Class notes
Adult Health 1 Exam 2
- Course
- Adult Health 1
- Institution
- Rockhurst University
Lecture notes of 33 pages for the course Adult Health 1 at Rockhurst University (Class notes)
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Adult Health Exam 2Changes in the Reproductive System Related to Aging
Female:
- Graying and thinning of pubic hair
- Decreased size of the labia majora and clitoris
- Drying, smoothing, and thinning of the vaginal walls
- Decreased size of the uterus and ovaries
- Atrophy of the endometrium
- Loss of tone and elasticity of the pelvic ligaments and connective tissue
- Increased flabbiness and fibrosis of breasts, which hang lower on chest wall; decreased erection of nipples
Male:
- Graying and thinning of pubic hair
- Increased drooping of the scrotum and loss of rugae
- Prostate enlargement, with an increased likelihood of urethral obstruction
Endoscopic Studies
Colposcopy – Examination of the cervix and vagina using a colposcope
- Locate exact site of precancerous and malignant lesions for biopsy
Laparoscopy – Direct examination of the pelvic cavity through an endoscope, performed under anesthesia
- Pre: NPO
- Post: Some pelvic and referred shoulder pain, observe incision sites for infection
Hysteroscopy – Fibrotic camera that is inserted into the vagina and examines the cervix and uterus
- Performed with regional nerve block
- Post: Some pelvic and referred shoulder pain
Biopsy Studies
Cervical – Cervical tissue is removed for cytologic study, performed early in menstrual cycle so less vascular
- Pre: Depends on anesthesia used, address anxiety
- Post: Monitor for bleeding and infections, nothing in vagina for 2 weeks, no heavy lifting
Endometrial – Used to obtain cells directly from the lining of the uterus to assess for cancer of the endometrium
- Assess menstrual disturbance and infertility
- Post: Cramping may occur, monitor for bleeding/infections, spotting 1-2 days, nothing in vagina for 1-2 days
Breast – Tissue aspirated through a large bore needle or through small incision, local anesthetic used
- Aspirated fluid from benign cysts may appear clear to dark green brown
- Bloody fluid suggests cancer
- Pre: Depends on anesthesia used, address anxiety
- Post: Mild pain alleviated with analgesics, ice, or heat, monitor incision for bleeding and infection, numbness
may occur around biopsy site, wear supportive bra for 1 week
,Prostate – Diagnostic tool for prostate cancer; Transurethral biopsy – insert needle through the wall of the rectum
- Pre: discuss positioning and discomfort during procedure, address anxiety
- Post: Educate regarding soreness and light rectal bleeding, blood in urine and stool for a few days in addition
to rust colored semen for several weeks, monitor for signs of excessive bleeding, infection, urinary
retention, post biopsy antibiotic
Prostate Cancer
Second most common type of cancer in men and if found early, has a near 100% cure rate – slow growing
Risk factors:
- Over the age of 65, African American males more often affected, family history of prostate cancer
Health promotion and maintenance
- Consider screening at age 50
- Healthy, balanced diet – decrease fats in diet-especially red meat, increase fruits, veggies, and high fiber
Prostate Cancer Assessment
History
Clinical Manifestations:
- Early symptoms: urinary retention, frequent bladder infections, difficulty starting urination
- Advanced symptoms: hematuria, swollen lymph nodes (especially in groin), pain, unexpected weight loss
Other diagnostic assessment:
- Transrectal ultrasound (TRUS), biopsy
Prostate Cancer Interventions
Active surveillance
- After initial diagnosis will monitor and only pursue active treatment if the symptoms become bothersome
Surgery
- Laparoscopic radical prostatectomy (LRP) – entire prostate removal
- Open radical prostatectomy – entire prostate removal
- Bilateral orchiectomy – removal of both testicles
Nonsurgical management
- Can be used as an adjunct to surgery or alternative intervention
o Used if the cancer is widespread or the patient’s condition or age prevents surgery
o Radiation, drug therapy (hormone therapy, chemotherapy)
Prostatitis Assessment
Inflammation of the prostate gland
Acute bacterial prostatitis:
- Occurs with the urethritis or an infection of the lower urinary tract
- Organisms may reach the prostate via the bloodstream or urethra
- Symptoms: fever, chills, dysuria, urethral discharge, boggy and tender prostate
Chronic bacterial prostatitis:
- Occurs in older men
, - Symptoms less dramatic – hesitancy, urgency, dysuria, difficulty initiating and terminating the flow of urine,
decreased strength and volume of urine, discomfort in the perineum, scrotum, and penis
Prostatitis Interventions
Treatment:
- Antibiotics; Acute bacterial prostatitis may require hospitalization with aggressive IV antibiotics
Complications:
- Epididymitis – inflammation of the epididymis; Cystitis – inflammation of the bladder
Testicular Cancer Assessment
Rare cancer, most often affecting men between 20 and 35 years of age
Common manifestations:
- Painless, hard swelling or enlargement of the testicle
Lab assessment:
- Alpha-fetoprotein (AFP); Beta human chorionic gonadotropin (hCG); Lactate dehydrogenase (LDH)
Other diagnostic assessment:
- Ultrasonography – identify fluid or solid mass and benign versus malignant
- CT and MRI – check for metastasis
Testicular Cancer Interventions
Surgical management:
- Radical unilateral orchiectomy; Radical retroperitoneal lymph node dissection (RPLND) may also be done
Nonsurgical management:
- Chemotherapy – may be used as adjuvant therapy or as primary treatment
- External beam radiation therapy (EBRT) – may be used after orchiectomy for localized disease
Benign Prostatic Hyperplasia (BPH)
Prostate gland enlarges and extend inward, causes bladder outlet obstruction
Cause:
- Unclear, likely the result of aging and the influence of androgens present in the prostate tissue
Risk Factors:
- Obesity, diabetes mellitus, testosterone and androgen supplements, inactivity
Benign Prostatic Hyperplasia Assessment
History
Clinical Manifestations:
- Urinary frequency and urgency, nocturia, difficulty in starting (hesitancy) and continuing urination, reduced
force and size of the urinary stream (“weak” stream), sensation of incomplete bladder emptying, straining
to begin urination, post-void dribbling or leaking, hematuria
Physical assessment by provider:
- Inspection, palpation, and percussion of the abdomen, digital rectal examination
Lab Assessment:
- Urinalysis and culture
o Increased WBCs if infection present
, o Microscopic hematuria
- Prostate-specific antigen (PSA)
o Can be elevated in BPH but also other prostate issues
- Other labs to rule out other causes:
o CBC – systemic infection (elevated WBCs), anemia (decreased RBCs from hematuria)
o BUN and serum creatinine – both elevated if leads to kidney disease
o Culture and sensitivity of prostatic fluid (could be expressed during the DRE to check for
prostatitis)
Imaging
- Transabdominal ultrasound
- Transrectal ultrasound
- Tissue biopsy – used to rule out prostate cancer
- Cystoscopy – scope used to evaluate for bladder neck obstruction
- Bladder ultrasound scan – evaluates for post void residual
Benign Prostatic Hyperplasia Medications
First treatment is drug therapy
5-alpha reductase inhibitor (5-ARI):
- Ex: finasteride (Proscar) and dutasteride (Avodart)
- Decreases Dihydrotestosterone (DHT) which reduces size of the prostate
- May need to take for as long as 6 months before improvement noticed
- Side effects: erectile dysfunction, decreased libido, dizziness due to orthostatic hypotension
Alpha-1 selective blocking agents:
- Ex: tamsulosin (Flomax)
- Relaxes smooth muscles in the prostate gland, creating less urinary resistance and improved urine flow
- Also cause vasodilation and reduced peripheral vascular resistance
- Side effects: assess for orthostatic hypotension, tachycardia, syncope
Most effective drug therapy approach is a combination of the two
Benign Prostatic Hyperplasia Interventions
Interventions
- Avoid drinking large volumes of fluid at one time
- Avoid alcohol, caffeine, and diuretics
- Void as soon as they feel the urge
- Avoid drugs that cause urinary retention – ex: anticholinergics, antihistamines, and decongestants
- Noninvasive techniques to destroy excess prostate tissue – ex: prostate artery embolization; transurethral
needle ablation; transurethral microwave therapy, interstitial laser coagulation, electrovaoraization of the
prostate
Surgical management
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