Exam 2 Adult Dev's Know

What breast changes see during/after menopause?

Drop of estrogen levels causes glandular breast tissue to shrink and replaces fat. Loss of volume, firmness, periods of tenderness/lumpness.

What are some risk factors that can cause menopause?

Age, smoking, family history of early menopause, chemotherapy, radiation therapy, Oophorectomy (immediate drop in estrogen), Total Hystorectomy, radical hystorectomy.

What are possible complications in Menopause?

Bone loss, osteoporosis, pelvic organ relapse, bladder/bowel training, kegel excersice. Ovarian cancer, uterine fibroids, fibrocystic breast condition, breast changes.

When is Hormone Therapy used in Menopause?

When symptoms affect quality of life. Increased risk of blood clots, stroke and breast cancer.

When is Hormone therapy NOT recommended?

With a patient with history of cancer, cardiovascular disease, blood clot risk, liver disease, unexplained bleeding.

What are risk factors in Breast Cancer?

Gene mutation (BRCA), Advanced age, family history, obesity, early menstruation.

What medication is used in hormone therapy for Breast cancer?

Tamoxifen

How does Tamoxifen work?

Inhibits estrogen binding to its receptors, results inability for tumor growth in breast tissue.

What are some side effects of Tamoxifen?

Hot flashes, night sweats, sleep disturbances, vaginal dryness/itching, decreased libido, weight gain, edema, constipation, nausea, thinning hair, fatigue, mood swings, depression, brain fog.

What are some complications of Tamoxifen to watch out for?

Report; blood clots, abnormal vaginal bleeding, changes to vision, bone loss, stroke, and liver issues.

Clinical presentations of Benign Prostatic Hyperplasia?

Difficulty voiding, weak stream, retention, dysuria, nocturia, increased frequency, incomplete emptying, hematuria, straining with urination.

What medications can be given for BPH?

Alpha-blockers and 5-Alpha reductase inhibitors.

What are side effects of Alpha-blockers?

-Orthostatic hypotension, headache, drowsiness, nasal congestion, retrograde ejaculation, edema

What is the main risk factor of Prostate Cancer?

Age >65

What is PSA and what is it used to diagnose?

is a blood test used for Asymptomatic patients. Baseline should be at 45 if are at risk of developing prostate cancer. After treatment should decline.

-Elevated does NOT confirm cancer diagnosis but is indicator, excreting more protein. Above 10.0 ng/ml is considered high chance.

What is the treatment medications for Prostate cancer?

Leuprolide, goserelin, triptorelin; lutenizing hormone-releasing hormone (LH-RH) agonist (chemical castration, monitor osteoporosis).

What complications caused by treatment, specifically Prostatectomy?

Infertility, urinary inc, urinary retention (after removal of cath), erectile dysfunction, infection.

What Lab test is used in Erectile Dysfunction?

Glycosylated hemoglobin= lipid panel; total testosterone; thyroid stimulating hormone, hemoglobin ALc.

What are risk factors of Erectile dysfunction?

obesity, endocrine disorders, beta blockers.

What medications are used for Erectile dysfunction?

PDE-5 Inhibitors= Sildenafil/Viagra, Vardenafil/Levitra, Tadalafil/Cialis

-Increases penile blood flow. Promote relaxation of smooth muscle.

Adverse effects= heartburn, headache, facial flushing, priapism.

What should the patient with Erectile dysfunction be talked about?

Encourage healthy lifestyle choices, excerisce, proper diet, stop smoking

What are complications of Erectile dysfunction?

mental health and relationships can decline as result of irregular penile function.

What is a Papanicolaou test?

Diagnostic screen used to collect cells from cervix from cervix to check for abnormal cervical cell changes. Precancerous cells, cervical cancer, HPV-related changes, and also some infections. Patient lies in Lithotomy during procedure with knees bent and feet placed in stirrups.

How does HPV effect body?

virus enters through microscopic break in skin or mucous membraness during sexual contact causes abnormal cellular growth.

Often resolves spontaneously within 2 years.

Manifestations of HPV are?

Uusally Asymptomatic, assess for gential lesions/warts for abnormal vaginal bleeding, assess emotional response to diagnose, encourage follow-up screen/appointments.

ITCHING, burning, irritation, tenderness, discomfort, pelvic discomfort, pain during intercourse, abnormal vaginal bleeding.

How to diagnose HPV?

HPV DNA test and HPV test to confirm and identify strain.

What should be monitored in a patient with HPV?

for signs of Cervical cancer like; abnormal vaginal bleeding, bleeding after intercourse, pelvic pain, abnormal vaginal discharge.

Treatment of HPV?

There is NO CURE, Gels, creams, ointments to treat genital warts= Iniquimod (Aldara) Podofilox (condyloes), Trichloroacetic acid.

What can be used as Prevention of HPV?

Vaccination-Gardasil= recommended ages 9-12 can be given up to age 46. Effective BEFORE sexual activity, protects against most high-risk types

Avoid smoking, attend follow-up appointments, screen even if no symptoms.

What stage of Syphilis does CHANCRE at vulva, vagina, anus, penis, oral cavity, or lips and is usually painless. 3-6 weeks?

Primary stage

What stage of Syphilis does a rash or lesions on palms, soles of feet, buttocks, upper thighs. Macular, papular or pustular. May include malaise, joint pain, headache, and occurs in 2 weeks-6 months?

Secondary stage

What stage of Syphilis has no symptoms and no transmission?

Latent stage (early)= <1 year infection

Latent stage (late)= > 1 year up to many years

What stage of Syphilis has life-threatening; neuroopsyphilis, cardiovascular, gummatous, can also infect liver and kidneys and can take up to 30 years?

Tertiary stage

How is Genital Herpes transmitted?

via contact with herpes lesions, genital or oral mucosa and get genital and oral secretions.

What causes Genital Herpes?

Herpes Simplex Virus type 2; rarely HSV-1

Main manifestations of Genital herpes?

Flu-like symptoms= body aches, fever, headache can accompany first outbreak

What triggers a recurrent episoides of genital herpes?

stress, illness, fatigue, sun exposure, hormonal changes, trauma, foods, dental procedures, decreased nutritional intake

What is Pelvic inflammatory diseased?

Inflammation of female reproductive organ often caused by untreated chlamydia or gonorrhea

Causes significant infertility

What are risk factors of PID?

Untreated chlamydia and gonorrhea, previous infection significantly increased risk for developing it, delays in treatment allows bacteria to spread into upper reproductive tract.

What is treatment for PID?

Cefoxitin OR Doxycycline

Pregnancy test should be completed to rule out ectopic pregnancy

What client education should be give to patients with PID?

monitor response to antibiotic therapy, encourage fluid intake, assess for medication side effects, reinforce med complience.

What medications are given for Genital herpes?

Acyclovir- antiviral, reduces length/severity; no cure, start at prodrome

Valacyclovir- antiviral- prodrug of Acyclovir. Better bioavailabilty than acyclovir, start at prodrome.

What medications are given for Gonorrhea?

Cefixime- 3rd-gen cephalosporin antibiotics, single oral dose; combine with azithromycin for _

Azithromycin- macrolide antibiotic, single dose given with Cefixime.

A nurse is caring for a client who has been diagnosed with benign prostatic hyperplasia (BPH) and is experiencing difficulty with urinary flow. Which of the following medications should the nurse anticipate being prescribed to decrease the size of the prostate?

Finasteride

A nurse is caring for a client who has prostate cancer. The nurse should expect the provider to prescribe which of the following medications for the client?

Leuprolide

A nurse is reviewing the medication record of a client who is starting leuprolide for treatment of prostate cancer. Which of the following medication types should the nurse recognize as a contraindication for use with leuprolide?

Atypical antipsychotics

A nurse is caring for a client who has prostate cancer and had a prostatectomy. Which of the following should the nurse understand is a potential complication of prostate surgery?

Erectile dysfunction

A nurse for a client who asks to be screened for cervical cancer because a relative has been diagnosed with it, Which of the following tests should the nurse expect the provider to use?

A Papanicolaou test

A nurse is reviewing the medication list of a client who has benign prostatic hyperplasia (BPH) who is experiencing difficulty starting urination and a weak urine stream. Which of the following medications should the nurse anticipate being prescribed to manage the underlying cause of these urinary manifestations?

Finasteride

A nurse is providing teaching to client who has new prescription for tamoxifen to treat breast cancer. The nurse should include that which of the following is an adverse effect of the medication?

Hot flashes

A nurse in providers clinic is caring for a client who reports erectile dysfunction and requests a prescription for sildenafil. Which of the following medications currently prescribed for the client is contraindicated to taking sildenafil?

Isosorbide

A nurse is reviewing the medical record of a client who has pelvic inflammatory disease (PID). Which of the following organisms should the nurse identify as a common cause of this condition?

N. gonorrhoeae

A nurse is caring for an adolescent client who has been diagnosed with testicular cancer. The nurse understands that testicular cancer most often develops from mutations of which of the following types of cells?

Germ cells

A nurse is caring for a client who has BPH. Which of the following medications should the nurse plan to adminster?

Finasteride

A nurse is preparing to administer chemotherapy to a client who has ovarian cancer. Which of the following antineoplastic medications should the nurse recognize as an alkylating agent that is classified as a platinum compound?

Cisplatin

A nurse is providing education about medications to a client who has breast cancer. Which of the following statements by the client indicates understanding of the education? 

“Tamoxifen will block the effects of estrogen on hormone-sensitive breast tumors."

A nurse is caring for a male client who has a new diagnosis of gential herpes (HSV 2), Which of the following should the nurse expect?

Influenza-like symptoms

A Nurse is teaching about adverse effects of anastrozole with client who has advanced breast cancer and is postmenopausal. Which of the following adverse effects should the client report to provider?

Musculoskeletal pain

A nurse is providing teaching to a client who has breast cancer and a new prescription for trastuzumab. Which of the following side effects should the nurse include?

Vomiting

A nurse is screening a client for cancer risk factors. The nurse records that the client is a 65-year-old male, clinically obese with a BMI of 31, has a history of past smoking, and drinks moderately. Which of the following is a primary risk factor for prostate cancer?

65 years old