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NR 545 Final exam Study Guide, Study Guides, Projects, Research of Nursing

Harvard UniversityNursing

NR 545 Final exam Study GuideNR 545 Final exam Study Guide

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NR 545 Final exam Study Guide
The final exam includes content from weeks 1-8.
Week 7 : renal and urological disorders
•Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment
•Review required readings, course lectures, case study and learning
activity. Fluid and electrolyte balance- processes in the kidney
•Hormones controls reabsorption of fluid and electrolytes
oAntidiuretic hormone
▪From posterior pituitary; controls reabsorption of water by altering permeability of distal convoluted tubule and collecting duct
oAldosterone
▪Secreted by adrenal cortex; controls sodium reabsorption and water by exchanging Na ions for K or hydrogen ions in distal
convoluted tubule
oAtrial natriuretic hormone
▪From heart; 3rd hormone controlling fluid balance by reducing Na and fluid reabsorption in kidneys
Renal circulation process
Laboratory testing- purpose and interpretation ; Age related urinary changes ; Conditions/diagnoses associated with urine color changes
Diagnostic test
•Urinalysis
oConstituents and characteristics of urine may vary w/ dietary intake, drugs, and care w/ which specimen is handled
oUrine is normally: clear, straw colored and has mild color
oUrine pH is 4.5-8.0
oAppearance
▪Cloudyindicate presence of large amounts of protein, blood cells or bacteria and pus
▪Dark colorindicate hematuria (blood), excessive bilirubin content or highly concentrated urine
▪Unpleasant or unusual odorindicate infection or result from certain dietary components or medications
oAbnormal constituents (present in significant quantities)
▪Blood (hematuria)
•small (microscopic) amounts of blood indicates infection, inflammation, or tumors in urinary tract
•large numbers of RBC (gross hematuria) indicates increased glomerular permeability or hemorrhage in tract
▪protein (proteinuria, albuminuria)
•indicates leakage of albumin or mixed plasma proteins into filtrate d/t inflammation and increased
glomerular permeability
▪bacteria (bacteriuria) and pus (pyuria)
•indicates infection in urinary tract
▪urinary casts (microscopic sized molds of tubules, consisting of one or more cells (bacteria, protein, and so on))
•indicates inflammation of kidney tubules
▪specific gravity
•indicates ability of tubules to concentrate the urine
•very low specific gravity= dilute urine; related to renal failure
▪glucose and ketones (ketoacids)
•found when DM is not well controlled
•blood test
oelevated serum urea (BUN and Cr)
▪indicate failure to excrete nitrogen wastes d/t decreased GFR
▪results from protein metabolism
ometabolic acidosis (decreased pH and Bicarb)
▪indicate decreased GFR and failure of tubules to control acid-base balance
oanemia (low hgb)
▪indicated decreased erythropoietin secretion and/or bone marrow depression d/t accumulated wastes
oelectrolytes
▪depend on related fluid balance
▪retention of fluid= GFR is decreased and may result in dilution effect
oantibody levelant streptolysin O (ASO) or ant streptokinase (ASK)
▪used for dx of post-streptococcal glomerulonephritis
orenin
▪indicate cause of HTN
•other test
oculture and sensitivity on urine specimens
▪used to identify the causative organism in urinary infection and select drug tx
oclearance test such as Cr or insulin clearance or radioisotope study
▪used to assess GFR
oradiologic test such as radionuclide imagining, angiography, US, CT, MRI and IV pyelography(IVP)
▪used to visualize structures and abnormalities in urinary system
ocystoscopy
▪visualizes lower urinary tract and may be used in performing a biopsy or removing kidney stones
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NR 545 Final exam Study Guide

The final exam includes content from weeks 1-8. Week 7 : renal and urological disorders

  • **Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment
  • Review required readings, course lectures, case study and learning activity. Fluid and electrolyte balance- processes in the kidney -** Hormones controls reabsorption of fluid and electrolytes o Antidiuretic hormone ▪ From posterior pituitary; controls reabsorption of water by altering permeability of distal convoluted tubule and collecting duct o Aldosterone ▪ Secreted by adrenal cortex; controls sodium reabsorption and water by exchanging Na ions for K or hydrogen ions in distal convoluted tubule o Atrial natriuretic hormone ▪ From heart; 3 rd^ hormone controlling fluid balance by reducing Na and fluid reabsorption in kidneys Renal circulation process Laboratory testing- purpose and interpretation ; Age related urinary changes ; Conditions/diagnoses associated with urine color changes Diagnostic test
    • Urinalysis o Constituents and characteristics of urine may vary w/ dietary intake, drugs, and care w/ which specimen is handled o Urine is normally: clear, straw colored and has mild color o Urine pH is 4.5-8. o Appearance ▪ Cloudy indicate presence of large amounts of protein, blood cells or bacteria and pus ▪ Dark color indicate hematuria (blood), excessive bilirubin content or highly concentrated urine ▪ Unpleasant or unusual odor indicate infection or result from certain dietary components or medications o Abnormal constituents (present in significant quantities) ▪ Blood (hematuria) - small (microscopic) amounts of blood indicates infection, inflammation, or tumors in urinary tract - large numbers of RBC (gross hematuria) indicates increased glomerular permeability or hemorrhage in tract ▪ protein (proteinuria, albuminuria) - indicates leakage of albumin or mixed plasma proteins into filtrate d/t inflammation and increased glomerular permeability ▪ bacteria (bacteriuria) and pus (pyuria) - indicates infection in urinary tract ▪ urinary casts (microscopic sized molds of tubules, consisting of one or more cells (bacteria, protein, and so on)) - indicates inflammation of kidney tubules ▪ specific gravity - indicates ability of tubules to concentrate the urine - very low specific gravity= dilute urine; related to renal failure ▪ glucose and ketones (ketoacids) - found when DM is not well controlled
    • blood test o elevated serum urea (BUN and Cr) ▪ indicate failure to excrete nitrogen wastes d/t decreased GFR ▪ results from protein metabolism o metabolic acidosis (decreased pH and Bicarb) ▪ indicate decreased GFR and failure of tubules to control acid-base balance o anemia (low hgb) ▪ indicated decreased erythropoietin secretion and/or bone marrow depression d/t accumulated wastes o electrolytes ▪ depend on related fluid balance ▪ retention of fluid= GFR is decreased and may result in dilution effect o antibody level ant streptolysin O (ASO) or ant streptokinase (ASK) ▪ used for dx of post-streptococcal glomerulonephritis o renin ▪ indicate cause of HTN
    • other test o culture and sensitivity on urine specimens ▪ used to identify the causative organism in urinary infection and select drug tx o clearance test such as Cr or insulin clearance or radioisotope study ▪ used to assess GFR o radiologic test such as radionuclide imagining, angiography, US, CT, MRI and IV pyelography(IVP) ▪ used to visualize structures and abnormalities in urinary system o cystoscopy ▪ visualizes lower urinary tract and may be used in performing a biopsy or removing kidney stones

o biopsy ▪ may be used to acquire tissue specimens to allow microscopic examination of suspicious lesions in bladder or kidney Renal calculi causes- the most common cause ; CVA testing: purpose, organ involvement, interpretation of findings (positive vs negative, associated diagnoses) urinary tract obstructions

  • older men= urinary tract obstructed by BPH or prostatic cancer
  • common causes: tumors, inflammation, scarring, stenosis, congenital defects, renal calculi
  • urolithiasis (calculi, or kidney stones) o kidney stones common and frequently recur if underlying cause not treated o patho ▪ calculi develop anywhere in urinary tract ▪ stone may be small or very large - staghorn calculus- very large stone that forms in the renal pelvis and calyces in the shape of a deer’s antlers ▪ form when there are excessive amounts of relatively insoluble salts in filtrate or when insufficient fluid intake creates a highly concentrated filtrate ▪ once any solid material or debris forms, deposits continue to build up on nidus and form a large mass - cell debris from infection may also form a nidus ▪ immobility may cause calculi bc of stasis of urine resulting in chemical changes in urine ▪ increasing fluid intake (at least 8 glasses of water/day) can assist in removing small stones ▪ stones one cause manifestations when obstruction in flow of urine in ureter ▪ calculi may lead to infection bc cause stasis of urine in area and irritate tissues - early indication of calculi ▪ if located in kidney or ureter, calculi may cause development of hydronephrosis - dilation of calyces and atrophy of renal tissue relate to back pressure of urine behind obstructing stone o etiology ▪ 75% made up of calcium salts ▪ 25% consisting of uric acid or urate, struvite (magnesium ammonium phosphate) or cystine (rare) ▪ Calculi should be examined and urinalysis completed to determine content of stone and predisposing factors ▪ Calcium stones (phosphate, oxalate or carbonate) for when calcium level in urine are high d/t hypercalcemia, parathyroid tumor or other metabolic disorders - Solubility of calcium salts and uric acid varies w/ pH of urine - Calcium salts form readily when urine is high in alkaline ▪ Inadequate fluid intake is major factor in calculus formation ▪ Calcium oxalate stones develop in ppl following vegetarian diets high in oxalate - Causing increased level of oxalate in urine ▪ Uric acid stones develop w/ hyperuricemia (d/t gout, high-purine diets, or cancer chemotherapy) and when urine is acidic o s/s ▪ stone in kidney or bladder frequently asymptomatic unless infections lead to investigation ▪ flank pain bc of distention of renal capsule ▪ obstruction of ureter causes an attack of renal colic - intense spasms of pain in flank area, radiating into groin that last until stone passes or is removed - pain is caused by vigorous contractions of ureter in an effort to force stone out o Dx o Tx

▪ N/V

▪ Cool moist skin ▪ Rapid pulse ▪ Radiologic exam confirms locations of calculi ▪ Small stones can be passed and urine strained to catch stones for analysis ▪ Fragmentation of larger stones

  • Extracorporeal shockwave lithotripsy o Uses sound waves to break up the stone
  • Laser lithotripsy o Uses a ureteroscope to locate the stone and a scope-mounted laser to destroy it
  • Percutaneous nephrolithotomy ▪ Tx of underlying condition ▪ Adjustment of urine pH by ingestion of additional acidic or alkaline substance ▪ Increased fluid intake Mechanism of action of medications diuretic drugs
  • referred to as “water pills”
  • used to remove excess sodium ions and water from body
  • increases excretion of water through kidneys and urinary output
  • reduces fluid volume in tissues (edema) and blood
  • prescribed for o HTN, edema, CHF, liver dz and pulmonary edema

▪ infections are ascending- arising from organisms in perineal area and traveling along continuous mucosa in urinary tract to bladder, then to ureters to the kidneys ▪ common causative organism: E. coli ▪ other organisms: Klebsiella, Proteus, Enterobacter, Citrobacter, Serratia, Pseudomonas, Enterococcus, coagulase-negative Staphylococcus, Chlamydia and Mycoplasma ▪ in men urethritis and prostatitis may accompany lower tract infections o etiology ▪ women more vulnerable to infection bc of shortness and width of urethra, proximity to anus and frequent irritation to tissues

  • irritation may be caused by sexual activity, baths and use of feminine hygiene
  • improper hygiene practices during defecation or menstruation also increase risk ▪ older men w/ prostatic hypertrophy and retention of urine frequently develop infections
  • any infection of prostate or testes is likely to extend to urinary structures ▪ children: congenital abnormalities common cause of infection
  • where obstructions to flow or reflex are present ▪ elderly at risk bc of tendency toward incomplete emptying, reduced fluid intake, impaired blood supply to bladder and immobility ▪ common predisposing factors:
  • incontinence w/ incomplete emptying of bladder
  • retention of urine in bladder
  • any obstruction to urine flow o results in growth of organisms bc bacteria isn’t flushed out of bladder
  • pregnancy, scar tissue, renal calculi (kidney stones) o urine and contaminants do not flow freely through and out of system
  • immunosuppression or DM (vascular impairment and glucosuria)
  • direct contamination of urethra and bladder may result from fecal incontinence
  • instruments or catheters o introduce bacteria into bladder and traumatize bladder wall, breaking barrier to infection - cystitis and urethritis o patho ▪ cystitis infection of bladder wall ▪ urethritis infection of urethra ▪ inflamed, red, swollen; sometimes ulcerated ▪ bladder wall is irritated and hyperreactive, bladder capacity is reduced o s/s ▪ some cases, manifestations are mild and may be unnoticed ▪ pain in lower abd ▪ dysuria (painful urination) ▪ urgency (need to void immediately) ▪ frequency (short intervals between voiding) ▪ nocturia (need for urination during the sleep period) ▪ system signs of infections
  • fever, malaise, nausea, leukocytosis ▪ cloudy urine w/ unusual odor ▪ urinalysis indicates bacteriuria (presence of bacteria in urine), pyuria and microscopic hematuria Pyelonephritis- pathophysiology, subjective complaints, PE findings, laboratory findings
  • pyelonephritis o patho ▪ may involve one or both kidneys ▪ infections extends from ureter into kidney, involving renal pelvis and medullary tissue (tubules and interstitial tissue) ▪ purulent exudate fill kidney pelvis and calyces and medulla is inflamed ▪ abscess and necrosis can be seen in medulla and extend through cortex to surface of capsule ▪ if severe infection, exudate con compress renal artery and vein
  • causing obstructions of urine flow to ureter ▪ bilateral obstruction= acute renal failure ▪ recurrent or chronic infection can lead to fibrous scar tissue
  • leading to loss of tubule function and hydronephrosis ▪ if severe and bilateral can cause chronic renal failure o s/s ▪ dysuria ▪ pain: dull, aching in lower back or flank area
  • results from inflammation that stretches the renal capsule ▪ system signs of infections
  • fever, malaise, nausea, leukocytosis ▪ urinalysis similar to cystitis except that urinary casts are present
  • consist of leukocytes or renal epithelial cells Occur d/t inflamed bladder wall by irritating urine

o tx ▪ antibacterial drugs

  • trimethoprim-sulfamethoxazole (Bactrim, Cotrim, Septra)
  • nitrofurantoin (furadantin)
  • cephalosporins (Keflex, duricef)
  • carbapenems (doribax)
  • amoxicillin
  • Fosfomycin  prescribed for pregnant women ▪ Increase fluid intake ▪ Essential to follow up on the course of antibx w/ urinalysis 4-6 weeks after course of meds is completed ▪ Chronic pyelonephritis causes insidious damage w/ areas of obstructive scar tissue ▪ Cranberry juice
  • Recommended as prophylactic measure
  • Tannin content reduces the capability of E. coli to adhere to bladder mucosa Week 8: Reproductive and sexual health **- Questions can include pathophysiology, health assessment (normal and abnormal), and pharmacologic treatment
  • Review required readings, course lectures, case study and learning activity. Male reproductive system- health assessment findings (normal and abnormal)** Congenital abnormalities of the penis
  • Epispadias and hypospadias o Epispadias- urethral opening on the dorsal (upper) surface of the penis, proximal to the glans ▪ If extends proximally and affects urinary sphincter, incontinence may result ▪ Infections may results from stricture at the opening ▪ Can be associated w/ exstrophy of bladder
  • Failure of abd wall to form across the midline o Hypospadias: urethral opening on the ventral (under) surface of the penis ▪ If occurs in proximal section of penis, considered more severe and may be accompanied by chordee
  • Chordee: ventral curvature of the penis ▪ Can be associated w/ cryptorchidism Surgical reconstruction (performed in stages) recommended for both to provide normal urinary flow and normal sexual function Disorders of the testes and scrotum
  • Cryptorchidism o Maldescent of the testis ▪ Occurs when one or both testes fail to descend into normal position in the scrotum during latter part of pregnancy o Tests may remain in abd cavity or discontinue the descent at some point in the inguinal canal or above the scrotum o Testis may assume abnormal position outside of scrotum- aka ectopic testis o Possible factors for Maldescent ▪ Hormonal abnormalities ▪ Short spermatic cord ▪ Small inguinal ring o If remain undescended then seminiferous tubules degenerate and spermatogenesis is impaired o Increased risk of testicular cancer in cryptorchid testes o Surgical positioning of testes in scrotum before 2 yr old is advisable
  • Hydrocele, spermatocele and varicocele o Hydrocele ▪ Occurring when excessive fluid collect in potential space between layers of tunica vaginalis ▪ May occur around one or both testes and can be distinguished by transillumination ▪ May occur as congenital defect in newborn when peritoneal fluid accumulates in scrotum
  • Fluid may be reabsorbed in time
  • Fluid may continue to escape from peritoneal cavity if proximal portion of processus vaginalis does not close off as expected after descent of testes
  • Scrotum fills w/ more fluid during day o Becoming larger and firmer
  • Fluid subsides during night ▪ Other common finding in an infant: inguinal hernia
  • Processus vaginalis remains open causing a loop of intestine that passes through the abnormal opening
  • Hernia leads to intestinal obstruction
  • Surgical repair recommended if opening remains patent or herniation persists o There’s a risk that the herniated intestinal loop may become strangulated ▪ Acquired hydrocele may result from: Scrotal injury, infection, tumor, or unknown cause
  • More common after middle age
  • Large amounts of fluid may compromised blood supply to testis o May require aspiration o Spermatocele ▪ Cyst containing fluid and sperm that develops between testis and the epididymis outside the tunica vaginalis

o dysmenorrhea ▪ painful menstruation; may be primary or secondary o primary dysmenorrhea ▪ no organic foundation and develops when ovulation commences ▪ majority of women experience some discomfort but for many the pain is sufficient to interrupt normal activities ▪ relieved after childbirth ▪ severe cramping pain related to excessive release of prostaglandin during endometrial shedding

  • prostaglandin: causes strong uterine muscle contractions and ischemia ▪ pain develops 24-48 hrs before or at onset of menses and lasts for 24-48 hrs ▪ n/v, headache and dizziness may accompany cramps ▪ relief may be afforded by
  • use of heating pad
  • exercise
  • medication (ibuprofen (advil)- an NSAID that inhibits prostaglandin synthesis)
  • alternative tx: use of oral contraceptives o lead to anovulatory cycles that are not painful o secondary dysmenorrhea ▪ results from pelvis disorders such as: endometriosis, uterine polyps or tumors, pelvis inflammatory disease (PID) o abnormal menstrual bleeding is common concerned ▪ examples of abnormal patterns
  • menorrhagia: increased amount and duration of flow
  • metrorrhagia: bleeding between cycles
  • polymenorrhea: short cycles of less than 3 weeks
  • oligomenorrhea: long cycles of more than 6 weeks ▪ cause of altered pattern is lack of ovulation
  • but may result from hormonal disorders such as thyroid abnormalities or pathologic conditions (tumors) ▪ any change in pattern is significant and should be investigated o premenstrual syndrome (PMS) ▪ condition that begins a week or so before the onset of meses and ends w/ onset of menses ▪ may cause nuisance symptoms such as
  • breat tenderness
  • wt gain
  • abd distention or bloating
  • irritability
  • emotional lability
  • sleep disturbances
  • depression
  • headache
  • fatigue
  • increased mental concentration and activity
  • lethargic ▪ more severe form is termed premenstrual dysphoric syndrome ▪ tx: tailored to person and may include hormonal therapy and use of diuretics or antidepressants PRN
  • endometriosis o presence of endometrial tissue outside the uterus on structures such as ovaries, ligaments or colon ▪ may affect distant sites (i.e. lungs) o ectopic endometrium responds to cyclic hormone variations, growing during proliferation and secretory stages of menstrual cycle and then degenerating, shedding, and bleeding o no exit point for blood and blood is irritating to tissues so local inflammation and pain result ▪ inflammation recurs w/ each cycle and eventually causes development of fibrous tissue o possible to palpate nodular tissue but confirmed by laparoscopy o fibrous tissue may cause adhesions and obstruction of involved structures (urinary bladder or colon) o when uterus pulled out of normal position and into retroversion by adhesions, infertility frequently results o fallopian tube may be blocked or ovary covered by fibrous tissue ▪ preventing mv of ovum into and through the tube causing infertility ▪ when endometrial tissue occurs on ovary a “chocolate cyst” develops
  • fibrous sac containing old brown blood o primary manifestations ▪ dysmenorrhea
  • pain may persist throughout menses and typically becomes more severe each month ▪ dyspareunia (painful intercourse)
  • may occur if vagina and supporting ligaments are affected by adhesions o cause not established o proposed mechanisms include ▪ migration of endometrial tissue up through fallopian tubes into peritoneal cavity during menstruation ▪ development from embryonic tissue at other sites

o tx ▪ spread of endometrium through the blood or lymph ▪ transplantation of tissue during sx (i.e. c-section) ▪ hormonal suppression of endometrial tissue w/ relief of pain associated w/ monthly cycle ▪ surgical removal of ectopic endometrial tissue o pregnancy and lactation also result in amenorrhea and atrophy of ectopic tissue ▪ do not cure endometriosis but delay further damage and alleviate symptoms Sexually transmitted infections- pathophysiology (including causative organism), subjective complaints, PE findings, laboratory findings, first line treatment , complications sexually transmitted diseases

  • Formerly called venereal diseases; encompass a broad range of infectious diseases that are spread by sexual contact
  • Standard STDs- Gonorrhea, syphilis, chlamydial infections- show evidence that infections (i.e. hepatitis B) may be spread by sexual contact
  • HIV is spread by both heterosexual and homosexual exchange of body fluids
  • Many concerns about STDs: o Immunity against recurrent infection is not achieved during first infection w/ many STDs; recurrent infections are common o More than 1 STD may be present at a time, careful testing and dx to uncover presence of second infection necessary o Frequently STDs are asymptomatic (especially in women) thus promoting spread of infection by persons who are unaware that they are carrying the microbes o No cure is available for viral STDs (herpes or HIV) but drugs are available to help limit acute stage of infection o Drug resistant microorganisms are becoming common, raising inherent risks associated w/ STDs o Infection may be transmitted by infected mother to fetus or newborn; resulting in congenital defects or death or disability for child o Partners of infected person are difficult to trace, notify and treat o Condoms are often not used or used improperly in high-risk situation ▪ Abuse of alcohol and used of date rape drugs have increased incidence of unprotected sex STI most associated with pelvic inflammatory disease
  • chlamydial infection- bacterial infection o considered one of most common STD o leading cause of PID o pathogen: C. trachomatis ▪ gram neg obligate intracellular parasite which requires a host cell to reproduce ▪ invade epithelial tissue of urogenital tract causing inflammation o males: becomes evident several weeks after exposure as urethritis (nongonococcal urethritis) and epididymitis ▪ manifestations of urethritis
  • dysuria, itching and whitish discharge from penis ▪ manifestations of epididymitis
  • painful, swollen scrotum, unilateral, fever , swollen inguinal lymph nodes ▪ proctitis: rectal inflammation w/ bleeding and discharge
  • may occur in anymore practicing anal intercourse o females: asymptomatic until PID develops ▪ may experience

▪ Bc how close male reproductive tract w/ urinary tract, continuous mucosa promotes spread of infection through the structures o Causes of common nonbacterial form of prostatitis and prostatodynia (painful prostate) are unknown o Patho ▪ Acute bacterial prostatitis

  • Causes tender, swollen gland; normally soft and boggy on palpation
  • Urine contains large quantities of microorganisms, pus, leukocytes
  • Expressed prostatic secretions contain many organisms confirming source of infections
  • Process may be painful and may actually spread infection or cause bacteremia ▪ Nonbacterial prostatitis
  • Indicated by large numbers of leukocytes in urine and prostatic secretions
  • Prostate gland not markedly enlarged ▪ Chronic prostatitis
  • Prostate only slightly enlarged, irregular and firm d/t fibrosis more extensive ▪ Most cases of prostatitis the urinary tract is infected and signs of dysuria, frequency and urgency occur
  • Other parts of reproductive tract (epididymis or testes) may be involved o Etiology ▪ Acute bacterial prostatitis- ascending infection (progresses up the urethra)
  • Caused primarily by E.col o But also pseudomonas, proteus, Enterobacter, klebsiella, serratia, streptococcus faecalis o s/s o tx ▪ Occurs in:
  • Young men in association w/ UTI d/t invasion by coliform bacteria from intestines
  • Older men w/ BPH
  • STDs (i.e. gonorrhea)
  • Instrumentation such as catheterization
  • Sometimes from hematogenous spread (through the blood) ▪ Chronic prostatitis: repeated infection by E.coli ▪ acute or chronic:
  • dysuria
  • urinary frequency and urgency (similar to cystitis)
  • fever and chills (acute infections)
  • low back pain or lower abd discomfort
  • severe inflammation in prostate o may cause obstruction of urinary flow, resulting in decreased urinary stream, hesitancy in initiating urination, incomplete bladder emptying and nocturia or frequency
  • fever, malaise, anorexia, muscle aching ▪ nonbacterial prostatitis
  • urinary signs are present often intermittently ▪ antibacterial drugs
  • ciprofloxacin (cipro) ▪ follow up test should confirm complete eradication ▪ nonbacterial prostatitis
  • anti-inflammatory drugs as well as prophylactic antibacterial Breast exam- health assessment findings (normal and abnormal), associated diagnoses ; Mammogram recommendations
  • Carcinoma of the breast o Common malignancy in women and a major cause of death o Patho ▪ Malignant tumors develop in upper outer quadrant of breast ▪ The central portion of breast is the next most common location ▪ Most tumors are unilateral
  • Although bilateral primary tumors may develop in some cases ▪ Different types of breast carcinomas but majority arise from cells of ductal epithelium
  • Cancer infiltrates surrounding tissue and frequently adheres to skin causing dimpling
  • Tumor becomes fixed when adheres to muscle or fascia of chest wall ▪ Malignant cells spread at an early stage; first to nearby lymph nodes ▪ Tumors in upper outer quadrant and central breast spread to axillary lymph nodes ▪ Widespread dissemination follows quickly
  • Mets to lungs, brain, bone and liver ▪ Tumor cells graded on basis of degree of differentiation or anaplasia ▪ Tumor then staged based on size of primary tumors, involvement of lymph nodes and presence of mets ▪ Presence of estrogen or progesterone receptors on tumor cell is major factor in determining how to treat individual cancer
  • i.e. tumor who is hormone dependent bc its growth is enhanced by particular hormone o etiology ▪ majority of cases occur in women >50 yr old

o s/s o dx o tx ▪ strong genetic predisposition has been supported by the identification of specific genes related to breast cancer (BRCA-1 and BRCA-2) ▪ other major factor: hormones

  • exposure to high estrogen levels o examples of exposure to estrogen include circumstances such as: long period of regular menstrual cycles (from an early menarche to late menopause), nulliparity (no children) and delay of first pregnancy ▪ other predisposing factors
  • fibrocystic disease w/ atypical hyperplasia
  • prior carcinoma in uterus or in other breast
  • exposure of chest to radiation
  • lack of exercise
  • smoking
  • high-fat diet ▪ initial sign: single, small, hard, painless nodule ▪ mass is freely moveable in early stage
  • becomes fixed in later stage ▪ dimpling of skin ▪ retraction of or discharge from nipple ▪ change in breast contour ▪ exudates from breast or fine needle ductal biopsy through the nipple ▪ Breast self-exam is recommended for all women >20 yr ▪ Mammography: routine screening tool
  • Detect lesions before become palpable or masses deep in breast tissue ▪ US and MRI: used to ID and characterize masses ▪ sx combined w/ radiation and chemo
  • lumpectomy- surgical removal of tumor involving minimal tissue loss o preferred method in stage 1 and 2
  • mastectomy may be necessary in more advanced vases ▪ strong genetic risk of recurrence woman may opt for mastectomy and breast reconstruction ▪ hormone therapy ▪ lymph node removed according to lymphatic pathway from tumor
  • number of lymph nodes removed depends on spread of tumor cells
  • removal or radiation of lymph nodes impairs lymphatic drainage from arm resulting in swelling and stiffness ▪ PT and exercise are important to maintain mobility and reduce swelling ▪ Chemo and radiation (adjuvant therapy): useful for eradicating any undetected micrometastases and used as palliative measures
  • Implant radioactive seeds in surrounding tissue after sx to provide localized radiation w/o need for daily treatment ▪ If tumor proves responsive to estrogen post-op therapy includes removal of hormonal stimulation
  • Premenopausal women ovaries are removed
  • Hormone-blocking agents: tamoxifen (nolvadex), raloxifene (evista) and toremifene (fareston) o Target estrogen receptors in tumor reduces the risk of cancer recurrence in postmenopausal women
  • Fulvestrant (faslodex)- blocks estrogen receptors on cancer cells and signals the cell to destroy the receptors ▪ Class of drugs that stop body from making estrogen after menopause includes
  • Anastrozole (arimidex)
  • Letrozole (femara)
  • Exemestane (aromasin) ▪ Other drug therapies include
  • Trastuzumab (Herceptin) and pertuzumab (Perjeta) o Block production of growth factor protein causing cancer cells to die
  • Ado-trastuzumab (kadcyla) combines Trastuzumab w/ a cell-killing drug
  • Lapatinib (tykerb) o Targets growth factor protein and can be used in combination w/ chemo
  • Palbociclib (ibrance) o Used in women w/ advanced hormone receptor- positive breast cancer
  • Everolimus (afinitor) o Targets a pathway that plays a role in growth of cancer cells o Used in combination w/ exemestane in women w/ advanced breast cancer
  • Stage 3 or stage 4: received bevacizumab (avastin) o Reduce growth of blood vessels in secondary tumors