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Final exam NS 212
male system & upper respiratory
| Question | Answer |
|---|---|
| what is the #1 teaching for BPH | prevention, decrease alcohol |
| what are imposrtant s/s for BPH? | urinary frequency, dribbling, urinary pain, incontinence, dysuria |
| complications of BPH | UTI(confusion is sign), BACK PAIN, RENAL FAILURE (3X GREATER), urinary retention, hamaturia,calculi |
| what is the tx for BPH? | WATCHFUL WAITING, TIMED VOIDING SCHEDULE, DECREASE CAFFEINE, SPICY FOODS, ARTIFICIAL SWEETNERS |
| how do you do a bladder scan for BPH? | have pt urinate, do an ultrasound, then insert a catheter & measure remaining output |
| does BPH predispose a pt to prostate CA | NO |
| what is used to dx BPH? | digital rectal exam (should be smooth & symmetrical) |
| which matters in BPH, size or affected area | area |
| hyperplasia in BPH is normal or abnormal | can be both |
| Proscar- what is it & pt teaching | 5-alpha reductase inhibitor shrinks prostate- decreases libido |
| what is TURP & it's complications? | Gold standard; needle inserted through urethra, prostate cauterized, RETROGRADE EJACULATION |
| what is pre-op for BPH? | catheter, COUDE (PRESSURE ON BLADDER) |
| what is pt teaching when d/c a foley? | must urinate @ least 6 hours later |
| what is important for post op for TURP? | bladder irrigation- have enough NS, irrigate for 24 hours or until absence of clots, if too much red clots, call HCP Also- kegel exercises |
| how do you manually irrigate? | put in 50 ml w/a big syringe (sterile), pull out 50 ml |
| what do you monitor w/post op TURP catheter irrigation? | output & Na+ level (associated w/dilutional hyponatremia) |
| who is at risk for prostate CA? | age over 65 and African Americans |
| PSA blood test? | useful marker for tumor volume (higher it is {>4}, the higher the mass), monitors success of tx (should be undetectable) |
| Are DRE & PSA diagnostic? | no- if high or abnormal, a biopsy is done (definitive) |
| Abnormal DRE | hard, assymetrical, fixed, nodular |
| what reduces the level of PSA? | Proscar medication |
| what increses the level of PSA? | DRE- do this after PSA or you get a false high |
| what is the retropubic approach for prostate CA? | low midline abdominal incision is made to access the prostate & lymph nodes may be removed as well |
| what is done for men who have less than 10 yrs life expectancy or comorbid dz or low stage tumor for prostate CA? | watchful waiting b/c more men die w/it than from it |
| why is the nerve sparing radical prostatectomy done for prostate CA? | to decrease erectile dysfx |
| what are nursing interventions for retropubic ressection approach for prostate CA? | pt teaching regarding erectile dysfx & urinary incontinence, monitor output of catheter, monitor drain left in place hemmorhage, urinary retention, infex, wound dehiscence |
| what do prostate CA need to grow? | testoserone |
| what is orchiectomy? | castration for prostate CA- REMOVAL OF BOTH TESTES |
| what is Lupron, how does it tx prostate CA? | leutinizing hormone releasing agonist causes transient increase in LH & FSH = CHEMICAL CASTRATION SIMILAR TO ORCHIECTOMY |
| what are the s/e of LUPRON & CASODEX? | HOT FLASHES, DECREASED LIBIDO, ERECTILE DYSFX, gynomastia |
| what is Casodex? | androgen receptor blocker- prostate CA grows w/testosterone so this blocks it from attaching to surface of prostate CA cells- CA may shrink in size |
| s/e radiation & chemo for Prostate CA? | dry, red, irritated, pain, diahrrea, cramping, bleeding, dysuria, frequency, hesitancy, sexual dysfx, BM suppression, nausea, alopecia |
| post-op teaching for vasectomy | use alternate birth control- takes @ least 10 ejaculations or 6 weeks to evacuate sperm |
| management of prostatitis | ANTBX (bacterial), caution w/opioids b/c it's chronic, NSAIDS FOR PAIN & INFLAMMATION, sitz, inc fluids, rest, use condom for sex (helps drain prostate) |
| epispadiad vs hypospadias | congenital deformity of urethra/meatus placement- EPISPADIAS is WORST (dorsal/on the side) vs beneath/ventral |
| what is phimosis? | inflammation around head of penis d/t lack of hygiene- makes retraction difficult- trapped bacteria/yeast (CNA notices when cleaning) |
| what do CNAs make sure of doing after providing perineal care for uncircumsized male? | retract skin & the REPLACE IT |
| what is priaprism? | painful erection longer than 6 hours- a MEDICAL EMERGENCY- TAKE THIS PT IN THE ER 1ST (TRIAGE) |
| what is priaprism tx with? | ice packs, aspiration, sedatives, relaxants |
| what is a risk factor for CA of the penis? | STD (HPV), not circumcised |
| what is cryptochidism? | undescended testes |
| what is peyronies dz? | curved or crooked penis caused by plaque formation in corpus cavernosum. Hard, nontender, palpable plaque found on posterior surface. Not dangerous- erectile pain, dysfx or embarrasment |
| viagra precautions | once a day, 1hr b/f sex, contraindicated w/nitrates |
| risk factors for testicular CA | 15-34 yo (self exam), more in whites, family hx, cryptochidism, DES med son, hx of mumps, orchitis |
| is the serum tumor marker for testicular tumor CA? | AFP |
| epididymitis is most likely d/t what? | inflammation r/t STD- tx w/anbx (both partners), rest, ice/elevate scrotum, no sex |
| persistent variocele r/t what? | worm-like veins in testes r/t infertility |
| what is testicular torsion? | twisting of spermatic cord supplying blood- MEDICAL EMERGENCY-necrosis/ischemia |
| what should u discuss w/pt w/testicular CA? | sperm banking, f/u to detect relapse |
| testicular CA survival associate with what? | early detection |
| what is the difference between primary & secondary erectile dysfx | primary- adequate erection has never occured; secondary- lost ability |
| opium and belladona suppositories used for? | bladder spasm & pain; s/e: anti-sludge & respiratory depression |
| saline nasal sprays | liquifies secretions & helps clear mucous; s/e: irritation |
| antihistamine precaution | adequate fluid intake |
| intranasal corticosteroids | SWISH & SWALLOW W/NASAL SALINE, MONITOR FOR FUNGUS, reduce systemic s/e, begin 2-3 weeks b/f allergy season, use on regular basis & not prn, , decreases inflammation but not immediately like decoingestants |
| Rhinoplasty teaching | no ASA or NSAIDS 2 weeks prior to surgery, tell pt there's a period of time w/edema & ecchymosis (bruise)- but they will look good |
| rhinoplasty post op | REALISTIC EXPECTATIONS, elevate HOB for 48 hrs, O2 as needed, non-ASA analgesic, DO NOT BLOW NOSE, ICE, MOUTH CARE, maintain airway, respiratory, pain, observe site for infx, bleeding, edema |
| s/s of nasal frax | racoon eyes |
| care for nasal frax | maintain airway #1, reduce edema, ice to reduce edema & bleeding, tx w/septoplasty or rhinoplasty |
| EPISTAXIS assessment | HTN does not increase for it but it makes it harder to control |
| first aid for epistaxis (bloody nose) | keep the pt quiet, pt in sitting position, pressure over soft portioon for 10-15 min, ice, anterior pack w/gauze, NO NOSE BLOWING heavy lifting for 6 weeks, watch elderly O2 w/nose packing, VASOCONSTRICTIVE AGENT, cauterization |
| what is allergic rhinitis? | runny nose from allergies |
| allergic rhinitis management | ID TRIGGERS, KEEP DIARY, AVOID TRIGGERS, ORAL ANTIHISTAMINE, NASAL DECONGESTANT SPRAY (NO > 3 DAYS TO PREVENT REBOUND CONGESTION), NASAL CORTICOSTERIOD SPRAY (MONITOR FOR FUNGUS), ALLERGY SHOT |
| pt education for URI | avoid closed spaces/crowds during cold season, do not use decongestants for >3 days, frequent hand washing & avoid hand-face contact, rest, fluids, diet, no anbx, antihistamines/decongestants dec nasal drip & really help |
| CPAP for sleep apnea | biggest risk for non-compliance (straight O2/loud machine)- ask "have u had it on all night?" |
| what is indicated for viral pneumonia & bacterial pneumonia? | viral; suppotive care, bacterial; anbx if started early |
| intervention for common cold | HANDWASHING |
| influenza management | advocate for vaccination for high risk pts, fluids, antipyretics, humidifier, lozenges, antihistamines |
| what do white patches indicate? | fungus |
| problems r/t pharynx; acute pharyngitis | throat pain, scratchy, difficulty swallowing, red and endematous pharynx with or w/out yellow exudate, RAPID STREP ANTIGEN TEST TO R/O STREP THROAT |
| strep throat cannot be __________ | missed (sore throat)--> may result in rheumatic fever/glomerulonephritis |
| who usually reports s/s of obstructive sleep apnea | spouse |
| s/s of sleep apnea | waking up tired, daytime sleepiness, hypercapnia |
| advantages of tracheostomy | less risk of LT damage to nairway, pt comfort b/c no tube in mouth, PT CAN EAT, more mobility |
| pt teaching for sinusitis | do not use decongestant for >3 days (rebound congestion) |
| live attenuated vaccine given to | everyone from 5-49 yo |
| inactivated vaccine given to | age > 50 yo |
| high risk & in need of influenza vaccine | age >50 yo, chronic cardiac/pulm dz, RESIDENTS OF LT CARE FACILITIES, IMMUNO-COMPROMISED, WOMEN IN 2ND/3RD TRIMESTER DURING SEASON |
| What is the most common complication of influenza? | PNEUMONIA |
| what do you keep next to the bed in case of emergency? | OBTURATOR |
| what should u NEVER do w/a fenestrated trache tube? | insert the decanulization plug in until cuff is deflated & inner cannula removed- causes respiratory arrest |
| what's a pt teaching for trache care while cuff inflated? | pt will not be able to speak |
| what should you do b/f providing trache care? | oxygenate the pt to prevent hypoxia |
| pressure for cuff inflation should be what? | <20-25 mm Hg |
| excessive cuff pressure can predispose to what? | tracheal necrosis |
| what should pt do b/f trache care to prevent aspiration? | cough up secretions prior to deflation |
| tube with an inflated cuff is used for... | risk for aspiration or mechanical ventilation |
| cuff should be inflated to _________ cuff volume | minimum |
| excessive cuff pressure can do what? | cause tracheal necrosis, compress tracheal capillaries, limit blood flow |
| minimal leak technique | inflate cuff w/minimum air to seal, then remove 0.1 ml of air (BUT risk for aspiration) |
| pt should do what prior to deflation to avoid aspiration? | cough up as much secretions as possible |
| when do u deflate cuff? | during exhalation to propel secretions into mouth |
| accidental trache dislogement, the nurse does what? | attempts to replace, put in opterator & call MD, if cannot be replaced in 1 min, call code |
| how do u evaluate aspiration? | add blue coloring to clear liquid & evaluate coughing/secretions or sux trachea for blue fluid |
| when do you apply suction for trache care? | only w/withdrawal |
| what's a complication of sux tracheostomy? | hypoxia (oxygenate beforehand to prevent)>HR >RR, restlessness & dysrhythmia |
| PREVENTING ASPIRATION | AVOID EATING WHEN FATIGUED, HOB ELEVATED, DON'T HURRY PT, DEFLATE CUFF COMPLETELY B/F MEALS, AVOID THIN WATERY LIQUID, CHIN DOWN WHEN SWALLOWING, sux after cuff deflation, dry swallow after eat bite |
| s/s of CA of the head & neck | leukoplakia, erythroplakia, painless growth, nonhealing ulcer, pain is a late sign, hoarseness, dysphagia, inability to move tongue, airway obstruction |
| what is done w/total laryngectomy? | entire larynx and preglottal area removed- PERMANENT TRACHEOSTOMY PERFORMED |
| intervention for dry mouth r/t radiation | fluid, sugarless candy, carry water all the time, pilocarpine hydrochloride, non alcohol mouthwash |
| interventions for stomatitis r/t radiation | avoid mouthwash, spicy foods, use mixture of antacid, benedryl & lidocaine to rinse mouth (not swallow) |
| what pre op info do u give for CA of head & neck? | NG TUBE, DRAIN TUBES, pain management, means of communication, feelings on appearance, all things r/t tracheostomy |
| post op for CA head & neck | AIRWAY CLEARANCE, RR, BREATH SOUNDS Q4H, MONITOR ABILITY TO SWALLOW W/GAG REFLEX, CDB & ambulation, sux as needed, clean inner cannula TID |
| stoma care; what should the pt do when coughing? | cover the stoma |
| what do you not change for 24H after tracheostomy procedure? | the ties |
| what is a hysterosalipinogram? | radiologic contrast dye used to see if cervix is open |
| what is dysmennorhea caused by? | excess prostaglandins |
| SIGNS OF HEMMORHAGE | INCREASED HR & RR, B/P DROP, SEVERE PAIN |
| ECTOPIC PREGO IS A _______________- | life threatening emergency- signs of hemmorhage |
| PID is usually d/t ________ | std (gonorrhe/syphilis)- not always |
| for PID, have pt in ______________ position | fowler's so absess does not go up |
| what is a sign of inflammation? | increased c-reactive protein |
| what is the tx for endometriosis? | remove ovaries(source)- goes away w/menopause |
| which CA for women is most deadly? | ovarian |
Created by:
arsho453
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