Exam 5 (med surg). All Questions and answers. Graded A+

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A nurse is caring for a client with a new diagnosis of benign prostatic hyperplasia (BPH). The nurse should anticipate a prescription for which of the following medications? diphenhydramine oxyb... utnin ipratroprium tamsulosin - ✔✔-tamsulosin -Alpha-adrenergic receptor blockers: smooth muscle relaxation in prostate. Relaxes urethra to facilitate urine flow. se: orthostatic hypotension, dizziness, retrograde ejaculation, nasal congestion also given for BPH: 5-alpha reductase inhibitors: Fin*asteride* and Dut*asteride*... reduces size of prostate gland. Pregnancy warning for finasteride Which of the following are possible complications of BPH? Select all that apply. Prostate cancer Urinary tract infection Bladder calculi (stones) Acute urinary retention Possible sepsis - ✔✔-Urinary tract infection Bladder calculi (stones) Acute urinary retention Possible sepsis Symptoms of BPH are primarily caused by obstruction of the urethra untreated chronic prostatitis decreased bladder compliance excessive secretion of testosterone - ✔✔-obstruction of the urethra The extent of urinary obstruction caused by BPH can be determined by which diagnostic test? cystometrogram transrectal ultrasound uroflowmetry postvoiding catheterization - ✔✔-Uroflowmetry Which of the following is an example of a 5-alpha reductase inhibitor? terazosin finasteride doxazosin oxybutnin - ✔✔-finasteride BPH does not predispose a male to prostate cancer. True or False? True False - ✔✔-true The transurethral resection of the prostate (TURP) is the gold standard surgical treatment for obstructing BPH. True or False? True False - ✔✔-true Which of the following are stool softeners/laxatives that will prevent straining of a bowel movement after an individual has a surgical procedure to relieve BPH? Select all that apply. magnesium citrate tamsulosin senokot diltiazem docusate sodium - ✔✔-magnesium citrate senokot docusate sodium What is the effect of finasteride (Proscar) in the treatment of BPH? Increased bladder tone that promotes bladder emptying Relaxation of the bladder detrusor muscle promoting urine flow Relaxation of the smooth muscle of the urethra A reduction in the size of the prostate gland - ✔✔-A reduction in the size of the prostate gland Prostatitis is common in young/middle-aged men (under age 50). True or False? True False - ✔✔-true hyperplasia - ✔✔-enlargement by increase in the *number* of *cells* benign - ✔✔-non-cancerous BPH occurs ______________ the prostate gland; prostate cancer occurs ___________ the prostate gland. outside; inside inside; outside inside; inside outside; outside - ✔✔-inside; outside Which of the following characterizes obstruction symptoms of the urethra in regards to BPH? (SATA) Dysuria Decrease in caliber of force of urinary stream Intermittency Decreased bladder emptying Incontinence - ✔✔-Decrease in caliber of force of urinary stream Intermittency Decreased bladder emptying **not associated w/ infection or inflammation Which of the following characterizes irritative symptoms of the urethra in regards to BPH? (SATA) Dysuria Intermittency Decreased bladder emptying Bladder pain Urinary frequency and urgency - ✔✔-dysuria Bladder pain Urinary frequency and urgency **associated w/ pain and inflammation ===BPH=== Benign Prostatic Hyperplasia: benign enlargement of prostate gland -occurs in older men (50 and up) -Does *not* predispose to prostate cancer -*inside* prostate gland ==Urinary Obstruction to Urethra== *Obstructive*: decrease force of urine; difficulty initiating urination; intermittency; dribbling; incomplete bladder emptying *Irritative*: urinary frequency/urgency; dysuria; bladder pain; nocturia; incontinence---**Associated w/ pain & inflammation** ==Diet Changes== decrease caffeine (diuretic effect); decrease artificial sweeteners; limit spicy/acidic food; avoid decongestants b/c they worsen s/s; decrease fluids in PM to avoid nocturia - ✔✔-===BPH Complications=== 1. acute urinary retention 2. UTI / Sepsis 3. Bladder stones: calculi may develop d/t *alkaline* nature of residual urine ===BPH Dx=== -hx/physical exam -*Digital Rectal Exam (DRE)*: after age *50* annual -UA w/ culture -PSA levels (norm: *less than 4*)-not definitive dx of cx -Creatinine (norm: *0.6-1.3*) -PVR: bladder scan (*greater than 200 = too much*) -TRUS (*T*rans*r*ectal *U*ltra*s*ound): *MOST IMPORTANT*. *ONLY WAY* to differentiate BPH from prostate cx -Uroflowmetry: measure vol urine expelled from bladder/second ===BPH Drugs=== 1. 5-alpha reductase inhibitors (Fin*asteride* and Dut*asteride*) .....*reduce size* of prostate gland .....3-6 months for improvement .....se: decrease libido, ejaculation, ED .....Pregnant Women: do not handle fin*asteride* b/c hormones in finasteride can cause *genital abnormalities to male fetus* 2. Alpha-adrenergic Receptor Blockers (Doxa*zosin*; Tera*zosin*; temsulosin) ......Promotes *smooth muscle relaxation* in prostate (relaxes urethra to facilitate urinary flow) .....se: orthostatic hypotension; dizziness; retrograde ejaculation (sperm goes back into penis and peed out); nasal congestion 3. Herbs: (*Saw Palmetto*) .....doesn't treat - ✔✔-===BPH Therapies=== 1. *T*rans*u*rethral *R*esection (TURP): *gold standard*; removal tissue of prostate using resectoscope inserted thru urethra .....Complications: hemorrhage; clot retention; ED; retrograde ejaculation 2. *T*rans*u*rethral *M*icrowave *T*herapy (TUMT): *HIGH WAVE* frequency directly to prostate to raise temp 113 F, causes death of tissue & relief from obstruction .....Complications: urinary retention (common) .....Postop: indwelling catheter 2-7 days .....Risks: killing bowel or rectal tissue .....Meds: *cephazolin* prophylaxis; *oxybutnin* bladder antispasmatic 3. *T*rans*u*rethral *N*eedle *A*blation (TUNA): *LOW WAVE* frequency to increase temp of prostate tissue for localized necrosis .....More precise than TUMT .....complications: urinary retention, UTI, irritative voiding s/s; hematuria (normal) 4. Laser Prostatectomy (invasive): removal of prostate via laser beam used for cutting, coag, vaporization .....catheter postop for 7 days .....se: retrograde ejaculation oxybutnin - ✔✔-bladder antispasmodic -ectomy - ✔✔-removal of affected tissue/organ Normal PSA level - ✔✔-less than 4 ng/mL --not definitive dx of cancer Creatinine - ✔✔-0.6 - 1.3 Bladder scan w/ urine over ________ mL, call doctor ASAP - ✔✔-200 reduces size of prostate gland: Finasteride Doxazosin [Show More]

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