Timby's Introductory Medical-Surgical Nursing: Chapter 55: Disorders of the Male Reproductive System Flashcards


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1
  • condition due to which one or both testes fail to descend into the scrotum
  • occurs mostly during childhood

Cryptorchidism

2

What could happen cryptorchidism isn't treated by the age of 2 years old?

  • seminiferous tubules atrophy and fibrose causing fertility to be compromised
  • testicular cancer

3

Treatment for cryptorchidism?

Orchiopexy

  • secures the scrotum in place
  • performed b/t ages 1 and 2 y/o

4

when both testicles are permanently absent, what can be implanted within the scrotum to provide a normal anatomic appearance?

Saline testicular prosthesis

5

Nurse management/interventions/teachings for clients with cryptorchidism?

  • for men at high risk for testicular cancer, teach them to perform testicular self-exams monthly during warm showers to detect any abnormal mass in the scrotum
  • consult with pcp if a consistent changing mass in the testis is detected

6

Review Client and Family Teaching 55-1

Review Client and Family Teaching 55-1

7

involves the rotation of the testicle that twists the spermatic cord around the testicular artery compromising blood flow to the testicle

Torsion of the Spermatic Cord

8

This client presents with:

  • sudden, sharp testicular pain w/ visible local swelling
  • nausea, vomiting, chills, and fever due to the pain
  • physical exam reveals extremely tender testis
  • elevation of the scrotum intensifies the pain by increasing the degree of the twist
  • may happen due to intense exercising, during sleep, or b/c of crossing the legs

Torsion of the Spermatic Cord

9

Tx for torsion of the spermatic cord

Immediate surgery to prevent atrophy of the spermatic cord and preserve fertility

10

Nursing interventions for clients who have surgery due to the torsion of the spermatic cord

  • Pre-Op: administer analgesics
  • Post-Op: apply jock-strap (scrotal suspensory) before client gets out of the bed; inspect dressing for drainage; give antibiotics; report any sudden pain

11
  • occurs in uncircumcised male clients
  • inability to retract prepuce (foreskin)
  • caused by congenitally small foreskin and poor hygiene and infection

Phimosis

12
  • occurs in uncircumcised male clients
  • strangulation of the glans penis from the inability to replace the retracted foreskin

Paraphimosis

13

This client presents w/:

  • pain w/ erection and intercourse
  • difficulty cleaning under the foreskin

Phimosis

14

This client presents w/:

  • painful swelling of the glans
  • severe edema
  • urinary retention

Paraphimosis

15

treatment for clients w/ paraphimosis and phimosis

  • Circumcision to relieve conditions permanently
  • If surgery is not indicated, client is instructed to wash under the foreskin daily and seek care

16
  • caused by E. coli
  • inflammation of the prostate gland
  • most often caused by microorganisms that reach the prostate by the way of the urethra

Prostatitis

17

This client presents w/:

  • glandular swelling and tenderness
  • GU problems
  • perineal pain/discomfort
  • an unusual sensation preceding or following ejaculation
  • low back pain
  • chills
  • dysuria
  • urethral discharge

Prostatitis

18

Tx for clients w/ prostatitis

  • 30 days of antibiotic therapy
  • mild analgesics
  • sitz bath

19
  • inflammation of the epididymis and testis
  • can lead to prostatitis or infection elsewhere in the body
  • Epididymitis
  • Orchitis

20

This client presents w/:

  • pain/swelling in the inguinal area and scrotum
  • fever and chills
  • pyuria
  • urine containing bacteria
  • swollen testis and epididymis
  • scrotal skin that is red and tense
  • Epididymitis
  • Orchitis

21

Tx for clients w/ epididymitis and orchitis

  • bed rest
  • scrotal elevation
  • analgesics
  • NSAIDS
  • local cold applications to reduce swelling (after swelling subsides, heat apps can be applied)
  • Epididymectomy: for clients who have recurrent, chronic, or intractable infections (results in sterility if performed bilaterally
  • sitz bath

22

nursing interventions for clients w/ epididymitis and orchitis

  • elevate the scrotum by putting tape across the thigh
  • place icebag under tender scrotum (avoid keeping cold bag next to the skin b/c it might cause tissue damage)
  • copious fluid intake
  • be aware of client's body image

23
  • aka 'impotence'
  • inability to achieve an erection
  • inability to achieve an erection sufficiently rigid enough for sex
  • inability to sustain an erection for satisfactory period of time

Erectile Dysfunction

24

Medications that can cause ED

  • Antidepressants
  • Antihistamines
  • Antihypertensives/Diuretics (Nitroglycerin)
  • Anti-Parkinson agents
  • Cancer agents
  • Opioid meds

25

This client presents w/:

  • difficulty in achieving and maintaining an erection
  • insufficient rigidity for penetrating the vagina or that intercourse is less than satisfactory

ED

26

Test used to determine if client has ED

  • Nocturnal penile tumescence and rigidity test
  • Doppler sonography (for men that PDE5 inhibitors, -fil meds, don't work for)

27

What medication is administered for a penile Doppler sonography? and at what angle?

  • alprostadil (caverject)
  • administered @ a 90 degree angle

28

tx for ED

  • PDE5 inhibitors (end in -fil)
  • Phentolamine (facilitates penile engorgement; administered at a 90 degree angle)
  • surgically implanted prosthesis
  • vascular surgery

29

If a client undergoes a penile implant, the nurse monitors for?

  • pain
  • swelling
  • bleeding
  • infection

30

After a client has penile implant, what should the nurse include in discharge teaching?

  • penis should be taped against the skin in a straight position for 2 week or longer, but it can be untaped for voiding
  • 3-6 weeks of sexual abstinence
  • avoid tight-fitting clothing
  • avoid contact sports
  • avoid heavy lifting for 3 weeks

31

a condition is which the penis becomes engorged and remains persistently erect w/o any sexual stimulation

Priaprism

32

This client presents w/:

  • an engorged penis that produces significant discomfort and interferes w/ arterial blood flow, urinary elimination
  • a vascular issue that may be caused by meds RX'd for ED

Priaprism

33

Medical TX for priaprism

  • terbutaline
  • phenylephrine

34
  • occurs as men age
  • interferes w/ emptying the bladder causing urinary retention

Benign Prostatic Hyperplasia (BPH)

35

This client presents w/:

  • takes more effort to void
  • narrow urine stream and decreased force
  • bladder empties incompletely
  • increased urge to urinate
  • nocturia
  • s/s of cystitis may develop

BPH

36

Diagnostic exams for dx'ing BPH

  • Completed first: PSA (prostate specific antigen)
  • Digital Rectal Exam (completed 2nd if PSA is elevated)

37

Medical and Surgical management for BPH

  • DREs
  • Tamsulosin
  • TURP
  • transcystoscopic urethroplasty

38

the balloon tip of a catheter is inflated for 10-20 minutes to stretch the prostatic urethra

transcystoscopic urethroplasty

39

part of the prostate is removed w/ a cutting instrument inserted through an endoscope

  • a continuous bladder irrigation is ordered after this to remove blood clots and residual tissue
  • clients may experience retrograde ejaculation, in which semen is deposited in the bladder rather through the urethra, rendering the client sterile
  • clients may have temporary or permanent incontinence

TURP

40

REVIEW CLIENT AND FAMILY TEACHING 55-2: MAINTAINING OPTIMAL BLADDER FUNCTION

REVIEW CLIENT AND FAMILY TEACHING 55-2: MAINTAINING OPTIMAL BLADDER FUNCTION

41

This client presents w/:

  • compromised blood flow
  • frequency, nocturia, dysuria
  • hematuria
  • hemospermia
  • ED
  • back pain or pain down the leg (when pain develops, the disease often is in an advanced stage)

Prostate Cancer

42

Diagnostics for Prostate Cancer?

  • 1: PSA that is greater than 4=DRE; >10= prostatic malignancy; >80= advanced metastatic disease
  • 2: DRE
  • 3: Transrectal Ultrasound confirms mass.
  • 4. Biopsy

43

Surgeries for prostate cancer

  • Suprapubic prostatectomy (for localized nodules)
  • Radical prostatectomy (for large tumors that may have spread)

44

This client presents w/:

  • testicular lump that is hard or granular
  • increase in the size of one testicle
  • heavy or dragging feeling in scrotum
  • dull ache in the groin or above the pubis
  • diminished sensitivity to testicular pressure
  • gradual or sudden swelling of the scrotum or lump felt on palpation

Testicular Cancer

45

Tumor markers for testicular cancer

  • alpha-fetoprotein
  • hCG

46

Medical and surgical management for testicular cancer

  • surgery (radical inguinal orchidectomy)
  • chemo and radiation
  • sperm banking should be discussed prior to medical and surgical tx

47

read nursing management on pg. 768/1024 for testicular cancer surgery

read nursing management on pg. 768/1024 for testicular cancer surgery

48
  • minor surgical procedure done in a PCP's office or clinic
  • the ligation of the vas deferens and results in permanent sterilization by interrupting the pathway that transports sperm
  • this client may wish to consider sperm banking before undergoing this procedure

Vasectomy

49

Nurse teaching for a client who receives a vasectomy

  • expect some bruising and incisional soreness after the local anesthesia wears off
  • apply ice packs to reduce swelling
  • take mild analgesics (tylenol or aspirin)
  • avoid strenuous activities for up to 5 days
  • resume sexual activities after 1 week
  • use a reliable method of contraception until PCP indicates sperm are not longer present
  • report severe pain, fever, or swelling at the top of the testes

50

surgical attempt to reverse a vasectomy by restoring patency and continuity to the vas deferens

vasovasostomy