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Genitourinary 4

  1. Complications of breast cancer
    1. metastases
    2. bone pain, neurologic changes, weight loss, anemia
    3. shortness of breath, cough, pleuritic pain, nonspecific chest discomfort
  2. Nursing interventions: assess
    1. health history
    2. type of education needed
    3. level of anxiety and fear
    4. coping ability
    5. available support systems
      1. reduce anxiety
      2. provide education
      3. enhance coping strategies
  3. Issues for male patient with breast cancer
    1. resembles cancer of the breast in women
    2. greater incidence in men in their 60's
    3. accounts for 1% of all cases
    4. prognosis is poor because men delay seeking treatment
    5. gynecomastiacan be a contributing factor
  4. Genitourinary Disorders
  5. Urinary tract infections (UTI)
    1. Infections, by various agents, of parts of the urinary system
    2. Etiology
      1. causative agent enters via urinary meatus
      2. women are more susceptible
      3. can be caused by poor voiding habits
      4. in women, acute infection caused most often by Escherichia coli
      5. in men, cause is usually obstructive abnormalities
    3. Findings
      1. dysuria, frequency, urgency, nocturia
      2. suprapubicpain
      3. Findings of hematuria
    4. Diagnostics
      1. urine dipstick
      2. urine microscopy
      3. urine culture
    5. Management
      1. antimicrobialtherapy as indicated:
      2. in uncomplicated infection:
        1. co-trimoxazole (Bactrim)
        2. ofloxacin (Floxin)
        3. nitrofurantoin (Macrodantin)
      3. in complicated infection:
        1. oral antimicrobialsas ordered
        2. IV antimicrobials may be indicated
    1. Complications
      1. pyelonephritis
      2. sepsis
    2. Nursing interventions
      1. assess:
        1. history of urinary tract infections (UTIs)
        2. voiding habits, personal hygiene, contraceptive methods
        3. history of vaginal discharges, itching, irritation, dysuria
      2. manage pain:
        1. systemic analgesics and
        2. urinary analgesics/antispasmodics
      3. client teaching 
        1. preventive measures
          • in the female client, discuss voiding after intercourse
        2. nutritional considerations
          • increase water intake
          • avoid coffee, tea, alcohol, and colas (carbonated and noncarbonated)
  6. Sexually transmitted diseases (STDs) and genital lesions
    1. Definition of STDs: diseases resulting from sexual intercourse with an infected individual.
    1. Etiologies
      1. genital herpes- herpes simplex virus (illustration)
      2. syphilis - treponema pallidum (illustration)
      3. chancroid - haemophilus ducreyi (illustration)
      4. lymphogranuloma venereum(LVG) - sub type of C. trachomatis
      5. condyloma acuminatum(genital warts) - subtype of human papillomavirus(HPV)
    1. Findings (see table on page 30 of this lesson)
      1. genital herpes: clustered painful vesicles and ulcers, mild lymphadenopathy; can be reactivated as a result of stress, infection, pregnancy, sunburn
      2. syphilis
        1. primary type: non-tender, painless, shallow, indurated clean ulcer, mild regional lymphadenopathy
        2. secondary type: maculopapularrash, mucous patches, fever, generalized lymphadenopathy(flu-like illness)
        3. chancroid: well circumscribed, painful ulcers with ragged borders, purulent exudate, tender inguinalnodes in 50% of patients
        4. lvg: small, transient, non-tender papuleulcer which precedes firm, unilateral inguinaland femoral lymph nodes (buboes) with a characteristic groove in between
        5. condyloma acuminatum: single or multiple soft, fleshy, vegetating growth(s); may occur on penis
    1. Diagnostics (for lab tests, see table on page 30 of this lesson)
      1. genital herpes:Tzank smear, viral culture
      2. syphilis: VDRL, rapid plasma reagin (RPR)
      3. chancroid: gram, gimesa, or Wright stain
      4. LGV: microimmunofluorescence testing of aspirate from bubo
      5. condyloma acuminatum: Papanicolaou test and/or biopsy
    2. Management and pharmacology - common agents in the treatment of STDs (choice depends on diagnosis):
      1. acyclovir sodium (Zovirax)
      2. penicillin (Megacillin)
      3. doxycycline hyclate (Vibramycin)
      4. tetracycline HCL (Achromycin)
      5. ceftriaxone sodium (Rocephin)
      6. topical therapies:
        1. podofilox (Condylox)
        2. podophylum resin (Podoben)
    1. Nursing interventions
      1. assess
        1. history of current lesions
        2. history of other sexually transmitted diseases
      2. reduce fear and anxiety
      3. discuss coping with altered body imag
  7. Renal calculi
    1. Definition - presence of stones in the kidneys
    2. Etiology
      1. causes:
        1. hypercalcemia
        2. hypercalciuria
        3. chronic dehydration
        4. high purinediet (organ meats, yeast, etc.)
        5. cystinuria(genetic disorder)
        6. chronic infections (proteus vulgaris)
        7. chronic obstruction with urinary stasis
        8. environmental factor: living in a warm, humid climate
      2. epidemiology
        1. more prevalent in men
        2. can be anywhere in the urinary system
        3. peak age of onset is 20 to 30 years of age
        4. spontaneous passage occurs in 80% of patients
        5. calculi can lodge and cause obstruction. Common sites are:
          • bladder neck
          • renal pelvis
          • ureters
        6. often recur in patients with history of two or more stones
    1. Findings
      1. pain - site dependent on location of obstruction
      2. increased hydrostatic pressure
      3. renal colic
      4. urethral colic
      5. findings can mimic cystitis
      6. with obstruction: when stones (calculi) block urine flow, client will show findings of UTI with fever and chills
      7. gastrointestinal findings
        1. nausea and vomiting
        2. diarrhea
        3. abdominal discomfort
    1. Diagnostics
      1. IVP to determine site and degree of obstruction
      2. retrograde or antegrade pyelography
      3. analysis of stone material
      4. urinalysis
      5. urine culture and sensitivity
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