Study Guide for RCUN Finals
Repro
Cryptorchidism - 1 or both testes fail to descend into scrotum, orchiopexy (performed 1-2 years of age),
testicular self exam (monthly, when warm in shower), & cause is unknown.
BPH - not cancer, older men, slow growing, & 1 in 4 men get it. S/S: frequency, hesitancy, urgency,
retention (overflow and stores in bladder-infection), & nephrosis (BUN & Cr). Dx: urinalysis, PSA (to
monitor after sx or rx therapy for prostate CA to see if it back & N range: 1.0-1.5ng/mL), BUN (N
range: 10-20), & Cr (N range: 0.5-1.5). Sx: TURP, TUIP. Tx: drugs (blocker-hytrin & flomax. Check:
BP) and hormonal (avodart). Female ⍉ touch.
TURP / CBI - TURP: through the urethra cut down. Why? Enlarge outlet. Pre Op - consent, NPO, labs,
meds, & bowel prep (laxative & enema). Intra op: anesthesia/scope, 3 way catheter. Post op: VS,
catheter management, pain management (spasms & B/O-belladonna/opium), catheter removed
(dribbling), monitor bleeding, retro (ejaculate), & ED. CBI: continuous bladder irrigation. Flush. Why?
Maintain patency & decrease blood clots. Nsg care: monitor color/output, fluid (record I/O), no heavy
lifting, & VS. Cx: infection & fluid imbalance (hyponatremia), fluid overload, & check. B/O-spasms.
Prostatitis, orchitis - Prostatitis: inflammation of prostate gland, caused by microorganisms. S/S:
glandular swelling, tenderness, perineal pain, discomfort, low back pain, fever, chills, dysuria, urethral
discharge. Tx: up to 30 days of ATB therapy, mild analgesics, & sitz bath. Sexual partners should be
treated, avoid caffeine, & avoid prolonged sitting. Orchitis: inflammation of testis, extension of
infectious agent, orchitis w/o epididymal involvement is
associated w/ viral mumps infection that occurs after puberty & may result in testicular atrophy &
sterility. S/S: pain, swelling, fever & chills w/ bacterial infection, urine contains pus & bacteria, & skin is
red & tense. Tx: bed rest, analgesics, cold application, & antiinflammatory’s.
Erectile dysfunction / priapism - ED: can’t go up, can’t stay up, come down too early, & not long enough.
Risk: DM, alcohol, hormonal performance, & anxiety. Dx: nocturnal tumescence test. Med Mgt: drug
(viagra, cialis, & uprima). Vacuum & implant. Priapism: can’t come down. Risk S/E: viagra & thickened
blood (sickle cell)S/S: pain >4 hours. Tx: vasoconstrictor, needle aspiration, & chop.
Cancer – cervical, breast, ovarian - Cervical: affects lower portion of uterus, 2nd MC malignancy,
mothers w/ DES, early sex, multiple sex partners, getting genital infections (HPV), pelvic rx, smoking,
chronic cervicitis, early menarche, late menopause, nulliparity, & obesity. S/S: bleeding (MC & 1st),
spotting (earliest too), pain, & symptoms of pressure on B/B Dx: exam, pap test, biopsy, rx, CT, MRI
(metastasis), barium study or IVP (B/B metastasis). Med and Sx Mgt: Rx, hysterectomy, chemo, &
uterus may be removed. Nsg Mgt: vaccine against HPV (11-26 y/o), regular exams, pap tests, emotional
support, & cytologic exams ↑ potential for early dx before invasion occurs. Ovarian: nonspecific
symptoms, heredity, more ovulation more risk, nulliparous, family hx, & dx’s of other ca. S/S: vague
lower abd. discomfort, urinary frequency, urgency, weight loss, severe pain, GI symptoms, & mass felt.
Dx: U/S, & tumor marker blood test, CA 125. Labs to be ordered: CA 125, alpha fetoprotein, & CEA. A
+ dx is made by microscopic examination. Breast: cancerous cells, malignant, F>50, 1:8 women, 1:50
men. Rx, alcohol, >estrogen, family hx, (↑ risk-early menarche, late menopause, & no babies). Dx:
mammography q2yrs, MRI (gene BRCA 1 & 2), & biopsy (confirms), Prevention: long term F/U,
bilateral prophylactic, tamoxifen therapy, mastectomy, & NSAIDs. S/S: bloody nipple discharge, orange
peel, dimpling, & visible breast different size. Med Mgt: rx & chemo. Cx: metastasis, lymphedema, &
emotional stress.
Fibroadenoma, fibrocystic breast disease - Fibroadenoma: benign breast mass, 1 place, younger women,
teenage, ↑ pregnancy, & gone at menopause. S/S: painless tender mass & unequal breasts. Dx: U/S,
digital mammography, & biopsy to confirm malignancy. Med Mgt: incisional biopsy. Patient teaching:
BSE. Fibrocystic: fluid filled cyst, movable, single or many, 30-50 F’s (middle age), hormonal (change in
menstruation), resolves w/ menopause. S/S: asymptomatic, movable nodules, & breast pain. Med Mgt:
analgesics, OCP, cold application, & ⍉ caffeine.
Mastectomy - removal of the entire breast tissue, chest muscle (pectoralis minor & pectoralis major),
neighboring lymph nodes. Lumpectomy: only if tumor is removed. Subcutaneous: all breast tissue is
removed, but skin & nipple remain intact. Modified radical: pectoralis minor. Radical: pectoralis major.
Post op: elevate arm on pillow, ✓ VS, ✓ dressing, & ✓ underneath too (bleeding). Infection S/S:
lymphedema. BSE. ⍉: abduction, BP, injections, blood draw, & IV’s. Exercise: wall climbing, rope
turning, pulley tugging, broomstick, & combing hair. Start ASAP-post op day 1 or 2.
TSS - AKA septic shock = bacterial infections (strep/staph). ↑ HR, ↑ T, ↓ BP. S/S: ↑ fever, chills, pain in
muscle, and hypotension. Risk factors: menstruating or non menstruating, OCP, tampons-supersize. Dx:
C/S (blood & urine), ↑ AST, ↑ ALT, ↑ BUN, ↑ bilirubin, ↓ platelets. Nsg Mgt: no tampon overnight (use
perineal pads), ✓ VS, hygiene/no douching, & monitor I/O. Med Mgt: IVF, ATB, analgesics, O2,
dopamine IV (↑ perfusion), dobutamine, & contact isolation.
Menorrhagia - excessive bleeding during menstruation, lasts more than 7 days, can be caused by
endocrine, coagulation, or systemic disorders. Symptomatic relief is accomplished w/ NSAIDs,
progestins, & hormonal contraceptives w/ combinations of progesterone & estrogen. D&C is done for
symptomatic relief. Endometrial ablation (detachment of lining of uterus) by photodynamic therapy or
uterine balloon therapy is a potential nonsurgical alternative. Photodynamic therapy used: light
sensitive substance applied to endometrial tissue, laser probe inserted through cervix, the laser light
causes sloughing of endometrium. Uterine balloon therapy used: balloon into uterus, balloon filled w/
isotonic saline solution, & heating solution to 87° for 8 minutes.
Endometriosis - tissue similar to lining of endometrium is found outside of the uterus. Cause: retrograde
menopause, tissue bleeds when shed but there is no outlet for it and the trapped blood causes pain then
adhesions, chocolate cyst develops. S/S: dysmenorrhea, pain on defecation, dyspareunia, & severe
abdominal pain due to rupture of chocolate cyst. Dx: pelvic exam, tender areas in lower pelvis &
laparoscopy confirms dx. Med and Sx Mgt: natural or sx menopause, estrogen progestin contraceptives
(to keep in nonbleeding phase of MC for 9 months), progestin (norethindrone) & synthetic androgen
danazol, removal of cyst, laparoscopy, & panhysterectomy (removal of uterus, both fallopian tubes, &
ovaries).
Communicable Diseases
Chlamydia, Gonorrhea, Syphilis - chlamydia: spread by genital contact, sexual intercourse. Untreated
can cause sterility in women. Autoinoculation-spread to eyes. S/S: urethral discharge, redness/irritation
of tissue, burning on urination, low abd. pain in women, testicular pain in men. Nucleic acid amplification
testing is most superior method for dx. Med Mgt: antimicrobials (azithromycin, doxycycline). Nsg mgt:
dental dam, advocating for sexual absence. Gonorrhea: 15-24 y/o, many women are asymptomatic,
transmitted by bacteria, microorganism invades urethra, vagina, rectum or pharynx. S/S: in men 2-6 days
after infection, urethritis w/ purulent discharge, pain on urination, most women have no s/s if yes
white/yellow discharge, intermenstrual bleeding. Dx: specimen of drainage, NAAT, & cultured
specimens. Syphilis: curable if treated early, 3 stages: 1. chancre, 2. rash, 3. tabes dorsalis. Med mgt:
single dose of Pen. G for 1st and 2nd stage. Three does for 3rd stage for 10-14 days.
Herpes / HPV - Herpes: associated w/ cold sores, anogenital sores, direct contact w/ oral or genital
secretions, by sexual contact, vesicles on penis, painful ulcers. Med mgt: acyclovir. HPV: factors that
contribute - casual sex w/ unknown partners, sex w/ high risk partners, more than 1 partner, & failure to
use contraceptives.
Childhood vaccination schedule
Types of immunity
Needlestick injury - report, document, identify person or source of blood, obtain HIV statuses of blood,
obtain counseling, receive most appropriate post exposure prophylaxis, & be tested for disease antibodies.
Natural body defenses
Transmission precaution - airborne: measles, TB, CP, SARS, HZ (shingles) (mask rest PRN, negative
pressure room, simple mask for patient in hall, private room). Droplet: I, S, P, P, M, M, R, R, R (mask
rest PRN, private room or shared, door may be open). Contact: M, L, S, C, C, H, W, E, R, I
(gown/gloves rest PRN, private or similar room, must be continent). Contact plus: C. diff, norovirus
(gown/gloves rest PRN, private room private or similar room, must be continent).
Urinary
Renal failure - Acute: sudden, rapid ↓ in renal fc, reversible w/ early tx, 4 phases (onset-reduced blood
flow), oliguric (<urinary volume occurs w/ in 48 hrs), diuretic (↑ water excretion, waste & electrolyte
secretions impaired: BUN, Cr, P, K-↑ in blood). Risk: hypovolemia/dehydration. Output <500 mL/day,
retention (K, Cr). N recovery 3-12 months or longer. ↑ GFR, decline BUN. (S/S - urinary change
(1.010-1.025) & osmolality, fluid volume excess (edema, HTN, CHF), metabolic acidosis-hydrogen ions
build up, bicarb used up-cause lethargy & stupor. Na+ may not be conserved by the kidneys. K+ excess ↑
putting heart at risk. Anemia (hematopoietic fc ↓, altered WBC levels-infection, Ca & deficit. Neurologic
disorders: symptoms of fatigue, difficulty concentrating, seizures, stupor, coma occur & condition
worsens. Diet: ↓ Na, ↓ K, ↓ P, ↑ Ca, ↑ calories, & fluid restriction. Chronic: Risk factors: DM, ↑ BP,
anemia, bone problems, fluid retention, autoimmune (lupus), GFR N: 90 mL/min or ↑. Stages: 1. 90 or ↑,
2. 60-89 mild ↓ renal fc, 3. 30-59 moderate renal insufficiency, 4. 15-29 severe renal insufficiency, 5. <15
kidney failure ESRD. S/S - puffy face, skin pale, GI (bleeding,ulceration), oral mucous membrane bleed,
blood in feces, vague symptoms: lethargy, H/A, anorexia, dry mouth. Pruritus, dry skin, muscle cramp,
bone pain (Ca ↓), tenderness, edema, fatigue, daily weight, ↓ fluids.
Hemodialysis / peritoneal dialysis - Hemodialysis: transporting blood from patient to dialyzer, H2O &
wastes (K, Cr, P, urea) from blood move into dialysate fluid that flows around fibers but not RBC &
protein, cycle takes 4-6 hours. Advantage: rapid removal of solutes & H2O, less time, no risk for
peritonitis, personnel performs procedure. Disadvantage: bulge from fistula or graft is obvious, risk for
infection, ↓ BP, disequilibrium syndrome (neurological condition believed to be caused by cerebral
edema), & strict fluid/dietary restrictions. Nsg Mgt: monitor wt, obtain labs from dialysis center, thrill &
bruit, note color of skin, avoid use of same puncture site, no injections for 2-4 hrs, hold meds/give after,
avoid heavy lifting, & wear loose clothing. May experience: SOB, dizziness, tachycardia, & diaphoresis.
Perineal: peritoneum-semipermeable membrane. Dialysate = ↑ dextrose same as blood plasma.
Diffusion = dialysate low concentration drawing, w/ higher concentration (fluid, waste, chemicals). 1.
Continuous ambulatory PD: 200 mL, 30-40 mins of dialysate, dwell time 4-10 hrs, lower bag fluid flows
by gravity. 2. Automated PD: machine instills, drains for about 3-4 times in 10-12 hrs HS. Drain: clear
fluid (report-cloudy, blood tinged), measure I/O, & if excruciating pain inform Dr. & hold next tx. Cx:
peritonitis (fever, N/V, rigidity, & glucose should pain due to glucose). Record: vitals, volume, meds. ⍉:
warm in microwave, use expired cloudy dialysate, & scissors to cut bandage/dressing. Clean cath.
insertion site, use sterile technique (gloves, mask, private room), follow dwell time. ↑ protein intake.
AV graft, AV fistula - AV fistula: artery & vein join, lasts longer, patency, 1-4 months to mature before
use. Mgt: assess VS, wt. pt. before and after, obtain labs (All from dialysis center). Inspect skin over
fistula to prevent infection, palpate for thrill, listen for bruit, ✓ color of skin, clean skin w/ soap & water,
avoid puncturing same site, & after dialysis don’t administer injection for 2-4 hrs. AV graft: plastic graft,
lasts less, 14 days can use, clogged easily, 3-5 years, bleeding issue. Client teaching: avoid lifting heavy
materials, loose clothing, do not sleep on that arm, no BP, keep skin clean, & assess bruit & thrill.
Cancer – bladder, kidney - Bladder: more men, 55 y/o, smoking, exposure to environmental carcinogens,
bladder stones, insufficient intake of fluids, rx, chemo, high urine ph. MC type is transitional cell
carcinoma or urothelial carcinoma. S/S: 1st MC is painless hematuria, change in urine color (may be on &
off), s/s of UTI, pelvic low back pain, wt. loss, weakness, bone pain, swelling in feet. Cystoscope exam,
biopsy, blue light fluorescence cystoscopy, retrograde pyelogram, CT, MRI, x ray, U/S. Med Mgt:
TURBT, fulguration, intravesical injection of bacillus, rx, photodynamic therapy.
Kidney transplant - medical procedure where a kidney is transplanted into a person w/ kidney failure.
Also effective tx for pt. w/ ESRD. Must be matched. Nsg Mgt pre op: avoid blood thinners including
aspirin prior to sx, medical hx, & look for suitable donor. Post op: ✓ VS, ✓ sx incision for infection,
kidney function monitoring, follow up visits, diet & lifestyle modifications, ✓ I/O, stay home/reverse
isolation, infection prevention, & emotional support. S/S of kidney transplant rejection: SOB, HTN,
oliguria, fever, abd. pain, swelling over transplanted kidney, wt gain, & ↑ serum Cr. 3 kidneys in abd. old
kidney not removed unless ↑ HTN. Med Mgt: basiliximab, azathioprine, corticosteroids, tacrolimus
mycophenolate, & sirolimus. S/E of these = ↑ risk for infection, must be taken daily.
Nephrectomy, urinary diversion
Types of urinary incontinence
Bladder retraining
Urinalysis
UTI
Acute / chronic glomerulonephritis, pyelonephritis
Nervous
Thrombolytic or Hemorrhagic stroke
Concussion, contusion
Migraine headaches, aneurysm
Seizures, meningitis, Guillain-Barre
Parkinson’s, Multiple Sclerosis, Myasthenia
SCI – quadriplegic or paraplegic
Craniotomy, craniectomy - craniotomy: sx procedure where skull is opened. Craniectomy: sx procedure
where a portion of cranial bone is removed.
Skull fracture
Hematomas
IICP
Sensory
Macular degeneration, glaucoma, cataract - Macular degeneration: is damage to the macula and usually
both eyes. Causes: aging, injury, & hemorrhage. 2 types - dry (deterioration of macula) & wet (swelling
d/t leaky BV around macula. 1st symptom - blurred vision/distorted vision. S/S: color vision disturbance,
difficulty reading, if the macula is irreparably damaged bulls eye area is absent (loss of central image),
peripheral vision is usually okay, clients can’t see by looking at images directly, turn head to side. Dx:
angio of eye. Med Mgt: laser (in early stages), magnifying glasses, & high intensity reading lamps. Nsg
Mgt: assist w/ ADL’s, assist w/ coping, & when walking turn head side to side. Glaucoma: 2nd MC
cause of blindness, d/t imbalance b/n production and drainage of aqueous fluid, when drainage is
obstructed = rising IOP (N: 10-21 mmHG), OAG: MC, CAG: LC, normal tension – IOP N but optic
nerve damage and loss of vision still occur, congenital, >40 y.o, family hx., DM, & high in AA, & 2ndary
(steroids, eye infections trauma). OAG: slow onset, degeneration & obstruction at trabecular network, &
increase IOP. CAG: sudden/acute onset, at narrowed junction where iris meets cornea, & attacks where
iris thicken w/ mydriatic drugs or pupil dilation in dark room. S/S: eye discomfort, blurry vision, halos,
decreased peripheral vision, feeling prescription glasses need to be changed. If closed angle: rock hard
eyes, pain, loss of vision,emergency, red conjunctiva, & corneal becomes cloudy. Med Mgt: mitotics
(carbachol, pilocarpine), to decrease IOP (timolol, echothiophate, epinephrine, dipivefrin), carbonic
anhydrase inhibitors (acetazolamide, methazolamide). Sx: laser iridotomy (hole in iris), laser
trabeculoplasty, corneal trephine (hole b/n cornea & sclera). Nsg Mgt: acute is an emergency, analgesics,
decrease noise/activity, never give mydriatics (atropine-dilates pupils), & stress glaucoma has no cure but
can be controlled. are cloudy opacity of lenses. Causes: congenital/familial tendency, trauma, aging
process, increase incidence in DM, UV rays/Rx, & steroids. S/S (earliest): halo sign around lights,
difficulty in reading, change in color vision, increase glaring, & distortion of objects. S/S (late): client can
only read the largest letter on the Snellen chart. White/gray spot visible behind pupil. Dx: slit lamp and
tonometry (pressure in eye). Sx: removal of cataract and done in an outpatient under LA. After sx: A eye glasses (eyes w/o lens cause client to see objects ⅓ larger than N, must use 1 eye to avoid seeing
distorted image, common to see coating applied to 1 side of eye glasses so only operated eye w/ corrective
lens is used), B - intraocular lens (MC & best). C - contact lenses (removed at night, cleaned, reinserted
daily, peripheral vision is not lost & objects appear abt actual size. Cx after cataract sx - infection,
hemorrhage, retinal detachment, & clouding of lens. Nsg. Mgt (teach) - avoid coughing, sneezing, heavy
lifting, patch OU, no lying on operative eye, administer stool softener, & wear sunglasses when going out.
Refractive errors - vision is impaired, blurred vision, recurrent H/A. Dx: snellen chart, jaeger chart,
retinoscopy, ishihara plates, tonometry. Med mgt: eyeglasses, (convex-to correct farsightedness &
concave-to correct nearsightedness), contact lenses (contraindicated in clients w/ eye infection, low tear
production, allergic reactions. Sx: keratotomy (LA, not always successful, Cx: infection, ↑ glare,
worsening of vision). Nsg mgt: perform screening exam.
Hearing loss, hearing aids
Trigeminal neuralgia - painful condition that involves 5th CN, mandibular, maxillary, ophthalmic.
Compression of nerve root. S/S: nerve pain, severe burning, several seconds to minutes, during a spasm
face twitches and eyes tear. Dx: MRI & CT. Med mgt: opioids, phenytoin, carbamazepine.
Otitis media - acute inflammation of the middle ear, usually unilaterally, serous-collection of pathogen
free fluid being tympanic membrane, purulent from spread of microorganisms from eustachian tube to
middle ear, fluid or pus increases pain, diminished hearing, pressure in middle ear, tympanic membrane
look red. Med mgt: tympanectomy, myringotomy (incisional opening of tympanic membrane),
myringoplasty (repairing perforated tympanic membrane), mastoidectomy (remove diseased tissue).
Meniere’s disease - increase production of fluid in the ear. Cause: unknown. Possible causes: infection,
trauma, migraine H/A, allergies, & heredity. Commonly unilateral: middle aged men and women but
sometimes also in children. S/S: triad of hearing loss, vertigo, tinnitus (H-T-V). Other S/S: nystagmus,
H/A ear fullness. Dx: caloric test, CT, audiometry.