Care of Male Patients with
Reproductive Problems
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Glandular units in the prostate that undergo
an increase in number of cells, resulting in
enlargement of prostate gland
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Symptoms
▫
▫
▫
▫
▫
▫
▫
Hyperirritable bladder
Urgency and frequency
Hypertrophied bladder wall muscles
Cellules and diverticula
Hydroureter
Hydronephrosis
Overflow urinary incontinence
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Transurethral resection of prostate (TURP)
• Prostatectomy
▫ Suprapubic
▫ Retropubic
▫ Perineal
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Urinary catheter with retention balloon
placed into bladder
• Traction via taping to patient’s abdomen or
thigh
• Uncomfortable urge to void continuously
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Prevalence
• Slow-growing, predictable malignancy
• First symptoms related to bladder neck
obstruction
• Assessment
▫ Digital rectal examination
▫ Prostate-specific antigen (PSA)
▫ Biopsy (to confirm)
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Inability to achieve or maintain erection for
sexual intercourse
• Organic vs. functional ED
• Assessment:
▫ Medical, social, sexual history
▫ Complete physical examination
▫ Duplex Doppler ultrasonography test
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Most common malignancy in men 15 to 34
years of age
• Curable, with early detection by testicular
self-examination and treatment with
combination chemotherapy
• Germ cell vs. non-germ cell tumors
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Cystic mass usually filled with straw-colored
fluid forms around testis, results from
impaired lymphatic drainage of scrotum,
causing swelling of tissue surrounding the
testes
• Treatment
▫ Drainage via needle and syringe
▫ Surgical removal
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Sperm-containing cyst develops on
epididymis alongside the testicle
• Normally small and asymptomatic, require no
intervention
• If large enough to cause discomfort,
spermatocelectomy is performed
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Cluster of dilated veins occurring behind and
above testis
• Can cause infertility
• Varicocelectomy performed through an
inguinal incision ; spermatic veins are ligated
in the cord
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Epidermoid (squamous) carcinomas
developing from squamous cells
• Circumcision in infancy—almost always
eliminates possibility of penile cancer
• Painless, wartlike growth or ulcer
• Excisional biopsy
• Radiation therapy
• Penectomy
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Constricted prepuce that cannot be retracted
over the glans; prepuce remains down around
tip of the penis
• Emergency; requires immediate treatment!
• Circumcision
• Warm bath to allow dressing to loosen
• Barbiturate sleeping medications
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Uncontrolled and long-maintained erection
without sexual desire; causes penis to become
large and painful
• Can occur from:
▫ Thrombosis of veins of corpora cavernosa
▫ Leukemia
▫ Sickle cell disease
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
•
•
•
•
•
•
Diabetes mellitus
Malignancies
Abnormal reflex
Some drug effects
Recreational drugs
Prolonged sexual activity
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
•
•
•
•
Inflammation of prostate gland
Acute vs. chronic bacterial prostatitis
Nonbacterial/chronic pelvic pain syndrome
Asymptomatic inflammatory prostatitis
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Inflammation of epididymis resulting from
infection or noninfectious source such as
trauma
• Treatment
▫ Bedrest
▫ Elevation of scrotum
▫ Scrotal support when ambulating
• Comfort measures
• Epididymectomy
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
• Acute testicular inflammation resulting from
trauma or infection
• Treatment
▫ Bedrest with scrotal elevation
▫ Application of ice
▫ Analgesics and antibiotics
• Mumps orchitis
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Etiologies, risk factors, comorbidities
Assessment (holistic approach)
Diagnostic tests
Nurse’s role in management
Interdisciplinary team’s role in management
Treatment and interventions
Teaching and health promotion (including
psychosocial implications)
8. Teaching and health promotion for at-risk
individuals
1.
2.
3.
4.
5.
6.
7.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
A 77-year-old man visiting his health care
provider reports difficulty starting his urine
stream and feeling like his bladder is not
completely emptying, as well as dribbling of
urine after urination.
1. What questions should the nurse ask when
taking this patient’s history?
2. What diagnosis is suspected based on the
patient’s symptoms?
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
When assessing the patient with benign
prostatic hyperplasia (BPH), what assessment
finding would the nurse expect?
A.
B.
C.
D.
Enlarged painful prostate gland
Distended bladder
Rectal bleeding
Tenderness over the kidneys
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
The patient has a prostate ultrasound and is diagnosed with BPH.
To manage it, the provider prescribes drug therapy with finasteride
(Proscar).
What should the nurse teach the patient about this drug?
A.
B.
C.
D.
It will constrict the prostate gland and improve urine flow.
It will decrease the level of dihydrotesterone (DHT) and shrink
the prostate.
It may cause postural hypotension; care should be taken when
changing positions.
Drugs used to treat erectile problems such as Viagra can make
side effects worse.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Nine months later, the patient’s symptoms have not significantly
improved, and he is referred to a surgeon for a transurethral
resection of the prostate (TURP).
Postoperatively, what are the priority nursing concerns for this
patient? (Select all that apply.)
A.
B.
C.
D.
E.
F.
Assess for signs of infection.
Keep the patient on bedrest for at least 2 days.
Administer pain and antispasmodic drugs as needed.
Monitor for changes in mental status.
Check urine output every 2 hours.
Remind the patient that urine will be blood-tinged.
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Postoperatively, the patient says that he feels like he needs to
urinate all the time.
What is the nurse’s best response?
A.
B.
C.
D.
“Just relax and let the urine go because there is a catheter in
place.”
“I will notify your surgeon immediately because this may
signal a complication.”
“This is a normal sensation because the catheter has a balloon
that presses on your urinary sphincter.”
“If you keep your leg straight, the sensation of needing to void
all the time will decrease.”
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Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
30
An older male is being evaluated for hydronephrosis.
What priority health history question may provide
information about a possible cause of this disorder?
A.
B.
C.
D.
“Do you have high blood pressure?”
“Do you have difficulty starting and continuing
urination?”
“Do you have a family history of kidney disease?”
“Have you had a recent urinary tract infection?”
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
The patient who has undergone a transurethral
resection of the prostate (TURP) is at high risk for
developing:
A.
B.
C.
D.
Perforation
Hemorrhage
Infection
Bladder spasms
Copyright © 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
How many American males are estimated to die of
testicular cancer annually?
A.
B.
C.
D.
350
520
725
1050
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