Male Reproductive Flashcards
When evaluating of the male reproductive system, what patient’s history do you need to look at?
- Allergies and meds
- Past medical/surgical hx
- Psychological history
- Family history
- Reproductive history
What are medications that can CAUSE sexual dysfunction????
- Alcohol, THC & other recreational drugs
- Anabolic steroids
- Antihypertensives meds
- Long term opiates
- Antidepressants
- Some meds for BPH
What physical examinations do you do for the male reproductive system???
- Inspection/palpation
- Digital Rectal Exam (DRE) – basically using couple of fingers & feeling thru the wall of rectum/prostate gland.
1) Psychosocial concerns, modesty, dignity (since it’s embarrassing for them, PROFESSIONALISM is important!!!!))
2) Alterations with BPH/benign prostatic hyperplasia:- Enlarged
- Non-tender
- Rubbery feel
3) Alterations with Prostate Cancer: - Enlargment
- Hard mass or nodule
- Induration
- Asymmetry
4) Additional findings with Prostate Cancer: - Fatigue & unexplained weight loss
- Signs of metastasis:
- Lungs –> difficulty breathing, SOB, (bloody) cough!
- Liver –> Pain, elevated liver enzymes!
- Bone –> Pain
- Lymph node –> Enlarged @ the groin!!
- TSE / Testicular Self-Exam
- Diagnostic test:
- Testosterone (if decreased libido, or ED)
- PSA (prostate specific antigen) - Transrectal Ultrasound (TRUS)
- Needle Biopsy, patient care
What do you need to know about prostate cancer??
- Slow growing malignancy which metastasizes to lymph nodes, bones (the pelvis, sacrum, lumbar spine), lungs and liver over time
- Etiologic factors:
- Cancer of “OLD MEN”
- More common in African Americans
- Family history
- Age 55 or older
- Diet low in fruits and veggies
What 3 things to teach about Testicular Self-Exam (TSE)???
- Same time EACH month!!
- During or after shower when testes are more palpable
- Need regular clinical exam by health care provider!
Testicular Self-Exam is important to teach to what age group???
Important to teach to Young Men!!!
What is the Transrectal ultrasound (TRUS)??
Taking the little wand into the rectum & it’ll show some kind of imaging of the prostate gland
What are the patient care for Needle BIOPSY???
- Enema and Antibiotics PRIOR
- Pain control:
- Meds
- Deep breathing/ relaxation - Post Care:
- Make sure that patient CAN VOID before leaving!!!
- Antibiotics
- Teach abt sign of infection, Like:
- Increase in pain
- Signs of UTI
- Discharge that is PURULENT!
- NORMAL TO HAVE SOME BLOOD IN THE URINE/STOOL/SEMEN for couple of days!!!
What do you need to know about Prostate Specific Antigen (PSA)??? FOR WHO AND WHAT IS THIS FOR????
(smth we do for older men when we’re concerned abt prostate cancer) :
- COLLECT BEFORE DRE
- 4 ng/mL or less, higher norma in ELDERLY and African Americans!!!!
- Why elevated??
1) Examining the prostate gland with a DRE can temporarily elevate the PSA.. That’s why take PSA before DRE!!
2) BPH CAN ELEVATE PSA TOO!!!
- a lot of things can cause FALSE AND NEGATIVE RESULT!!!!
What do you need to know for Needle Biopsy and the Patient care????
- Enema and Abx PRIOR
- Pain management: meds and Deep breathing/Relaxation!!
- Post Care:
1) MAKE SURE THEYRE ABLE TO VOID BEFORE LEAVING
2) ABX
3) REPORT SIGNS OF INFECTIONS, LIKE:- Increase pain in urination*
- SIGNS OF UTI*
- DISCHARGE THAT IS PURULENT!!!!
- ITS NORMAL TO HAVE BLOOD IN THE URINE/STOOL/SEMEN FOR COUPLE OF DAYS!!!
What is Normal/expected after a Needle Biopsy?? WHAT FINDING IS CONCERNING AND SHOWS SIGN OF INFECTION???
Infection is when their discharge is purulent!!!!!
Normal when they have some blood in the urine/stool/semen for several days!!!!!!!!!
What does the American Cancer Society recommends about DRE and PSE?????**
Recommends yearly DRE and PSA for men older than 50 years of age, Men over 40-45 years of age IF they’re at high risk of infection for prostate cancer (like AFRICAN AMERICAN AND THOSE WITH FIRST DEGREE RELATIVE DX AT AN EARLY AGE). Age 40 if they’re for higher risk (MORE THAN ONE FIRST-DEGREE RELATIVE DX AT AN EARLY AGE)!!!!
What is BPH and what can cause it?? What are the potential consequences/complications??
Enlargement of the prostate gland due to aging, estrogen/testosterone imbalance or high levels of Dihydrotestosterone (DHT)!!!
Potential Consequences:
1. Lower urinary Tract symptoms (impact quality of life)
2. Acuter urinary retention
3. Urinary tract infection/UTI
4. Bladder stone
5. Bladder damage
6. Kidney damage (pyelophritis, post renal AKI)
What are signs of renal insufficiency with BPH????
(FCE, PAB)
1. Fatigue
2. Coolness
3. Edema
4. Pruritis*
5. Appetite loss/Anorexia
6. BUN, Creatinine
What are the diagnostics for BPH????
- DRE
- Urinalysis, CBC (for infection)****
- PSA (elevated)
- Renal Function Test
- Urine flow/Voiding Test
What can you EXPECT/ anticipate of patients with BPH???
- Difficulty urinating, 2. High Frequency,
- Not fully emptying the bladder,
- Dribbling!!!!
- Nocturia
- Painful urinating
(BURNING WHILE URINATING IS NOT A SIGN OF BPH!!!!!)**
What are the 8 patient teachings for BPH???
- Avoid EVENING Fluids!!!
- Some patients are taught to intermittently cath themselves
- DOUBLE VOIDING
- Activity
- Kegel’a Exercise
- Avoid ALCOHOL AND CAFFEINE
- Lose some weight
- Go when u first feel the urge
what are the 2 general information about BPH meds???
- Beneficial (they won’t have those annoying urinary tract symptoms)
- AVOID: Anticholinergic (Atropen/Atropine), Antihistamines, and Decongestants
What are the surgical options for BPH?????
- Prostatic stents
- TIPS (TUIP) procedure
- TUMT procedure
- Laser surgery
- TURP/ Trans-urethral resection of prostate
What are the medications for BPH??
- 5-Alpha Reductase Inhibitors (5-ARIs)
- Finasteride (Proscar), Dutasterise (Avodart) - Alpha-Adrenergic Blockers
- Tamsulosin (Flomax), Terazosin (Hytrin), Doxazosin (Cardura) - Phosphodiesterase-5 inhibitors (PDE-5)
- Tadalafil (Cialis)
What are 4 concerns of prostate surgery?????**
- BLEEDING (#1 concern!!!) And Infection
- Urinary incontinence**
- Retrograde Ejaculation**
- Erectile Dysfunction***
What is TURP and what is it used for???? What are the primary concerns for it????
Removal of the enlarged portions of the prostate through the urethra using the endoscopic instrument.
For BPH treatment of prostate cancer palliation!!!!
Primary concerns: BLEEDING (#1 concern) And Infection!!!!
What are the POST OP PATIENT CARE FOR prostate surgery????
- General post op care (CDB, diets, pain management)
- MONITOR Hemaglobin and Hematocrit
- INFECTION CONCERNS
- Keep stool soft, AVOID STRAINING = bleeding
- Bladder spasms
- Increase Fluid intake
W is the Cather Care for Prostate Surgery???
Continuous Bladder Irrigation!!!
1. 3-way catheter
2. Purpose of irrigation:
- Flash out clots or debris that may have accumulated in the area
- Keep potency
- Bleeding control
- Drainage/Output:
1) Pale Yellow, Pink Tinged : DESIRED OUTCOME!!!!
2) Blood tinged, Clots, Tissue Debris: Normal at First!!!Increase irrigation, may need to manually irrigate
3) Bright Red/ Deep Burgendy: NOT GOOD!! ASSESS AND INTERVENE!!!!!!
- Increase irrigant flow
- Ensure traction!!!**
- Consider SPASMS**
- ASSESS VS (BP reduced, HR increased, signs of low perfusion)
- IV Fluids!!
- CALL HCP AND RAPID RESPONSE !!!!!!!!***** - Catheter Occlusion:
1) How to know:
- Urine leakage around the catheter
- Parient reports spasm, urge to void
- No output in bag!!
- Input Greater than Ouput!
2) What to do:
- Make sure there’s NO KINK!
- Manually Irrigate!!!!!
What are the Discharge Teaching for Prostate Surgery???!!!!
- INCREASE PO fluid intake***
- normal 2000-2500 a day
- Increase if blood/clots/debris in the urine
- KEEP STOOL SOFT**
- REPORT SIGN OF INFECTION***
- What to expect
- Burning, Frequency, Dribbling, Leakage
- Urine blood tinged, clots, debris for several days!
- IF PATIENT COMES HOME WITH CATHETER:***
- hygiene and infection prevention
- How to empty bag
- I&O
- Increase fluid
- Leg Bag*
- Kegel exercise
- ADDITIONAL CONCERNS:** (avoid encourage encourage … PROVIDE, no sec, wait before continuing anticoagulant)
- AVOID CAFFEINE/ALCOHOL*
- ENCOURAGE KEGEL*
- ENCOURAGE REST, NO HEAVY LIFTING = straining = bleeding
- PROVIDE EMOTIONAL SUPPORT!!**
- NO SEX FOR 4-6 WEEKS!!!**
- WAIT BEFORE CONTINUING ANTICOAGULANT!!!!***
What is Testicular cancer and who does it affect??? WHAT CAUSES IT?
- Rare cancer that affects men 15-35 yrs of age!!!!
- Due to Sperm-producing-cells (MOST COMMON) or from cells that produce testosterone!!!!!
- FAVORABLE PROGNOSIS
- Tropic to brain, lungs, and bones!!!!!!!**
Who are MORE at risk for Testicular Cancer!????**
- “Cryptorchidism”
- Testicular cancer in undescended tissue 80% of time!!!
- 20% of PREMIE BOYS will have cryptorchidism!!!! - History of trauma, infections
- Family tendency
- CAUCASIAN RACE!!!!!**
Which race is most at risk for Prostate cancer? WHICH RACE US at most risk for Testicular Cancer???
- Prostate cancer = African American
- Testicular cancer = Caucasians
What are the 5 assessment findings of testicular cancer????
- Often painless lump, hardness or swelling (With or Without redness)
- Heavy or firm feeling of the SCROTUM
- *DULL ACHES of scrotum or in the abdomen, Testicular Pain Possible!
- Inguinal and Supraclavicular node swelling
- SYMPTOMS OF METASTASIS (brain, lungs, bones)
What are the diagnostics for Testicular Cancer??????
- Tumor markers: Alpha-feto protein (AFP), Human chorionic, Gonadotropin (hCG)
- Imaging: US, CT, MRI
(3. OLIGOspermia, Azoospermia)
What is the surgical treatment for Testicular cancer called???? What is it and what can it result in?
WHAT IS the special concerns ???***
Orchiectomy!!!!
1. Surgical removal of the testicle WITH lymph node dissection
2. Can cause nerve damage and impact Ejaculation!!!!!
3. may need surgery, then Chemotherapy and Radiation Therapy!!
Special Concerns:
1. Infertility!!!!!
1) Education
2) Possible Sperm Banking (Oligospermia and Azoospermia common at dx)
- COLLECT SPERM BEFORE SURGERY, CHEMO, & RADIATION!!!!!!!!!!*****
What are the post op considerations for Testicular cancer!??????
- Pain management: meds, ice, scrotal support
- REPORT SIGNS OF INFECTION!!**
- SILICONE PROSTETHIC
- CONTINUE TSE ON THE remaining testicular
- TUMOR MARKERS AND SCANS recommended by HCP
What is a slow growing cancer that’s found often in an older men and African Americans???
PROSTATE CANCER!!!
Which cancer caused by a LOW DIET IN FRUITS AND VEGGIES?????
PROSTATE CANCER!!!!!!!
