Chapter 49 assessment and management of problems related to male reproductive processes
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Chapter 49 Assessment and Management of Problems Related to Male Reproductive Processes. Male Reproductive System. Includes conditions that affect reproduction, sexuality, and urinary elimination Patient may experience anxiety and embarrassment

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Chapter 49 Assessment and Management of Problems Related to Male Reproductive Processes

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Chapter 49 assessment and management of problems related to male reproductive processes

Chapter 49Assessment and Management of Problems Related to Male Reproductive Processes


Male reproductive system

Male Reproductive System

  • Includes conditions that affect reproduction, sexuality, and urinary elimination

  • Patient may experience anxiety and embarrassment

  • Be sensitive to cultural and emotional issues related to sexuality and the genitals to accomplish effective assessment and communication

  • Provide for privacy and education


Structures of the male reproductive tract

Structures of the Male Reproductive Tract


Assessment

Assessment

  • Urinary function and symptoms

  • Sexual function and manifestations of sexual dysfunction

  • Symptoms related to urinary obstruction

    • Increased urinary frequency

    • Decreased force of stream

    • “Double” or “triple” voiding

    • Nocturia, dysuria, hematuria, and hematospermia

  • Medications, drug, and alcohol use

  • Presence of conditions that may affect sexual function (diabetes, cardiac disease, and multiple sclerosis)


Plissit

PLISSIT

  • Model of sexual assessment and intervention

    • Permission

    • Limited Information

    • Specific Suggestions

    • Intensive Therapy


Physical assessment

Physical Assessment

  • Digital rectal exam

  • Testicular exam


Examination of the prostate

Examination of the Prostate


Diagnostic tests

Diagnostic Tests

  • Prostate specific antigen (PSA)

  • Ultrasonography

  • Prostate fluid or tissue analysis

  • Tests of male sexual function


Disorders of male sexual function

Disorders of Male Sexual Function

  • Erectile dysfunction

    • Psychogenic and organic causes

    • Organic causes include vascular, endocrine, hematological, and neurologic disorders, trauma, alcohol, medications, and drug abuse

    • Chart 49-1 lists classes of medications associated with erectile dysfunction

  • Ejaculation problems

    • Premature ejaculation

    • Retrograde ejaculation


Evaluation and treatment of erectile dysfunction

Evaluation and Treatment of Erectile Dysfunction


Medical management

Medical Management

  • Pharmacologic therapy

    • Oral medications: sildenafil (Viagra)

      • Side effects include headache, flushing, dyspepsia

      • Caution with retinopathy

      • Contraindicated with nitrate use

    • Injected vasoactive agents

      • Complications include priapism(persistent abnormal erection)

    • Urethral suppositories

  • Penile implants

  • Negative pressure devices

  • See Table 49-2


Conditions of the prostate

Conditions of the Prostate

  • Prostatitis: inflammation caused by an infectious agent

    • Treatment includes appropriate anti-infective agents and measures to alleviate pain and spasm

  • Benign prostatic hyperplasia (BPH, enlarged prostate)

    • Affects half of men over age 50 and 80% of men over age 80

    • Manifestations are those of urinary obstruction, urinary retention, and urinary tract infections

    • Treatment

      • Pharmacologic: alpha-adrenergic blockers, alpha- adrenergic antagonists, and antiandrogen agents

      • Catheterization if unable to void

      • Prostate surgery


Prostate cancer

Prostate Cancer

  • Second most common cancer and the second most common cause of cancer death in men

  • Risk factors include increasing age, familial predisposition, and African American race

  • Manifestations

    • Early disease has few/no symptoms

    • Symptoms include urinary obstruction, blood in urine or semen, and painful ejaculation

    • Symptoms of metastasis may be the first manifestations

  • Early diagnosis is vital; regular health screening is crucial

  • Treatment may include prostatectomy, radiation therapy, hormonal therapy, and/or chemotherapy


Prostate surgery procedures

Prostate Surgery Procedures


Prostate surgery procedures cont

Prostate Surgery Procedures (cont.)


Nursing process assessment of the patient undergoing prostatectomy

Nursing Process—Assessment of the Patient Undergoing Prostatectomy

  • Assess how the underlying disorder (BPH or prostate cancer) has affected the patient’s lifestyle

  • Urinary and sexual function

  • Health history

  • Nutritional status

  • Activity level and abilities


Nursing process diagnosis of the patient undergoing prostatectomy

Nursing Process—Diagnosis of the Patient Undergoing Prostatectomy

  • Anxiety

  • Acute pain preoperatively

  • Acute pain postoperatively

  • Deficient knowledge


Collaborative problems potential complications

Collaborative Problems/Potential Complications

  • Hemorrhage and shock

  • Infection

  • DVT

  • Catheter obstruction

  • Sexual dysfunction


Nursing process planning the care of the patient undergoing prostatectomy

Nursing Process—Planning the Care of the Patient Undergoing Prostatectomy

  • Major goals preoperatively include adequate preparation and reduction of anxiety and pain

  • Major goals postoperatively include maintenance of fluid volume balance, relief of pain and discomfort, ability to perform self-care activities, and absence of complications


Relief of pain

Relief of Pain

  • Monitor urinary drainage and keep catheter patent

  • Assessment of pain

    • Bladder spasms cause feelings of pressure and fullness, urgency to void, and bleeding from the urethra around the catheter

  • Medication and warm compresses or sitz baths relieve spasms

  • Administer analgesics and antispasmodics as needed

  • Encourage patient to walk but to avoid sitting for prolonged periods

  • Prevent constipation

  • Irrigate catheter as prescribed


Three way system for bladder irrigation

Three-Way System for Bladder Irrigation


Interventions

Interventions

  • Reduce anxiety

    • Be sensitive to potentially embarrassing and culturally charged issues

    • Establish a professional, trusting relationship

    • Provide privacy

    • Allow the patient to verbalize concerns

    • Provide and reinforce information

  • Provide patient teaching including explanations of anatomy and function, diagnostic tests and surgery, and the surgical experience


Rehabilitation and home care

Rehabilitation and Home Care

  • Provide patient and family teaching for home care including care of urinary drainage devices and recognition and prevention of complications

  • Regain bladder continence

    • Regaining control is a gradual process (dribbling may continue for up to one year depending upon the type of surgery)

    • Perineal exercises

  • Avoid straining, heavy lifting, long car trips (for 6 to 8 wks)

  • Diet: encourage fluids and avoid coffee, alcohol, and spicy foods

  • Assess sexual issues and provide referrals as needed


Testicular cancer

Testicular Cancer

  • Most common cancer in men age 15 to 40

  • Highly treatable and curable

  • Risk factors: undescended testicles, positive family history, cancer of one testicle, Caucasian American race

  • Manifestations: painless lump or mass in the testes

  • Early diagnosis: monthly testicular self-exam (TSE) and annual testicular exam

  • Treatment: orchidectomy, retroperitoneal lymph node dissection (open or laparoscopic), radiation therapy, and chemotherapy


Testicular self exam

Testicular Self-Exam


Nursing management

Nursing Management

  • Assess physical and psychological status

  • Support coping ability

  • Address issues of body image and sexuality

  • Encourage a positive attitude

  • Provide patient teaching

  • Provide TSE and follow-up care


Conditions affecting the penis

Conditions Affecting the Penis

  • Hypospadias and epispadias

  • Phimosis

  • Penile cancer

    • Bowen’s disease

  • Priapism

  • Peyronie’s disease

  • Urethral stricture

  • Circumcision


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