Transcript Medical-Surgical Nursing: An Integrated Approach, 2E

Medical-Surgical Nursing: An
Integrated Approach, 2E
Chapter 31
NURSING CARE OF THE
CLIENT: MALE
REPRODUCTIVE SYSTEM
NVOC 22C
Eliza Rivera-Mitu, RN, MSN
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Anatomy and Physiology
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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.
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Common Diagnostic Tests for
Reproductive System Disorders
Laboratory Tests
Type Title Here
Alpha-fetoprotein; Cultures; Human chorionic gonadtropin;Serum calcim;Serum analysis
Prostate-specific antigen; Prostatic smear;Serum alkaline phosphatase;
Radiologic Tests
Dynamic infusion cavernosometry and cavernosography
Surgical Tests
Prostatic biopsy; Testicular biopsy
Other Tests
Nocturnal tumescence penile monitoring
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Inflammatory Diseases:
Epididymitis
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A sterile or nonsterile
inflammation of the epididymis.
A sterile inflammation may be
caused by direct injury or reflux
or urine down the vas deferens.
Nonsterile inflammation may
occur as a complication of
gonorrhea, chlamydia, mumps,
tuberculosis, prostatitis, or
urethritis.
Symptoms include sudden,
severe pain in the scrotum,
scrotal swelling, fever, dysuria,
and pyuria.
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Inflammatory Diseases:
Orchitis
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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.
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Inflammatory Diseases:
Prostatitis
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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.
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Nursing Interventions
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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
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Inflammatory disorders
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Interventions
Analgesic
 Antibiotic
 Procaine = anesthetic
 Stool softeners
 Digital massage – rectally – release infected
fluid
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Benign Prostatic Hyperplasia
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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 75% of men over
the age of 70 demonstrate
some increase in the size of the
prostate gland.
Although this disorder is not
harmful, the urinary outlet
obstruction is a problem.
Early symptoms include
hesitancy, decreased force of
stream, urinary frequency, and
nocturia.
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Benign Prostatic Hyperplasia
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Diagnosis:
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PSA – prostate specific antigen = high
Rectal examination – most reliable
Ultrasound
Cystoscopy – visualization of bladder
IVP – Intravenous Pyelography – inject a dye through
vein – visualize bladder, ureters, kidney – allergic to
shellfish or iodine?
BUN – blood, urea, nitrogen – urine, blood – increase
Serum creatinine – Increased
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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 fluid overload=water
intoxication
•Edema, mental status =
agitation, lethargy
•Monitor for distention bladder
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Benign Prostatic Hyperplasia
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Management
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Stent
Balloon
Surgical
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TURP
TULIP – Transurethal Ultrasound-guided Laser-induced
prostatectomy
• Less invasive
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PROSTATECTOMY
Perineal prostectomy – incision through perineum
Suprapubic resection – lower abdomen – incision through the
bladder – urethrotomy
Retropubic – lower abdomen – does not go through the bladder
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Benign Prostatic Hyperplasia
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Pharmacological
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Alpha blockers – relax the smooth muscles
along urinary tract (Hytrin, Cardura) – p. 852
• S/E: dizziness – orthostatic hypotension
Belladonna & Opium suppository – reduce
post-op bladder spasm
 Narcotic analgesic – relieve p-op pain –
Vicodin, Morphine, Codeine – S/E constipation
 Proscar – androgen hormone inhibitor – may
arrest prostate enlargement
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Benign Prostatic Hyperplasia
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Nsg. Interventions
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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
Avoid straining
Observe bladder distention & spasms = ask for
antispasmodic – stops spasms = pain, increase blood
clots
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Malignant Neoplasms:
Breast Cancer
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Breast cancer in males is
an uncommon disorder.
Because it is so
uncommon, it is all the
more dangerous as it is
not considered a threat.
Late diagnosis is quite
common; therefore, males
need to be educated in
self-examination.
Signs and symptoms
include breast lumps, pain,
or discharge from nipple.
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Malignant Neoplasms:
Breast Cancer
Management
•Chemo, radiation, surgical removal
•Subjective data assessment
•pain,emotional & educational needs
•Objective data assessment
•Rating scale, drainage, VS –temp increase, BP,
Pulse, Resp – increased d/t pain
•Nursing management
•P-op: elevate affected arm, not to apply
pressure, B/P, drawing blood, IVs
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Malignant Neoplasms:
Prostate Cancer
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The second leading cause of cancer deaths in men.
Risk factors include: advancing age (over 55); firstdegree relative with prostate cancer; AfricanAmerican heritage; high level of serum
testosterone.
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Five-year survival rate is 89%.
Prostate Cancer
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S/S
Early tumor – no symptoms
 Subjective
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• Back pain, same symptoms as BPH – hesitancy,
decrease pressure, frequency, dysuria, urinary
retention
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Objective
• Symptoms from metastasis
• Lumps – inguinal
• Enlarged lymph nodes
• Blockage of urethra, and rectal dysfunction
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Diagnostic Test – Prostate CA
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Rectal examination
PSA- prostate specific antigen – elevated
Prostatic smear – abnormal cells, dysplasia
Acid phosphatase – prostate – 100x higher than
normal – PAP – prostatic acid phosphatase
Serum alkaline phosphatase – increased if bone
metastasis
Bone scan – metastasis
MRI, CT scan
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Treatment – Prostate CA
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Radiation, chemo, surgical removal
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Radical perineal prostatectomy – removal of prostate,
surrounding tissues, lymph nodes – inguinal area
Urethra is anastomosed to the bladder
Urostomy
Bilateral orchiectomy (removal of testes)
TURP
Estrogen therapy – inhibits serum testosterone =
contradicts
Agonists of LH – estrogen
Radioactive seed implant – rectally
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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
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Malignant Neoplasms:
Testicular Cancer
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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 35.
Essential for clients to learn TSE (testicular
self-examination). – monthly
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During shower
Five-year survival rate is 95%.
Management same as prostate cancer
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Assessment
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Subjective data
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Heaviness in scrotum
Weight loss
Scrotal pain
Emotional and educational needs
Anxiety or depression
Objective data
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Palpation of abdomen and scrotum – enlarged
Gynecomastia – enlarged breasts
Mass in testes
Drainage, swelling, hemorrhage – post-op
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Malignant Neoplasms:
Testicular Cancer
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Malignant Neoplasms:
Penile Cancer
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A rare cancer that
has a high
correlation with poor
hygiene and delayed
or no circumcision.
Males with a history
of STDs are also
predisposed to
developing penile
cancer.
Symptoms
include a painless,
nodular growth on the foreskin,
fatigue, and weight loss
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Penile cancer
Surgery – primary treatment
 Penectomy – removal of the penis
 Urostomy – suprapubic or perineal
 No catheterization
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Crytorchidism
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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)
•Inject a sclerosing
solution – decrease
the swelling
•Hydrocelectomy – remoal of the sac
•Nsg Interventions:
•Preoperative and postoperative
management
•Scrotal support (elevation)
•Supportive to parents/patient
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Hypospadias
Classes of hypospadias by
location of the meatus.
 (A) Anterior, on the inferior
surface of the glans penis.
 (B) Coronal, in the
balanopenile furrow.
 (C) Distal, on the distal third
of the shaft.
 (D) Penoscrotal, at the base
of the shaft in front of the
scrotum.
 (E) Scrotal, on the scrotum
or between the genital
swellings.
 (F) Perineal, behind the
scrotum or genital swellings.
Abnormal placement of the urethral
opening
Tx: repair of the foreskin, surgery
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Spermatocele – herniation,
protrusion
-non-tender cyst, epididymis, rete testis
Contains milky fluid and sperm
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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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Torsion of the spermatic cord
-Abnormal scrotal
pain
-Scrotal edema
-Nausea &
vomiting, sl. Fever
-Treatment:
-immediate surgery
to untwist the cord,
suturing of the
testicle to the
scrotum
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Impotence
The inability of an adult male to have an
erection firm enough or to maintain it long
enough to complete sexual intercourse.
 Three types: functional (psychosocial
factors); atonic (result of medications and
disease) and anatomic (Peyronie’s disease,
which causes development of nonelastic,
fibrous tissue just beneath the penile skin).
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Peyronie’s disease
•Fibrous plaque
•Can not penetrate vagina
•Atonic impotence
•Antihypertensive,
sedatives, antidepressants,
tranquilizers, nicotine,
drugs & alcohol
•Diabetes, vascular
neurological disorder
•Functional
•Decreased libido
Sx – silicone cylinder flexible or
inflexible
Hydraulic implant, has pump
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Infertility
Causes of infertility in males include
varicoceles, cryptorchidism, impaired
sperm, insufficient number of sperm, and
hormonal imbalance.
 Tight-fitting underwear and use of hot tubs
or saunas may decrease the sperm count.
 Treatment includes counseling,
medications, circulatory aids, and surgery.
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Contraception
Contraceptive options available to males
include abstinence, coitus interruptus withdrawal, condoms, or voluntary surgical
sterilization (vasectomy)
 Coitus – sexual intercourse
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Vasectomy
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http://www.vasectomymedical.com/features/
vasectomy-videos.html
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