chapter055
TRANSCRIPT
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Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Timby/Smith: Introductory Medical-Surgical Nursing, 10/e
Chapter 55: Caring for Clients with Disorders of the Male Reproductive
System
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Structural AbnormalitiesStructural Abnormalities
• Cryptorchidism
– Testes undescended; Empty scrotum; Lie in inguinal canal, abdominal cavity
– Unknown cause; Asymptomatic
– Impact on sperm production, fertility
– Risk for testicular cancer
– Treatment: Androgen therapy; Orchiopexy
– Nursing management
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QuestionQuestion
Is the following statement true or false?
Cryptorchidism is evidenced by painful swelling of the scrotum.
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AnswerAnswer
False.
Cryptorchidism is asymptomatic. It is evidenced by an empty scrotum and the testes lie in inguinal canal, or abdominal cavity.
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Structural AbnormalitiesStructural Abnormalities• Torsion of the Spermatic Cord
– Twisted spermatic cord; Artery kinked; Compromised blood flow to testicle
– Spermatic cords congenitally unsupported
• Assessment Findings: Signs and Symptoms
– Sudden, sharp testicular pain; Local swelling; Nausea, vomiting, chills, and fever
• Diagnostic Findings: Physical Examination
• Treatment: Immediate Surgery
• Nursing Management
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Structural AbnormalitiesStructural Abnormalities
• Phimosis, Paraphimosis
– Occur among uncircumcised males, opening of the foreskin is constricted
– Signs and symptoms
• Pain with erection and intercourse
• Difficulty cleaning under foreskin
• Painful swelling of glans
• Edema; Urinary retention
– Treatment: Circumcision; Hygiene
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Structural AbnormalitiesStructural Abnormalities• Hydrocele, Spermatocele, and Varicocele
– Swelling of the scrotum
– Hydrocele and spermatocele: No treatment
– Varicocele: Surgically repaired; Cause of male infertility
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Infectious, Inflammatory ConditionsInfectious, Inflammatory Conditions• Prostatitis: Inflammation of the Prostate Gland
– Escherichia coli; Microbes that cause STDs; Psychosexual problem
• Signs and Symptoms
– Glandular swelling; Tenderness; Perineal pain
– Unusual sensation prior to/after ejaculation
– Low back pain; Fever; Dysuria; Urethral discharge
• Treatment: Antibiotic therapy; Analgesics; Sitz baths
• Nursing Management
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QuestionQuestionIs the following statement true or false?
Prostatitis has several causes.
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AnswerAnswerTrue.
Prostatitis is inflammation of the prostate gland caused by E. coli, STD microbes, psychosexual problems, etc.
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Infectious, Inflammatory ConditionsInfectious, Inflammatory Conditions• Epididymitis, Orchitis: May occur alone or
simultaneously; Uni- or bilateral epididymitis
• Causes: Infectious agent causing prostatitis; Infection in body; Noninfectious epididymitis (long-term indwelling catheter, genitourinary procedures)
– Orchitis: Viral mumps after puberty
• Signs and Symptoms: Pain, swelling in inguinal area, scrotum; Fever; Chills
• Treatment: Bed rest; Scrotal elevation; Local cold applications; Analgesics/Anti-inflammatory agents; Antibiotic therapy; Epididymectomy
• Nursing Management
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Erection Disorders: Erectile DysfunctionErection Disorders: Erectile Dysfunction
• Pathophysiology and Etiology: Ineffective
– Neurologic stimulation
– Arterial blood flow
– Trapping of venous blood
• Physical and psychological origins
• Assessment Findings: Signs and Symptoms
– Difficulty in achieving or maintaining an erection
– Insufficient rigidity
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Erection Disorders: Erectile DysfunctionErection Disorders: Erectile Dysfunction• Diagnostic Findings
– Nocturnal penile tumescence and rigidity test
– Vascular ultrasound studies
• Medical, Surgical Management
– Change in drugs that cause impotence
– Drug therapy; Treatments to facilitate penile engorgement
– Vascular surgery; Penile implants
• Nursing Management
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Erection Disorders: PriapismErection Disorders: Priapism• Priapism: Persistent erection without sexual
stimulation
– Etiology: Vascular problem; Medical condition; Side effect of medication
– Symptoms: Discomfort; Interference with arterial blood flow and urinary elimination; Tissue damage
– Treatment: Vasoconstrictive medications; Draining trapped blood; Emergency surgery
– Emotional support
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Erection Disorders: Benign Prostatic Hyperplasia Erection Disorders: Benign Prostatic Hyperplasia
• Pathophysiology, Etiology: Increased number of cells in prostate
– Resulting in decreased diameter of the prostatic section of the urethra
• Assessment Findings: Signs and Symptoms
– Gradual onset; Difficulty urinating, emptying bladder; Nocturia; Urgency
• Diagnostic Findings
– DRE; Cystoscopy; IVP; Blood chemistry tests
– PSA; Transrectal ultrasound
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Erection Disorders: Benign Prostatic Hyperplasia Erection Disorders: Benign Prostatic Hyperplasia
• Medical, Surgical Management
– Monitoring with DREs
– Drug therapy
– Alternative therapy
– Surgical procedures
• TURP; TUIP
• TULIP; TUNA
• Prostatectomy
• Nursing Management
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Prostate CancerProstate Cancer
• Pathophysiology, Etiology
– Increased testosterone; High-fat diet; Family history
– Occurs in periphery of the gland; GU symptoms; Untreated cells spread by bloodstream and lymphatics
• Assessment Findings: Signs and Symptoms
– Frequent urination; Nocturia; Dysuria; Hematuria; Hemospermia; Erectile dysfunction; Back pain, pain down leg—metastasis
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Prostate CancerProstate Cancer• Diagnostic Findings: Rectal examination; PSA;
Transrectal ultrasound; Radiographs; MRI; CT; IVP; Elevated serum acid phosphatase
• Medical, Surgical Management
– Annual screening @ 50 y.o.
• At age 45: African Americans; 1st degree family history < 65 y.o.
– Treatment: Observation, surgery, radiation, hormone therapy, or combination
– Surgery: Suprapubic prostatectomy; Radical prostatectomy; Bilateral orchidectomy; Potential complications
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QuestionQuestionIs the following statement true or false?
Prostatic screening should begin for all men at age 60.
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AnswerAnswerFalse.
Annual prostatic screening should begin for men with a 10-year life expectancy at age 50. Screenings should begin at age 45 for African Americans and men who have immediate relatives with a history of prostatic cancer before 65 years of age.
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Prostate CancerProstate Cancer
• Medical, Surgical Management (Cont’d)
– Radiation therapy: Used alone or with other therapies; Side effects
– Hormone therapy
• Men with D stage carcinoma; Antiandrogenic or estrogenic drugs; Feminizing side effects
• Nursing Management
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Testicle CancerTesticle Cancer• Pathophysiology and Etiology
– Cryptorchidism
– Early degeneration of cells in undescended testis or testes; Abnormal cellular changes
– Seminomas; Nonseminomas
• Assessment Findings: Signs and Symptoms
– Scrotal swelling; Hard, nontender nodule; Abdominal pain; General weakness; Testicular aching
• Diagnostic Findings: Tumor markers; IVP; Lymphangiography; CT; MRI
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Testicle CancerTesticle Cancer• Medical, Surgical Management: Treatment depends
on the stage of the disease
– Autologous bone marrow transplantation; Sperm banking
– Surgery: Radical inguinal orchiectomy; Spermatic cord ligation; Radical retroperitoneal lymph node dissection
– Chemotherapy; Radiation
• Nursing Management
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Penis CancerPenis Cancer• Rare; Occurs more often in uncircumcised men
• Probable progress: Chronic irritation; Precancerous skin lesion; Malignancy
• Diagnosis
– Biopsy; CT; MRI
• Treatment
– Tumor excision; Chemotherapy
– External or interstitial radiation therapy
– Amputation
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Elective SterilizationElective Sterilization• Vasectomy: Ligation of vas deferens
– Minor surgical procedure
– Permanent sterilization
• Interruption of the pathway that transports sperm
– Procedure has no effect on erection or ejaculation
• Nursing Management
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