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Chapter 49

Chapter 49. Assessment and Management of Problems Related to Male Reproductive Processes. Anatomy and Physiology. The scrotum (two parts; each contains a testis, an epididymis, and a portion of the spermatic cord, otherwise known as vas deferens).

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Chapter 49

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

  2. Anatomy and Physiology • The scrotum (two parts; each contains a testis, an epididymis, and a portion of the spermatic cord, otherwise known as vas deferens). • The prostate (an encapsulated gland that encircles the proximal portion of the urethra). • The penis.

  3. Assessment • Health History and Clinical Manifestations • Physical Assessment • Digital Rectal Examination • Testicular Examination • testicular self-examination (TSE) • Diagnostic Evaluation • Prostate-Specific Antigen Test • Prostate Fluid or Tissue Analysis

  4. Inflammatory Diseases:Epididymitis • an infection of the epididymis, which usually descends from an infected prostate or urinary tract. • Symptoms include unilateral pain and soreness in the inguinal canal, sudden, severe pain in the scrotum, scrotal swelling, fever, pyuria, bacteriuria, dysuria, and pyuria.

  5. Epididymitis/ treatment • If it is caused by a chlamydial infection, the patient and his wife must be treated with antibiotics. • observe for abscess formation • epididymectomy (excision of the epididymis from the testis) may be performed for patients who have chronic, painful conditions

  6. Nursing Management • bed rest and scrotal support to prevent traction on the spermatic cord and to relieve pain. • Intermittent cold compresses to ease the pain. • Sitz baths may help resolve the inflammation. • Analgesic for pain relief as prescribed. • Instructs patient to avoid straining, lifting, and sexual stimulation until the infection is under control. • He needs to know that it may take 4 weeks or longer for the epididymis to return to normal.

  7. Inflammatory Diseases:Orchitis • An inflammation of the testes that most often occurs as a complication of a bloodborne infection originating in the epididymis. • Causes include gonorrhea, trauma, surgical manipulation, and tuberculosis and mumps that occur after puberty. • Symptoms include sudden scrotal pain, scrotal edema, chills, fever, nausea, and vomiting.

  8. Inflammatory Diseases:Prostatitis • An inflammation of the prostate which is a common complication of urethritis caused by chlamydia or gonorrhea. • Symptoms include perineal pain, fever,dysuria, and urethral discharge.

  9. Nursing Interventions • Inflammatory Disorders: • Encourage bed rest • Monitor VS, esp. temp for fever • Monitor I & O • Assess pain • Sitz bath – provide comfort = PROSTATITIS • Provide ice pack to scrotum to decrease swelling • Elevate or provide scrotal support

  10. Inflammatory disorders • Interventions • Analgesic • Antibiotic • Procaine = anesthetic • Stool softeners • Digital massage – rectally – to release infected fluid

  11. Benign Prostatic Hyperplasia • BPH is a progressive adenomatous enlargement of the prostate gland that occurs with aging. • More than 50% of men over the age of 50 and 80% of men ≥ 80 demonstrate some increase in the size of the prostate gland. • Risk factors: smoking, heavy alcohol consumption, hypertension, heart disease, and diabetes • Early symptoms include hesitancy, decreased force of stream, urinary frequency, and nocturia. Then frequent UTIs

  12. Benign Prostatic Hyperplasia • Diagnosis: • Rectal examination – most reliable • Urine analysis • Ultrasound • SerumBUN & creatinine to evaluate kidney function

  13. TURP • Transurethral Resection of the Prostate • Continuous irrigation = reduce or prevent clot formation = clogs urethra = urinary retention = kidney damage • Monitor I & O • 3-way f/c • Monitor for distention - bladder

  14. Benign Prostatic Hyperplasia • Management • Foley’s catheter (stylet needed, inserted by urologist) • Surgical • TURP • PROSTATECTOMY • Perineal prostectomy – incision through perineum • Suprapubic resection – lower abdomen – incision through the bladder – urethrotomy • Retropubic – lower abdomen – does not go through the bladder

  15. Benign Prostatic Hyperplasia • Pharmacological • Alpha blockers – relax the smooth muscles along urinary tract • Narcotic analgesic – relieve post-op pain – Morphine, Codeine

  16. Benign Prostatic Hyperplasia • Nursing Interventions • Increased fluids – monitor I & O • Maintain gravity drainage of F/C • Monitor blood clots and color = bright red = bleeding • Keep irrigation flowing, note clots • Monitor VS – pain level, temp – orally, NOT rectal • Avoid straining, provide stool softeners • Teach deep breathing, relaxation technique • Observe bladder distention & spasms = ask for antispasmodic – stops spasms = pain, increase blood clots

  17. Malignant Neoplasms:Prostate Cancer • The second leading cause of cancer deaths in men. • Risk factors include: advancing age (over 55, more than 70% of cases diagnoses at age ≥ 65 ); first-degree relative with prostate cancer; African-American heritage; high level of serum testosterone. • Five-year survival rate is 98%.

  18. Prostate Cancer • S/S • Early tumor – no symptoms • Subjective • Back pain, same symptoms as BPH – hesitancy, decrease pressure, frequency, dysuria, urinary retention, painful ejaculation. • Objective • Symptoms from metastasis • ? Blood in urine or semen. • Lumps – inguinal • Enlarged lymph nodes • Blockage of urethra, and rectal dysfunction

  19. Diagnostic Test – Prostate CA • Digital Rectal Examination • PSA- prostate specific antigen – elevated • Bone scan to detect metastasis • MRI, CT scan • Complications • Sexual dysfunction (gets worse with treatment)

  20. Treatment – Prostate CA • Radiation, chemo, surgical removal • Complete surgical removal of the prostate, seminal vesicles, tips of the vas deferens, and often the surrounding fat, nerves, and blood vessels • Bilateral orchiectomy (removal of testes) • TURP • Estrogen therapy – inhibits serum testosterone = contradicts • Agonists of LH – estrogen • Radioactive seed implant – rectally

  21. Nursing process • Anxiety related to concern and lack of knowledge about the diagnosis, treatment plan, and prognosis • Reduced stress and improved ability to cope • Urinary retention related to urethral obstruction secondary to prostatic enlargement or tumor and loss of bladder tone due to prolonged distention/retention • Improved pattern of urinary elimination

  22. Deficient knowledge related to the diagnosis of: cancer, urinary difficulties, and treatment modalities • Understanding of the diagnosis and ability to care for self • Imbalanced nutrition: less than body requirements related to decreased oral intake because of anorexia, nausea, and vomiting caused by cancer or its treatment • Maintain optimal nutritional status

  23. Sexual dysfunction related to effects of therapy: chemotherapy, hormonal therapy, radiation therapy, surgery • Ability to resume/enjoy modified sexual functioning • Pain related to progression of disease and treatment modalities • Relief of pain

  24. Impaired physical mobility and activity intolerance related to tissue hypoxia, malnutrition, and exhaustion and to spinal cord or nerve compression from metastases • Improved physical mobility • Collaborative Problems: Hemorrhage, infection, bladder neck obstruction • Goal: Absence of complications

  25. Nsg interventions – Prostate CA • BPH interventions • Be supportive – expect feminization, more emotional, educate • Gynecomastia – enlargement of the breast • Control pain – terminally ill = hospice, palliative care

  26. Malignant Neoplasms:Testicular Cancer • Although it accounts for only 1% of all cancer in men, it is the most common cancer in young men between the ages of 15 and 40. • Essential for clients to learn TSE (testicular self-examination). – monthly • During shower • Five-year survival rate is 95%. • Management same as prostate cancer

  27. Risk Factors • Undescended testicles (cryptorchidism), • A family history of testicular cancer, • Cancer of one testicle, • Ethnicity: more common in white Caucasian

  28. Assessment • Subjective data • Heaviness in scrotum • Weight loss • Scrotal pain • Anxiety or depression • Objective data • Palpation of abdomen and scrotum – enlarged • Mass or lump on the testicle and usually painless

  29. Medical Management • The testis is removed by orchiectomy

  30. Crytorchidism

  31. Hydrocele • Collection of amber fluid within the testes, tunica vaginalis, and spermatic cord • Painful • Swelling • Discomfort in sitting and walking • Treatment: aspiration (usually in children) • Hydrocelectomy – removal of the sac • Nsg Interventions: • Preoperative and postoperative management • Scrotal support (elevation) • Supportive to parents/patient

  32. Varicocele • Vein- dilation • Spermatic cord = Vas deferens • Occurs when incompetent or absent valves in the spermatic venous system permits blood to accumulate and increase hydrostatic pressure • Hyperthermia – decrease spermatogenesis = fertility • Bluish discoloration • Wormlike mass

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