CHAPTER 43 NURSING CARE OF MALE PATIENTS WITH
- Slides: 86
CHAPTER 43 NURSING CARE OF MALE PATIENTS WITH GENITOURINARY DISORDERS
PROSTATE DISORDERS • Prostatitis • Benign Prostatic Hyperplasia • Prostate Cancer
PROSTATITIS • Inflammation of prostate gland • Can be acute or chronic • 4 types • Acute bacterial • Chronic prostatitis/chronic pelvic pain syndrome • Asymptomatic inflammatory prostatitis
PROSTATITIS • Signs and Symptoms • Urine Retention • Pain • Fever, Chills • Urgency • Low back pain • Frequency • Perineal pain • Hesitancy • Postejaculation pain • Dribbling • Dysuria
PROSTATITIS • Diagnosis • Interventions • Digital Rectal Exam (DRE) • Antibiotics • Urine Culture • Anti-inflammatory Agents • Expressed Prostate Secretion (EPS) • Stool Softeners • Cystoscopy • Prostatic Massage • Sitz Baths • Dietary Changes • Alpha-Adrenergic Blockers • Surgery
PROSTATITIS • Prevention • Complications • Regular and complete emptying of bladder • Urinary retention • Safe sexual practices • Secondary infections • Avoid bladder irritants • Erectile dysfunction
PROSTATITIS • Nursing Diagnoses • Urinary Retention • Knowledge deficit related to cause, treatment and prevention of prostatitis • Acute Pain • Anxiety
BENIGN PROSTATIC HYPERPLASIA (BPH) • Increase in number of cells • Signs and Symptoms • Obstruction • • • Decrease in force of stream Hesitancy Dribbling Urinary retention Incontinence Feelings of incomplete emptying • Irritation • Nocturia • Dysuria • Urgency
BENIGN PROSTATIC HYPERPLASIA (BPH) • Diagnosis • DRE • Urinalysis • BUN, Creatinine • Prostate Specific Antigen (PSA) • Urodynamic Flow Studies • Transrectal Ultrasound • Cystoscopy
THERAPEUTIC INTERVENTIONS • Symptom Control • Interventions • Catheterization • “Watchful Waiting” • Fluids • Alpha-Adrenergic Blockers • Antibiotics • Nonsurgical Invasive Treatments • Surgery
TRANSURETHRAL RESECTION OF THE PROSTATE (TURP) • Resectoscope into Urethra • Overgrown Tissue Chipped Away • Prostate Tissue Regenerates • Continuous Catheter Irrigation • Monitor Urine
BLADDER IRRIGATION
TURP • Complications • Clots • Bladder Spasms • Infection • Urinary Incontinent • Hemorrhage • Erectile Dysfunction • Retrograde Ejaculation
RADICAL PROSTATECTOMY • Removal of entire prostate gland • Methods • Open prostatectomy • Suprapubic • Retropubic • Perineal • Minimally invasive prostatectomy • Laparoscopic
PROSTATECTOMY
POSTOPERATIVE NURSING DIAGNOSES • Risk for Bleeding • Monitor Urine Output and Bleeding • Encourage Fluids • Teach Patient to Avoid • Constipation • Lifting • Aspirin and NSAIDS
POSTOPERATIVE NURSING DIAGNOSES • Acute Pain • Monitor Pain • Irrigate Catheter as Ordered • Administer Analgesics, Antispasmodics • Teach Relaxation and Deep Breathing
POSTOPERATIVE NURSING DIAGNOSES • Urge Urinary Incontinence • Teach Kegel Exercises • Offer Condom Catheter or Pads • Encourage to Continue Fluids • Discuss Prolonged Incontinence with Physician
POSTOPERATIVE NURSING DIAGNOSES • Knowledge Deficit • Teach to Avoid (About 6 Weeks) • Heavy Lifting • Stairs • Driving • Strenuous Exercise • Straining • Sexual Activity • Aspirin and NSAIDS
POSTOPERATIVE NURSING DIAGNOSES • Anxiety • Educate • Retrograde Ejaculation • Talk with Physician if Erectile Dysfunction Occurs
PROSTATE CANCER • Most common cancer for men • Testosterone driven • Spreads by 3 routes • Local invasion • Lymph nodes • Vascular system
PROSTATE CANCER • Risk Factors • Age • High Testosterone • High Fat Diet • Family History • African American • Occupational Exposures
PROSTATE CANCER • Signs and Symptoms • Rare in Early Stages • Later Stages • Urinary Obstruction • Hematuria • Urinary Retention • Advanced (Metastatic) • Bone Pain • Anemia • Weakness • Weight Loss • Fatigue
PROSTATE CANCER • Diagnosis • DRE • PSA • PAP • Transurethral Ultrasound with Biopsy • Bone Scan
PROSTATE CANCER • Therapeutic Interventions • Early • Testosterone-Suppressing Medications • Later Stages • TURP or Prostatectomy • Radiation Therapy • Brachytherapy • Metastatic • • Bilateral Orchiectomy Estrogen Therapy Chemotherapy, Radiation Radical Prostatectomy
PROSTATE CANCER • Complications • Difficulty Urinating • Infection • Erectile Dysfunction • Pain • Fractures • Weight Loss • Depression
PENILE DISORDERS • Peyronie’s Disease • Curved/Crooked when Erect • Priapism • Prolonged Painful Erection • Phimosis/Paraphimosis • Foreskin not Retractable
CANCER OF THE PENIS • Risk Factors • Not Circumcised as Baby • HPV • Therapeutic Interventions • Surgery • Radiation • Chemotherapy
TESTICULAR DISORDERS • Cryptorchidism • Undescended Testes • Hydrocele • Fluid in Scrotal Sac • Varicocele • Varicose Veins of Scrotum • Epididymitis • Inflammation or Infection of Epididymis • Orchitis • Inflammation or Infection of Testes
TESTICULAR CANCER • Risk Factors • Cryptorchidism • Family History • DES Use by Mother • Caucasian • High Socioeconomic Status
TESTICULAR CANCER • Signs and Symptoms • Early • Small Painless Lump • Swelling • Heavy Feeling • Breast Enlargement and Tenderness • Late • Symptoms of Metastasis
TESTICULAR CANCER • Diagnosis • Ultrasound • Chest X-Ray and CT • Blood for Tumor Markers • Biopsy • Staging
TESTICULAR CANCER • Therapeutic Interventions • Surgery • Radiation • Chemotherapy
TESTICULAR CANCER • Nursing Care • Teach Testicular Self-Examination • Provide Emotional Support • Discuss Sperm Bank Deposit • Offer Cancer Support Group
VASECTOMY • Cut or Cauterize Vas Deferens • Provides Permanent Birth Control • Effective About 3 Months Following Surgery
VASECTOMY
ERECTILE DYSFUNCTION (ED) • Problem Obtaining or Maintaining Erection • Pathophysiology/Etiology § Circulation § Nerve Supply § Hormone Balance § Limbic System § Obstructive Sleep Apnea § § § Medications Stress Illness Fatigue Alcohol/Drugs
ERECTILE DYSFUNCTION • Diagnosis • History • Blood Tests • Glucose • Testosterone • Liver, Cardiac, and Kidney • Blood Disorders • Infection • Evaluation of Circulation • Psychosocial Evaluation
ERECTILE DYSFUNCTION • Therapeutic Interventions • Medication • Meaningful Relationship • Injection • Medication Changes • Transurethral • Oral Medication • Viagra, Cialis, Levitra • Hormone Therapy • Herbal Remedies • Sexual Devices • Surgery • Implants • Vascular Surgery
PENILE IMPLANTS
INFERTILITY • Causes • Pretesticular • Endocrine • Testicular • Varicocele • Idiopathic (spontaneous) • Post-testicular • Surgery • Injury
INFERTILITY • Diagnosis • History • Physical Examination • Diagnostics
INFERTILITY • Therapeutic Interventions • Changes in Sexual or Lifestyle Practices • Surgery if Indicated • In Vitro Procedures • Adoption
A man comes to a clinic with complaints of frequency, urgency, and feeling that he canno empty his bladder. The nurse expects to prepare him for which procedure? 1. Blood test for prostate-specific antigen 2. Blood test for human chorionic gonadotropin 3. Digital rectal exam of the prostrate 4. Urodynamic flow study
A client has a diagnosis of Benign prostatic hyperplasia (BPH) and asks what the doctor means by “watchful waiting. ” Which response by the nurse is best? 1. “The doctor will have you visit once a month to check out your prostate. ” 2. “The doctor will want you to report back on your symptoms regularly to monitor your condition. ” 3. “You don’t have anything wrong with your prostate yet, but you will need to get it checked on often. ” 4. “ I am not really sure what he means by that, but I will have him come back and talk to you. ”
Which assessment finding is expected in a man diagnosed with varicocele? 1. Scrotum is tender and red. 2. Scrotum feels like a “bag of worms. ” 3. Painless lump is noted on testicle. 4. Testicle is extremely tender.
A 28 year male reports to the nurse that he has been having trouble maintaining an erection. Which assessment finding should the nurse further explore? 1. His father had prostate cancer at 70 years of age. 2. He has had multiple sex partners over the last five years. 3. He drinks about a case of beer over each weekend. 4. He smokes 2 packs of cigarettes per day.
A client has returned from a transurethral prostatectomy (TURP) with a continuous bladder irrigation. Which of the following assessment findings should the LPN/LVN report to the registered nurse? 1. BP 135/80, Pulse 88, Respirations 20, Temp 98. 0 2. Client states his pain is a level 6 out of 10 3. The catheter bag contains bright cherry red urine 4. The catheter tubing is secured to his abdomen
CHAPTER 37 ACUTE KIDNEY INJURY AND CHRONIC KIDNEY DISEASE
ACUTE KIDNEY INJURY (AKI) • Sudden Loss of Kidney Function • Azotemia • Accumulation of Toxic Waste • Fluid and Electrolyte Imbalance • 3 Phases: Oliguric, Diuretic, & Recovery • Can be Reversible
ACUTE KIDNEY INJURY • Oliguric Phase • Less than 20 -30 ml/hr or 400 ml/day • Can last 2 weeks to several months • Fluid retention • Electrolyte imbalances • Metabolic acidosis
ACUTE KIDNEY INJURY • Diuretic Phase • Excretion of waste products again • Kidneys unable to concentrate urine • Hypovolemia, Hypokalemia, and Hypotension • Can last 1 -3 weeks
ACUTE KIDNEY INJURY • Recovery Phase • Begins as glomerular filtration rate rises • BUN and Creatinine decrease • Can take up to one year to fully recover
ACUTE KIDNEY INJURY CAUSES • Prerenal Failure • Intrarenal Failure • Postrenal Failure
ACUTE KIDNEY INJURY CAUSES • Prerenal Injury • Decreased blood supply to the kidney • Causes • Dehydration, blood loss, shock, trauma or blockage in renal arteries, NSAIDs, COX inhibitors • Diagnosis • Determine the cause
ACUTE KIDNEY INJURY CAUSES • Intrarenal Injury • Damage to nephrons inside the kidney • Causes • Ischemia, reduced blood flow, toxins, infection, trauma, nephrotoxins, allergic reactions, and severe muscle injury
ACUTE KIDNEY INJURY CAUSES • Nephrotoxins • Diagnostic Contrast Media • Antibiotics • Analgesics • Other • Heavy Metals • Chemicals
ACUTE KIDNEY INJURY CAUSES • Postrenal Injury • Obstruction that blocks flow of urine out of the body • Causes • Stones, tumors of ureters or bladder, enlarged prostate • Diagnosis • Radiology exams • Surgery
ACUTE KIDNEY INJURY • Prevention • Check Serum Creatinine Prior to Contrast Media or Nephrotoxic Meds • Follow Protocols to Prevent Contrast Induced Nephropathy • Hydrate Before/After Contrast Media • Monitor Peak/Through Levels of Nephrotoxic Drugs per Institutional Policy
ACUTE KIDNEY INJURY • Therapeutic Interventions • Treat Cause • Supportive Treatment • Dialysis • Continuous Renal Replacement Therapy
CONTINUOUS RENAL REPLACEMENT THERAPY (CRRT) • Removes Fluid/Solutes in Controlled, Continuous Manner in Unstable AKI Patients • Can be done in Conjunction with Hemodialysis • Removes Fluids/Solutes • Returns Blood
CHRONIC KIDNEY DISEASE • Gradual Decrease in Kidney Function • Progressive & Irreversible • Build Up of Nitrogenous Waste Product and Uremia • Unable to Maintain Metabolic, Fluid, & Electrolyte Balance
CHRONIC KIDNEY DISEASE • Pathophysiology • Large Proportion of Nephrons are Damaged • Early (Silent) Stage • 50% of Nephrons Lost • Renal Insufficiency Stage • 75% of Nephrons Lost • End-stage • 90% of Nephrons Lost
CHRONIC KIDNEY DISEASE • Causes • Diabetic Nephropathy • Nephrosclerosis • Glomerulonephritis • Autoimmune Diseases
CHRONIC KIDNEY DISEASE • Signs & Symptoms • Fluid Accumulation • Electrolyte Imbalances • Waste Products Retained • Acid-base Imbalances • Anemia
CHRONIC KIDNEY DISEASE
CHRONIC KIDNEY DISEASE • Therapeutic Interventions • Diet • High Calorie • Low Protein (Unless Dialysis) • Low Sodium, Potassium, Phosphorus • Increased Calcium • Vitamins • Fluid Restriction
CHRONIC KIDNEY DISEASE • Therapeutic Interventions • Medications • Diuretics • Antihypertensives • Phosphate Binders • Vitamin D/Calcium Supplements • Kayexalate prn
CHRONIC KIDNEY DISEASE • Dialysis is Needed When: • Symptoms of Fluid Overload • High Potassium • Acidosis • Pericarditis • Vomiting • Neurological Signs • Uremia
DIALYSIS • 2 types • Hemodialysis and Peritoneal Dialysis • Remove toxins • Correct fluid and electrolyte imbalances • Can be used to treat drug overdoses
HEMODIALYSIS
PERITONEAL DIALYSIS
HEMODIALYSIS • Artificial Kidney Removes Waste Products and Excess Water from Blood • Side Effects • Weakness, Fatigue • Hypotension • Cardiac Dysrhythmias • Angina • Muscle Cramps • Bleeding
HEMODIALYSIS • Requires vascular access • Temporary • Central Vein • Permanent • A-V Fistula • A-V Graft
HEMODIALYSIS • Vascular Access Care • Thrill, Bruit • Protect • Neurovascular Checks • Dressings and Incisions • tourniquets, needle sticks or BP
HEMODIALYSIS ACCESS SITES
PERITONEAL DIALYSIS • Continuous Dialysis Done by Patient or Family • Removes Wastes/Fluids from Peritoneal Cavity • Peritoneal Catheter • Exchange Process: Fill, Dwell Time, Drain
PERITONEAL DIALYSIS • Education • Sterile technique • Clean environment • Site care • Diet & fluid restrictions • Complication • Peritonitis
KIDNEY TRANSPLANT • Advantages over dialysis • Can reverse damage • Patient not dependent on dialysis • No dietary restrictions
KIDNEY TRANSPLANT • 3 options • Family donor • Living, non-related donor • Cadaver • Immunosuppressants
KIDNEY TRANSPLANT • Nursing Diagnoses • Excess Fluid Volume • Impaired Skin Integrity • Activity Intolerance • Risk for Injury • Risk for Infection • Imbalanced Nutrition: Less Than Body Requirements
KIDNEY TRANSPLANT • Nursing Care • Excess Fluid Volume • Monitor Weight • Intake and Output • Fluid Restriction • Monitor for Fluid Retention • Electrolyte Imbalance • Monitor Levels • Dietary Restrictions • Monitor Dysrhythmias
KIDNEY TRANSPLANT • Nursing Care (cont’d) • Waste Products • Oral Care, Skin Care • Lotion • Protect from Injury • Impaired Hematological Function • Protect from Injury/Infection
REVIEW QUESTION Which of these actions is the priority action to prevent acute kidney injury? 1. Check Serum Creatinine Prior to Contrast Media or Nephrotoxic Meds 2. Follow Protocols to Prevent Contrast Induced Nephropathy 3. Hydrate Before/After Contrast Media 4. Monitor Peak/Through Levels of Nephrotoxic Drugs per Institutional Policy
Which of these is the priority during data collection for a patient with a vascular access? Select all that apply. 1. 2. 3. 4. 5. Listen for a bruit at the access Palpate thrill at the access Flush access with heparin Observe bruising at site Note tenderness at site
- Nursing diagnosis for undescended testis
- Nursing management of patient with cataract
- Esophageal varices nursing management
- Chapter 58 care of patients with liver problems
- Chapter 55 care of patients with stomach disorders
- Nursing diagnosis on ocd
- Nursing positioning
- Ventriculostomy care
- Factors of care that patients can expect to receive
- Levels of nursing care primary secondary tertiary
- Chapter 41 rehabilitation and restorative nursing care
- Pie charting nursing examples
- The nursing assistant and the care team chapter 2
- Describe the care team and the chain of command
- Tracheostomy stoma
- Emergency move vs rapid extrication
- 10 principles of lifting when moving a patient
- Chapter 8 lifting and moving patients
- Chapter 16 lesson 3 the female reproductive system
- Team nursing care delivery model
- Definition of nursing diagnosis
- Nursing process in psychiatric nursing
- Example of a nursing care plan
- What is a disadvantage of functional nursing?
- Nursing care plan hallucinations
- Post operative nursing management
- Preoperative checklist definition
- Nursing care of hospitalized child
- Post operative nursing care
- Nail care procedure in nursing
- Deskuamatif gingivitis
- Hernia nursing care plan
- Care plan for angina
- Post operative nursing care
- What is atraumatic care in pediatric nursing
- Atraumatic care techniques
- Nursing definition according to virginia henderson
- Nursing diagnosis of somatoform disorder
- External fixation device nursing care
- Nursing care plan case scenario
- Nursing care of hospitalized child
- Contraindications for nails
- Family care plan in community health nursing
- Gout care plans
- Nursing care logo
- Endoscopy nursing responsibilities
- Minerva cast
- Nursing care plan for burns
- Hospital environment for sick child definition
- Nursing care plan concept map
- Nursing care plan for homicidal ideation
- Aspiration risk nursing diagnosis
- Rn division 1
- Chapter 17 preoperative nursing management
- Primary nursing vs total patient care
- Testicular cancer nursing interventions
- Self care requisite
- Nursing management of chronic liver disease
- Anxiety goals nursing
- Care plan for pulmonary embolism
- Nursing care plan for acute pancreatitis
- External csf drainage
- Fundamentals of nursing care concepts connections & skills
- Subjective and objective data for fracture
- Nursing care plan for typhoid fever slideshare
- Slideshare images
- Gastritis nursing diagnosis slideshare
- Distributive shock
- Schizophrenia disorganized behavior
- Progressive patient care definition
- Tracey whitley novant health
- Lochia ppt
- Nursing care plan of mumps
- Physical assessment
- Nursing management of rheumatoid arthritis
- Nursing care plan for conjunctivitis slideshare
- Nursing care plan for anemia slideshare
- Nursing management of fetal distress
- Nursing care plan for postpartum hemorrhage slideshare
- Nursing care for pulmonary tuberculosis slideshare
- Nursing care plan for headache slideshare
- Nursing care plan for pneumonia
- Cushing's triad
- Cvc care bundle checklist
- Nursing care plan for head injury slideshare
- Futuristic nursing definition
- Nursing management of anemia