Adult Health Exam (Final) Nurs 3411- E. Garza UTRGV

Inflammation of the kidney caused by a bacterial infection(E-coli) that was originally found in the bladder that made its way up to the kidney

What is pyelonephritis and what causes it?

By using an IV urogram and by measuring creatinine clearance, BUN, and creatinine levels

How do you diagnose chronic pyelonephritis?

-Patient will complain of pain and a burning sensation

-An ultrasound and CT scan will locate any obstruction to the urinary tract

-Urine culture and sensitivity test will see what organism is involved to ensure proper medication is given

What are the assessment and diagnostic findings of acute pyelonephritis?

-Drink plenty of fluids and cranberry juice

-Continue the antimicrobial agents even after signs and symptoms subside

-Avoid using a douche

-Avoid wiping from back to front

What would you educate to your patients who have a UTI?

It should feel rubbery and free of nodules and masses

How should the prostate feel?

E. Coli

What organism is prostatitis caused by?

A PSA >4 ng/ml indicates prostate cancer, benign prostatic hyperplasia (BPH), or acute prostatitis

What does an elevated prostate specific antigen (PSA) indicate?

Symptoms in early stages are rarely produced

What are symptoms of prostate cancer in its early stages?

-Digital Rectal Exam (DRE)

-Serum Postate Specific Antigen (PSA)

-Transrectal Ultrasound (TRUS) with biopsy

What tests and screenings are done to diagnose prostate cancer?

Prostate Cancer

Digital Rectal Examination (DRE) is used in the detection of what?

Through a histologic examination in where tissue is removed surgically to properly diagnose and determine the stage of the cancer

How do you confirm the diagnosis of prostate cancer?

When there are changes within the body's normal function

EX: cardiovascular disease and endocrine disorders

What is an organic erectile dysfunction?

When ED occurs as a result of the man's thoughts or feelings

EX:Anxiety/Depression

What is a psychogenic erectile dysfunction?

Nocturnal penile tumescence

What test is used to determine how many erections a man achieves during REM sleep?

Headaches, flushing, indigestion, and dizziness are the common side effects of all ED medications

All medications for erectile dysfunction exhibit what side effects?

Nasal congestion, abnormal vision, diarrhea, rash, and low blood sugar

What are the side effects of Sildenafil?

Runny nose, sinusitis, flu-like symptoms, nausea, back pain, and joint pain

What are the side effects of Vardenafil?

Back pain and muscle aches

What are the side effects of Tadalafil?

Pain at injection site and plaque formation

What are the side effects for injectable medication used to treat ED?

Urethral and genital pain (Can increase risk for hypertension and syncope)

What are the side effects of a urethral suppository used to treat ED?

Internal radiation that is implanted directly into the cancerous tissue

What is brachytherapy?

Prostate and testicular cancer patients

What patients use brachytherapy?

By performing monthly testicular self examinations and by getting annual examinations

How do you detect testicular cancer early?

Once a month after a warm shower (scrotum is at its most relaxed)

When should men perform their testicular self examinations?

Alfa-fetoprotein (AFP) and Beta-human chorionic gonadotropin (beta-hCG)

What tumor markers may be elevated in patients with testicular cancer?

-To confirm a cancer diagnosis

-To determine the stage of a cancer

-To check how well the treatment of a cancer is working

What are tumor markers used for?

Microscopic analysis of a tissue

What is the only definitive way to determine if cancer is present in the body?

Testicular cancer

What type of cancer is 95% curable if caught early?

Orchiectomy- removal of one or both testes

What is the primary treatment for testicular cancer?

-Renal insufficiency

-Hearing problems

-Peripheral neuropathy

-Secondary cancers (rarely)

What are the long term side effects associated with the treatment of testicular cancers?

To detect any recurrence of the cancer (most recurrences occur 2 years post-op)

Why should nurses educate testicular cancer survivors to adhere to follow up appointments?

18-24 months

How long should couples be on birth control for after receiving the last cycle of chemo treatment for testicular cancer?

Noncancerous enlargement of the prostate gland

What is benign prostatic hyperplasia (BPH)?

Benign Prostate Hyperplasia (BPH)

What is the most common disease to develop within aging men?

-Urinary tract

-Family history of prostate disease

-Previous surgical procedures

What should be the primary focus when assessing a patient for BPH?

Large, rubbery, non-tender prostate gland

What does a digital rectal exam reveal in a patient with BPH?

Cardiac and respiratory disorders

Patients with BPH may also experience what type of disorders?

-Frequent/poor urination

-Nocturia

-Hesitation to pee

-Low/slow stream of urine

-UTIs

Common symptoms of BPH

Catheterize the patient

What should be done if a patient goes to the ER and they cannot urinate?

Incision made in the bladder to drain the urine

What is a cystostomy?

When the BPH is mild with no complications present in the patient

When would a patient with BPH be managed with "watchful waiting?"

Alpha-adrenergic blockers

What class of medications are used to improve the symptoms of BPH and the overall flow of urine by relaxing the smooth muscle of the bladder neck?

Surgical removal of the prostate gland through the penis

What is a transurethral resection of the prostate (TURP)?

Transurethral Resection of the Prostate (TURP)

What is the surgical treatment for BPH?

-Input and output

-Vital signs

-Level of consciousness

-Heart and lung sounds

-Dysuria

-Weak urine stream

What should you monitor for in a patient who is post TURP procedure?

A hormonal disorder causing anovulation, excess androgen, and multiple ovarian cysts

What is polycystic ovarian syndrome (PCOS)?

-Obesity

-Insulin resistance

-Glucose intolerance

-Dyslipidemia

-Sleep apnea

-Infertility

-Irregular periods

What are manifestations of PCOS?

-Diabetes

-Cardiovascular disease

-Fatty liver diseae

-Anxiety/depression

Patients with PCOS have an increase for what conditions?

A cluster of emotional, behavioral, and physical symptoms occurring during the luteal phase of the menstrual cycle (phase before the period)

What is premenstrual syndrome (PMS)?

Breast soreness, weight gain, fatigue, low back pain, headaches

Physical symptoms of PMS ?

Mood swings, binge eating, crying spells

Behavioral symptoms of PMS?

A more severe form of PMS

What is premenstrual dysphoric disorder (PMDD)?

Whole grains, fruits, vegetables, and an increase in water intake

What are patients who are experiencing PMS symptoms recommended to eat?

-SSRIs for the depressive episodes

-Ibuprofen for the pain in the breasts, cramps, and back

What medications are given to patients experiencing moderate to severe PMS?

-Thick, cottage cheese appearance that is white

-Slightly elevated pH (normal is 3.5-4.5)

-Pruritus and irritation

What are the manifestations of candida?

Antifungals such as miconazole or nystatin

What medications treat candida?

-Tight clothing

-Nylon underwear

-Pregnancy

-Oral contraceptives

What factors can cause candida?

Stage immediately before menopause where physical changes begin to occur

What is perimenopause?

Hormonal fluctuations and irregular periods

Characteristics of perimenopause

Permanent cessation of menstruation (must be 12 months of absent menstrual bleeding)

What is menopause?

Menopause

Decrease in estrogen and ovulation and an increase in FSH is associated with what condition?

-HOT FLASHES

-NIGHT SWEATS

-Increase in body fat

-Increased bone loss

-Thinning of pubic hair and shrinkage of labia

-Decrease in vaginal secretions

-Increased vaginal pH (increases risk for vaginal infections)

-5 Fs (fatigue, forgetfulness, feeling blue, fat gain, and feeling fussy)

What are the manifestations of menopause?

HRT is medication containing estrogen or progestin often used to treat symptoms of menopause (use lowest dose possible)

What is hormone replacement therapy (HRT)?

-Women who have had a hysterectomy

-Breast and uterine cancer history

-Impaired liver function

Who is HRT not recommended for?

DVT and pulmonary embolism

What risks are increased when women use HRT?

To treat hot flashes

What is venlafaxine in a low dose used for?

Cervical cancer caused by HPV

What do pap smears screen for?

Redo the pap smear in 1 year

What happens if a patient's pap smear is abnormal but the patient does not show any signs of HPV infection?

Treat the infection and then redo the pap smear once the patient has healed from the infection

What happens if a patient's pap smear is abnormal and the patient is showing signs of HPV infection?

When a pap smear appears abnormal and if lesions were noted in the cervix

When would a prompt colposcopy be performed on a woman?

5-7 days after the menses has started

When is the best time for a woman to perform a breast self examination (BSE)?

-Always inspect the breasts simultaneously before palpating them (standing)

-Use 3 flat fingers and palpate the breast, making sure you start from the outer breast and working your way towards the nipple

-Repeat the process but now laying down

-Remember the tail of spence!

What techniques should be noted when doing a BSE?

Long-acting reversible contraceptives (LARC)

EX: IUDs and single rod implant

What is the most effective reversible method for pregnancy prevention with a failure rate of less than 1%

-Thrombophlebitis

-Cerebrovascular disease

-Known/suspected breast cancer

-Known/suspected pregnancy

-Hyperlipidemia

(AVOID HORMONAL CONTRACEPTIVES WITH THESE PATIENTS)

What are absolute contraindications in patients receiving hormonal contraceptives?

-Severe headaches

-Severe hypertension

-Type 2 diabetes

-Gallbladder disease

-Morbid obesity

(BE CAUTIOUS WITH HORMONAL CONTRACEPTIVE IN PATIENTS THAT HAVE THESE CONTRAINDICATIONS)

What are relative contraindications of patients receiving contraceptives?

-Excessive bleeding

-Cramps/backaches

-Ectopic pregnancy

-Displacement or dislodge of IUD

Disadvantages of IUD

Women must be certain they no longer want children (procedure is irreversible)

Disadvantages of the female sterilization procedure?

Around the nose and mouth

Where is HSV-1 located?

Genitals

Where is HSV-2 found?

Condoms

How do you prevent the transmission of HSV-2?

Acyclovir

How to treat HSV-1?

An STI that is caused by a protozoan

What is trichomoniasis?

Frothy, yellow-green discharge that can be irritating and has an unpleasant smell

What are the manifestations of trichomoniasis?

With metronidazole or tinidazole

(you MUST treat the sexual partner(s) as well!)

How do you treat trichomoniasis?

Alcohol

What should patients avoid when taking metronidazole or tinidazole?

Growth of endometrial tissue outside of uterus

What is endometriosis?

-Dysmenorrhea

-Chronic pelvic pain

-Pain during sex

-Infertility

-Dysuria

What are the manifestations of endometriosis?

-Those with a family history

-Women with short menstrual cycles

-Menarche at young age

-Never being pregnant

Who is at risk for endometriosis?

-Engage in safe sex

-Stop smoking

-Receive HPV vaccine

-Get a pap smear every 3 years

How do you educate your patient to avoid cervical cancer?

-Folate

-Beta carotene

-Vitamin C

What should women with cervical cancer increase in their diet?

Noncancerous tumors of smooth muscle in the uterus

What are uterine fibroids?

-Pain and backache

-Pressure

-Bloating

-Constipation and urinary problems

What are some symptoms resulting from the pressure of developing uterine fibroids?

Before the mastectomy procedure

When would a patient be referred to a plastic surgeon when getting ready to undergo a mastectomy?

-Clarify if patient wants breast reconstruction

-Inform patient they will go home with drains

-Inform patient they will have decreased ROM in arm and shoulder

What are preoperative nursing interventions for a patient undergoing a mastectomy?

-Relieve pain and discomfort (oxycodone and acetaminophen)

-Manage soreness, numbness, tingling, and pulling sensations

-Promote positive body image

-Educate on cleaning and emptying of the draining tubes

-Monitor for lymphedema

What are postoperative nursing interventions for a patient who got a mastectomy?

To treat cancer, uterine bleeding, endometriosis, persistent pain, and previous injury to uterus

Why would a patient get a hysterectomy?

-Relieve pain and anxiety

-Improve body image

-Educate the patient on management of symptoms that may occur following the surgery

What are postoperative nursing interventions for a patient undergoing a hysterectomy?

If vaginal discharge, foul odor, excessive bleeding, any leg redness, or elevated temperature is noted

When would a patient contact their surgeon following a hysterectomy?

Painful menstruation

What is dysmenorrhea?

Painful sexual intercourse

What is dyspareunia?