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Health Assessment 4 > Ch. 24 Male GU > Flashcards

Ch. 24 Male GU Flashcards

1
Q

Why might a man withdraw from engagement in sexual activity?

A
  • Loss of spouse
  • Depression
  • Preoccupation w/ work
  • Marital or family conflict;
  • Side effects of medication such as antihypertensives
  • psychotropics
  • antidepressants
  • antispasmodics
  • sedatives
  • tranquilizers or narcotics and estrogen
  • heavy alcohol use
  • lack of privacy
  • economic/emotional stress
  • poor nutrition
  • fatigue
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2
Q

Dev. competence: infants: development and location of testes

A

i. Prenatally, testes develop in abdominal cavity near the kidneys.
ii. Testes descend along inguinal canal into scrotum before birth.
iii. At birth, each testis measures 1.5 to 2 cm long and 1 cm wide.

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3
Q

Dev. comp.: adults/aged adult: fertility changes in males

A

there is no definite end to fertility as there is with women; production of sperm begins to decrease around 40 years although it continues into 80-90 y.o.

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4
Q

by what age does testosterone production begin to decline?

A

30 y.o.

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5
Q

Changes in aging male

A

Testosterone production declines after 30 but very gradually, so resulting physical changes are not evident until later in life. Gradual decrease in testosterone production after the age of 30.
Aging male—decreasing pubic hair, penile size
Slower, less intense sexual response
Erection takes longer to develop.
Ejaculation shorter, less forceful, with rapid detumescence

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6
Q

what is detumescence?

A

the process of subsiding from a state of tension, swelling, or (especially) sexual arousal.

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7
Q

Sub. data: frequency (or urination) - normal

A

avg adult voids 5-6 times/day

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8
Q

what are normal causes in change of urinary frequenc

A

varying fluid intake, individual habits

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9
Q

What is polyuria

A

excessive quanTity

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10
Q

oliguria

A

< 400 ml/24hrs

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11
Q

causes of nocuturia

A

occurs w/ frequency and urgency in urinary tract disorders. Also, can occur with: cardiovascular, habits, dieuretics

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12
Q

What is nocturia

A

waking during the night to pee

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13
Q

what is hematuria and is it concerning?

A

hematuria is blood in urine; its never a good sign and need to determine the cause. Worry about lesion or prostate enlargement.

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14
Q

subj. data: dysuria and possible causes

A

painful urinating. Causes include: acute cystitis, prostatitis, urethrititis.

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15
Q

Subj. data: hesitancy and straining - what is it

A

Includes loss of force and decreased caliber

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16
Q

What is terminal dribbling?

A

dribbling such that you must stand closer to toilet

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17
Q

Possible causes of hesitancy and straining?

A

Sense of residual urine (do you feel a need to urinate afterward?)
Recurrent episodes of acute cystitis.
Symptoms (of UTI) suggest bladder outlet obstruction from progressive BPH.

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18
Q

Urine Color - what is usual color and what does it mean (generally)?

A

normal urine is yellow. For a color change lasting more than 1 day, person should seek care.

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19
Q

Blue urine

A

medications, foods such as asparagus, dye after prostate surgery

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20
Q

Dark gray urine

A

urine contains melanin, melanuria

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21
Q

Tea colored urine

A

liver disease, jaundice, moglobinuria, meds or dyes, blood

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22
Q

Pink urine

A

menses, food, laxatives, kidney stones, UTI

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23
Q

Red urine

A

Blood, nephritis, cystitis, cancer, following prostate surgery

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24
Q

Orange urine

A

meds, food/food dyes, laxatives, dehydration, jaundice

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25
Q

Yellow urine

A

Natural yellow is urochrome excretion, a pigment in blood; bright neon with vit. supps

26
Q

Pale yellow urine

A

clear, watery with excess liquids; acute viral hep, cirrhosis

27
Q

Cloudy urine

A

UTI, Kidney stones

28
Q

Past GU hx (including types of incontinence)

A

Urge incontinence: involuntary urine loss from overactive deterusor muscle in bladder.
Stress incon: involuntary urine loss with physical strain
Ask about hx of stones, flank pain, UTI, prostate trouble

29
Q

Subj. data: penis

A

ask about pain, lesions. Ask about urethral discharge which could occur with infection.

30
Q

Subj. data: scrotum

A

Concern with any self-deciphered mass alerts you to careful exploration during exam.
Bulge/swelling in scrotum? Any dragging heavy feeling in scrotum?
a. Possible hernia.

31
Q

what abnormal findings could lumps/swelling in scrotum signify?

A

spermatocele, hydrocele, varicocele, rarely testicular cancer

32
Q

Sub. data: sexual activity and contraceptive use. Q.s to include

A

Questions about sexual activity should be routine in review of body systems
(ask about sexual preference): Gay and bisexual men need to feel acceptance to discuss health concerns. Men who have sex with men are at increased risk for STI; physiological distress.

33
Q

Sub. Data: STI contact

A

Ask about any sexual contact w/ a person having an STI. When, did you get it, how was it treated, do you use condoms to prevent STI’s, any q. or concerns?

34
Q

Nocturnal enuresis

A

involuntarily urinating at night after age 5 to 6.

35
Q

add’l hx for infants/children. Molestation

A

Screen for sexual abuse – for prevention, teach child that is not ok for someone to look at or touch his private parts while telling him it’s a secret.
Naming three trusted adults will include someone outside the family – important, since most molestation is by a parent.

36
Q

add’l hx for Preadolescents and adolescents

A

i. Ask about body changes
ii. Ask about nocturnal emissions: an occasional boy confuses this with a sign of STI or feels guilty
iii. Avoid term “having sex” – ambiguous and teens can take it to mean anything from foreplay to intercourse. Use behavior specific words
iv. Ask about specific BC last time you had sex which opens up dialogue and reveals not using any method of birth control.
v. TSE: assess knowledge of testicular self-exam.
vi. Screen for sexual abuse.
vii. Gardasil: recommended for boys 9 to 26 for prevention of STI genital warts in men and reducing HPV related cervical cancer in women.

37
Q

add’l hx for aging adult

A

i. Early symptoms of enlarging prostate may be tolerated or ignored. Later symptoms are more dramatic: hematuria, UTI
ii. Incontinence if any involuntary leaking of urine
iii. Nocturia may be caused by diuretic meds, habit or fluid ingestion 3 hrs before bedtime; coffee and alcohol have diuretic effects.
iv. Fluid retention from mild HF or varicose veins produces nocturia b/c recumbency at night mobilizes fluid
v. Discuss sexual activity. Older person generally is not reluctant to discuss and welcomes.

38
Q

Normal position of urethral meatus

A

positioned just about centrally

39
Q

abnormal findings upon inspection of penis

A

open sores, inflammation, lesions, solitary ulcers (chancre); grouped vesicles or superficial ulcers, wartlike papules

40
Q

Phimosis

A

abnormal finding of narrowed opening of prepuce so cannot retract foreskin

41
Q

paraphimosis:

A

abnormal finding with painful constriction of glans by retracted foreskin

42
Q

hypospadias:

A

abnormal finding with ventral location of meatus

43
Q

epispadias

A

abnormal finding with dorsal location of meatus

44
Q

abnormal finding re: pubic hair

A

pubic lice or nits can be seen with unaided eye. Excoriated skin usually accompanies.

45
Q

Foreskin: normal findings

A

foreskin should not be inflamed and should be cleaned daily. There should not be any red/swollen appearance.

46
Q

Causes of scrotal swelling

A

heart failure, renal failure, local inflammation

47
Q

characteristics of swollen scrotum

A

taut and pitting

48
Q

normal findings of scrotal inspection

A

Asymmetry is normal, with left scrotal half usually lower than the right.

49
Q

abnormal scrotum findings

A

Scrotal swelling may be taut and pitting. This occurs with HF, renal failure or local inflammation.
Absent testes could be temporary migration or true cryptorchidism.
Atrophied testes are small and soft.
Nodules warrant ultrasound imaging.
An indurated, swollen and tender epididymis indicates epididymitis.

50
Q

Inspection of Hernia

A

Bulge at the external inguinal ring or femoral canal can indicate hernia. A hernia may be present but easily reduced and may appear only intermittently w/ an increase in intraabdominal pressure.

51
Q

Palpate Inguinal nodes: where and abnormal findings

A

i. Palpate horizontal chain along groin inferior to inguinal ligament and vertical chain along upper inner thigh.
ii. Abnormal findings include: Enlarged, hard, matted, fixed nodes.

52
Q

Self Care: Testicles: TSE for self care

A

T: Timing;
S: Shower, warm water relaxes scrotal sac;
E: Examine, check for changes, report changes immediately

53
Q

Assessment of urinary function: ABNORMAL findings

A

i. Cloudiness suggests presence of WBC’s, bacteria, casts.
ii. Certain drugs or foods can change urine color.
iii. Proteinuria indicates glomerular disease in nephron.
iv. Glycosuira suggests hypersgycemia occurring with DM
v. Increased WBC’s occur w/ UTI
vi. Increased RBS’s occur w/ UTI, Glomerulonephritis, renal calculi, trauma and cancer

54
Q

What do creatinine levels measure?

A

Creatinine measures GFR. GFR is normally 125 mL/min. When GFR decreases by ½ serum creatinine level doubles, indicating decreased kidney fn. BUN rises with decreased kidney fn but is less specific.

55
Q

Dev. Comp. Aging Adults. Physical changes

A
  1. thinner, graying pubic hair and decreased size of penis
  2. size of testes may decrease and feel less firm
  3. Scrotal sac is pendulous w/ less rugae.
  4. Scrotal skin may become excoriated if man continually sits on it.
56
Q

Urethritis

A

infection of urethra which causes painful, burning urination or pruritus. Meatus edges are red, everted and swollen with purulent discharge. urine is cloudy w/ discharge and mucus shreds. 50% are caused by chlamydia. Imp. to differentiate cause b/c antibiotic tx is different.

57
Q

Renal Calculi

A

Renal stones form in kidney tubules and then migrate and become urgent when they pass into ureter, become lodged, and obstruct urine flow. Severe flank pain with radiation to groin or abdomen, N/V, restlessness, hematuria.

58
Q

Acute urinary retention

A

abrupt inability to pass urine w/ bladder distention and lower abd. pain. More common in men due to BPH. Must catheterize to relieve acute discomfort.

59
Q

Urethral sticture

A

pinpoint, constricted opening at meatus or inside alone urethra. Can be congenital or secondary to injury.

60
Q

NAVEL

A

Nerve, Artery, Vein, Empty Sac, Lymphatics

Health Assessment 4 (4 decks)

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