NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders
NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders
NURS 6501 Knowledge Check Women’s and Men’s Health, Infections, and Hematologic Disorders
The case study concerns a 60-year-old man with complaints of urinary frequency and incontinence that started after having chemo and radiotherapy three years ago to treat prostate cancer. The patient is more worried about his low back and hip pain that started roughly one month ago, which he thought was caused by lifting heavy boxes. Lab results show a normal urinalysis and CBC, and PSA of 7.2. The prostate is enlarged and nodular on DRE. The purpose of this assignment is to discuss prostatitis as it relates to the patient case.
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Why prostatitis and infection happen and causes of a systemic reaction.
Prostatitis occurs due to inflammation of the prostate gland. Bacterial prostatitis mainly occurs with urethritis or a lower urinary tract infection (UTI). It is commonly caused by Enterobacter, Escherichia coli, Group D streptococci, and Proteus (Pirola et al., 2019). The microbes reach the prostate through the urethra or bloodstream. The patient presents with symptoms of chronic bacterial prostatitis like urinary frequency and incontinence. This could have been caused by the inoculation of bacteria during therapy or microorganisms from a lower UTI spreading to the prostate (Pirola et al., 2019).
Furthermore, chronic prostatitis manifests with pain in and around the penis, testicles, anal area, lower abdomen, and lower back. It also presents with an enlarged or tender prostate on digital rectal examination (DRE). Therefore, the patient’s low back and hip pain, as well as findings of an enlarged, nodular prostate, can be pointed to chronic prostatitis.
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Benign prostatic hyperplasia (BPH) is a risk factor for prostatitis. The patient’s history of prostate cancer can be attributed to chronic bacterial prostatitis. The bacteria may have been inoculated to the prostate during the chemotherapy and radiotherapy. The patient has an elevated PSA level of 7.2 and an enlarged nodular prostate, which can be attributed to prostate cancer (McCance & Huether, 2019). Local clinical manifestations of prostate cancer include lower urinary tract symptoms, hematuria, hematospermia, erectile dysfunction, and urinary retention. The patient’s urinary frequency and incontinence can further be attributed to the current prostate cancer.
The patient’s mild degenerative changes in the spine and cystic mass near the spine can be due to metastatic spinal cord compression (MSCC). MSCC occurs when cancer cells spread from the prostate and grow in or near the spine, pressing on the spinal cord (Patnaik et al., 2020). A systemic reaction occurs in a patient with prostatitis when the causative organisms enter the circulation through the lymphatic or blood system and cause infection to other body organs. This results in systemic symptoms like fever, chills, malaise, tachycardia, tachypnea, and myalgia.
Conclusion
The patient has symptoms consistent with chronic bacterial prostatitis, like urinary frequency and incontinence. Chemotherapy may have caused prostatitis when pathogens are inoculated into the bladder. Besides, the patient has symptoms consistent with prostate cancer, like an enlarged, nodular prostate and elevated PSA levels. The degenerative changes and cystic mass near the spine are likely due to the spread of cancer cells from the prostate. A systemic reaction can occur when causative organisms migrate from the prostate to the circulation.
References
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier
Patnaik, S., Turner, J., Inaparthy, P., & Kieffer, W. K. (2020). Metastatic spinal cord compression. British journal of hospital medicine (London, England : 2005), 81(4), 1–10. https://doi.org/10.12968/hmed.2019.0399
Pirola, G. M., Verdacchi, T., Rosadi, S., Annino, F., & De Angelis, M. (2019). Chronic prostatitis: current treatment options. Research and reports in urology, 11, 165–174. https://doi.org/10.2147/RRU.S194679
NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders
What antibiotics have dietary precautions?
Links to an external site. are a type of medication used to treat bacterial infections. They work by stopping the infection or preventing it from spreading. There are many different types of antibiotics. Some are broad-spectrum, meaning they act on various disease-causing bacteria. Others are designed to kill certain species of bacteria. While many foods are beneficial during and after antibiotics, some should be avoided. Some antibiotics require specific dietary precautions to ensure their effectiveness and prevent interactions or side effects(Huizen, 2021). The following are some common antibiotics and their dietary precautions.
Tetracyclines (e.g., doxycycline, minocycline): These antibiotics should not be taken with dairy products (milk, cheese, yogurt) or antacids containing calcium, magnesium, aluminum, or iron. These substances can bind to tetracyclines, reducing their absorption and effectiveness. Take tetracyclines at least 1-2 hours before or 4-6 hours after consuming dairy products or antacids.
Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Avoid taking fluoroquinolones with dairy products, calcium-fortified foods, or mineral supplements (calcium, magnesium, zinc) as they can reduce the absorption of the antibiotic. Take these medications at least 2 hours before or 6 hours after consuming such products.
Macrolides (e.g., erythromycin, clarithromycin, azithromycin): Macrolides should generally be taken on an empty stomach, about 1 hour before or 2 hours after meals. However, some forms of macrolides, such as azithromycin, can be taken with or without food.
Linezolid: Avoid foods rich in tyramine while taking linezolid. Tyramine-rich foods include aged cheeses, cured meats, fermented, or pickled foods, soy products, and alcoholic beverages. Linezolid can interact with tyramine and lead to a potentially dangerous increase in blood pressure.
Metronidazole: Alcohol should be avoided while taking metronidazole and for at least 72 hours after completing the course of the antibiotic. Combining alcohol and metronidazole can cause severe nausea, vomiting, and flushing.
Sulfonamides (e.g., sulfamethoxazole/trimethoprim)
Cephalosporins: Cephalosporins generally are not associated with significant dietary restrictions, but it’s always best to follow the specific instructions your healthcare provider or pharmacist gives.
Patients should always read the medication label and follow the instructions provided by their healthcare provider or pharmacist.
What antibiotics cause photosensitivity?
Certain antibiotics can cause photosensitivity, a condition in which the skin becomes more sensitive to sunlight and may result in an exaggerated sunburn-like reaction. Exposure to sunlight while taking these antibiotics can lead to skin rash, redness, itching, and even blistering. The following antibiotics are known to cause photosensitivity:
Tetracyclines (e.g., doxycycline, minocycline):
Tetracyclines are well-known for causing photosensitivity reactions. If you are prescribed a tetracycline antibiotic, taking precautions and avoiding excessive sun exposure is essential. Wearing protective clothing, using sunscreen with high SPF, and staying out of direct sunlight during peak hours can help reduce the risk of photosensitivity reactions.
Fluoroquinolones (e.g., ciprofloxacin, levofloxacin): Some fluoroquinolone antibiotics have been associated with photosensitivity reactions. Protecting your skin from excessive sunlight is essential when taking antibiotics like tetracyclines.
Sulfonamides (e.g., sulfamethoxazole/trimethoprim)
Macrolides (e.g., erythromycin, clarithromycin): While macrolides are not as strongly associated with photosensitivity as tetracyclines and fluoroquinolones, some cases of photosensitivity have been reported with these antibiotics.
Doxycycline and Retinoids Combination: It’s worth noting that taking doxycycline along with certain retinoids used for acne treatment can increase the risk of photosensitivity.
Use sunscreen with a high sun protection factor (SPF), wear protective clothing like hats and long sleeves, and seek shade to minimize the risk of photosensitivity reactions. Educate patients to Contact healthcare providers for guidance if they experience skin changes or reactions while on antibiotics (Kowalska et al., 2021)
What patient counseling would you provide?
Doctors provide patient counseling when prescribing antibiotics to ensure safe and effective medication use. Here are some common points that a doctor may cover during antibiotic counseling:
Indication: Explain the reason for prescribing the antibiotic. Discuss the specific infection or condition it is meant to treat.
Dosage and Schedule: Provide clear instructions on how and when to take the antibiotic. Emphasize the importance of taking the medication as prescribed and completing the full course, even if the patient feels better before finishing.
Administration: Instruct the patient on whether to take the antibiotic with or without food and if any specific dietary restrictions or precautions are necessary.
Potential Side Effects: Discuss common side effects of the antibiotic and what to do if they occur. Also, inform the patient about severe or rare side effects requiring immediate medical attention.
Allergies and Adverse Reactions: Ask the patient about known allergies to antibiotics or other medications. Inform them of possible allergic reactions and what to do in case of an adverse reaction.
Drug Interactions: Inform the patient about any potential drug interactions with the prescribed antibiotic and other medications they may be taking. This includes over-the-counter medications, herbal supplements, and recreational drugs.
Photosensitivity (if applicable): If the antibiotic is known to cause photosensitivity, advise the patient to protect their skin from sunlight and ultraviolet (UV) light exposure.
Pregnancy and Breastfeeding: If the patient is pregnant or breastfeeding, discuss the safety of the antibiotic and whether there are any potential risks.
Storage: Provide instructions on how to store the antibiotic properly, including temperature requirements and keeping it out of reach of children.
Missed Doses: Advise the patient on what to do if they miss a dose. It’s essential to avoid doubling up on doses but to take the next scheduled dose and continue the course as prescribed.
Follow-Up: Schedule a follow-up appointment to assess the patient’s progress and ensure the treatment works effectively.
Reference
Huizen, J. (2021, December 17). What are the side effects of antibiotics? https://www.medicalnewstoday.
Kowalska, J., Rok, J., Rzepka, Z., & Wrześniok, D. (2021). Drug-Induced Photosensitivity—From light and chemistry to biological reactions and clinical symptoms. Pharmaceuticals, 14(8), 723. https://doi.org/10.3390/
NYSDOH NY. (2016, October 28). Educating patients about antibiotic use [Video]. YouTube. https://www.youtube.com/watch?
Question 1
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Scenario 1: Polycystic Ovarian Syndrome (PCOS) A 29-year-old female presents to the clinic with a complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 11 years of age. She began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted. Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management. Question 1. What is the pathogenesis of PCOS? |
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Question 2
4 out of 4 points
Scenario 1: Polycystic Ovarian Syndrome (PCOS) A 29-year-old female presents to the clinic with a complaint of hirsutism and irregular menses. She describes irregular and infrequent menses (five or six per year) since menarche at 11 years of age. She began to develop dark, coarse facial hair when she was 13 years of age, but her parents did not seek treatment or medical opinion at that time. The symptoms worsened after she gained weight in college. She got married 3 years ago and has been trying to get pregnant for the last 2 years without success. Height 66 inches and weight 198. BMI 32 kg.m2. Moderate hirsutism without virilization noted. - Laboratory data reveal CMP within normal limits (WNL), CBC with manual differential (WNL), TSH 0.9 IU/L SI units (normal 0.4-4.0 IU/L SI units), a total testosterone of 65 ng/dl (normal 2.4-47 ng/dl), and glycated hemoglobin level of 6.1% (normal value ≤5.6%). Based on this information, the APRN diagnoses the patient with polycystic ovarian syndrome (PCOS) and refers her to the Women’s Health APRN for further workup and management. Question How does PCOS affect a woman’s fertility or infertility? Selected Answer: PCOS is the leading cause of infertility in women (McCance & Huether, 2019). Infertility results from alterations in androgen production, follicular disturbances, and an absence of ovulation. In other words, PCOS negatively impacts fertility because women with the condition do not ovulate or release an egg each month due to an overproduction of estrogen by the ovaries. Correct Answer:
Ovulation problems are usually the primary cause of infertility in women with PCOS. Ovulation may not occur due to an increase in testosterone production or © 2020 Walden University 2 because follicles on the ovaries do not mature. Due to unbalanced hormones, ovulation and menstruation can be irregular. A hyperandrogenic state is a cardinal feature in the pathogenesis of PCOS. Excessive androgens affect follicular growth, and insulin affects follicular decline by suppressing apoptosis and enabling follicle to persist. There is dysfunction in ovarian follicle development. Inappropriate gonadotropin secretion triggers the beginning of a vicious cycle that perpetuates anovulation Response Feedback: [None Given] - Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS: NURS 6501 Knowledge Check: Women’s and Men’s Health, Infections, and Hematologic Disorders
Question 3
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Scenario 2: Pelvic Inflammatory Disease (PID) A 30-year-old female comes to the clinic with a complaint of abdominal pain, foul smelling vaginal discharge, and fever and chills for the past 5 days. She denies nausea, vomiting, or difficulties with bowels. Last bowel movement this morning and was normal for her. Nothing has helped with the pain despite taking ibuprofen 200 mg orally several times a day. She describes the pain as sharp and localizes the pain to her lower abdomen. Past medical history noncontributory. GYN/Social history + for having had unprotected sex while at a fraternity party. Physical exam: thin, Ill appearing anxious looking white female who is moving around on the exam table and unable to find a comfortable position. Temperature 101.6F orally, pulse 120, respirations 22 an | ||||