Transcript Airgas template

Assessment and
Management of
Problems Related to
Male
Reproductive Processes
Copyright © 2008 Lippincott Williams & Wilkins.
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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
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Male Reproductive System
• Testes (encased in the scrotum)
– Spermatogenesis
– Testosterone secretion
• Penis
– Copulation
– Urination
• Prostate gland
– Produces a secretion that is suitable to the needs of
spermatazoa
• Vas deferens, Cowper’s gland, epididymis
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Male Reproductive system
• Age-related changes
– Prostate enlarges
– Prostate secretion decreases
– Testes become smaller and firmer
– Fibrotic changes in the corpus cavernosa (ED)
– Testosterone level decreases
• Hypogonadism occurs in 25% of older men
• Decrease in libido
• Decrease in number of viable sperm
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Structures of the Male
Reproductive Tract
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Assessment
• Urinary function and symptoms
• Sexual function and manifestations of sexual dysfunction
• Sexual history, including STDs
• 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)
• History of surgeries
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Physical Assessment
• Inspection of the penis and testes
• Digital rectal exam
– Yearly for men over age 50
– Assess size, shape, consistency of prostate gland;
assess anus for hemorroids, masses, lesions
• Testicular exam
– Inspection and palpation for abnormalities
– Testicular self exam should begin in adolescence
• Penis is inspected and palpated for ulcerations,
nodules, inflammation, discharge; foreskin
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Examination of the Prostate
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Diagnostic Tests
• Prostate specific antigen (PSA)
– Blood test (0.2-4.0 mcg/L)
– Levels increase with prostate cancer; but maybe
nonspecific
• Ultrasonography
– Maybe performed if abnormalities found on DRE or to
differentiate testicular mass
• Prostate fluid or tissue analysis
• Tests of male sexual function
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Disorders of Male Sexual
Function
• Erectile dysfunction (ED)
– Inability to attain or maintain an erect penis that
allows for satisfactory sexual performance
– Approximately 50% of men >age 40-70
– Psychogenic and organic causes
– See table 55-10 for risk factors
• Include anatomic, cardiorespiratory, drug induced (!),
endocrine, GU, neurologic, psychologic, vascular
– Treatment depends on the cause
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Evaluation and Treatment of Erectile
Dysfunction
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Medical Management
• Pharmacologic therapy
– Oral medications: sildenafil, vardenafil, tadalafil
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Side effects include headache, flushing, dyspepsia
Caution with retinopathy
Contraindicated with nitrate use
Review drugs
– Injected vasoactive agents
• Complications include priapism (persistent abnormal erection),
fibrotic plaques at injection site
– Urethral suppositories (alprostadil)
• Penile implants
• Vacuum constriction device
• Sexual Couseling
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Disorders of Male Sexual
Function
• Ejaculation problems
– Premature ejaculation
• Inability to control ejaculatory reflex and reaches orgasm
before or shortly after the beginning of intercourse
• Treatment often behavioral, possibly phamacologic
– Retrograde ejaculation
• Semen travel toward the bladder rather than exiting the
body - muscles of the bladder neck do not tighten
properly
• Electroejaculator utilized if pregnacy is desired
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Conditions of the Prostate
• Prostatitis: inflammation of the prostate gland, often
due to and infectious agent
– Acute and chronic classifications
– Manifestations : burning, urgency, frequency, prostadynia
• Acute bacterial may also result in fever, chills, low back pain,
dysuria, nocturia, prostate pain
• Chronic bacterial manifests as frequency, urgency, backache,
ejaculatory pain; it is a major cause of relapsing UTI; more insidious
– Goal : avoid abcess formation and sepsis
– Treatment includes appropriate anti-infective agents
(possibly IV for acute) and measures to alleviate pain and
spasm
• Sitz baths, antispasmodics, analgesics
• Increase fluid intake
• In chronic, measure
to stimulate ejaculation
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Conditions of the Prostate
• Benign prostatic hyperplasia (BPH; enlargement of the
prostate gland)
– Hypertrophied lobes of prostate may obstruct urethra, causing
urinary retention
– Affects half of men over age 50 and 90% of men over age 80
– Other risk factors: family history, environment, diet, obesity,
excess ETOH
– Manifestations : gradual onset of urinary obstruction, urinary
irritation (see table 55-1)
– Potential complications
• Urinary obstruction
• May lead to renal calculi, urinary tract infection
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Conditions of the Prostate
• BPH
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Diagnosis generally made through H & P
• Additional tests may include UA, PSA, rectal ustrusound,
uroflowmetry
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Treatment
• Drug therapy
– 5-a reductase inhibitors (finasteride, dutasteride)
– Alpha blockers (doxazosin, terazosin, tamsulosin) symptomatic relief; do not treat hyperplasia
– Herbal therapy - saw palmetto
• Surgery
– TURP
– TUIP
– Minimally invasive surgeries
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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, ?dietary
factors - fat
• 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
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Prostate Cancer
• Early diagnosis is vital; regular health screening is crucial
– PSA and DRE for >50 years; if abnormal, biopsy
• Complications: sexual dysfunction
• Treatment may include
– Watchful waiting (deferred treatment)
– Prostatectomy
• Radical prostatectomy
– Radiation therapy
• Teletherapy (external beam)
• Brachytherapy with radioactive seeds in prostate gland
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Exposure to others minimal
Avoid close contact with pregnant women
Condom with intercourse
Local side effects
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Prostate Cancer
• Hormonal therapy
– Cancer may be controlled by androgen
withdrawal
– May be done via surgical castration
(orchiectomy) or with meds
• Chemotherapy
– Limited to those with hormone refractory therapy
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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
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Nursing Process—Diagnosis of
the Patient Undergoing
Prostatectomy
• Anxiety
• Acute pain preoperatively
• Acute pain postoperatively
• Deficient knowledge
• Sexual dysfunction
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Collaborative Problems/Potential
Complications
• Hemorrhage and shock
– High risk d/t very vascular gland
– Formation of clots may obstruct catheter outflow
• Infection
– Includes UTI and epidydimitis
• DVT
• Catheter obstruction
• Sexual dysfunction
• Urinary incontinenceCopyright © 2008 Lippincott Williams & Wilkins.
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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
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Relief of Pain
• 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
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Maintaining Catheter Patency
• Continuous bladder irrigation
– Rate set for light pink urine
• Manual irrigation per orders
– Aseptic technique
• Careful I/O
• Monitor for color of urine and clots
– Small clots expected in first 24 hours
– Bright red blood may indicate hemorrhage
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Three-Way System for Bladder
Irrigation
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Interventions
• Monitoring and managing potential
complications
– Hemorrhage
• Observe color, amount, consistency of drainage
• Report changes
• VS, I&Os
– Infection
• Avoid rectal insertions
• Aseptic technique with dressing changes
• Monitor for s/sx of infection
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• DVT
Interventions
– Early ambulation
– Compression stockings
• Obstructed catheters
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Careful management of 3 way bladder irrigation
Assess for bladder distension
Assess tubing for kinks, patency
Irrigation as ordered - with NS
• Sexual Dysfunction
– Education about return of libido, possible ED treatements as
ordered by MD
– Trusting environment, encourage discussion of concerns 28
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Interventions
• Urinary incontinency or dribbling is common
– Encourage Kegel exercises hourly
– Teach to stop several times during urination
– Often improves within 12 months
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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
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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 (kegel) exercises
• Avoid straining, heavy lifting (10 lb) , long car trips (for 6 to 8
wks)
• Diet: encourage fluids and avoid coffee, alcohol, and spicy
foods (bladder irritants)
• Assess sexual issues and provide referrals as needed
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• Orchitis
Testicular conditions
– Inflammation of the testes (congestion or infection)
– Acute onset of scrotal pain and edema
– Antinfective agents, ice packs, analgesics, antiinflammatories
• Epididymitis
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Infection of the epididymis
Bacterial infection usually from prostate or urinary tract
Pain in the inguinal canal, pyuria, fever, chills
Patient and sexual partner need to be treated with antibiotics
May require surgical intervention
Also bed rest, scrotal elevation, cold compresses, analgesics
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Testicular Cancer
• Most common cancer in men age 15 to 34
• Highly treatable and curable; onset usually 20s
• Risk factors: undescended testicles, positive family
history, cancer of one testicle, Caucasian American
race
• Manifestations: painless lump or mass in the testes;
possible dull ache; metastatic manifestations
• Early diagnosis: monthly testicular self-exam (TSE)
and annual testicular exam ; ultrasound
• Treatment: orchiectomy, retroperitoneal lymph node
dissection, radiation therapy, and chemotherapy
– May consider sperm bank before treatment
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Testicular Self-Exam
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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
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Vasectomy
• Procedure for male sterilization - ligation or
resection of part of the vas deferens
– Typically an outpatient procedure
• Nursing management
– Ice bags to reduce swelling
– Cotton, jockey-style briefs for support
– Educate that fertility remains for 4-8 weeks after
procedure (until stored spermatozoa have been
evacuated)
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Conditions Affecting the Penis
• Hypospadias and
epispadias
• Phimosis
• Priapism
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