Male Reproductive In Class Activity

Question 1

More information on urinary patterns
The patient’s pattern of awakening during the night to urinate has increased significantly since his last visit.
The risk for BPH and prostate cancer risk increases with age, with nightly urination being a key indicator.
Color urine
Odor - infection
Med history
How much urine - little bit each time may mean retention
Strain to void
Stream weak
When started
UTI?

Answer 1

What further assessment data should the nurse collect regarding Mr. Bahr’s statement about awakening more frequently to urinate?

Question 2

Examples include urinary frequency and urgency, difficulty starting a stream of urine, reduced force and size of the urinary stream, sensation of incomplete bladder emptying, straining to begin urination, post-void dribbling or leaking (common if sig retention), and presence of blood in the urine.

Answer 2

More information on urinary patterns

Question 3

Exam men over 50 have annually to eval possible enlargement prostate
Not diagnose prostate cancer - tells if prostate enlarge - if enlarged - prostate around urethra and as enlarges compressed urethra so have all urinary symptoms
transurethral/transrectal (preferred) - punch through rectal wall and get specimen

Answer 3

DRE - digital rectal exam

Question 4

As age increases
See trend - seeing increases in PSA - monitor overtime if cont see increase overtime; BPH increases and infection can as well
Measures the amount of prostate-specific antigen - Protein produced by cells in the prostate
If a prostate is enlarged then PSA levels can be elevated
A PSA test is often ordered as standard of care even in the absence of an enlarged prostate.
Higher levels of PSA can be associated with the presence of prostate cancer
Serum acid phosphatase levels and early prostate cancer antigen can also be elevated in prostate cancer - specific to prostate cancer

Answer 4

What is the purpose of a PSA blood test? Why would this test be ordered?

Question 5

It can also be elevated with advancing age and with BPH (benign prostatic hypertrophy), prostate cancer, age
Screening not diagnostic
Early diagnosis allows for quick intervention and treatment that can be life-saving.
Increased with BPH, age, cancer - screening; not diagnostic - Something wrong with prostate
Gen to prostate

Answer 5

Higher levels of PSA can be associated with the presence of prostate cancer

Question 6

2 diff classes - blocks testosterone: prostate shrinks to help with urinary symp; relaxes smooth muscle and allows for easier stream around urethra
Blocks testosterone: Side effects: erectile dysfunction, decreased libido, dizziness due to orthostatic hypotension, more fatigue, increased breast tissue - blocking testosterone; takes awhile
Relaxes smooth muscle: Assess for orthostatic hypotension, tachycardia, syncope; vasodilating and relax; works quickly

Answer 6

What are treatment options for BPH? - Meds

Question 7

Most common is TURP (transurethral resection of prostate)
Postoperative care for TURP
Increase fluid intake
See what flow is and adjust based on right color; clear - slow down flow; red - up flow; initially see pink but want get to clear/bright yellow

Answer 7

If medications are not successful what is the most common treatment for BPH?

Question 8

TURP - into urethra; pretty traumatic; remove sections of the prostate; can be brutal; cutaway some prostate tissue that is compressing on urethra
Most common

Answer 8

Most common is TURP (transurethral resection of prostate)

Question 9

Catheter in place after surgery
Monitor for infection - Risk for infection - messing with catheter all time
Prevent complications of immobility
Assess pain and VS q 2-4 hours
Maintain the rate of the continuous bladder irrigation (CBI) to ensure clear urine without clots and bleeding

Answer 9

Postoperative care for TURP

Question 10

Will feel the urge to void continuously
Stay in place for awhile
Foley and flushing it - clear bladder and urethra all time - reason is because stuck large catheter - trauma and bleeding and if bleeding stays there and not flushing that can clot; purpose continuous bladder irrigations (CBIs) can bleed little bit but want prevent clot - cause retention and serious issues - clear bladder and urethra; typ 24 hrs but sometimes longer
3 way catheter - urinary catheter; 2 L bags of saline into bladder and drains into foley catheter - feel like have void all time because constantly filling bladder; filling them and empty catheter; goes into bladder and drains out

Answer 10

Catheter in place after surgery

Question 11

Normal saline used and need 3 way urinary catheter
Assess color, consistency, and amount of urine output - Imp monitor output - goal: light pink: not bright red or large clots because those obstruct - sometimes tissue and bits clot in beginning but not large - those obstruct; want keep flow going so preventing clots because extremely painful; adjust based on color
Normal for the urine to be pink after surgery
Check the drainage tube frequently for external obstructions (kinks) and internal obstructions (blood clots, decreased output); Check for kinks - make sure flowing right - so much in bladder so really uncomfy really fast
After catheter is removed, may experience burning on urination, urinary frequency, dribbling, little leakage since catheters large; want good urinary func before d/c
Symptoms are normal and will decrease
May also pass small clots and tissue debris for several days; Bright red urine - report after catheter removed

Answer 11

Maintain the rate of the continuous bladder irrigation (CBI) to ensure clear urine without clots and bleeding

Question 12

At least 2000 to 2500 mL daily - keep kidneys flowing
Will decrease dysuria and keeps the urine clear

Answer 12

Increase fluid intake

Question 13

In the early postoperative period after transurethral resection of the prostate (TURP), Mr. Bahr will be at risk for hemorrhage. The prostate gland is highly vascular, and bleeding can be excessive.
Prostate extremely vascular and so very high risk bleeding; want baseline H&H and want check clotting factors

Answer 13

Why were these labs done? RBC, platelet count, H&H, PT, aPTT

Question 14

Evaluate kidney function
When kidney function is impaired, BUN and creatinine are elevated
Backflow of urine from the bladder to the kidney can cause kidney impairment
Kidney func - severe BPH and lot symp - can have lot urinary retention and can lead to kidney injury; severe urinary retention over long period can damage kidneys

Answer 14

Why were these labs done? - BUN and serum creatinine

Question 15

Not want straining -

Answer 15

increases bleeding

Question 16

When assessing Mr. Bahr’s urine in the immediate postoperative period, what characteristics would you anticipate?
A. clear and amber
B. pink
C. cloudy and yellow
D. brown with sediment

Answer 16

Answer: B

Question 17

Hemorrhage is a possible complication of transurethral resection of the prostate (TURP). If hemorrhage occurred, shock could develop. Which signs of shock might be assessed if hemorrhage occurred? (Select all that apply)
A. Decreased blood pressure
B. Increased heart rate
C. Lower abdominal pain
D. Pallor
E. Elevated temperature
F. Restlessness

Answer 17

Answer: A, B, D, F
Decreased blood volume, vasoconstriction; HR increases to compensate for lower BP
Typ no increase in temp

Question 18

Mr. Bahr complains of severe “cramping and tightness” in his abdomen. Which actions should the nurse implement? (Select all that apply)
A. Apply gentle massage over the lower abdomen
B. Have him lie in the fetal position
C. Encourage him to use relaxation techniques he learned preoperatively
D. Notify the HCP immediately
E. Check the urinary drainage tube for kinks and clots
F. Check the HCP’s prescription to see if medication is prescribed for relief of spasms

Answer 18

Answer: C, E, F
Not an emergency - not need HCP
s/s of some bladder spasms/cramping - not uncommon post-TURP to have probs with that; first thing do is check urinary drainage for kinks and clots

Question 19

Mr. Bahr’s urinary catheter has been removed. Plans are made for discharge if he is able to void. How would you assess for urinary retention (Select all that apply)?
A. Inspect for edema of the penis
B. Inspect the suprapubic area for distention
C. Palpate the suprapubic area for distention
D. Percuss the suprapubic area for tympany

Answer 19

Answer: B, C
Retention would be dullness

Question 20

A teaching plan is developed for Mr. Bahr immediate needs after discharge. Which needs should be included in the plan? (Select all that apply)
A. Need for high fluid intake
B. Use of enemas as needed
C. Regular walking
D. Immediate resumption of aerobic exercise
E. Perineal exercises
F. Immediate resumption of sexual activity
G. Need to avoid heavy lifting

Answer 20

Answer: A, C, E, G
High fluid intake - unless contraindicated
Do want prevent constipation, bearing down, lot straining; enemas is extreme just do stool softener
Issues with incontinence; strengthening perineal muscles
Avoid heavy lifting postop - prevent bleeding

Question 21

Mr. Bahr needs instructions about the signs and symptoms of complications of the TURP that should be reported to the HCP. What signs and symptoms should be reported?
A. Urine dribbling
B. Gross hematuria
C. Pale urine
D. Cloudy urine after intercourse

Answer 21

Answer: B
Gross - large amount
Large amount of bleeding
Some dribbling if had continuous bladder irrigation - if over long period time and other signs of retention then report
Pale urine - fine
Cloudy urine - semen retrograde into urethra and when pee have cloudy urine

Question 22

A client is interested in learning about the risk factors for prostate cancer. Which factors does the nurse include in the teaching? (Select all that apply.)
A. Family history of prostate cancer
B. Smoking
C. Obesity
D. Advanced age
E. Eating too much red meat
F. Race

Answer 22

Answer: A, D, E, F
Ethnicity - higher risk for prostate cancer
Age biggest one
Happens when old and progresses really slowly
Screening really imp annually after age 50 need DRE
PSA - should be drawn
Risk factors
Health promotion and maintenance

Question 23

Over the age of 65
Race
Family history of prostate cancer

Answer 23

Risk factors

Question 24

African American males more often affected

Answer 24

Race

Question 25

Screening
Healthy, balanced diet

Answer 25

Health promotion and maintenance

Question 26

Consider screening at age 50

Answer 26

Screening

Question 27

Decrease animal fats in diet-especially red meats; Low red meat diet
Increase fruits, vegetables and high fiber foods

Answer 27

Healthy, balanced diet

Question 28

Retention
Difficulty voiding
Some bladder infection
Sim s/s with BPH - tumor in prostate and compressing on urethra - depends on size of tumor
urinary retention
bladder infections
difficulty starting urination

Answer 28

What symptoms would be expected with early prostate cancer?

Question 29

Like Most types cancer with addition of blood in urine
Hematuria
swollen lymph nodes
Pain
unexpected weight loss

Answer 29

What about symptoms with advanced disease?

Question 30

Frequent monitoring with no treatment; just watch and see
Why is this common with prostate cancer?
What are other treatment options?

Answer 30

A client is diagnosed with prostate cancer. The client’s wife is concerned about the fact that the oncologist has recommended “active surveillance”. What does this mean?

Question 31

It is a very slow growing cancer; slowest growing of all cancers; depending on age of pat may recommend this - frequent PSA and rectal exams to see how progresses if risk of treatment more damaging than letting it be

Answer 31

Why is this common with prostate cancer?

Question 32

Can be diagnosed prostate cancer early
Depends on pats and HCP
50s - recommend surgery
Prostatectomy - 50s; very effective; diff side effects
Radiation - very effective; diff side effects; older men
Chemo - metastasized; common; recurrent prostate cancer
Hormone therapy - testosterone blockers - shrink prostate; common with prostatectomy or radiation
Long-term survival rate sim; depends on age, provider
Metastasized whole diff thing - PET scan see if metastasized see what best treatment option

Answer 32

What are other treatment options?

Question 33

A patient is diagnosed with acute bacterial prostatitis. What assessment findings does the nurse expect to find? (Select all that apply)
A. Fever
B. Chills
C. Dysuria
D. Urinary incontinence
E. Decreased strength of urine stream
F. Boggy and tender prostate

Answer 33

Answer: A, B, C, F
Bacterial - inflammation/infection of prostate; acute/chronic; acute - younger pop secondary to another infection; chronic - older pop
Signs of infection
Boggy - squishy; prostate firm and if infection is squishy
What are the differences between acute and chronic prostatitis?

Question 34

Symptoms are less dramatic in chronic
Chronic occurs more frequently in older men; like with BPH, difficulty starting stream and force of stream; older pat
Acute usually occurs from an infection of lower urinary tract; infectious type looking; do: antibiotics

Answer 34

What are the differences between acute and chronic prostatitis?

Question 35

Hesitancy, urgency, difficulty starting and terminating urine stream, decreased strength and volume of urine, pain in perineum, scrotum and penis

Answer 35

Symptoms are less dramatic in chronic

Question 36

A 34-year-old client comes to the clinic with concerns about an enlarged left testicle and heaviness in his lower abdomen. Which diagnostic test would the nurse expect to be ordered to confirm testicular cancer?
A. Alpha-fetoprotein (AFP)
B. Prostate-specific antigen (PSA)
C. Prostate acid phosphatase (PAP)
D. C-reactive protein (CRP)

Answer 36

Answer: A
Look at for testicular cancer; common symptom; lump find and usually unilateral; mass/enlargement need get eval; + lab then do testicular biopsy
What treatment would be expected?

Question 37

Orchiectomy and possible lymph node removal - more common younger men still have children with 1 and have good outcomes but depends if not metastasized
Chemotherapy or radiation - metastasized

Answer 37

What treatment would be expected?