Medical Surgical Nursing II Chapter 61

1
Medical Surgical Nursing IIChapter 61

• Caring for Clients with Disorders of the Male
  Reproductive System

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Structural Abnormalities

• Cryptorchidism when one or both testes do not
  descend into the scrotum
• cause not known
• must be corrected in order to prevent
  sterility, usually by 2 years of age
• 1 testis must be in scrotum to ensure production
  of sperm
• increased risk for testicular cancer
• May descend during childhood or puberty

• Torsion of the spermatic cord a twisting of the
  spermatic cord that results in decreased blood
  flow to the testicle -fig 61-2
• S/S sudden, sharp testicular pain with redness
  swelling
• Treatment emergency surgery

3

• Phimosis is the inability in uncircumcised males
  to retract the foreskin
• S/S painful erection and intercourse, inability
  to clean under the foreskin
• Treatment circumcision

• Paraphimosis is a strangulation of the glans
  penis due to inability to replace the retracted
  foreskin in uncircumcised males
• S/S pain, swelling
• Treatment circumcision

4
Prostatitis

• An inflammation of the prostate gland that
  surrounds the urethra at the neck of the bladder.
  Causes narrowing of the urethra
• Causes infections that enter through the urethra

• S/S perineal pain, low back pain, fever, chills,
  dysuria urethral discharge
• Treatment antibiotic therapy for as long as 30
  days, analgesics, sitz baths. Treatment of
  sexual partner.

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Epididymitis Orchitis-fig 61-4, 61-5

• May occur alone or together
• Caused by an infectious agent, long term
  indwelling foley catheter or after cystoscopy or
  prostatectomy
• Orchitis w/o epididymitis is associated with
  viral mumps infection that occurs after puberty
  results in sterility

• S/S pain swelling in the inguinal area,
  fever, chills
• Treatment bed rest, elevation of the scrotum,
  analgesics, anti-inflammatory medications
• Nursing measures scrotal elevation, ice packs

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Erection Disorders

• IMPOTENCE
• the inability to achieve or maintain an
  erection must be multiple or persistent
  incidences to be considered a pathologic problem
• Causes drugs, aging, HTN, DM, anxiety or
  depression
• Treatment table 61-2 fig 61-10 change drugs,
  vacuum devices, self-injecting drugs, penile
  implants

• PRIAPISM
• when the penis becomes engorged remains erect
  in the absence of sexual stimulation
• Causes vascular problems, side effects of
  impotence treatments
• Treatment vasoconstricting meds, draining the
  trapped blood with a needle, emergency surgery

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Benign Prostatic Hyperlasia

• BPH is an enlargement of the prostate gland by
  normal cells
• caused by aging can cause narrowing of the
  urethral opening which results in urine retention

• S/S difficulty voiding, decreased force,
  stream, incomplete bladder emptying causing
  cystitis, nocturia
• Treatment drug therapy see table 61-1 various
  types of surgeries to enlarge the bladder outlet
  fig 61-12

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PROSTATE CANCER

• most common in men gt 50 yrs old
• 3rd most common cause of cancer deaths in all
  men
• 1st most common cause of death in men gt 75 yrs
  old

• S/S none at first, then frequency of urination,
  nocturia dysuria. With metastases may have
  back pain, bone pain
• Detected by digital rectal exam, PSA, biopsy
• Treatment depends on tumor size, microscopic
  characteristics presence or absence of
  metastases, table 61-4

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Prostate Cancer (cont)

• Drug therapy table 61-2
• Nursing management see nursing care plan 61-2
• For continuous bladder irrigation fig 61-13

• Suprapubic catheter care nursing guidelines 61-1

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Testicular Cancer

• Rapidly metastasizing
• Onset 18 40 years
• Risk hx of cryptorchidism
• S/S scrotal edema, lump box 61-1

• Medical Mgmt table 61-5
• Surgery radical orchiectomy
• Chemotherapy
• Radiation
• Nursing Mgmt
• preop - responds to distress over having
  cancer talk about sperm banking before procedure
• postop usual nursing care emotional support

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Elective Sterilization

• Vasectomy an outpt procedure done in the MD
  office where the vas deferens is cut sperm
  cannot be transported to the outside
• Fig 61-15
• no effect on erection, ejaculation or libido

• Must use another form of birth control until the
  ejaculatory fluid is free of sperm, which may
  take several weeks
• See client teaching

12
General Nutritional Considerations

• High fat diets may increase the risk of prostate
  cancer by 30-50
• Saw palmetto is used by some men to relieve
  symptoms of BPH

13
General Pharmalogical Considerations

• Platinum based drugs such as cisplatin (Platinol)
  are very effective in treating certain forms of
  testicular cancer.
• Administration of antiemetic drugs prior to
  chemotherapy can reduce incidence of nausea
  vomiting. Cisplatin, however, does not respond
  to antiemetics.
• Certain medications such as HTN, antidepressants,
  narcotics can cause sexual dysfunction in some
  men.

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General Gerontologic Considerations

• Impotence increases as men age 15-25 of all men
  experience some impotence by age 65.
• Impotence is not a normal part of aging, however,
  other causes should be explored.