Medical-surgical Nursing Demystified

(Sean Pound) #1

CHAPTER 9 Genitourinary System^385



  • Urinary frequency—need to urinate frequently due to pressure on bladder

  • Urinary urgency—need to get to bathroom quickly to urinate due to pressure
    on bladder

  • Nocturia—need to get up at night to urinate due to pressure on bladder

  • Decrease in force of urinary stream

  • Intermittent stream of urination

  • Hematuria

  • Palpable nodule on digital rectal examination

  • Urinary retention due to enlargement of the tumor, blocking flow of urine

  • Back pain due to metastasis


INTERPRETING TEST RESULTS



  • PSA elevates as tumor size increases.

  • Digital rectal exam may reveal nodule.

  • Transrectal ultrasound used to identify prostate cancer and determine the stage.

  • MRI to identify prostate lesions and involvement of surrounding tissue or
    lymph nodes.

  • Biopsy to identify cell type.

  • Alkaline phosphatase elevates with metastasis to bone.


TREATMENT



  • Radiation therapy:

  • External beam.

  • Brachytherapy—insertion of radioactive substance into prostate.

  • Surgery—radical prostatectomy.

  • Chemotherapy.

  • Cryosurgery—freezing of tissue with ultrasound guidance.

  • Watchful waiting—monitoring PSA and ultrasound depending on patient’s
    age and cell type of cancer and any comorbidities.

  • Hormonal treatment to suppress natural androgen production:

  • leuprolide

  • goserelin

  • estrogen

  • Orchiectomy to reduce natural androgen production.

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