TOPIC 9 - male reproductive disorders Flashcards
physical assessment
assess for inguinal hernia, examination of external genitalia, exam rectum and prostate, psychosocial assessment
prevalence of testicular cancer
less than 1% of all cancer
most common in young men between 15-44
more common in males with undescended testes or family history
manifestations of testicular cancer
may grow fast or slow, depends on size of tumor
painless lump in scrotum/scrotal swelling/feeling of heaviness
scrotal mass usually non-tender and firm
complaints of dull ache or heavy sensation in lower abdomen, perianal area, or scrotum
diagnostic studies
palpation
digital rectal exam
cancerous mass if firm and does not transilluminate
ultrasound
transrectal
xray and CT of abdomen and pelvis
labs
AFP, LDH, hCG
surgeries
radical orchiectomy (removal of testis, spermatic cord, and regional lymph)
after surgery
radiation and chemo - cisplatin
side effects of treatments
pulmonary toxicity
kidney damage
nerve damage
hearing loss
infertility
ejaculatory dysfunction
what happens to the prostate in BPH
prostate size increases, leading to disruption of outflow of urine
risk factors for BPH
Aging
Obesity (in particular increased waist circumference)
Lack of physical activity
Alcohol consumption
Erectile dysfunction
Smoking
Diabetes
A positive family history of BPH in first-degree relatives may also be a risk factor.
irritative s/s of BPH
Nocturia
Urinary frequency
Urgency
Dysuria
Bladder pain
Incontinence
obstructive s/s of BPH
Decrease in caliber and force of the urinary stream
Difficulty initiating a stream
Stopping and starting stream several times while voiding
Dribbling at the end of urination
labs for BPH
CBC
BUN
Crt
PSA
EPCA - 2 (flomax and proscar)
complications of BPH
urinary retention
– tx : catheter or surgery
UTI secondary to stasis, can lead to sepsis
bladder calculi : alkanization of residual volume
hydronephrosis (distended pelvis by urine that cannot flow through ureter = renal failure)
diagnostics of BPH
digital rectal exam, urinalysis with culture, PSA, Crt, postvoid residual, transrectal ultrasound, cystoscopy
drugs for BPH
finasteride (reduce size of prostate)
doxazosin and tamulosin (relax smooth muscle of prostate)
side effects of tamsulosin
dizzy, drowsy, runny nose, retrograde ejaculation
finasteride side effects
affect hormone levels
false PSA levels
how long does it take for finasteride to be effective
6 months
TURP
transurethral resection of prostate
for prostate cancer and BPH
widens diameter of urethra to improve urination
decrease symptoms of BPH and prostate cancer
client education for continuous bladder irrigation
Discomfort with the catheter in place
Initially, urine should be clear, may have occasional small blood clots in it
As the irrigation continues, urine may have a pink tinge or remain clear
Empty the client’s drainage bag frequently
CBI is usually stopped when urine has been clear or slightly pink urine for 1 to 2 days.
Report bladder pain or if bladder feels full.
Report if fluid is leaking around your catheter
monitor for what to prevent complications with drainage system
bladder distension
pain
bleeding
clots
ensure catheter is patent
hemorrhage
incontinence
VTE
interventions for complications related to bladder irrigation
incontinence - teach kegel exercises
VTE - low dose heparin, SCD, exercise
what confirms the diagnosis of prostate cancer
prostate biopsy
prostatectomy
done when lymph biopsies are likely
if they are unable to spare the nerves …
client will be impotent
