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GU System Benign Prostatic Hypertrophy

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GU System Benign Prostatic Hypertrophy Powered By Docstoc
					GU System - Handout 1: Male Reproductive System
Behavioral Objectives: By the end of this lecture the student will be able to:
    Review the anatomy and physiology of the genito-urinary systems
    Describe the physical assessment of the GU systems
    Discuss the application of the nursing process as it relates to patients with disorders of the
      GU system
    Describe etiology, pathophysiology, clinical manifestations, nursing management and
      patient education for the following GU disorders:
          o Prostatitis,
          o Orchitis
          o Prostatic hypertrophy
          o Prostatic neoplasm’s
    Discuss the nursing interventions in pre and post-operative care of patients undergoing
      Prostatectomy


1. Introduction
   A. Several organs are both _______________ & _________________ system
   B. Diseases of the male reproductive system are treated by __________________
2. Anatomy and physiology
   A. Brunner & Suddarth’s pg 1740 - 1742
   B. Testes
       i) Descend into the peritoneum in the __________ ________ of fetal life
       ii) Characteristics
           (1) _____________
           (2) _____________
           (3) _____________
           (4) _____________
       iii) Encased in the _________________( ________ temperature)
       iv) Spermatogenesis: ________________________ of sperm
       v) Spermatozoa: _______________ sperm
       vi) Collecting tubule: Transmit the spermatozoa to the ___________________
       vii) Testes have two functions
           (1) Formation of _________________
           (2) Secretion of the male sex hormone ___________________

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   C. Vas deferens (ductus deferens)
          (1) ___________ upwards  __________ cavity, then downward  __________
   D. Seminal vesicles
      i) It acts as a ____________________ for testicular secretions.
      ii) The tract is continued and passed the ______________________ duct
      iii) Passes through the ___________   gland and enters into the ________
   E. Accessory glands
      i) Prostate gland
          (1) Location: Below the _________ of the ____________ Surrounds the __________
          (2) Function: Secretes chemicals to help _______________
      ii) Cowper’s gland / bulbourethral gland
          (1) Location: Below the _______________________
          (2) Function: _____________________ for sperm
   F. Penis
      i) Dual function
          (1) _________________
          (2) _________________
      ii) Urethra: _________which carries ________________& ______________________
      iii) The glans: Tip of the ________________:
      iv) Covered penile skin is called ______________________
      v) Circumcision: ________________ removed
3. Physical assessment
   A. Brunner and Suddarth’s Medical Surgical Nursing pg 1742-1744
   B. Health history
          (1) Evaluate _____________________ & __________________________ function
          (2) Frequency
          (3) Force of stream
          (4) “Double” void
          (5) Dysuria
          (6) Hematuria
          (7) Hematospermia: _____________ in the ejaculated _______________

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           (8) Medications: __________________; Psychotropic agents; anti - _____________
           (9) Diagnosis: ______________ & _________________
           (10)        Smoking
   C. Physical assessment
           (1) Digital Rectal Examination (DRE)
                 (a) Recommended age _____________
                 (b) Frequency: ________________
                 (c) Assessment: _________________ (size, shape & consistency)
           (2) Testicular examination
                 (a) Frequency: _________________ (self)
                 (b) Assessment: Abnormalities and ________________
           (3) PSA
                 (a) P_____________ S ____________ A _____________
                 (b)  PSA = ____________________
                    (i) BPH; Prostatitis; Foley Catheter
                    (ii) DRE - ________________cause  in PSA
4. Small group questions:
   A. Describe the path a spermatozoa takes from formation to ejection
   B. What are the male sex hormones and where are they formed?
   C. What type of doctor would a man see if he is having sexual dysfunction?
   D. While assessing the testes what would be normal findings?
   E. What are the male accessory glands and what are their purposes?
   F. Describe the purpose and procedure of a DRE, Testicular exam and PSA screen. How
       often should men have these screens done?


5. Prostatitis
   A. Brunner and Suddarth’s Medical Surgical Nursing pg 1750-1751
   B. Pathophysiology
       i) Inflammation of the prostate gland cause by _____________ agents
       ii) _________________is the most common
       iii) Microorganisms are usually carried to the prostate from the ___________

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   C. Clinical manifestations
      i) ____________ discomfort
      ii) _____________, ____________, frequency & __________ after ejaculation
      iii) _____________ in the prostate
      iv) Dys__________
      v) May produce
           (1) ____________ & __________
           (2) Rectal or ______________ ____________ pain
   D. Assessment and diagnostic findings
      i) History
      ii) Culture
      iii) _____________ examination of the tissue
      iv) D.R.E. = _____________ _______________ & firm
      v) Divided urinary specimen
           (1) Clean __________ of the penis
           (2) Void ____________ ml into 1st container ( ______________urine)
           (3) Without interrupting the stream, collect _____________ of urine in 2nd container
                ( ______________urine)
           (4) Results: if Prostatis + UA = ____________& ______________ present
      vi) Prostatic massage
           (1) _______________ fluid  3rd container
   E. Medical management
      i)      *___________________________________
           (1) Trimethroprim sulfamethoxazole ( _______________)
      ii) Bed rest
      iii) *__________________ agent
      iv) *Anti- _______________ medications
      v) *Bladder ___________
      vi) __________ baths
      vii) *_________ softeners (____________________)
      viii)     *_____________________ agents

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   F. Nursing process of Patients with Prostatitis
      i) Assessment
      ii) Diagnosis
          (1) ______________ r/t inflammation, bladder spasms
          (2) _____________ _____________ r/t obstruction
          (3) _____________ _____________ r/t discomfort
          (4) ______________ r/t uncertain outcome
      iii) Planning and Goals
      iv) Nursing Interventions
          (1) Administer (See * under medical management)
          (2) Comfort measures: ___________ bath
          (3) Fluids: ________________ force fluids
          (4) Avoid Foods and liquids that have _________________
              (a)                                               (d)
              (b)                                               (e)
              (c)                                               (f)
          (5) Avoid _______________
          (6) Avoid ___________ for long periods
      v) Evaluations/Expected patient outcomes
6. Orchitis
   A. Brunner and Suddarth’s Medical Surgical Nursing pg 1769
   B. Orchitis is an inflammation of the __________________.
   C. Etiology
      i) ____________                                  iv) Parasitic
      ii) Testicular congestion                        v) Trauma
      iii) Viral
   D. Signs & Symptoms
      i) ___________________ & ________________________
   E. Treatment
      i) Rest
      ii) Elevate ________________

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       iii) _____________ pack
       iv) Antibiotics?
       v) _______________________
       vi) Anti - ______________________
7. Prostatic hypertrophy / Benign Prostatic Hyperplasia / Enlarged prostate
   A. Brunner and Suddarth’s Medical Surgical Nursing pg 1751-52
   B. Pathophysiology
       i)   Prostate gland ______________  urinary ________________
       ii) Age: >___________ years
   C. Clinical Manifestations
       i)   Prostate Gland: _____________; rubbery and non-_____________
       ii) Urinary _________________
       iii) ________________ of the ureters and kidneys
       iv) Results in ______________
   D. Assessment and diagnosis
       i) ___________ exam
            (1) BPH = Develops in the __________________ prostate
            (2) Cancer = Develops in the __________________prostate
       ii) Urinalysis
       iii) Renal function test
       iv) Complete blood studies
   E. Medical Management
       i) ________________ to relieve acute obstruction
       ii) Prostatectomy
            (1) TURP __________ ____________ ___________ ____________
       iii) ________________ resection of the prostate
            (1) ______________________ & lasors
            (2) Tissue vaporizes or necrotic  ___________________
   F. Nursing process of Patients with Prostatic hypertrophy
       i) Assessment
       ii) Diagnosis/intervention

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          (1) Acute ____________related to bladder distention secondary to enlarged prostate
              as manifested by complaints of discomfort
              (a) Catheter
              (b) _______________
              (c) Percuss _____________________ for __________________
              (d) Maintain _____________________ of the catheter
              (e) Assess ________________
          (2) Risk for ________________ (urinary tract) related to indwelling catheter,
              environmental pathogens, and urinary stasis
              (a) Assess elevated _________________; urine _______________ or ________
              (b) U/A
              (c) Fluids______________
              (d) ____________Aseptic technique
          (3) ____________, related to actual or potential sexual dysfunction, possible
              diagnosis of cancer, and lack of knowledge regarding surgical procedure and
              postoperative care as manifested by verbalization of fear about impact of surgery
              on sexuality, questioning or inaccurate comments about surgical care.
              (a) Teach
              (b) Assess
              (c) Provide_________________________________________
       iii) Planning and Goals
       iv) Evaluations/Expected patient outcomes
8. Prostatic neoplasm / cancer
   A. Brunner and Suddarth’s Medical Surgical Nursing pg 1752-61
   B. Pathophysiology
       i) Most common _______________________ in men
       ii) Risk Factors
          (1) Increase _________________
          (2) ________________ American male
          (3) A ____________________________ predisposition
   C. Clinical manifestations

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      i) Early stages ______________________
      ii) Late stage
          (1) __________________ ____________  dysuria, hesitancy, dribbling
          (2) ___________ in the urine
          (3) ___________ ejaculation
      iii) Metastasis: to _______________ & _________________
   D. Assessment and diagnostic procedures
      i) ___________________ & ____________________
   E. Medical management
      i) Surgical management
          (1) Radical prostatectomy
             (a) Removal of prostate & ____________ vesicles
             (b) Complications _______________& _______________
      ii) Radiation therapy
          (1) ____________ stage
          (2) _____________ weeks of therapy _______ day
          (3) Advantage: preserves ______________
   F. Nursing process of Patients with Prostatic neoplasm’s
      i) Assessment
      ii) Diagnosis / Interventions
          (1) ____________________related to concern and lack of knowledge about the
             diagnosis, treatment plan and prognosis
             (a) Assess
             (b) Provide
             (c) Teach
          (2) Urinary _______________ R/T urethral obstruction secondary to Prostatic
             enlargement or tumor and loss of bladder tone D/T prolonged distention/retention
             (a) Baseline
             (b) Assess S&S of ______________________
                 (i) _____ urine output                             (iii)Supra-pubic ___
                 (ii) _____ frequency                               (iv) C/O __________

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             (c) Catheterization to check for ______________________
                (i) Sterile
                (ii) Irrigate
                (iii)Monitor
             (d) Position for urination:____________________________
             (e) Administer_________________
             (f) Monitor
         (3) Deficient knowledge related to the diagnosis of cancer, urinary difficulties and
             treatment modalities
             (a) Encourage ___________________________
             (b) Teach _____________________ & ______________________care
         (4) Imbalanced ________________: less than body requirements R/T decreased oral
             intake because of anorexia, nausea and vomiting caused by cancer or its treatment
             (a) Assess____________________
             (b) Weight
             (c) Food _________________
             (d) N&V____________________________ & ___________________________
             (e) ______________________ meals
         (5) Sexual dysfunction related to effects of therapy: chemotherapy, hormonal therapy,
             radiation therapy surgery
             (a) Assess _____________ function
             (b) Inform of _______________ effects on sexuality
             (c) Include the ___________________
         (6) Pain related to progression of disease and treatment modalities
             (a) Evaluate _________________
             (b) Avoid ______________ that  pain
             (c) Administer analgesics/ ______________________
         (7) Impaired physical mobility and activity intolerance related to tissue hypoxia,
             malnutrition and exhaustion and to spinal cord or nerve compression from
             metastases
             (a) Assess ________________causing limited mobility

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              (b) Administer _________________ relief
              (c) Encourage use of _____________________
              (d) __________________________
              (e) Positioning
              (f) Assess _________________________ status
9. Pre and post-operative care of patients undergoing a Prostatectomy
   A. Brunner and Suddarth’s Medical Surgical Nursing pg 1761-69
   B. Transurethral resection of the prostate TURP
       i) Most _________________
       ii) Endoscopy: Surgical and ____________ scope  _________________  ______
       iii) Gland is removed in __________________________
       iv) Advantages
          (1) No abd. _______                                (4) _____ morbidity
          (2) ___ risk                                       (5) _____ pain
          (3) _______ hospitalization
       v) Disadvantages
          (1) Recurrent ___________________: _______________________
          (2) Delayed _________________
          (3) ____________________ dysfunction
       vi) Specific nursing implications
          (1) Monitor for
          (2) Observe for _____________stricture
              (a) _______________________________________________________________
   C. Nursing process of Patients with Prostatectomy
       i) Assessment
          (1) How affected -______________________
          (2) _____________________problems?
          (3) _______________?
          (4) __________________dysfunction?
       ii) Diagnosis / interventions
          (1) Preoperatively

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             (a) Anxiety about surgery and its outcome
                 (i) Assess _______________ & _________________
                 (ii) Establish & encourage ___________________________
                 (iii)Assess knowledge - ______________________________
                 (iv) Inform ______________________________
                 (v) ________________________
             (b) Acute pain related to bladder distention
                 (i) ______________________________
                 (ii) Meds: ______________________________
                 (iii)Assess _________________________distention
             (c) Knowledge deficit: prepare the patient
                 (i) Elastic ____________________ stocking
                 (ii) Enema
                 (iii)No _____________________________
      iii) Nursing interventions – Postoperatively
         (1) Maintaining fluid balance d/t irrigation of surgical site
             (a) I&O: ____________________________
             (b) Check _______________________
             (c) Confusion
             (d) Respiratory distress  crackles = ________________________
         (2) Relieving pain d/t bladder spasms
             (a) Day 1 _____________________ Day 2 ______________________
             (b) Meds to _______________bladders
             (c) ________________________to pubis
             (d) ___________________ baths
             (e) ____________________________agents
             (f) Do not _______________for a long time
             (g) _____________________softeners
         (3) Monitoring and managing potential complication of hemorrhaging
             (a) Drainage ___________ ___________(within ______ hours)
             (b) Monitor ______________

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             (c) ________________
             (d) ____________________component treatment /transfusion
         (4) Monitoring and managing potential complication of infection
             (a) Monitor________________& ____________
             (b) Heat ______________ & Sitz bath
             (c) Antibiotics ( ________________________)
             (d) ____________, urinary frequency, urgency
             (e) _____________technique with catheter
             (f) ______& _______
         (5) Monitoring and managing potential complication of Deep vein Thrombosis
             (a) Prophylactic low dose ____________________
             (b) Elastic ___________________________socks
             (c) Monitor for ___________ (_____________Sign & ________ pulses)
             (d) Early ___________________
         (6) Monitoring and managing potential complication of Obstructed Catheter
             (a) ______________ (Furosemide)
             (b) Increase __________
             (c) Assess __________________________
             (d) Check catheter for_____________, _______________, placement
             (e) Decreased ____________ / increased ________________
         (7) Monitoring and managing potential complication of sexual dysfunction
             (a) Meds
             (b) Privacy
             (c) ___________________ therapy
             (d) Determine _________________ of level of functioning
             (e) Include ___________________________




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