Medical-Surgical Nursing
According to the B-Train
Brief Overview
Short and sweet explanation of what my purpose is. This is to be updated as much
as possible. With notes from class, slides, and the textbook, I hope to come up with
some easy to remember study guides to help us get through this class.
I will attempt to continue to update
this guide. I, Eina Jane, am the
main editor of this project. I have
hopes of passing on whatever
knowledge I may have accrued
over the years.
Nursing school is hard. I, for one,
admit having difficulty adjusting to
the pace of the program. It will take time, but it does
happen. If you need help, there are a lot of resources
available. Take advantage of our professors’ office
hours. If you are determined, it will happen.
Ramapo’s nursing program is different from other
nursing programs. It provides students a basic foun-
dation of the sciences in order to comprehend the
more advanced topics covered in nursing practicum.
It provides non-science oriented students access to
the basic theories of nursing science. Although nurs-
ing may seem far from science, its foundation relies
on the laws of physics, the chemistry of compounds,
the biology of life, and the many ‘mumbo-jumbo’
that makes the sciences a difficult subject to compre-
hend. After a two year completion of these pre-
1
Fall 2007 - Volume I
requisites, juniors are now considered to be nursing
majors. The curriculum is strict and does not allow
for a customized schedule. This is where this guide
comes in. It is in no shape or form supposed to re-
place actual textbook reading and note-taking. This
is a supplement. I hope to make this a simpler ver-
sion of the text book, and more organized than our
notes. I will try my best to make this an easy read.
Bergenfield B-Train Chronicles
The crew: Shayne
Roselle Aca-Ac, Eina
Jane Marie Adlawan,
Ton Garcia and Karyn
Joy Jaramillo left its
mark yet again. At-
tending Englewood
Hospital’s Nursing
Program is one of the biggest accomplishments of
their lives. Keeping an upbeat outlook in life, they
continue to pursue their dreams of becoming nurses.
The program tests their ability to adapt and learn
new ways of surviving the real world. The real world
has forced them to use their special abilities to go out
there, work hard, and have fun.
Medical Surgical Nursing: According to the B-Train Fall 2007 - Volume I

So how do we use this guide? Alternate Format Ques-

Essentially this tions will also be fea-
guide is the Pow- tured, along with ration-
erpoint (C) slides ales to the answers.
reformatted to an
easier to read
form.
Legend
Aside from the Important
slides, additional
Keep in Mind
information from the lecture and textbook are pro-
vided if necessary. Sample NCLEX questions are in- Refer to Book
cluded at the end of each volume.
Online / CD
These questions will be from Saunders, ATI, NCLEX
Made Easy, and other NCLEX review type books.

Eina Jane & Co.

Wandering Fruits, Inc.

MEDICAL SURGICAL NURSING: ACCORDING TO THE B-TRAIN SEES IT

Copyright (c) 2007 by Eina Jane & Co.

All rights reserved.

Printed in the United States of America

2
Meet the Candidates
Hey guys! A little something-something about the editors. We are students trying
to survive just like you. If you have any questions, don’t hesitate to ask. ^_^

Einakinz
“Huh?”

Ton-Ton
“Dunzo.”

Ateh Karyn
“Woof!”

3
 Shiine
This sexy nurse to be is awesome. Ar-
tistic, wonderful, funny and gorgeous.
Shiine poses the ability to kick-butt in
anything she wants. Pool. Table
Table-Tennis. Art. Don’t Mess.
The sweet girl transferred to another program, but up-
dates are always an IM or Myspace away. Stay strong,
and show those Filipinos how the B-train handles
Summer 07 Karyn’s 21st
4
nursing. Review guides. Chat rooms. Speed Uno.
Cooking. Wii. This is how we tackle the stress that
comes with the program. jk. HAHAHA. We manage.
One exam at a time; that is how we do it.
We hope you are enjoying the Philippines!!! We are
so jealous. LOL. We miss you! The crew is not the
same without you. Keep in touch! Don’t forget to
share your nursing school stories with us. HAHAHA.
^_^
Shannanigans
 GEnitoUrinary based on lectures by Professor John Fajvan, RN, MSN

First chapter for the senior year.

When you gotta go, you gotta go.

5
What is that? Clinical Manifestations of - amoxicillin [Amoxil, Tri-
In the new NCLEX, they may mox]
Cystitis include:
provide us a picture where we are
asked to point and click on the • burning or pain during urination - ciprofloxacin [Cipro]
photo.
• frequent urination - nitrofurantoin [Furadantin,
Macrodantin]
Know what and where these fol-
• cloudy / foul-smelling urine
lowing parts:
- sulfamethoxazole-
• pain directly above pubic bone trimethoprim [Bactrim, Septra]
1. Abdominal aorta
• children under 5 - less concrete - trimethoprim [Proloprim,
2. Right renal artery
symptoms [weakness, irritabil- Trimpex]
3. Left renal artery ity, reduced appetite, vomiting]
Interstitial Cystitis
4. Inferior vena cava • older women - NO symptoms, IC causes discomfort / pain in the
looks like a part of aging [weak- bladder and abdomen.
5. Right renal vein ness, falls, confusion, fever]
More common in women than
6. Left renal vein • occasionally, blood in urine men. Women’s symptoms get
worse during periods, pain during
7. Right adrenal gland Management of Cystitis: intercourse.
8. Right kidney • drink water sufficiently to flush
Natural lining of bladder [epithe-
bladder thoroughly
lium] protected from toxins in
9. Renal cortex
• empty bladder completely when urine by a coating of enzymes
10. Renal medulla urinating [place yourself back- [mucopolysaccharides] called the
wards on the toilet, so you lean GAG [glycoaminoglycan] layer.
11. Renal pelvis against the wall to completely
In IC, protective layer is defective
empty bladder - hunching over
12. Renal pyramid allowing toxins to penetrate into
to read does not work]
‘interstitial layers’ of bladder, de-
13. Renal papilla polarize nerve endings, thus caus-
• cranberry juice / capsules every-
day which prevents bacteria ing severe irritative voiding symp-
14. Renal hilum [hilus]
from sticking to the bladder wall toms and bladder pain.
15. Ureters
• urinating immediately after in- Clinical Manifestations of
16. Bladder tercourse flushes most bacteria Interstitial Cystitis in-
from urethra
clude:
Cystitis
Infection of the bladder. • urinate at least once every 3hrs • persistent, urgent need to urinate

BUT it’s usually used to call other
infections and irritations in the
lower urinary system.
• First line of treatment: antibiot- • frequent trickles, sometimes up
ics, depends on health of pt and to 60x a day
bacteria found in urine. From
simple to complex:

6
• pain in suprapubic [pelvis] or
between vagina / anus in women
or scrotum / anus in men [perin-
eal]
• pelvic pain during intercourse,
men have painful ejaculation
• chronic pelvic pain
Management of Intersti-
tial Cystitis:
Basic concept of therapy -
modify diet to help pts avoid
foods that irritate the damaged
bladder wall.
• Avoid alcohol, coffee, tea,
herbal tea, green tea, all sodas
[especially diet], concentrated
fruit juices, tomatoes, citrus
fruit, cranberries, B vitamins,
vitamin C, monosodium glu-
tamte [MSG], chocolate, potas-
sium rich foods [bananas]
Pentosan polysulfate sodium
[Elmiron (R)] - only ORAL
medication approved by FDA
for IC
- chemically similar to GAG -
helps rebuild epithelium by coat-
ing bladder wall
- take up to 6mo. to provide
symptom relief; 25% experience
significant relief within 4wks
- taken long-term to keep
symptoms from recurring
- uncommon side fx: GI dis-
comfort, reversible hair loss
Dimethyl Sulfoxide [DMSO,
Rimso-50(R)] - only FDA ap-
proved INSTILLATION treat-
ment
- instilled through urethra and
directly into bladder via catheter
- enters bladder wall, reduces
inflammation, pain, painful
muscle contractions
- may be mixed with steroids,
or other local anesthetics
- may leave garlic taste / smell
on skin / breath for up to 72hrs
- heparin similar to GAG and
may help to repair problems
caused by GAG deficiency in
bladder
- blood, liver, kidney tests re-
quired every 6mo. during
DMSO therapy
Urethritis
Inflammation of the urethra
caused by infection.
Although irritation of urethra
may occur in variety of clinical
conditions, it’s a broad term used
to describe a syndrome of STDs:
gonococcal urethritis [GU] and
nongonococcal urethritis [NGU].
Clinical Manifestations of
Urethritis include:
• timing: symptoms generally be-
gin 4days to 2wks after contact
with infected partner, or patient
maybe asymptomatic [assess
sexual history]
7
• urethral discharge: fluid may be
yellow, green, brown / tinged
with blood, production is unre-
lated to sexual activity
• dysuria: localized to meatus or
distal penis, worst during first
morning void, alcohol consump-
tion
• urinary frequency and urgency
typically absent; if present, ei-
ther should suggest prostatitis or
cystitis
• itching: sensation urethral itch-
ing / irritation may persist be-
tween voids, some pts have itch-
ing instead of pain or burning
• orchalgia: men sometimes c/o
heaviness in genitals; associated
pain in testicles should suggest
epididymitis, orchitis, or both
• menstrual cycle: women occa-
sionally c/o worsening symp-
toms during menses
• foreign body or instrumentation:
pt should be question about re-
cent urethral catheterization or
instrumentation, either medical
or self-induced [foreign body] -
causes traumatic urethritis
• urethritis following catheteriza-
tion, occurs up to 20% of pts
receiving intermittent catheteri-
zation; 10x more likely to occur
with latex catheters than sili-
cone catheters
Management of Urethri-
tis:
 objective: treat infection until
urine is sterile and at the same
time correct underlying cause
Urosepsis
Occurrence of bacterial seeding
into blood stream due to an UTI
causing generalized infection
Clinical Manifestations for
Urosepsis include:
• UTI - increased frequency of
urination
• burning sensation on urination
• flank pain
• blood in urine and fever
• increased heart rate [tachycar-
dia]
• decreased blood pressure and
unconsciousness
What is the Prostate?
Gland in male reproductive system
located just below bladder and in
front of the rectum.
About the size of a walnut. Sur-
rounds part of urethra.
Produces fluid that makes up part
of the semen.
Benign Prostatic Hy-
pertrophy [BPH]
Benign [non-cancerous] condition.
Overgrowth of prostate tissue
pushes against the urethra, block-
ing flow of urine.
Prostate Cancer
Cancer that forms in tissues of
prostate.
Occurs in older men.
Estimated new cases and death
from prostate cancer in US in
2007:
• New cases: 218,890
• Deaths: 27,050
Clinical Manifestation of
Prostate Cancer include:
weak or interrupted flow of
urine
• frequent urination [especially at
night]
• trouble urinating
• pain / burning during urination
• blood in urine / semen
• pain in back, hips, pelvis that
does not go away [metastases]
• painful ejaculation
Stage 1 Prostate Cancer
Found in the prostate only.
8
Cannot be felt during digital
rectal exam and not visible
by imaging.
Management of Stage
I Prostate Cancer:
•watchful waiting[surveil-
lance]
• radical prostatectomy, usually
with pelvic lymphadenectomy,
with / without radiation therapy
after surgery. May be possible to
remove the prostate without
damaging nerves that are neces-
sary for an erection
• external-beam radiation therapy
• implant radiation therapy
• clinical trials
- high-intensity focused ultra-
sound
- radiation therapy
- evaluating new treatment
option
Stage II Prostate Cancer
More advanced than Stage I.
Has NOT spread outside prostate.
Could be palpated during digital
rectal exam [DRE] or seen during
rectal ultrasound examination
Management of Stage II
Prostate Cancer:
• radical prostatectomy, usually
with pelvic lymphadenectomy,
 with / without radiation therapy
after surgery. May be possible to
remove the prostate without
damaging nerves that are neces-
sary for an erection
• watchful waiting [surveillance]
• external-beam radiation therapy
with or without hormone therapy
• implant radiation therapy
• clinical trials
- radiation therapy with or
without hormone therapy
- ultrasound-guided cryosur-
gery
- hormone therapy follwed by
radical prostatectomy
- evaluating new treatment
options
Stage III Prostate Cancer
Spread beyond outer layer of pros-
tate to nearby tissues.
May be found in seminal vesicles
[glands that help produce semen]
Also called Stage C Prostate Can-
cer
Management of Stage III
Prostate Cancer:
• external-beam radiation therapy
with or without hormone therapy
• hormone therapy
• radical prostatectomy, usually
with pelvic lymphadenectomy,
with or without radiation therapy
after surgery
• watchful waiting [surveillance]
• radiation therapy, hormone ther-
apy, transurethral resection of
the prostate as palliative therapy
to relieve symptoms caused by
cancer
• clinical trial
- ultrasound-guided cryosur-
gery
- hormone therapy followed
by radical prostatectomy
- evaluating new treatment
options
Stage IV Prostate Can-
cer
Metastasized [spread] to lymph
nodes near or far from prostate,
or to other parts of body: blad-
der, rectum, bones, liver, lungs.
Often spreads to bones.
Also called Stage D1 Prostate
Cancer and Stage D2 Prostate
Cancer
Management of Stage IV
Prostate Cancer
• hormone therapy
• external-beam radiation
therapy with or without
hormone therapy
• radiation therapy or
TURP of prostate as pal-
9
liative therapy to relieve symp-
toms caused by cancer
• watchful waiting [surveillance]
• clinical trial of radical prostatec-
tomy with orchiectomy [testo-
terone driven cancer]
Transurethral Resec-
tion of the Prostate
[TURP]
Tissue removed from prostate us-
ing resectoscope [thin, lighted tub
with cutting tool at the end] in-
serted through urethra.
Prostate tissue blocking the ure-
thra is cut away and removed
through resectoscope.
Suprapubic Pros-
tatectomy
Surgical pro-
cedure that
requires a
large inci-
sion in lower
abdomen,
through
which pros-
tate and
nearby
lymph nodes can be removed.
Takes 2-3hrs to perform.
Followed by 4-6day hospital stay.
Retropubic Pros-
tatectomy
Prostate removed through an inci-
sion in the wall of the abdomen.
Risk for bleeding / blood clots.
Need continuous bladder irrigation
[CBI].
Perineal Prostatec-
tomy
Prostate removed through and in-
cision in the area between scrotum
and anus
Nephrolithiasis
Process of forming a stone in the
kidney or lower down in the uri-
nary tract.
Development of stones related to:
• decreased urine volume
• increased excretion of stone-
forming components such as
calcium, oxalate, urate, cystine,
xanthine, phosphate
Stones form in urine collecting
area [pelvis] of the kidney and
may range from tiny to staghorn
stones the size of the renal pelvis
itself.
Clinical Manifestations of
Nephrolithiasis include:
• severe abdominal pain of sudden
onset [worse than child birth]
unilateral flank pain [one side]
• lower abdominal pain
• nausea / vomiting
Glomerulonephritis
Kidney disease caused by in-
flammation of internal kidney
structures [glomeruli].
May be temporary / reversible
condition, or may get worse.
Progressive glomerulonephritis
may result in destruction of kidney
glomeruli and chronic renal failure
and end stage renal disease
May be caused by specific prob-
lems with immune system, but
precise cause of some cases is un-
known
• diabetes mellitus
• multiple sclerosis
• AIDS/HIV
Renal failure = NO advil,
ibuprofen, motrin, contrast dye
• must check BUN / Creati-
nine levels periodically
10
Clinical Manifestations of
Glomerulonephritis in-
clude:
• Initial symptoms:
- blood in urine [dark, rust-
colored, brown]
- foamy urine [beer]
• Progressive symptoms:
- unintentional weigh loss
- nausea / vomiting
- malaise / fatigue
- headache
- frequent hiccups
- generalized itching [uric acid
irritating skin]
- decreased urine output
- easy bruising / bleeding
- decreased alertness [unfil-
tered toxins
- may lead to eventual coma
Management of Glomeru-
lonephritis:
• treatment varies depending on
cause of disorder, type, severity
of symptoms
• primary treatment goal: control
symptoms
high blood pressure may be dif-
ficult to control - MOST impor-
 tant aspect of treatment [avoid
stroke] - antihypertensive meds
• corticosteroids [too much =
damage kidneys], immunosup-
pressives may be used to treat
some causes of chronic glomeru-
lonephritis
• dietary restrictions: salt, fluids,
protein, other substances to aid
control hypertension or kidney
failure
• dialysis or kidney transplanta-
tion may be necessary to control
symptoms of renal failure and to
sustain life
Nephrotic Syndrome
Disorder where kidneys have been
damaged, causing them to leak
protein from blood into urine.
Proteinuria [>3.5g/day], hypalbu-
mineria, hyperlipidemia, edema.
Clinical Manifestations of
Nephrotic Syndrome in-
clude:
most common sign: excess
fluid in the body - takes several
forms
• puffiness around eyes, especially
in the morning
pitting edema over legs
• fluid in pleural cavity causing
pleural effusion
• fluid in peritoneal cavity causing
ascites
Management of Neph-
rotic Syndrome:
• nothing: some cases will im-
prove with time, require no spe-
cial treatment, others respond to
very poorly to any known treat-
ment
• oral steroids: [prednisolone] one
form of the disease [‘minimal
change disease’] very sensitive
to steroids; short-term use
minimizes potential side-effects
immunosuppression: more diffi-
cult cases thought to be triggered
by own immune system; thera-
pies come as tablets or drips
given in the hospital - not com-
monly used because of toxicitiy
- but sometimes effective in
some pts
What is Renal Fail-
ure?
Divided into two categories:
acute renal failure and chronic re-
nal failure.
Type of renal failure determined
by trend in serum creatinine.
Chronic renal failure generally
leads to anemia and small kidney
size on ultrasound.
Acute Renal Failure
Rapidly progressive loss of renal
function.
Oliguria [<400 mL/day]
Body water / fluid / electrolyte
imbalances.
11
Variety of underlying causes must
be identified to stop the progress.
Dialysis may be necessary to
bridge time gap required for treat-
ing fundamental cause.
Three Types of Acute Re-
nal Failure:
• Pre-Renal
- decreased blood flow to kid-
neys leading to ischemia in
nephrons [mechanical problems]
- prolonged hypoperfusion can
lead to tubular necrosis and
acute renal failure
- caused by: shock, heart
failur, pulmonary embolism,
anaphylaxis, pericardial tampon-
ade, sepsis
• Intrarenal [intrinsic]
- actual tissue damage caused
by inflammatory or immuno-
logic processes or from pro-
longed hypoperfusion [physical
damage / necrosis]
- caused by: acute interstitial
nephritis, exposure to nephro-
toxins, acute glomerulonephritis,
vasculitis, hepatorenal syn-
drome, acute tubularl necrosis
[ATN], renal artery stenosis/
thrombosis [blood clot]
• Post-Renal
- obstruction of urine collect-
ing system anywhere from caly-
ces to urethral meatus
 - obstruction of bladder must
be bilateral to cause post-renal
failure unless only one kidney is
functional
- caused by: urethral/bladder
cancer, renal/ureteral/bladder
stones, atony [decreased muscle
tone] of bladder, prostatic hy-
perplasia / cancer, cervical can-
cer [metastasis], urethral stric-
ture
Phases of Oliguric Acute
Renal Failure [<400ml/
day]
• Onset Phase
- begins with precipitating
event and continues until olig-
uria develops
- can last from hours to sev-
eral days
• Oliguric Phase
- Urine output 100-400mL/
day that does not respond to
fluid challenges or diuretics
- diuresis can result in output Many major organs contained in
of up to 10L [10,000mL] of di- cavity [liver, kidneys, stomach,
lute urine per day bowel].
- usually occurs 2-6wks after Membrane has many tiny holes
onset of oliguric acute renal fail- and acts as filter, allowing waste
ure and continues until BUN products and fluid from blood to
level increases to rise pass through.
• Recovery Phase [Convalescent
Phase]
- pt begins to return to normal
levels of activity
- renal function may continue
to improve for up to 12mo after
oliguric acute renal failure be-
gan
- pt is particularly vulnerable
to additional injury during this
time
Chronic Renal Failure
May develop slowly and show few Holes are too small to allow large
initial symptoms. molecules to pass through there-
fore blood and dialysate will never
Long term result of irreversible mix.
acute disease or part of disease
progression. Performed daily at home.

Most common cause: diabetes

- Lasts 8-15days but can last
for several wks, especially in
older pts or those having pre-
existing renal insufficiency
• Diuretic Phase [High-Output
Phase]
- often prompt onset with
urine flow increasing rapidly
over period of several days
mellitus
End-stage renal failure [ESRF] =
ultimate consequence, where di-
alysis is required unless donor for
renal transplant is found
Peritoneal Dialysis
[PD]
Uses the peritoneum, natural
membrane that lines cavity of ab-
domen.
Hemodialysis
Man-made membrane, or dialyzer.
Partly does work of kidneys to fil-
ter waste and remove extra fluid.
Blood circulates through dialyzer
for several hours during treatment,
with a machine controlling speed
and several safety factors.
Most often done 3x/week for 3-
4hrs at a dialysis center.

12
All blood is filtered: risk for
shock, hypokalemia, low protein/
salt/fluids
Renal Cancer
Forms in tissues of kidney.
Renal cell carcinoma: forms in
lining of very small tubes in kid-
ney that filter blood and remove
waste products.
Renal pelvis carcinoma: forms in
center of kidney where urine col-
lects.
Wilm’s Tumor: kidney cancer that
usually develops in children under
5yo [removal of kidney, recur-
rence = death].
Several types of tumor: benign
and malignant may occur
Most common type: fluid-filled
area called a cyst
• Simple cysts do not progress
to cancer; requires no follow-up
• Complex cysts do not have
typical benign appearance and
may contain cancer
In US, kidney cancer accounts for
about 3% of all cancers, approx
12,000 kidney cancer deaths/year
Occurs more in males, diagnosed
between 50-70yo, but can occur at
any age
Adults, most common type = renal
cancer [renal adenocarcinoma or
hypernephroma]
Clinical Manifestations of
Renal Cancer include:
• Rarely causes s/s in early stages
• Disease progression
- pain in back, just below ribs
that does not go away
- weight loss
- fatigue
- intermittent fever
- mass in area of kidneys
that’s discovered during a physi-
cal exam
Staging of Renal Cancer
• Stage I
- primary cancer 7cm [3in] or
less
- limited to kidney, with no
spread to lymph nodes or distant
sites
• Stage II
- primary cancer greater than
7cm [3in]
- limited to kidney, with no
spread to lymph nodes or distant
sites
• Stage III
- primary cancer less OR
greater than 7cm [3in]
- spread to SINGLE lymph
node
13
- primary tumor may have
spread to renal veins or vena
cava, but only spread directly
and not out of the local area of
kidney
• Stage IV
- spread to distant sites
- invades directly beyond local
area
- has more than one lymph
node involved
Management of Renal
Cancer:
• partial or complete nephrectomy
- may include removal of ad-
reneal gland, retroperitoneal
lymph nodes, possibly tissues
involved by direct extension
[invasion] of tumor into sur-
rounding tissues
- if tumor spread into renal
vein, inferior vena cava, possi-
bly right atrium [angioinvasion],
portion of tumor can be surgi-
cally removed
- for metastasis, surgical re-
section of kidney [cy;todreductiv
nephrectomy] may improve sur-
vival, as well as resection of
solitary metastatic lesion
• radiation therapy = not com-
monly used because not usually
successful; may be used to palli-
ate skeletal metastases
• chemotherapy in some cases, but
unlikely cure unless all cancer
surgically removed
Testicular Cancer
Most common type of cancer af-
fecting men 15-35yo.
• significant loss of size in one of
testicles
• feeling of heaviness in scrotum
• dull ache in lower abdomen /
groin
• retroperitoneal lymph node dis-
section
• radiation therapy for seminoma
• chemotherapy for non-
seminoma

Can strike ANY male, ANY • sudden collection of fluid in - Platinol [cisplatin]: adminis-
scrotum tered in hospital, toxicity of
TIME.
platinum solution
Almost always curable if found • pain or discomfort in testicle /
scrotum - Vepesid / VP-16 [etoposide]
early.

Most found by men themselves, • enlargement / tenderness of - Blenoxane [bleomycin sul-

either as PAINLESS lump, or
hardening or change in size of tes-
ticle, or pain in testicle
Children born with undescended
testicle have increased risk of get-
ting testicular cancer regardless of
whether surgery is done to correct
problem. However, surgery should
still be done to preserve fertility.
Can be treated with surgery, radia-
tion therapy, chemotherapy, sur-
veillance, or a combination.
breasts fate]: once a month injection at
doctor’s office; respiratory tox-
Who is usually affected? icity - pulmonary fibrosis
• white males • surveillance
• northern European: Denmark, - CBC
Finland, Norwegian, etc
- LDH
• No known cause
- tumor markers
Staging of Testicular Can-
- beta HCG [serum pregnancy
cer
test] = determines germ cell car-
• Stage I: cancer confined to testi- cinoma
cle
Iggy Text: Ch. 72-75
• Stage II: spread to retropertoneal
lymph nodes, located in rear of
body below diaphragm and be-
tween the kidneys

• Stage III - spread beyond lymph

Clinical Manifestations of
Testicular Cancer include:
• enlargement of testicle
• painless lump
nodes to remote sites in body,
including lungs, brain, liver,
bones
Management of Testicular
Cancer
• inguinal orchiectomy

14
NCLEX Questions

15