NURSING 701 FINAL STUDY GUIDE CHAPTER 59 TO 73

 Prostatitis- Inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. • Due to infection or blockage.  S/S: • Perineal discomfort • Burning • Urgency • Frequency • Pain w/ voiding  Medical Management: • Antibiotics • Ejaculation  decreases prostate fluid.  Nursing Management: • Promote adherence • Patient teaching • DO NOT push fluids  dilutes medication. • Avoid catheters  Benign Prostatic Hyperplasia: noncancerous enlargement or hypertrophy of the prostate. • Obstructs bladder from being able to empty.  S/S: • Increased frequency • Nocturia • Urgency • Difficulty in starting urination • Decrease in volume or force • Dribbling • Sensation that the bladder has not emptied  Medical Management: • Medications – Flomax (maximizes flow of urine) o Hytrin – Relaxes prostate muscle • TUIP  decreases swelling • Transurethral needle ablation  destroys the prostate. • Microwave thermotherapy  heat w/ probe through the urethra that destroys the prostate. • Saw palmetto  OTC medication  Prostate Cancer: Testosterone dependent • DRE (digital rectal exam) over age 50 screenings. • Over 40 if considered at risk  Risk factors: • Increasing age • Family predisposition • AA race  Manifestations: • Barely any s/s • Urinary obstruction • Blood in urine or semen. • Painful ejaculation • Symptoms of metastasis (pain, anemia, fatigue)  Medical Management: • Prostatectomy  Primary treatment; removal of prostate • Radiation therapy • Hormonal therapy  ADT (androgen deprivation therapy) • Chemotherapy • Cryosurgery  freezing tissue via a probe (destroys urethra) o Only if prostatectomy is not tolerated.  Complications w/ surgery: • Hemorrhage and shock: o Highest priority!! • Infection • DVT  due to immobility • Catheter obstruction  continuous bladder irrigation • Sexual dysfunction  Nursing Management: • Maintain fluid balance • Pain relief o Bladder spasms • Patient teaching: o Drainage devices  catheter o Incontinence o Avoid straining and heavy lifting o Avoid long car trips  avoid sitting for 2 months. o Diet = increase fluids, avoid coffee, ETOH  Continuous Bladder Irrigation: 3 way foley • Fluid swishes in bladder and drains out into foley. • Purpose = prevent blood clots. o Pink tinged urine o Increase rate if getting lots of red drainage / clots. o Less red the next day • Document how much is going in and what is going out: o Expect that there is more output than what is going in.  Epididymitis: Infection of the epididymis • #1 cause is E.Coli.  antibiotics • May be r/t UTI. • May take a while to recover • Risks: STI history, recent urinary tract surgery, lack of circumcision, history of enlarged prostate, indwelling catheter. • Keep penis away from anal area.  Testicular Cancer: • Highly treatable and curable. • Risk Factors: o Undescended testes o (+) family history o Cancer of one testicle o Caucasian  Manifestations: • Painless lump in the testes. • Screening  Monthly self-exams (TSE). • Annual testicular exam  Treatment: • Orchidecttomy  removal of the testis • Lymph node dissection • Radiation  shield other testicle that does not have cancer. • Chemotherapy  Nursing Management: • Assess physical and psychological status • Coping • Body issues and sexuality • (+) attitude • Encourage TSE  Vasectomy: Male sterilization; resection of vas deferens. • Spontaneous reanastomosis – Vas deferens find each other again and re-connect  no longer sterile.  Complications: • Bruising • Infection  Nursing Management: • Ice bags • Patient education o Practice birth control until fertility is confirmed. o 4 wks  post surgery o 4 wks and 8 wks  verification for sterility o 30-36 ejaculations  sterile  Conditions Affecting the Penis:  Hypospadias – When urethral opening is at the underside of the peins.  Epispadias – When the urethral opening is on the top (dorsal) of the penis.  Phimosis – Constricted foreskin; Catheter insertion.  Penile cancer • Bowen’s disease – Cancer of the penile shaft.  Priapism – Erection over 4 hours.  Peyronie’s disease – Curved penis when erect  Urethral stricture – Narrowing of the urethra.  Circumcision – Excision of the foreskin. Chapter 15: Oncology: Nursing Management in Cancer Care  Cancer: Disease process that begins when an abnormal cell is transformed by the genetic mutation of cellular DNA. • Men: o Lung o Prostate o Colorectal • Women: o Lung o Breast o Colorectal  Malignant Process: • Cell Proliferation – Uncontrolled growth, with the ability to metastasize and destroy tissue and cause death. • Cell characteristics – Presence of tumor specific antigens, altered shape, structure, and metabolism. • Metastasis (3 types): o Lymphatic spread – Most common; spread through the lymph system. o Hematogenous spread – Spread through blood. o Angiogenesis – Creation of new vessels around cancer tumor.  Carcinogenic Agents and Factors: • Viruses and bacteria – Epstein barr virus • Physical factors  sun, radiation exposure • Chemical agents  tobacco: 70%, asbestos • Genetics  high fat, ETOH, smoked meats, nitrates/nitrites (hot dogs) • Hormones  disturbances  Role of the Immune System: • Normal: o T-Cells  recognize foreign cells o B- Cells  produce antibodies o Lymphokines o Natural Killer Cells • Immune System Failure: o Failure to hide “self vs. non-self” ▪ Immune system is never activated o Decreased immunity = increased incidence of cancer. o Ability to hide  cancer cells hide o Suppressor T-Cells  activated too much and do not fight off what it should  Primary and Secondary Prevention: • Primary Prevention: Reduce risk of disease through health promotion and risk reduction. o Avoid known carcniogens  radiation, ETOH, smoking o Lifestyle and dietary changes o Patient education • Secondary Prevention: Screening and early detection o Identifying high risk o Screening for skin cancer, mammograms  7 Warning Signs of Cancer: • C = change in bowel/bladder habits • A = A sore that does not heal • U = unusual bleeding • T = thickening or lump • I = indigestion or difficulty swallowing • O = obvious change in a wart or mole • N = nagging cough or hoarseness  Diagnosis of Cancer: • 1. Determine presence and extent • 2. Identify metastasis • 3. Evaluate function of involved body systems and organs • 4. Obtain tissue cells for analysis o Staging: Size, local invasion, lymph node involvement, and metastasis.  TNM: ▪ 0-4; 4 = metastasis o Grading: Differentiation of cells ▪ Increases = more severe o Well differentiated = Benign (I) o Undifferentiation = malignant (metastasis) • T = size or primary tumor • N = lymph node involvement • M = presence of absence of metastasis • DISCUSSED BY PHYSICIAN NOT THE NURSE!!  Cancer Management: • Cure – eradication of disease • Control – contain growth / spread of disease o Prolong survival • Palliation – relief of symptoms o Not seeking / expecting a cure  Surgical Treatment: • Diagnostic surgery • Biopsy: o Excisional – removal of entire tumor o Needle – Insert needle into the tumor and remove tissue o Incisional – removing wedge of tumor. • Tumor removal: o Wide excision – take out the tumor and a lot of tissue around the tumor. o Local excision – removal of the tumor itself. • Prophylactic surgery – removal; remove the risk of getting cancer. o Family history and genetic predisposition • Palliative surgery – reduce symptoms • Reconstructive surgery  Radiation Therapy: • Rapidly producing cells are more sensitive to radiation than other cells • Desired to kill 95% of tumor w/ radiation. • Internal radiation  implants • External implants • Dosage o Want to kill 95% of tumor. • Toxicity: o Skin and hair o GI  easy nausea o Bone marrow ▪ Thrombocytopenia  low platelets • Skin Reaction: o First degree  destroys hair roots o Second degree  sweat glands are destroyed; hair loss may be permanent; erythema ▪ Hyperthermia = concern o Third degree  Purple areas; scabs form; Hair loss is permanent o Fourth degree  Rare; stop after 3rd degree. • Increased risk for secondary malignancy w/ radiation therapy for leukemia or lymphoma. • Minimize skin damage: o Avoid sun exposure, trauma to skin, adhesive tape. o Caution w/ soap o Pat skin dry. o Avoid bath salts, perfumes, ointments or lotions. o Avoid sponges and wash cloths. o Soft, lightweight clothing.  GI Reaction: • Xerostomia – Dry mouth due to decreased salivation. • Change in food taste  becomes metallic • Decreased salivation • N/V  decreased appetite • Anorexia • Diarrhea  Bone Marrow Reaction: • Anemia: H&H o Hemoglobin is decreased! • Leukopenia: WBC count (low) • Thrombocytopenia: low platelets  Systemic Effects: • Fatigue • Malaise • Anorexia  Protectino: • Decrease time of exposure • Increase distance • Shielding  Internal Radiation Precautions: implants utilized • Private room • Encourage self-care = decreased time exposed. • Film badge • Limit visitors  young children • Implant  dislodged o Hospital policy? o DO NOT PICK UP THE IMPLANT.  Chemotherapy: Agent used to destroy tumor cells by interfering with cellular function and replication. • Cell-cycle specific: Work at certain part of the cell cycle. • Cell-cycle nonspecific: Do not target specific part of the cell cycle.  IV Infiltration: • Extravasation – Degradation / necrosis of tissue. • Stop infusion • Apply ice • Administer antidote  injection; clock around infusion site (negate costic action of agent). • PREVENTION is KEY! o Assess IV prior to chemotherapy.  Chemotherapy Side Effects:  Stomatitis: inflammation of oral tissue • Avoid mouthwash (ETOH  dries mucous membranes) • Nystatin  swish and swallow; thrush • Lidocaine  orally for pain • Toothbrush  soft; avoid flossing. • Lubricant  lips • Avoid hot, spicy foods. • Fluid intake  Anorexia: • Identify the cause. o May alter the hunger center o N/V • Enteral feedings • TPN • Small, frequent meals o High calories • Minimize food odors o Cook foods outside o Open windows o Milkshakes • Patient preferences  N/V: • Small, frequent meals. • Dietary consult • Cold, bland foods • Antiemetics: o IV if vomiting o Give liberally and prophylatically o 30-60 minutes before eating o Vomiting = Sit up and turn head to side  Renal Toxicity: • Uric Acid excretion: o BUN and CREATININE  increased = renal failure o CREATININE CLEARANCE  decreased = renal failure ▪ 24 hour urine tests for creatinine clearance. ▪ Kidney is not able to remove creatinine. • Encourage oral intake • Monitor output • Decrease dosage of chemotherapy  Alopecia: • Sign of disease • Wigs • AVOID shampooing/brushing hair. • AVOID hair treatments.  Cardiopulmonary: After time there is a (-) effect. • Monitor EF (55-65%) • Monitor for s/s of CHF • SOB • Monitor for pneumonia • Coughing  Reproductive: • Sterility • Chromosomal abnormalities • Sperm banking • B/C during chemotherapy to prevent birth defects.  Bone Marrow Depression: • Neutropenia  dropping WBC = CALL THE PHYSICIAN o Normal = 4,000-10,000 o Greater than 10,000 = infection o Less than 4,000  can’t fight infection o Less than 2,000 = NEUTROPENIA. ▪ Reverse isolation. ▪ Less than 500 = CRITICAL EMERGENCY  CALL MD. o Nadir Effect: Lowest point of WBC  most susceptible for infection: 7-10 days after treatment. ▪ Lasts 7-10 days = WBC ▪ RBC – 7-10 days ▪ Platelets – 10 days • Anemia • Thrombocytopenia: o Platelet below 50,000  bleeding precautions. ▪ NO IM injections ▪ Minimize needlesticks ▪ Avoid straight razors  Cancer Nutrition: • N/V complication • Sight and smell of food can lead to N/V. • Bring in favorite foods.  Neutropenic Precautions: • Good handwashing • S/S of infection are blunted!!! • Aseptic technique • No flowers, fresh fruits (canned, cooked ONLY). • Risk for infection is VERY HIGH, but usually only temporary.  Anemia Interventions: • Observe for s/s o Low H and H o Pale skin o Tired, fatigue  #1 complaint!! ▪ Hemoglobin  transfuse at 8. • Rest periods • Administer oxygen • Blood transusions  Thrombocytopenia Nursing Interventions: At risk for bleeding. • Observe for s/s of bleeding • s/s for bleeding into the brain o Change in LOC o HA, Restlessness • Platelet transfusion  30 minutes; as fast as patient can tolerate. • Encourage soft toothbrush • Stool softeners • AVOID aspirin  Chemotherapy: Protection for health care workers • Wear surgical gloves • Disposable gowns • Luer-lock fittings  twist syringe on o Prevent leakage o Prevent infection • Proper disposal • S/S of exposure (to nurse): o N/V o Dizziness o Alopecia o Nasal mucosa ulcerations  Controlling Pain: • Acute or Chronic pain (chronic is more frequent) o Acute – trauma from surgery o Chronic – pain syndromes (nerve tissue injury), necrosis • Anxiety increases pain. • Schedule pain medications  Decreasing Fatigue: • Most significant and frequent symptoms of patients receiving cancer therapy. • Allow periods of rest and activity. • Regular, light exercise. • Nutritional counseling  high calories, high protein.  Bone Marrow Transplantation: • Types: o Allogenic – from a donor o Autologous – From patient o Syngeneic – identical twin • Graft vs. Host Disease: T cells in bone marrow received attack recipients body. o Immunosuppressant medications to prevent.  Hyperthermia: • Temperature above 106.7 degrees F • Malignant cells are more susceptible to elevated temperatures. • Regional perfusion  specific part of the body • Hyperthermia probes  inserted in towards the tumor. • Chemotherapeutic agents • Whole-body hyperthermia  immersion in water that heats the body.  Complications: • Infection • Bleeding • Superior vena cava sndrome – congestion of blood due to tumor suppressing on superior vena cava. • Hypercalcemia – Due to bone destruction; most common emergent oncological complications o MOST COMMON EMERGENT ONCOLOGICAL COMPLICATION! • Spinal cord compression • Pericardial effusion – due to radiation • DIC • SIADH – Syndrome of inappropriate ADH ( increased release of ADH). o Non-pitting edema; lay flat to resolve edema. o Acute stage = lay them flat  resolves edema (unless there is trouble breathing). • Tumor lysis syndrome – As cancer cells are destroyed intravascular substances leak into blood. o Causes changes in potassium (hyperkalemia) “circle k” = chief intracellular ion  Hospice: • Poor prognosis • Less than 6 months to qualify • Focuses on: o quality of life o Palliation of symptoms o Psychosocial and spiritual care Chapter 33: Assessment and Management of Patients w/ Hematologic Disorders  Anemias: Lower than normal hemoglobin; no oxygen to carry throughout bloodstream. • Hypoproliferative: Deficiency in production in RBC’s. • Hemolytic: Premature destruction of RBC’s. • Or due to blood loss  Manifestations: • Fatigue  chief complaint • Pallor • Cardiac symptoms  tachycardia, SOB w/ exertion. • Tongue changes  smooth, sore characteristic. • Nail changes  brittle • Angular cheilosis  Corners of the mouth get dry and bleed. • Pica  Unusual cravings of non-edible foods. o Chalk, dirt, soap  Medical Management: Correct or control the disease. • Transfuse PRBC (packed RBC) • Specific to anemia type: o Diet o Iron / vitamin supplement  iron, folic acid and B12 o Bone marrow transplant  more serious cases o Immunosuppresive therapy  prevent further destruction of stem cells.  Complications: Related to poor perfusion. • Heart failure • Angina • Paresthesias  numbness and tingling • Confusion  Interventions: • Balance physical activity • Nutrition • Patient education and compliance w/ medication regimen. • Monitor VS and pulse Ox.  Iron Deficiency Anemia: Low intake of dietary iron. • Blood loss (GI) • Menorrhagia • Pregnancy  need for iron increases.  Clinical Manifestations: • Smooth, sore tongue • Brittle nails • Angular cheilosis • Pica  Medical Management: • Oral iron • Vitamin C  helps with the absorption of iron.  Nursing Management: • Education • Diet: o Meats o Beans o Green leafy veggies o Orange juice  high in vitamin c (helps store iron so body can absorb). • Medication instructions: Best absorbed on an EMPTY stomach o Before or with meals o Liquid form  may discolor teeth (take medication through a straw) ▪ Rinse mouth and have good oral care. o Discolored stool  dark green, or black color.