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LSC Ch 75 Male Repro
LSC Nursing
| Question | Answer |
|---|---|
| BPH | Part of aging, prostate grows inward-narrowing urethra, renal complications, |
| Assessment of BPH | Urinary Pattern, Frequency, Nocturia, Hesitancy, reduced force & Size of stream, Feel bladder is not completely empty, dribble post void |
| Physical Exam for BPH | Check for other urinary problems: Hematuria, proteinuria, Digital Exam, uniform, elastic, non-tender, boggy enlargement, CA: hard nodule |
| Labs & Dx Studies for BPH | UA/UC, PSA (false +), Cystoscopy, Residual urine US after voiding, Urodynamic pressure flow studies |
| Nursing Dx for BPH | Urinary Retention (blockage), Urinary Incontinence (over-distention), Disturbed sleep pattern, Risk for infection (residual urine) COLLABORATIVE Dx: Potential for renal insufficiency or chronic renal disease |
| Drug therapy Dihydrotestosterone for BPH | finasteride (PROSCAR) & dutasteride (AVODART) SE: ED, Decreased libido, takes up to 6mos before improvement noted, women of child bearing age should not handle these! |
| Drug Therapy: Alpha Adrenergics for BPH | tamsulon (FLOMAX) & alfuzosin (UROSATRAL) for BPH & HTN: doxazosin (CARDURA) & Terazosin (HYTRIN) SE: orthostatic hypotension, bedtime dosing decreases the risk hypotension, ED drugs can worsen these SE |
| Other drugs and CAT for BPH | Estrogen & Detrol SE for Detrol: constipation, retention, confusion, dry mouth, blurred vision CAT: saw pametto extract, lycopene (tomatos), check herbal supplements may interact w/meds |
| Interventions for BPH | Frequent sexual intercourse/masturbation to relieve prostatic fluid, avoid alcohol, diuretics, caffeine, avoid drugs causing urinary retention: anticholinergics, antihistamines, decongestants |
| Medical Interventions for BPH | Destroy excess prostate tissue via heat: transurethral needle ablation, transurethral microwave therapy, interstitial laser coagulation, electrovaporization, prostatic stents in urethra Less risk, Less bleeding |
| Surgical Interventions for BPH | TURP: Trans urethral resection of prostate: only small pieces of gland remoed, gland still can grow Newer TX: Laser enucleation of prostate, Transurethral US guided laser incision, DO NOT REQUIRE continuous badder irrigation |
| Nursing Role Post Op Continuous Bladder Irrigation for TURP | 2-2L bags Normal Saline, Regulate sol. Fast rate 1st then slow if urine stays light, apply traction to cath by pin to compr. stockings,ie: decrease rate as less color increase rate with increased color, pt on bedrest during procedure |
| Bladder Spasms Post Op TURP | Due to cath or blood clots in cath, very painful, B&O suppoitories (keep in fridge), Hyocsyamine (Anaspaz) |
| Patient Care Post OP TURP | Increase fluid intake to keep urine dilute, bleeding usually stops w/in 24hrs, bladder spasms may renew bleeding, irrigate cath (MD Order) Increase rate of closed bladder irr. Monitor voiding post cath removal, sexual function unaffected, monitor UTI's |
| Home Care after TURP | Temporary loss of urine control, dribbling, pads until control resumes, kegel exercises to regain urine control |
| Prostate Cancer Guidelines for Screening | annual DRE men >50, Arican American Men or any man w/1st degree relative with BPH at age 45, 2 or more 1st degree relatives at age 40, abnormal PSA >4.0 ng/mL (no sex/masturbation 48hrs beore test) |
| Nutritional Interventions for Prostate Cancer | Decrease animal fat and red meat, More fish and foods high in omega3 fatty acids, fruits & vegies, tomatoes, watermelon, pink grapefruit, papaya, broccoli, cauliflower, cabbage, kale (slow tumor growth) |
| Assessment of Prostate CA | basically the same as BPH, check groin for swollen nodes/metastasis, PSA w/DRE-check hematuria, Test Early Prostate Cancer Antigen EPCA-2 early se marker, Elev. acid phosphatase, Mets: alkaline phosphatase, *US w/biopsy is primary dx |
| BPH | urinary retention (blockage), urinary incontinence, disturbed sleep pattern, risk for infection, collab. dx: Potential for renal insuff. or Chronic Renal Disease |
| Prostate CA | Prostate CA: Impaired urinary elim, anxiety/fear, acute/chronic pain, sex dysfunction grieving, Collab. Dx: Potential for Metastasis |
| Prostate CA Interventions | Older Pop (80-90yrs old) watchful waiting, Local therapy: surgery & rad, systemic therapy: chemo, Surgical Mgmt depends on stage and surgeon |
| Prostate CA Post Op Cares | wound drains, manage pain, stool softners, foley cath 7-14 days, antispasmotics, routine post op care |
| Non Surgical Interventions for Prostate CA | Rad Therapy: Radiation Proctitis: Pass mucus & blood, rectal urgency/inflammation, resolves in 4-6 wks, limit spicy, fatty foods, caffeine, & dairy products |
| Drug Therapy for Prostate CA | Hormones: LHRH Antagonists: Lupron, Zoladex; Reduce testosterone production, Hot flashes, decreased libido, gynecomastia |
| biphosphonates & antiandrogen drugs (Prostate CA) | Biphosphonates: pamidronate (Aredia) prevents bone fx, Anti-androgens: Flutamide (eulexin) block ability to use androgens-metastatic disease, use w/Lupron |
| Chemotherapy for Prostate CA | metastasis: Docetaxel (Taxotere) & Cisplatin (Platinol) |
| Other drugs for Prostate CA | If all others fail; Ketoconazole (Nizoral): antifungal, affects liver-monitor blood levels, take on empty stomach, do not use w/histamine blockers or antacids, interacts w/coumadin, dilantin, prednsone Corticosteroids for palliation |
| Alternative Therapy for Prostate CA | Cryotherapy- only if cancer is restricted to prostate, no incision CAT Same as BPH, soy protein |
| Community Based Care for Prostate CA | Lifting restriction 15#'s, urinary cath care(up to 2wks), don't strain-use stool softners, shower/no tub baths, rare |
| Peyronie's Disease | abnormal bending of the penis during erection |
| Erectile Dysfunction | organic gradual deterioration, decreased frequency and firmness, prostatectomy or back surgery, smoking, ETOH use, antihypertensive, Functional: psychological NL nocturnal and morning erections, sudden onset-stress |
| Assessment of Erectile Dysfunction | Hormone testing, testosterone, LH & FSH levels, decreased libido, small testicles, sparse beard growth, duplex US:arterial & venous blood flow |
| Drug Therapy for ED | Slidenafil (viagara) and vardenafil (Levitra), take med within 30min-1hr of stimulation, tadalafil (Cialis) works for up to 36hrs, needs stim to work, abstain from ETOH, SE: HA, facial flushing, nasal stuffiness, do not take w/nitrates aspirin/tylenol HA |
| Transderm Patch | attach to scrotum, testosterone patch, SE breast enlargement, increases risk of prostate CA, heart, kidney or liver disease leads to fluid retention and CHF, causes itching, discomfort, irritation, women can absorb it and experience facial hair/acne |
| Androderm Patch | Apply to Back, Abdomen, Upper Arms or Thighs, Apply Daily, Rotate site 1x/wk. Females: don't come in contact with patch |
| Vasodilating Drug Inj | Alporstadil (Caverject), Paverine, Phentolamine (Regitine) or a combo of these drugs, inj side of penis w/27-30gauge needle, SE: Priapism, scarring, fibrosis, bleeding, bruising, pain, infection, vasovagel response |
| Testicular Cancer | Germ Cell: Seminoma (most CA's)sperm producing cells, localize, metastasize late, rad therapy, orchiectomy-usually unilateral Non Germ Cell:do not metastasize, Leydig cells: secrete excess. testosterone, Androblastoma: estrogen, Orchiectomy or chemo |
| Warning Signs of Testicular CA | any enlargement or swelling of a testicle, collection of fluid in the scrotum, dull ache in lower abd, back or groin, heavy feeling in scrotum, enlargement or tender breasts |
| Assessments for Testicular CA | Physical: one healthy testes, has sexual function, may make pt sterile, low sperm count, psychosocial |
| Lab Assessment for Testicular CA | Tumor Biomarkers, Seminoma Tumors: LDH (lactate dehydrogenase, Non seminoma Tumors: AFP alpha-fetoprotein, benign-no tumor markers, elevated testosterone-tumor in leydig cells if levels remain elevated after tx- metastasize |
| Dx Tests for Testicular CA | US-mass solid or fluid filled, benign, malignant, CT ab & chest: metastatic lesions, Lymphangiography, MRI, CXR & Bone scan |
| Interventions Testicular CA | Health teaching about therapies, sperm bank teaching, before tx, 3-6samples 2-4days apart, may need tx 1st, |
| Surgical Interventions for Testicular CA | Unilateral Orchiectomy, Open Approach: more radical disease spread, LAP/MIS: Incision above pubic bone on the side of testicle, testicle pulled up thru inguinal canal, spermatic cord is cut, 3rd option, remove scrotum |
| Post Op Care for Orchiectomy | Depends on approach- MIS/scrotal 1-2days, Open-3-4 days Assess/Teach Incisions, Drains, Urinary Cath care, Pain |
| Non Surgical Interventions for Testicular CA | High Risk Metastatic disease, chemo: Cisplatin & etoposide (VePesid), may add Beomycin )Blenoxane, advanced disease 3 drugs: Cisplatin, Vinblastin, or Taxol SE: Cisplatin cardiac effects; Rad Therapy and Stem Cells after Chemo |
| Hydrocele | cystic mass around testes: trauma-bike bars: PAIN late sign, Impairs blood flow to testes, Exam & US, Tx none or drained by aspiration, or small incision, elevate scrotum, ice, wear scrotal support, stay off feet 3-5days |
| Spermatocele | sperm containing cyst on epididymis, trauma or infection, congenital defect, pain w/large size, |
| Varicocele | varicose veins (dilated), above & behind testes, most often on Left side, Dx: scrotal palpation, if painful surgically removed, may cause sterility, |
| Scrotal Torsion | twisting of the spermatic cord, puberity or strenuous exercise, pain, reddened, blood in semen, lump, exam & US, surgically untwist, |
| Cryptochidism | Failure of testicle to descend, if not corrected by age 6 increase risk of cancer & infertility, Exam & US, Surgical Orhiopexy Repair, |
| Cancer of Penis | Slow growing, lump under foreskin or penile skin, cases reduced w/circumcision, tx: Biopsy, Radiation, Penectomy (partial or total), Ureterostomy or maybe able to save urethra, Psychosocial issues |
| Phimosis | can't retract foreskin- important to clean prepuce |
| Paraphimosis | can't return foreskin- remember to return foreskin all the way after cleaning, poor hygeine, vigorous intercourse, impedes blood flow leading to tissue death, swollen, hard, reddened |
| Treatment of phimosis and paraphimosis | circumcision, education post procedure: soak in tub to remove dressing next day, support & ice comfort, OTC analgesics or low dose opioid, sutures reabsorb, resume activities in 1wk, sexual activities in 1-2wks when there is no pain |
| Priapism | Erection that does not end, Tx: increase venous drainage from corpora cavernosa (penal vein), Demerol- hypotensive effects, catheterize if can't void, reassure understanding |
| Prostatitis | 4types: bacterial (acute & chronic), viral/STD's, protatodynia, UTI Symptoms: backache, boggy enlarged prostate, decreased libido |
Created by:
ginabeana
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