Urge incontinence Client Education | Keep a voiding diary and Kegel exercise diary, use biofeedback, prompt voiding, and physical therapy |
| Kegel Exercises | Pelvic floor muscle exercises, a behavior intervention for addressing symptoms of stress, urge, and mixed continence. |
| Stress Incontinence | Involuntary loss of urine through an intact urethra as a result of sneezing, coughing, or changing position. |
| Functional Incontinence | Instances in with lower urinary tract function is intact but other factors, such as severe cognitive impairment make it difficult for the patient to identify the need to void |
| Iatrogenic Incontinence | Involuntary loss of urine due to extrinsic medical factors, predominantly medications |
| Mixed Urinary Incontinence | Which encompasses several types of incontinence, it is involuntary leakage associated with urgency and also with exertion |
| Urge Incontinence and the use of Oxybutynin Chloride to Decrease Symptoms | Anticholinergic used to relieve symptoms of urinary incontinence and frequency that accompany an overactive bladder. It acts directly to relax smooth muscle. |
| Urge Incontinence and the use of Oxybutynin Chloride Client Education | Do not cut, crush, or chew XR, drink water frequently, rinse mouth frequently |
| Urge Incontinence and the use of Oxybutynin Chloride Possible Unwanted Side-Effects | Drowsiness, dizziness, blurred vision, dry mouth, nausea, urinary hesitancy, and decreased sweating |
| Signs & Symptoms of Lower Urinary Tract Infections (UTI) | Pain, increased urination, increased urgency, hesitancy, and changes in urine characteristics. |
| Cystitis | Inflammation of the urinary bladder |
| Prostatitis | Inflammation of the prostate gland |
| Urethritis | Inflammation of the urethra |
| Client Education for the Prevention of Upper Urinary Tract Infections & Pyelonephritis | Causes of UTIs can be from infrequent emptying of the bladder, sexual intercourse, contraceptive use, and personal hygiene practices. Always ensure liberal fluid intake, frequent voiding, and adequate hygiene measures. Daily intake of 1 glass of cranberry juice per day have shown a decrease in UTIs. |
| Interstitial Nephritis | Inflammation of the kidney |
| Urosepsis | Spread of infection from urinary tract to the bloodstream that results in a systemic infection |
| Bacteriuria | Presence of bacteria in the urine |
| Nocturia | Awakening at night to urinate |
| Neurogenic Bladder | Dysfunctional bladder |
| Pyelonephritis | Inflammation of renal pelvis |
| Pyelonephritis Basic Definition | Bacterial infection of the renal pelvis, tubules, and interstitial tissue of one or both kidneys |
| Signs & Symptoms of Pyelonephritis | Chills, fever, leukocytosis, bacteriuria, and pyuria. Low back pain, flank pain, nausea and vomiting, headache, malaise, and painful urination |
| Risk Factors for Pyelonephritis | Females, pregnant women, urinary tract blockage, weakened immune system, damage to nerves around the bladder, long use of urinary catheter, vesicoureteral reflux |
| Pyuria | WBC present in urine |
| When to use Short-Term Oral Antibiotics in Pyelonephritis | Acute, uncomplicated pyelonephritis when the patient is not showing signs of sepsis, dehydration, nausea or vomiting. Treated in the outpatient setting. |
| When to use Long-Term Prophylaxis Antibiotics for Pyelonephritis | When bacteria is detected in the urine, and to limit the recurrence of infections. Or in those with chronic recurring infections |
| When to use IV Antibiotics for Urgent Needs in Pyelonephritis | In any UTIs where there is severe infections, sepsis, and the patient is admitted |
| Renal Calculi Definition | Stones formed in the urinary tract when urinary concentrations of substances such as calcium oxalate, calcium phosphate, and uric acid increase. |
| Renal Calculi Risk Factors | Urinary stasis, periods of immobility, increased calcium concentrations in the blood, certain medical conditions, IBS, bowel resections, ileostomies, antacid use, |
| Renal Calculi Ureteral Obstruction Signs & Symptoms | Acute, excruciating, colicky, wavelike pain that radiates down the thigh and to the genitalia. |
| When Do Stones Spontaneously Pass in Patient's with Renal Calculi | Typically if under 1 cm (5 mm) |
| Foods to Avoid with Oxalate Stones | Spinach, strawberries, rhubarb, tea, peanuts, wheat bran |
| Foods to Avoid with Uric Acid Stones | Low purine diet. Avoid Shellfish, anchovies, asparagus, mushrooms, and organ meats |
| Foods to Avoid with Calcium Stones | Protein, sodium, |
| Interventions for Treating Kidney Stones | Increase water intake, and one glass of cranberry juice per day, drink 2 glasses of water at night time to awake during the night and prevent urine from becoming too concentration, avoid sudden increases in environmental temp |
| Expected Assessment Findings for a Patient Post-Lithotripsy | Blood in urine, back pain, bruising on back |
| Priority Medications to be Administered in Renal Colic | Opioid Analgesics to prevent shock and syncope, and NSAIDs. IV fluids to keep urine dilute |
| Long-Term Management of Renal Colic | Depends on the type of stones occurring. Allopurinol (used in uric acid stones), Hydrochlorothiazide (used in calcium stones) |
| Renal Colic | A stone in the renal pelvis which presents with dull, deep, aching in the flank or costovertebral area of the back |
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