Exam 3

BPH- Benign Prostatic Hyperplasia

Characterized by excessive cell growth of the prostate gland . A physiologic change of aging

BPH- Benign Prostatic Hyperplasia risk factors

• Aging

BPH- Benign Prostatic Hyperplasia S / S

Frequency ( urinating ) Dribbling of urine ( small amounts of urine with each episode ) Incomplete bladder emptying Straining to urinate Weak urinary stream Sudden urges to urinate .

BPH- surgical tx

Transurethral needle ablation ( TUNA ) ( slower recovery ) Transurethral resection of the prostate ( TURP ) ( faster recovery ) Transurethral incision of prostate ( TUIP )

BPH- tests done to dx

Digital Rectal Exam ( DRE ) PSA test ( Rules out prostate cancer but cannot diagnose prostate cancer ) Urine flow studies Ultrasound Cystoscopy

Prostate cancer-S/S

. Early stages- asymptomatic Advanced stage- Trouble urinating, Erectile dysfunction, Blood in semen, bone pain

Prostate cancer - risk factors

Age, AA men- (at greater risk), Obesity, Diet, Fx

Prostate cancer- dx test

DRE & PSA

Testicular torsion- S / S

-Sudden onset of severe unilateral scrotal pain—(Occurs during activity or rest Scrotal )

-swelling

-Erythema

-Abdominal pain

-Nausea

-Vomiting

Testicular torsion- dx test

scrotal pain Lab tests and imaging studies usually are not necessary

IF THERE IS UNCERTAINTY C / diagnosis

-Radionuclide scan of the testicles -Ultrasonography

Testicular torsion- surgical tx

Detorsion

Testicular torsion- Risk factors

Age- male under 25

Orchitis-

inflammation of the testes

Orchitis-

testes Bilateral or unilateral

Orchitis causes

-Bacterial infection

-Mumps virus

-STD- chlamydia and gonorrhea

Orchitis-Risk factors

Older than 45 y / o

Long-term use of folly catheter

Lack of mumps vaccine

Freq UTIs

Orchitis S/S

Blood in semen Discharge from penis Fever

Groin pain

Pain w / intercourse or ejaculation

Pain w / urination ( Dysuria )

Testicle pain

Dx test of orchitis

Testicular ultrasound

Urinalysis

Urine culrure

NAAT-( tests to screen for gono and chlamydia)

epididymitis

inflammation of the epididymis

Epididymitis causes

E.coli

Infection( UTI, Gono, Chlamydia)

Medications

Injury/irritation

Obstruction of urine flow

epididymitis risk factors

uncircumcised males

unprotected sex

recent groin injury

use a catheter

athletes

repetitive activities

epididymitis s/s

acute scrotal/inguinal pain

urethral discharge

dysuria

Fever

Urinary- urgency, frequency

Dx test of epididymitis

Urinalysis

Urine culture

CBC

NAAT( Chlamydia and gonorrhea)

epididymitis complications

abscesses, fistulas, infertility, testicular necrosis, and chronic epididymitis

varicocele

enlarged veins of the spermatic cord and lack of blood drainage of the testes

hydrocele

sac of clear fluid in the scrotum

Varicocele and Hydrocele s/s

Heaviness of scrotum Swelling in scrotum

Varicocele and Hydrocele complications

Infertility

Syphilis-

bacteria ( T. pallidum )

Syphilis risk factors

Engaged in high-risk sexual behavior

Dxed with other STDS Exchanged sex for drugs IV drug abusers Incarcerated adults

Fetus can be infected transplacental in pregnant women

Syphilis stage 1

Primary- painless Chancre( skin lesions)

Secondary Syphilis

Rash develops all over the body

Fever

Headache

Malaise

Latent syphilis

Disease dominant ( May "heal")

Gummas form

Tertiary syphilis

Neurosyphilis- meningitis, stroke, paresis, dementia

CV complications- aortic arthritis

Syphilis Dx test

-Rapid plasma reagin(RPR)

- Venereal disease research lab( VDRL)

-PCR testing and Darkfield microscope

-ICE syphilis recombinant antigen test

Syphilis possible complications

Brain, CV, and organ damage

Stillbirth

Chlamydia s/s

Often asymptomatic in both males and females

Females: pos vaginal bleeding/discharge

- friable cervix and discharge

Male: possible urethritis

Chlamydia pos complication

-Nongonococcal urethritis

PID

Epididymitis

Fitz-Huge Curtis syndrome( fibroids develop around the liver)

Gonorrhea s/s

Men- dysuria (2-5 days after exposure)

Purulent discharge

Women- purulent discharge

Dysuria

Genital pruritus

Vag spotting

Gonorrhea pos complications

Arthritis

Meningitis

Myocarditis

Penile balanitis

Urethritis

Gonorrhea n Chlamydia pt education

Safe sex is the best sex . Resistant to many of the body's defenses

Trichomoniasis-

MOST COMMON ( NONVIRAL ) STI

Trichomoniasis- S / S

Almost all are asymptomatic .

Testicular pain-Epididymitis

- Most females are asymptomatic

-Vaginal discharge Bloody Purulent Green Yellow

-Abnormal vaginal odor. Musty May smell " Fishy "—Dyspareunia ( painful sex and postcoital after sex ) bleeding -Vulvovaginal irritation and burning Vulvovaginal itching

Trich pos complications

Infertility

Pregnancy issues Cervical neoplasia

Post op issues

Increased risk of STIS ( HIV )

PID

Trich pt edu

Treat all partners .

No sex a week after treatment and until partners finish treatment

HSV1- HSV2-

HSV1- commonly cause oral " cold sores . " HSV2- Most commonly causes genital infection transmitted through sexual activity .

HsV s/s

May be asymptomatic Painful recurrent blisters ( in pelvic area ) Burning Local tenderness Erythema

HSV transmission

Maternal transmission Sexual transmission

Hsv pt edu

Latex condoms One person or monogamous Get checked for STIs

HPV Human papilloma virus

some strands lead to genital warts or cervical cancer

-different types

70 distinct genetic types

Complications of HPV

Anal , vulvar , vaginal , rectal , oropharyngeal , Laryngeal cancers

HIV

Hep C

HVS

Chlamydia

HPV preventive measures

HPV vaccine

No cure

Pap smear test

STD knows the different types

Chlamydia

Gonorrhea

Syphilis Herpes simplex Virus

HPV

PID

PID

sexually transmitted bacteria spread from vagina to fallopian tubes , uterus or ovaries

. PID S / S -

asymptomatic

Low abdominal pain Pelvic pain

Menstrual irregularities

which ones are mandatory reportable ?

Chlamydia

Gonorrhea

Syphilis

HIV(pt does not have to be identified or treated)

Std pt edu

Abstinence during treatment

Partner notification and treatment

Std pt edu #2

Safe sex practices

Re screen- 3 months .

Cervical cancer s/s

-No signs in early stages -Unusual vaginal bleeding

-Watery bloody vaginal discharge

-Pelvic pain during intercourse

Cervical cancer risk factors

HPV Weakened immune systems . Smoking

Cervical cancer - diagnostic test

Biopsy

Cervical cancer- screening test

HPV DNA test Pap smear

Ovarian cancer s/s

-Swollen tummy

-feeling bloated

-Urgency& Persistent painful urinating

-tender tummy

-No appetite or feeling full quickly .

Ovarian cancer- risk factors

Jewish descent

Age

Fx

Obesity

Smoking

infection

DX test

Pelvic exam

CT

MRI

ultrasound Biopsy

Menopause s/s

Hot flashes

Night sweats

Irritability

Anxiety

Insomnia

Menopause pt edu

Low estrogen High FSH

COPD- Chronic obstructive pulmonary disorder-

a combination of chronic bronchitis emphysema and hyperreactive airway disease . Causes chronic obstruction of airflow from the lungs Pt does not have the ability to fully exhale . Air pockets develop overtime Irreversible

COPD- cause

Smoking

IV drug abuse ( emphysema )

COPD- S/S

Dyspnea

Cough or wheezing Hypoxia

Respiratory distress ( clubbing of the fingers ) Ankle edema

Right ventricle heart failure

COPD- Dx

PFTS ( spirometers ) Chest x - ray

COPD- complications

RVF

-Pulmonary hypertension

chronic bronchitis " blue bloater"

productive cough and bronchial inflammation Productive cough • At least 3 months out of the year for at least 2 years

chronic bronchitis risk factor

Smoking

Air pollutants

Dust & silica

Fx

Chronic bronchitis s/s

BLUE

B- Big & Blue skin "cyanosis" (hypoxia)

L- Long term "chronic" COUGH & sputum

U- Unusual lung sounds. (Crackles & Wheezes)

E- Edema peripherally

JVD

Weight gain

CB pathophysiology

Hypersecretion of mucus and chronic productive cough for 3 months in 2 consecutive years. Chronic irritants = chronic inflammation leads to vasodilation of local arterioles, congestion, airway mucous membrane edema or swelling and bronchospasm.

CB pos complications

-pulmonary hypertension

-cor pulmonale

RHF

-respiratory failure

Emphysema

• A serious disease that destroys lung tissue and causes breathing difficulties.

Enlargement of air space

• Well perfused

Emphysema s/s

Pink

P- Pink skin& pursed-lip breathing (huffing and puffing)

I- Increased chest "Barrel chest"

N- No chronic cough (minimal)

K- Keep tripoding.

o Clubbing fingers

Emphysema causes

smoking, air pollution, genetics, untreated pulmonary disease

Pt education for emphysema

o Smoking cessation

o Oxygen therapy

o Pulmonary rehabilitation

o Pneumococcal and influenza vaccine

pathophysiological changes in the lungs- emphysema

o The alveoli are injured. Excess air in the alveoli. The alveolar walls are weakened, distended, and cannot recoil. (Accumulate excessive carbon dioxide)

Oxygen levels copd

88%-92%

Use of oxygen contraindicated

Supplemental O2 removes a COPD pt's hypoxic( low level of oxygen) repistaroy drive causing hypoventilation which causes higher carbon dioxide levels, apnea( puases in breathing) and respiratory failure.

Too much oxygen can be dangerous

Asthma

chronic inflammatory disorder that causes reversible airway constriction because of bronchial hyperreactivity

Asthma causes

genetic, exercise, cold air, allergens, NSAIDs

Viral infection- rhinovirus

types of asthma

Mild intermittent

Mild persistent

Moderate persistent

Severe persistent

mild intermittent

symptoms occur less than twice a week

mild persistent asthma

Symptoms occur >2x/wk, but not daily

moderate persistent asthma

Daily symptoms occur w/ exacerbations 2x/wk

severe persistent asthma

Symptoms occur continually, along w/ frequent exacerbations that limit physical activity & QOL

Risk factors or asthma

FHx of asthma, obesity, allergic rhinitis

dx tests asthma

PFTs:

Compare with normal pts adjusted for age, sex, height, ethnicity

SPIROMETRY

↓ FEV1 and FEV1/FVC

Check for reversibility pre and post bronchodilator

>12% or 200mL ↑ FEV1 or 15% or 200mL ↑ FVC is (+)

+/- allergy testing - high rate of atopy

CXR - usually normal

Pos complications of Asthma

status asthmaticus( severe asthma attacks)

S/S of asthma

--wheezing

--chest tightness

--SOB

--coughing fits

Asthma pt education

proper inhaler use and technique, the role of medication, and avoidance of environmental precipitants. periodic self-monitoring with a peak flow meter, asthma action plan

pneumonia

Bacterial infection of the lungs

pneumonia s/s

Coughing, CRACKLES, sputum production, pleuritic chest pain, shaking, chills, fever, dyspnea, tachypnea, malaise, decreased breath sounds

Pneumonia causes

bacterial, viral, parasitic

pneumonia risk factors

- Advanced age

- Lung diease

- Smoking

- Immuno suppressed

- Bed riddin

- Post- Op