NRNP 6531 FINAL EXAM STUDY GUIDE - Walden University

NRNP 6531 FINAL EXAM STUDY GUIDE 1. Testicular torsion Definition: Testicular torsion - obstruction of blood flow to the testes because of a twisting of the arteries and veins in the spermatic cord resulting in occlusion of blood flow. Occurs in 12-18 year olds. Usually unilateral, effecting the left testis. Two types: extravaginal and intravaginal. Extravaginal (rare, seen in neonates)- twisting of the spermatic cord, testis, and process vaginalis; intravaginal (seen in adolescents)- failure of the testis to adhere to the scrotal wall, creating a “bell clapper deformity.” Different from torsion of the appendix testis. Presenting Symptoms: sudden in onset, extremely painful, and may awaken the patient from sleep or be trauma induced. Testicular pain, experience abdominal pain, nausea, and vomiting; 25% of patients have a fever. Clinical manifestations-testicle that rides high in the scrotum and an absent cremasteric reflex on examination 3 Differential Diagnoses: testicular appendix torsion, epididymitis, epididymo-orchitis, hydrocele Pattern Recognition: Most common in the left hemiscrotum. Scrotal edema and erythema may be seen. The affected side may have a higher position as a result of rotation. The spermatic cord is swollen and extremely tender, the epididymis may be felt anteriorly, and the majority of patients will have an absent cremasteric reflex. In some instances a small area of cyanosis (blue dot sign) may be present on the scrotal skin and indicates torsion of the appendix testis. Treatment options: Surgical consultation with surgical exploration – needs to occur in 6 hours. Review questions: 1. A 24-year-old man presents with sudden onset of left-sided scrotal pain. He reports having intermittent unilateral testicular pain in the past but not as severe as this current episode. Confirmation of testicular torsion would include all of the following findings except: A.unilateral loss of the cremasteric reflex. B.the affected testicle held higher in the scrotum. C.testicular swelling. D.relief of pain with scrotal elevation. ** 2. In assessing a man with testicular torsion, the NP is most likely to note: A.elevated PSA level. B.white blood cells reported in urinalysis. C.left testicle most often affected. ** D.increased testicular blood flow by color-flow Doppler ultrasound. 3. Anticipated organ survival exceeds 85% with testicular decompression within how many hours of torsion? A.1 B.6 ** C.16 D.24 4. To prevent a recurrence of testicular torsion, which of the following is recommended? A.use of a scrotal support B.avoidance of testicular trauma C.orchiopexy ** D.limiting the number of sexual partners 2.) Hydrocele (member did not use template, no review questions received-this is all I got) Definition: an accumulation of fluid within the tunica vaginalis surrounding the testicle; it may also result from a patent processus vaginalis at birth and sometimes closes spontaneously within the first 1 to 2 years of life. Hydroceles are the most common cause of painless scrotal swelling.; in adults they are often the result of trauma, a hernia, testicular tumor, or torsion or a complication of epididymitis. Presenting Symptoms: Usually painless and may be present for long periods, partially resolve, and recur before the patient seeks medical attention. Gradual enlargement of the scrotum occurs with marked edema, which may be uncomfortable because of the added weight. A hydrocele may occur secondary to a tumor when excess serous fluid accumulates in the scrotal sac. It will transluminate but may make testicular palpation difficult. Leik Review: Hydrocele more common in infants. Serous fluid collects inside the tunica vaginalis. During scrotal exam, hydroceles are located superiorly and anterior to the testes Most hydroceles are asymptomatic. Will glow with transillumination. If new-onset hydrocele in an adult or enlarging hydrocele, order scrotal ultrasound and refer to urologist. Differential Diagnoses: Epididymitis, Testicular torsion, epididymal cyst Review questions: 1. A patient who has had a swollen, nontender scrotum for one week is found to have a mass within the tunica vaginalis that transilluminates readily. The family nurse practitioner suspects: a.) a hydrocele. b.) a varicocele. c.) an indirect inguinal hernia. d.) carcinoma of the testis. 3.) Chronic Kidney failure: (member did not use template, no review questions received-this is all I got) Definition: The absence of kidney function. Kidney failure is also known as End Stage Kidney Disease. It is characterized by anuria and the need for renal replacement therapy or kidney transplant. The kidneys and urinary tract system no longer filter blood, create filtrate. Or excrete urine in amounts sufficient to clear waste and balance fluid intake with output. Key highlights: Proteinuria or hematuria, and /or a reduction in the glomerular filtration rate, for more than 3 months duration. The most common causes are diabetes mellitus and hypertension. Most people are asymptomatic and the diagnosis is determined only by laboratory studies. Differential diagnosis: obstructive uropathy, nephrotic syndrome, glomerulonephritis 4.) Acute tubular necrosis (member did not use template, no review questions received-this is all I got) Definition: reversible or irreversible type of renal failure caused by ischemic or toxic injury to renal tubular epithelial cells. The injury results in cell death or detachment from the basement membrane causing tubular dysfunction. A history of hypotension, fluid depletion, or exposure to nephrotic agents is usually present. In otherwise healthy individuals, when the underlying insult is corrected, the patient frequently has a good outcome with c...

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