Ch. 72 Care of pts with Male Reproductive Problems
Post-op radical prostectomy
Complications could include: Infection Severe pain Urinary infection Urinary elimination problems Erectile dysfunction
The nurse is educating a group of young men about testicular self-examination (TSE). Which statement by a member of the group indicates teaching has been effective? "I will examine my testicles right before taking a shower." "I will squeeze each testicle in my hand to feel any lumps." "I will only report any large lumps to my primary health care provider." "I will look and feel for any lumps or changes to my testes."
"I will look and feel for any lumps or changes to my testes." **In TSE, the client would look and feel for any lumps or changes to the testes. Any lumps that are detected would be immediately reported. With early detection by monthly TSE and treatment, testicular cancer can be successfully cured.A TSE would be performed immediately following a shower. The client would gently roll each testicle between the thumb and forefinger. All lumps must be reported to the primary health care provider, no matter the size.
Avoid these meds that cause urinary retention if BPH present
Anticholinergics Antihistamines Decongestants
When is the best time for the nurse to begin discharge planning and a community-based plan of care for a client with prostate cancer? Before surgery After surgery 2 days before being discharged The day of discharge
Before surgery **Planning needs to begin as early as possible and would be started on admission and before surgery.After surgery is not the correct time to begin planning. Planning must begin earlier than 2 days before discharge.
Post op TURP
Observe for and report bloody urine with clots **increase continuous bladder irrigation or irrigate the bladder per agency or surgeon protocol
Drug therapies for BPH (5-ARI and alpha blocking agents) side effects
Orthostatic hypotension Erectile dysfunction Decreased libido Dizziness Liver dysfunction
Why is prostate cancer screening often emphasized to the African-American population in the United States? Metastasis of prostate cancer is higher. Prostate cancer occurs at an earlier age. There is no relation to having any first-degree relative with prostate cancer prior to age 65. Clinical presentation is different.
Prostate cancer occurs at an earlier age. **In the United States, prostate cancer affects African-American men the most and at an earlier age. African-American men have a slighter higher normal PSA value, but the reason for this difference is not known.There is no difference in prostate cancer metastasis, or clinical presentation of prostate cancer in the African-American population as compared to other populations. African Americans or men who have a first-degree relative with prostate cancer before the age of 65 years have a higher risk for prostate cancer. Men who have multiple first-degree relatives with prostate cancer at an early age need to discuss screening at age 40 years (ACS, 2016).
Which method is a common integrative health therapy for benign prostatic hyperplasia (BPH)? Acupuncture Calcium supplements Serenoa repens Yoga
Serenoa repens **Serenoa repens (saw palmetto), a plant extract, is often used by men with early to moderate BPH. They believe that this agent relieves their symptoms and prefer this treatment over prescription drugs or surgery. However, studies on the effectiveness of Serenoa repens have not shown that it is effective. The nurse must remind clients wanting to use complementary and integrative health therapies to check with their primary health care provider before using them.Acupuncture, calcium supplements, and yoga are not common alternative therapies for BPH.
When discussing care and treatment of prostate cancer with clients, it is important for the nurse to remember that the most common issue among men who have been diagnosed with prostate cancer is the alteration of which factor? Comfort because of surgical pain Mobility after treatment Nutrition because of radiation side effects Sexual function after treatment
Sexual function after treatment **Altered sexual function is one of the biggest concerns of men after cancer treatment. Tell the client that function will depend on the type of treatment he has. Common surgical techniques used today do not involve cutting the perineal nerves needed for an erection.Comfort, mobility, and nutrition are important but are typically not the foremost concern in the minds of men with prostate cancer.
A client receiving radiation therapy calls the nurse to report rectal urgency, cramping, and passing of mucus and blood. What is the nurse's best response? "This is an emergency. Go directly to the emergency department." "This is normal and will resolve as soon as the treatment stops." "Avoid caffeine and continue drinking plenty of water and other fluids." "Limit spicy or fatty foods, caffeine, and dairy products."
"Limit spicy or fatty foods, caffeine, and dairy products." **The nurse's best response is to limit spicy or fatty foods, caffeine, and dairy products. The client's symptoms indicate that he is experiencing radiation proctitis (rectal mucosa inflammation), a common complication of radiation therapy.The client's symptoms do not indicate an emergency, but they need to be reported to the primary health care provider. The client's symptoms would resolve 4 to 6 weeks after the treatment stops. Avoiding caffeine and drinking water and other fluids describe what the client would do if he is experiencing radiation cystitis.
A client with prostate cancer asks why he must have surgery instead of radiation, even if his cancer is the least-invasive type. What is the nurse's best response? "It is because your cancer growth is large." "Surgery is the most common intervention for a cure." "Surgery slows the spread of cancer." "The surgery is to promote urination."
"Surgery is the most common intervention for a cure." **The nurse's best response is that surgery is the most common intervention for a cure, because some localized prostate cancers are resistant to radiation.The size of the tumor is not likely to be the reason for the client to have surgery. A bilateral orchiectomy (removal of both testicles) is palliative surgery that slows the spread of cancer by removing the main source of testosterone. A transurethral resection of the prostate (TURP) is done to promote urination for clients with advanced disease. It is not used as a curative treatment.
A client with testicular cancer is worried about sterility and the ability to conceive children later. Which resource does the nurse refer the client to before surgery takes place? American Cancer Society American Fertility Society RESOLVE: The National Infertility Association A sperm bank facility
A sperm bank facility **If the client is interested in having children, he would be encouraged to arrange for semen storage as soon as possible after diagnosis. A sperm bank facility provides comprehensive information on semen collection, storage of semen, the storage contract, costs, and the insemination process. Sperm collection needs to be completed before radiation therapy or chemotherapy is started. After radiation therapy or chemotherapy has been started, the client is at increased risk for producing mutagenic sperm, which may not be viable or may result in fetal abnormalities.The client is referred to the American Cancer Society for more generalized information on testicular cancer. The American Fertility Society and RESOLVE: The National Infertility Association are appropriate referrals if permanent sterility occurs and sperm storage has not been feasible.
A client has undergone transurethral resection of the prostate (TURP). Which interventions does the nurse incorporate in this client's postoperative care? Select all that apply. Administer antispasmodic medications. Encourage the client to urinate around the catheter if pressure is felt. Perform intermittent urinary catheterization every 4 to 6 hours. Place the client in a supine position with his knees flexed. Assist the client to mobilize as soon as permitted.
Administer antispasmodic medications Assist the client to mobilize as soon as permitted. **Antispasmodic drugs can be administered to decrease the bladder spasms that may occur due to catheter use. Assisting the client to a chair as soon as permitted postoperatively will help to decrease the risk of complications from immobility. An indwelling catheter and continuous bladder irrigation are in place for about 24 hours after TURP.The client would not try to void around the catheter. This would cause the bladder muscles to contract and may result in painful spasms. Intermittent urinary catheterization is not necessary and increases the risk for infection. Typically, the catheter is taped to the client's thigh, so he needs to keep his leg straight.
The RN working in the hospital emergency department is assigned to care for these four clients. Which client does the nurse attend to first? Adolescent with an erection for "10 or 11 hours" who is reporting severe pain Young adult with a swollen, painful scrotum who has a recent history of mumps infection Middle-aged adult discharged 2 days ago after a transurethral resection of the prostate who has increased hematuria Older adult with a history of benign prostatic hyperplasia and palpable bladder distention
Adolescent with an erection for "10 or 11 hours" who is reporting severe pain **The nurse first attends to the client who has had an erection for "10 or 11 hours." This client has symptoms of priapism which is considered a urologic emergency because the circulation to the penis may be compromised. With an erect penis, the client may also be unable to void.The client with a swollen, painful scrotum, the client with hematuria, and the client with a history of benign prostatic hyperplasia do not require the nurse's immediate attention.
A client with prostate cancer asks the nurse for more information and counseling. Which resources does the nurse suggest? Select all that apply. American Cancer Society's Man to Man program Us TOO International Save My Prostate Society National Prostate Cancer Coalition Client's church, synagogue, or place of worship
American Cancer Society's Man to Man program Us TOO International National Prostate Cancer Coalition Client's church, synagogue, or place of worship **The American Cancer Society's Man to Man program helps the client and partner cope with prostate cancer by providing one-on-one education, personal visits, education presentations, and the opportunity to engage in open and candid discussions. Us TOO International is a prostate cancer education and support group that is sponsored by the Prostate Cancer Education and Support Network. The National Prostate Cancer Coalition provides prostate cancer information. The client's church, synagogue, or place of worship is a community support service that may be important for many clients.There is no such organization as the Save My Prostate Society.
The nurse will conduct prostate screening and provide education about prostate cancer with which male client? A young adult with a history of urinary tract infections A client who has sustained an injury to the external genitalia An adult male who is older than 50 years A sexually active client
An adult male who is older than 50 years **A man who is 50 years or older is at highest risk for prostate cancer. The risk increases for men who have a first-degree relative (brother, father) with the disease.A history of urinary tract infections, injury to the external genitalia, and sexual activity are not risk factors for prostate cancer.
After returning from transurethral resection of the prostate, the client's urine in the continuous bladder irrigation system is a burgundy color. Which client needs does the nurse anticipate after the surgeon sees the client? Select all that apply. Antispasmodic drugs Emergency surgery Forced fluids Increased intermittent irrigation Monitoring for anemia
Antispasmodic drugs Monitoring for anemia **Although not a common occurrence, bleeding may occur in the postoperative period. Venous bleeding is more common than arterial bleeding. The surgeon may apply traction on the catheter for a few hours to control the venous bleeding. Traction on the catheter is uncomfortable and increases the risk for bladder spasms, so analgesics or antispasmodics are usually prescribed. Hemoglobin and hematocrit would be monitored and trended for indications of anemia.Emergency surgery and increased intermittent irrigation would be indicated for an arterial bleed, which would be a brighter red color. Forced fluids are indicated after the catheter is removed.
A client with benign prostatic hyperplasia is being discharged with alpha-adrenergic blockers. Which information is important for the nurse to include when teaching the client about this type of pharmacologic management? Select all that apply. Avoid drugs used to treat erection problems. Be careful when changing positions. Keep all appointments for follow-up laboratory testing. Hearing tests will need to be conducted periodically. Take the medication in the afternoon.
Avoid drugs used to treat erection problems. Be careful when changing positions. Keep all appointments for follow-up laboratory testing. **Drugs used to treat erectile dysfunction can worsen side effects, such as hypotension. Alpha-adrenergic blockers may cause orthostatic hypotension and can cause liver damage. The nurse needs to remind the client to be careful when changing positions and to keep all appointments for follow-up laboratory testing.These drugs do not affect hearing. Alpha-adrenergic blockers need to be taken in the evening to decrease the risk of problems related to hypotension.
A young adult with testicular cancer is admitted for unilateral orchiectomy and retroperitoneal lymph node dissection. Which nursing action is best for the nurse to delegate to unlicensed assistive personnel (UAP)? Encourage the client to cough and deep-breathe after surgery. Discuss reproductive options with the client and significant other. Teach about the availability of a gel-filled silicone testicular prosthesis. Evaluate the client's understanding of chemotherapy and radiation treatment.
Encourage the client to cough and deep-breathe after surgery. **Reminding clients to perform coughing and deep-breathing activities can be delegated to UAPs.Client education and evaluation are more complex skills that must be done by licensed nurses.
Which assessment finding causes the nurse to suspect that a client may have testicular cancer? Hematuria Penile discharge Painless testicular lump Sudden increase in libido
Painless testicular lump **A painless lump or swelling in the testicles is the most common assessment finding of testicular cancer.Hematuria is not a symptom of testicular cancer but could be indicative of other conditions such as bladder cancer. Penile discharge is not a symptom of testicular cancer but could be indicative of another condition. A sudden increase in libido is not a symptom of testicular cancer.
The nurse is caring for a client with erectile dysfunction who has not had success with common treatment modalities. The nurse anticipates that the primary health care provider will recommend which treatment for this client? Penile implants Penile injections Transurethral suppository Vacuum constriction device
Penile implants **Penile implants (prostheses), which require surgery, are used when other modalities fail. Devices include semirigid, flexible, or hydraulic inflatable and multicomponent or one-piece instruments.Penile injections and transurethral suppositories are tried before using the option of last resort. A vacuum constriction device is easy to use and is often the first option that is tried.
What will the nurse include in teaching to assist the client who has undergone open radical prostatectomy surgery to overcome urinary incontinence? Ask the primary health care provider about prescribing sildenafil (Viagra). Use analgesic medications as needed to maintain comfort Practice Kegel exercises to improve muscle control Practice routine self-catheterization and bladder retraining
Practice Kegel exercises to improve muscle control **Practicing Kegel exercises may help to regain urinary continence. A radical prostatectomy may lead to urinary incontinence because the internal and external sphincters may be damaged during surgery.Sildenafil is useful after radical prostatectomy to help restore erectile function, not for incontinence. Analgesic medications do not help with urinary continence. Self-catheterization and bladder retraining are used for neurogenic bladder.
The potential problem of grief is most relevant to a client after which procedure? Cystoscopy Transurethral microwave therapy Radical prostatectomy Sperm banking
Radical prostatectomy **A radical prostatectomy may lead to erectile dysfunction, which could present a potential problem of grief at loss of function.Cystoscopy, a test to view the interior of the bladder, the bladder neck, and the urethra, does not affect sexuality. Transurethral microwave therapy is a minimally invasive procedure involving high temperatures that heat and destroy excess prostate tissue and does not affect sexuality. The process of sperm banking would not result in a diagnosis of altered self-image. However, the diagnosis leading to the necessity of sperm banking might cause grief.
Hormone treatment for prostate cancer works by which action? Decreased blood flow to the tumor Destruction of the tumor Shrinkage of the tumor Suppression of the growth of the tumor
Suppression of the growth of the tumor **Hormone therapy, particularly antiandrogen drugs, inhibits tumor progression by blocking the uptake of testicular and adrenal androgens at the prostate tumor site. Because most prostate tumors are hormone dependent, clients with extensive tumors or those with metastatic disease may be managed by androgen deprivation. Luteinizing hormone-releasing hormone (LH-RH) agonists or antiandrogens can be used. Antiandrogens may be used alone or in combination with luteinizing hormone-releasing hormone agonists for a total androgen blockade (hormone ablation).Hormone treatment for prostate cancer does not decrease blood flow to the tumor, destroy the tumor, or shrink the tumor.