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Laxative and stool softener Indwelling urinary catheter

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Title: Laxative and stool softener Indwelling urinary catheter


1
This is chapter 73
  • Care of Patients with Breast Disorders

2
Benign Breast Disorders
  • Fibroadenoma, most common cause of breast masses
    during adolescence may occur in patients in
    their 30s
  • Solid, slowly enlarging, benign mass round,
    firm, easily movable, nontender, and clearly
    delineated from the surrounding tissue
  • Usually located in the upper outer quadrant of
    the breast

3
Fibrocystic Breast Condition
  • Fibrocystic changes of the breast that include a
    range of changes involving the lobules, ducts,
    and stromal tissues of the breast
  • Most often occurs in premenopausal women between
    20 and 50 years of age
  • Thought to be caused by an imbalance in normal
    estrogen-to-progesterone ratio

4
Collaborative Management
  • Symptomatic management
  • Hormonal manipulation
  • Drug therapyvitamins C, E, and B complex
  • Diuretics
  • Avoidance of caffeine
  • Reduction of dietary fat
  • Mild analgesics

5
Collaborative Management (Contd)
  • Limited salt intake before menses
  • Well-padded supportive bra
  • Local application of heat or ice for pain relief

6
Ductal Ectasia
  • Benign breast problem of women approaching
    menopause caused by dilation and thickening of
    the collecting ducts in the subareolar area
  • Mass that is hard with irregular borders, tender
  • Greenish brown nipple discharge, enlarged
    axillary nodes, and edema over the site of the
    mass

7
Intraductal Papilloma
  • Occurs most often in women 40 to 55 years of age
  • Benign process in the epithelial lining of the
    duct, forming an outgrowth of tissue

8
Intraductal Papilloma (Contd)
  • Trauma and erosion within the duct, resulting in
    bloody or serous nipple discharge
  • Diagnosis aimed first at ruling out breast cancer

9
Gynecomastia
  • Benign condition of breast enlargement in men
  • Can be a result of primary cancer such as lung
    cancer
  • Causes include
  • Drugs
  • Aging
  • Obesity

10
Gynecomastia (Contd)
  • Underlying disease causing estrogen excess
  • Androgen deficiency
  • Breast cancer

11
Breast Cancer
  • Types of breast cancer
  • Complications include
  • Invasion of lymph channels causing skin edema
  • Metastasis to lymph nodes
  • Bone, lungs, brain, and liversites of metastatic
    disease from breast cancer
  • Ulceration of overlying skin

12
Nipple Retraction
13
Peau dorange
14
Breast Cancer in Men
  • Of all breast cancers, only 1 occur in men.
  • Breast cancer in men usually presents as a hard,
    painless, subareolar mass.
  • Breast cancer in men is often a widely spread
    disease because it is usually detected at a later
    stage than in women.

15
Mammography
  • Baseline screening mammography yearly beginning
    at age 40 years is recommended.
  • Barriers to mammography.

16
Breast Self-Examination
  • The goal of screening for breast cancer is early
    detection because breast self-examination cannot
    prevent breast cancer.
  • Early detection reduces mortality rate.
  • Teach breast self-examination.

17
BSE
18
Breast Care
  • Clinical breast examination
  • Cancer surveillance
  • Prophylactic mastectomy
  • Chemoprevention

19
Anxiety
  • Interventions
  • Anxiety for the woman with breast cancer begins
    the moment the lump is discovered.
  • Level of anxiety may be related to past
    experiences and personal associations with the
    disease.
  • Allow the patient to ventilate feelings.
  • Flexibility is the key to nursing care.

20
Potential for Metastasis
  • For patients with late-stage breast cancer,
    nonsurgical treatment may be the only
    alternative tumor may be removed with local
    anesthetic, follow-up treatment with hormonal
    therapy, chemotherapy, and sometimes radiation.

21
Potential for Metastasis (Contd)
  • For breast cancer at a stage for which surgery is
    the main treatment, follow-up with adjuvant
    radiation, chemotherapy, hormone therapy, or
    targeted therapy is commonly prescribed.

22
Surgical Management
23
Surgical Management (Contd)
  • Removal of the mass
  • Neoadjuvant therapy
  • Axillary node dissection
  • Sentinel lymph node biopsy
  • Breast-conserving surgery
  • Modified radical mastectomy

24
Postoperative Care
  • Avoidance of using the affected arm for blood
    pressure measurement, giving injections, or
    drawing blood
  • Monitoring of vital signs
  • Care of drainage tubes
  • Comfort measures
  • Mobility and diet
  • Breast reconstruction

25
Adjuvant Therapy
  • To decrease the risk of recurrence, adjuvant
    therapy consists of
  • Radiation therapy
  • Chemotherapy
  • Hormonal therapy
  • Stem cell transplantation
  • Targeted therapy

26
This is chapter 74
  • Care of Patients with Gynecologic Problems

27
Primary Dysmenorrhea
  • One of the most common gynecologic problems,
    occurring most often in women in their teens and
    early 20s.
  • Treatment
  • NSAIDs, acetaminophen, anti-prostaglandins, oral
    contraceptives
  • Complementary and alternative therapies

28
Premenstrual Syndrome
  • A collection of symptoms that are cyclic in
    nature
  • Nutrition therapy
  • Drug therapyhormonal therapy. Oral
    contraceptives, gonadotropin-releasing hormone,
    serotonin-reuptake inhibitors
  • Complementary and alternative therapies

29
Endometriosis
  • Endometriosis is endometrial tissue implantation
    outside the uterine cavity.

30
Interventions
  • Drug therapy
  • Complementary and alternative therapy
  • Surgical management

31
Dysfunctional Uterine Bleeding
  • Bleeding that is excessive or abnormal in amount
    or frequency

32
Dysfunctional Uterine Bleeding (Contd)
  • Associated with
  • Endocrine disturbances
  • Polycystic ovary disease
  • Stress
  • Obesity or underweight
  • Long-term drug use
  • Anatomic abnormalities

33
Collaborative Management
  • Nonsurgical management includes hormone
    manipulation.
  • Surgical management includes
  • Dilation and curettage procedure
  • Laser or balloon endometrial ablation
  • Myomectomy
  • Hysterectomy

34
Menopause
  • Normal biologic event marked for most women by
    the end of menstrual periods (12 months of
    amenorrhea)
  • Role of hormone replacement therapy in the
    management of symptoms
  • Perimenopause indicated by changes in ovarian
    function
  • Management

35
Vulvovaginitis
  • Vaginal discharge and itching
  • Inflammation of the lower genital tract resulting
    from a disturbance of the balance of hormones and
    flora in the vagina and vulva
  • Characterized by itching, change in vaginal
    discharge, odor, or lesions

36
Toxic Shock Syndrome (TSS)
  • First recognized in 1980 when it was found to be
    related to menstruation and tampon use
  • Staphylococcus aureus
  • Abrupt onset of high temperature, headache, sore
    throat, vomiting, diarrhea, generalized rash,
    hypotension
  • Management

37
Uterine Prolapse
  • Stages of uterine prolapse are described by the
    degree of descent of the uterus
  • Dyspareunia, backache, pressure in the pelvis,
    bowel or bladder problems
  • Pessaries
  • Surgery

38
Uterine Prolapse (Contd)
39
Cystocele and Rectocele
40
Fistulas
  • Abnormal opening between two adjacent organs or
    structures
  • Urethrovaginal fistula
  • Vesicovaginal fistula
  • Rectovaginal fistula
  • Management

41
Benign Neoplasms
  • Ovarian cyst
  • Uterine leiomyoma
  • Nonsurgical management
  • Surgical management

42
Uterine Leiomyomas
43
Cervical Polyps
  • Pedunculated tumors (on stalks) arising from the
    mucosa and extending to the opening of the
    cervical os
  • Polyp removala simple office procedure

44
Endometrial (Uterine) Cancer
  • Endometrial cancer is a reproductive cancer, of
    which adenocarcinoma is the most common type.
  • The main symptom is postmenopausal bleeding.
  • Diagnostic assessment includes these tests
  • CA-125 tumor marker
  • Chest x-ray

45
Endometrial (Uterine) Cancer (Contd)
  • Possible testing for gene causing HNPCC
  • IV pyelography
  • Barium enema
  • CT of the pelvis
  • Liver and bone scans
  • Hysteroscopic examination of the uterus
  • Proctosigmoidoscopy

46
Surgical Management
  • Total hysterectomy and bilateral
    salpingectomy/oophorectomy

47
Surgical Management (Contd)
  • Total abdominal hysterectomy and bilateral
    salpingo-oophorectomy
  • Radical hysterectomy with bilateral pelvic lymph
    node dissection for stage II cancer

48
Nonsurgical Management
  • Radiation therapy
  • Intracavitary radiation (brachytherapy)
  • External radiation
  • Drug therapy
  • Chemotherapy
  • Hormone therapy
  • Complementary and alternative therapies

49
Cervical Cancer
  • Disorder is a progressionfrom totally normal
    cervical cells, to premalignant changes in
    appearance of cervical cells (dysplasia), to
    changes in function, and ultimately to
    transformation to cancer
  • Carcinoma in situ
  • Preinvasive or invasive

50
Health Promotion and Maintenance
  • HPV vaccine (Gardasil)

51
Clinical Manifestations
  • Patient often asymptomatic
  • Classic symptompainless vaginal bleeding
  • Watery, blood-tinged vaginal discharge that may
    become dark and foul-smelling as the disease
    progresses

52
Clinical Manifestations (Contd)
  • Leg pain
  • Flank pain
  • Unexplained weight loss, pelvic pain, dysuria,
    hematuria, rectal bleeding, chest pain, and cough

53
Diagnostic Assessment
  • Pap smear
  • Squamous atypia, inflammatory atypia, or minor
    atypia abnormalities
  • Bethesda system
  • Colposcopic examination
  • Endocervical curettage

54
Early Surgical Procedures
  • Loop electrosurgical excision procedure
  • Laser therapy
  • Cryotherapy

55
Surgical Procedures
  • Hysterectomy
  • Pelvic exenteration

56
Ovarian Cancer
  • Most common typeserous adenocarcinoma
  • Vague abdominal discomfort, dyspepsia,
    indigestion, gas, and distention
  • Ovarian antibody CA-125, ultrasound, IV
    pyelography, barium enema, upper GI radiographic
    series to rule out tumors

57
Nonsurgical Management
  • Chemotherapy with agents such as cisplatin,
    carboplatin, and paclitaxel
  • Radiation therapy

58
Surgical Management
  • Total abdominal hysterectomy and bilateral
    salpingo-oophorectomy
  • Staging

59
Vulvar Cancer
  • Most are squamous cell carcinomas.
  • Women often report irritation or itching in their
    perineal area or a sore that will not heal.
  • Toluidine blue test identifies abnormal cells.
  • Keyes dermal punch is used for tissue biopsy.

60
Management
  • Laser therapy
  • Radiation therapy
  • Surgical managementvulvectomy or skinning
    vulvectomy or radical vulvectomy

61
Vulvectomy
62
Postoperative Care
  • Providing wound care
  • Promoting urinary and bowel elimination
  • Managing pain
  • Addressing sexuality

63
Vaginal Cancer
  • Rare
  • Treatment with any of these
  • Laser therapy
  • Wide excision
  • Partial or total vaginectomy
  • Topical chemotherapy
  • Radiation therapy

64
Fallopian Tube Cancer
  • Rarest of all gynecologic cancers
  • Most common symptomspostmenopausal bleeding,
    increased abdominal pain, watery vaginal
    discharge, leukorrhea
  • Treatmenttotal abdominal hysterectomy and
    bilateral salpingo-oophorectomy with omentectomy

65
This is chapter 75
  • Care of Male Patients with Reproductive Problems

66
Benign Prostatic Hyperplasia
  • Glandular units in the prostate that undergo an
    increase in the number of cells, resulting in
    enlargement of the prostate gland
  • Hyperirritable bladder, urgency and frequency,
    hypertrophied bladder wall muscles, cellules and
    diverticula, hydroureter, hydronephrosis, and
    overflow urinary incontinence

67
BPH
68
Potential Complications of BPH
69
Assessment
  • Urinary pattern, frequency, nocturia, and other
    symptoms of bladder neck obstruction
  • Lower urinary tract symptoms
  • Hesitancy, intermittency, reduced force and size
    of urinary stream, a sensation of incomplete
    bladder emptying, and post-void dribbling
  • Hematuria

70
Laboratory Assessment
  • Complete blood count
  • Blood urea nitrogen and creatinine levels
  • Prostate-specific antigen
  • Other diagnostic studies

71
Drug Therapy
  • 5-alpha reductase inhibitor (5-ARI)
  • Alpha-blocking agents
  • Alpha blockers
  • Estrogens and androgens
  • Antimuscarinic agent

72
Other Nonsurgical Measures
  • Thermotherapy

73
Surgical Procedures
  • Transurethral resection of the prostate (TURP)
  • Suprapubic prostatectomy
  • Retropubic prostatectomy
  • Perineal prostatectomy

74
Prostatectomy Procedures
75
Continuous Bladder Irrigation
  • Three-way urinary catheter with a 30- to 45-mL
    retention balloon through the urethra into the
    bladder
  • Traction via taping to patients abdomen or thigh
  • Uncomfortable urge to void continuously
  • Antispasmodic medications

76
CBI
77
Postcatheterization Care
  • Patient feels burning on urination as well as
    some urinary frequency, dribbling, and leakage.
  • Symptoms are normal and will subside.
  • Monitor fluid intake.

78
Prostate Cancer
  • Most common invasive cancer among men in the
    United States
  • One of the slowest growing malignancies
    metastasizes in a predictable pattern
  • First symptoms related to bladder neck
    obstruction

79
Prostate Cancer (Contd)
  • Digital rectal examination
  • Prostate-specific antigen
  • Biopsy necessary to confirm suspected prostatic
    cancer

80
Prostate Cancer (Contd)
81
Surgical Management
  • Minimally invasive surgery
  • Open surgical technique
  • Prostatectomy
  • TURP
  • Bilateral orchiectomy
  • Preoperative care

82
Postoperative Care of Radical Prostatectomy
  • Hydration with IV therapy
  • Caring for wound drains
  • Preventing emboli
  • Preventing pulmonary complications
  • Antibiotics
  • Analgesics

83
Postoperative Care of Radical Prostatectomy
(Contd)
  • Laxative and stool softener
  • Indwelling urinary catheter
  • Antispasmodic

84
Complications
  • Urinary incontinence
  • Erectile dysfunction

85
Nonsurgical Management
  • Radiation therapy
  • Hormonal therapy
  • Chemotherapy
  • Cryotherapy
  • Complementary and alternative therapies
  • Targeted therapy

86
Erectile Dysfunction
  • Inability to achieve or maintain an erection for
    sexual intercourse
  • Organic erectile dysfunction
  • Functional erectile dysfunction
  • Assessment
  • Medical, social, sexual history
  • Complete physical examination
  • Duplex Doppler ultrasonography test

87
Interventions
  • Drug therapy includes sildenafil (Viagra),
    vardenafil (Levitra), and tadalafil (Cialis).
  • Avoid alcohol before sexual intercourse.
  • Common side effects include headaches, facial
    flushing, and stuffy nose.
  • Men who take nitrates should not take these
    drugs profound hypotension and reduced blood
    flow to vital organs can result.

88
Vacuum Devices
  • Cylinder fits over the penis and sits firmly
    against the body.
  • Vacuum is created to draw blood into the penis to
    maintain an erection.
  • Rubber ring (tension band) is placed around the
    base of the penis to maintain the erection
    cylinder is removed.

89
Injecting the Penis
  • Vasodilating drugs can make the penis erect by
    engorging it with blood
  • Caverject
  • Paverine
  • Regitine
  • Combination of any or all of these drugs

90
Intraurethral Applications
  • Alprostadil is a self-administered suppository
    that is placed in the urethra with an applicator.
  • Erection occurs in about 10 minutes and lasts 30
    to 60 minutes.
  • Burning of the urethra can occur after
    application, as well as syncope.

91
Prosthesis
  • Penile implants are used when other modalities
    fail.
  • Implants are semirigid, malleable, or hydraulic
    inflatable and multicomponent or one-piece
    instruments.
  • Reservoir is placed in the scrotum.
  • Major disadvantages are device failure and
    infection.

92
Testicular Cancer
  • Although uncommon, this cancer is the most common
    malignancy in men 15 to 34 years of age.
  • With early detection by testicular
    self-examination and treatment with combination
    chemotherapy, testicular cancer can be cured.
  • Germ cell tumors arise from sperm-producing
    cells.
  • Nongerm cell tumors

93
Laboratory Assessment
  • Alpha-fetoprotein (AFP)
  • Beta human chorionic gonadotropin (hCG)
  • Lactate dehydrogenase (LDH)
  • Ultrasound
  • Computed tomography
  • Magnetic resonance imaging

94
Interventions
  • Surgery is the main treatment for testicular
    cancer
  • Preoperative care
  • Operative procedure
  • Postoperative care

95
Nonsurgical Management
  • Chemotherapy
  • Radiation therapy

96
Risk for Sexual Dysfunction
  • Interventions include
  • Oligospermia, azoospermia
  • Health teaching about reproduction, fertility,
    and sexuality
  • Sperm storage
  • Other reproductive options

97
Potential for Metastasis
  • Interventions include
  • Surgical management
  • Preoperative care
  • Operative proceduresradical retroperitoneal
    lymph node dissection, orchiectomy

98
Potential for Metastasis (Contd)
  • Postoperative care expected problems include
  • Pain from surgical incisions
  • Immobility
  • Injuries related to invasive catheters or tubes

99
Hydrocele
  • Cystic mass is usually filled with straw-colored
    fluid that forms around the testis resulting from
    impaired lymphatic drainage of the scrotum,
    causing a swelling of the tissue surrounding the
    testes.
  • Hydrocele may be drained via needle and syringe,
    or it may be removed surgically.

100
Spermatocele
  • A sperm-containing cyst develops on the
    epididymis alongside the testicle.
  • Normally, spermatoceles are small and
    asymptomatic and require no interventions.
  • If they become large enough to cause discomfort,
    a spermatocelectomy is performed.

101
Varicocele
  • A cluster of dilated veins occur behind and above
    the testis.
  • Varicoceles can also cause infertility.
  • Varicocelectomy is performed through an inguinal
    incision in which the spermatic veins are ligated
    in the cord.

102
Common Problems
103
Cancer of the Penis
  • Epidermoid (squamous) carcinomas developing from
    squamous cells
  • Circumcision in infancyalmost always eliminates
    the possibility of penile cancer
  • Painless, wartlike growth or ulcer
  • Excisional biopsy
  • Radiation therapy
  • Penectomy

104
Phimosis and Paraphimosis
  • Constricted prepuce that cannot be retracted over
    the glans prepuce remains down around the tip of
    the penis
  • Emergency requiring immediate treatment
  • Circumcision
  • Warm bath to allow dressing to loosen
  • Barbiturate sleeping medications

105
Priapism
  • Uncontrolled and long-maintained erection without
    sexual desire causes the penis to become large
    and painful
  • Can occur from
  • Thrombosis of veins of corpora cavernosa
  • Leukemia
  • Sickle cell disease

106
Priapism (Contd)
  • Diabetes mellitus
  • Malignancies
  • Abnormal reflex
  • Some drug effects
  • Recreational drugs
  • Prolonged sexual activity

107
Collaborative Management
  • Urologic emergency
  • Goal of interventionto improve the venous
    drainage of the corpora cavernosa
  • Meperidine
  • Warm enemas
  • Urethral or suprapubic catheterization
  • Large-bore needle or surgical intervention

108
Prostatitis
  • Inflammation of the prostate gland
  • Acute bacterial prostatitis
  • Chronic bacterial prostatitis
  • Nonbacterial/chronic pelvic pain syndrome
  • Asymptomatic inflammatory prostatitis

109
Epididymitis
  • Inflammation of the epididymis resulting from an
    infection or noninfectious source such as trauma
  • Treatmentbedrest with scrotum elevated on a
    towel, scrotal support when ambulating
  • Comfort measures
  • Epididymectomy

110
Orchitis
  • Acute testicular inflammation resulting from
    trauma or infection
  • Treatmentbedrest with scrotal elevation,
    application of ice, and administration of
    analgesics and antibiotics
  • Mumps orchitis
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