TOPIC 9 - male reproductive disorders

Question 1

physical assessment

Answer 1

assess for inguinal hernia, examination of external genitalia, exam rectum and prostate, psychosocial assessment

Question 2

prevalence of testicular cancer

Answer 2

less than 1% of all cancer
most common in young men between 15-44
more common in males with undescended testes or family history

Question 3

manifestations of testicular cancer

Answer 3

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

Question 4

diagnostic studies

Answer 4

palpation
digital rectal exam
cancerous mass if firm and does not transilluminate
ultrasound
transrectal
xray and CT of abdomen and pelvis

Question 5

labs

Answer 5

AFP, LDH, hCG

Question 6

surgeries

Answer 6

radical orchiectomy (removal of testis, spermatic cord, and regional lymph)

Question 7

after surgery

Answer 7

radiation and chemo - cisplatin

Question 8

side effects of treatments

Answer 8

pulmonary toxicity
kidney damage
nerve damage
hearing loss
infertility
ejaculatory dysfunction

Question 9

what happens to the prostate in BPH

Answer 9

prostate size increases, leading to disruption of outflow of urine

Question 10

risk factors for BPH

Answer 10

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.

Question 11

irritative s/s of BPH

Answer 11

Nocturia
Urinary frequency
Urgency
Dysuria
Bladder pain
Incontinence

Question 12

obstructive s/s of BPH

Answer 12

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

Question 13

labs for BPH

Answer 13

CBC
BUN
Crt
PSA
EPCA - 2 (flomax and proscar)

Question 14

complications of BPH

Answer 14

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)

Question 15

diagnostics of BPH

Answer 15

digital rectal exam, urinalysis with culture, PSA, Crt, postvoid residual, transrectal ultrasound, cystoscopy

Question 16

drugs for BPH

Answer 16

finasteride (reduce size of prostate)
doxazosin and tamulosin (relax smooth muscle of prostate)

Question 17

side effects of tamsulosin

Answer 17

dizzy, drowsy, runny nose, retrograde ejaculation

Question 18

finasteride side effects

Answer 18

affect hormone levels
false PSA levels

Question 19

how long does it take for finasteride to be effective

Answer 19

6 months

Question 20

TURP

Answer 20

transurethral resection of prostate
for prostate cancer and BPH
widens diameter of urethra to improve urination
decrease symptoms of BPH and prostate cancer

Question 21

client education for continuous bladder irrigation

Answer 21

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

Question 22

monitor for what to prevent complications with drainage system

Answer 22

bladder distension
pain
bleeding
clots
ensure catheter is patent
hemorrhage
incontinence
VTE

Question 23

interventions for complications related to bladder irrigation

Answer 23

incontinence - teach kegel exercises
VTE - low dose heparin, SCD, exercise

Question 24

what confirms the diagnosis of prostate cancer

Answer 24

prostate biopsy

Question 25

prostatectomy

Answer 25

done when lymph biopsies are likely

Question 26

if they are unable to spare the nerves …

Answer 26

client will be impotent