Brunner Ch 53 Assessment and Management of Patients with Male Reproductive Disorders

A man tells the nurse that their father died of prostate cancer and the client is concerned about their own risk of developing the disease, having heard that prostate cancer has a genetic link. What aspect of the pathophysiology of prostate cancer would underlie the nurse's response? A. A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. B. HNPCC is a mutation of two genes that causes prostate cancer in men and it is autosomal dominant. C. Studies have shown that the presence of the TP53 gene strongly influences the incidence of prostate cancer. D. Recent research has demonstrated that prostate cancer is the result of lifestyle factors and that genetics are unrelated.

ANS: A Rationale: A number of studies have identified an association of BRCA-2 mutation with an increased risk of prostate cancer. HNPCC is a form of colon cancer. The TP53 gene is associated with breast cancer.

A 22-year-old male client is being discharged home after surgery for testicular cancer. The client is scheduled to begin chemotherapy in 2 weeks. The client tells the nurse that they do not think he can take weeks or months of chemotherapy, stating that they have researched the adverse effects online. What is the most appropriate nursing action for this client at this time? A. Provide empathy and encouragement in an effort to foster a positive outlook. B. Tell the client it is their decision whether to have chemotherapy. C. Report the client's statement to members of their support system. D. Refer the client to social work.

ANS: A Rationale: Clients may be required to endure a long course of therapy and will need encouragement to maintain a positive attitude. It is certainly the client's ultimate decision to accept or reject chemotherapy, but the nurse should focus on promoting a positive outlook. It would be a violation of confidentiality to report the client's statement to members of their support system and there is no obvious need for a social work referral.

A nurse is providing care for a client who has recently been admitted to the postsurgical unit from PACU following a transurethral resection of the prostate. The nurse is aware of the nursing diagnosis of Risk for Imbalanced Fluid Volume. In order to assess for this risk, the nurse should prioritize what action? A. Closely monitoring the input and output of the bladder irrigation system B. Administering parenteral nutrition and fluids as prescribed C. Monitoring the client's level of consciousness and skin turgor D. Scanning the client's bladder for retention every 2 hours

ANS: A Rationale: Continuous bladder irrigation effectively reduces the risk of clots in the GU tract but also creates a risk for fluid volume excess if it becomes occluded. The nurse must carefully compare input and output, and ensure that these are in balance. Parenteral nutrition is unnecessary after prostate surgery and skin turgor is not an accurate indicator of fluid status. Frequent bladder scanning is not required when a urinary catheter is in situ.

A client has just returned to the floor following a transurethral resection of the prostate. A triple-lumen indwelling urinary catheter has been inserted for continuous bladder irrigation. What, in addition to balloon inflation, are the functions of the three lumens? A. Continuous inflow and outflow of irrigation solution B. Intermittent inflow and continuous outflow of irrigation solution C. Continuous inflow and intermittent outflow of irrigation solution D. Intermittent flow of irrigation solution and prevention of hemorrhage

ANS: A Rationale: For continuous bladder irrigation, a triple-lumen indwelling urinary catheter is inserted. The three lumens provide for balloon inflation and continuous inflow and outflow of irrigation solution

A client who is postoperative day 12 and recovering at home following a laparoscopic prostatectomy has reported that the client is experiencing occasional "dribbling" of urine. How should the nurse best respond to this client's concern? A. Inform the client that urinary control is likely to return gradually. B. Arrange for the client to be assessed by the urologist. C. Facilitate the insertion of an indwelling urinary catheter by the home care nurse. D. Teach the client to perform intermittent self-catheterization.

ANS: A Rationale: It is important that the client know that regaining urinary control is a gradual process; the client may continue to "dribble" after being discharged from the hospital, but this should gradually diminish (usually within 1 year). At this point, medical follow-up is likely not necessary. There is no need to perform urinary catheterization.

A client has experienced occasional urinary incontinence in the weeks since their prostatectomy. In order to promote continence, the nurse should encourage which of the following? A. Pelvic floor exercises B. Intermittent urinary catheterization C. Reduced physical activity D. Active range of motion exercises

ANS: A Rationale: Pelvic floor muscles can promote the resumption of normal urinary function following prostate surgery. Catheterization is normally unnecessary, and it carries numerous risks of adverse effects. Increasing or decreasing physical activity is unlikely to influence urinary function.

A 35-year-old man is seen in the clinic because the client is experiencing recurring episodes of urinary frequency, dysuria, and fever. The nurse should recognize the possibility of what health problem? A. Chronic bacterial prostatitis B. Orchitis C. Benign prostatic hyperplasia D. Urolithiasis

ANS: A Rationale: Prostatitis is an inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. Symptoms are usually mild, consisting of frequency, dysuria, and occasionally urethral discharge. Urinary incontinence and retention occur with benign prostatic hyperplasia or hypertrophy. The client may experience nocturia, urgency, and decrease in volume and force of urinary stream. Urolithiasis is characterized by excruciating pain. Orchitis does not cause urinary symptoms.

An 83-year-old client has been prescribed finasteride. When performing client education with this client, the nurse should be sure to tell the client to take what action? A. Report the planned use of dietary supplements to the health care provider. B. Decrease the intake of fluids to prevent urinary retention. C. Abstain from sexual activity for 2 weeks following the initiation of treatment. D. Anticipate a temporary worsening of urinary retention before symptoms subside

ANS: A Rationale: Some herbal supplements are contraindicated with finasteride, thus their planned use should be discussed with the health care provider or pharmacist. The client should maintain normal fluid intake. There is no need to abstain from sexual activity and a worsening of urinary retention is not anticipated.

A 29-year-old client has just been told that they have testicular cancer and needs to have surgery. During a presurgical appointment, the client admits to feeling devastated that they require surgery, stating that it will leave them "emasculated" and "a shell of a man." The nurse should identify what nursing diagnosis when planning the client's subsequent care? A. Disturbed body image related to effects of surgery B. Spiritual distress related to effects of cancer surgery C. Social isolation related to effects of surgery D. Risk for loneliness related to change in self-concept

ANS: A Rationale: The client's statements specifically address the perception of the body as it relates to the client's identity. Consequently, a nursing diagnosis of Disturbed Body Image is likely appropriate. This client is at risk for social isolation and loneliness, but there's no indication in this scenario that these diagnoses are present. There is no indication of a spiritual element to the client's concerns.

A nurse is teaching a 53-year-old man about prostate cancer, given the fact that the client has a family history of the disease. What information should the nurse provide to best facilitate the early identification of prostate cancer? A. Have a digital rectal examination and prostate-specific antigen (PSA) test done as recommended. B. Have a transrectal ultrasound every 5 years. C. Perform monthly testicular self-examinations, especially after age 60. D. Have a complete blood count (CBC), blood urea nitrogen (BUN), and creatinine assessment performed annually.

ANS: A Rationale: The incidence of prostate cancer increases after age 50. The digital rectal examination, which identifies enlargement or irregularity of the prostate, and the PSA test, a tumor marker for prostate cancer, are effective diagnostic measures that are especially relevant when a client has a family history. Testicular self-examinations won't identify changes in the prostate gland due to its location in the body. A transrectal ultrasound and CBC with BUN and creatinine assessment are usually done after diagnosis to identify the extent of disease and potential metastases.

The nurse is leading a workshop on sexual health for men. The nurse should describe what organic causes of erectile dysfunction? Select all that apply. A. Diabetes B. Testosterone deficiency C. Anxiety D. Depression E. Parkinsonism

ANS: A, B, E Rationale: Organic causes of ED include cardiovascular disease, endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyperthyroidism, and hypothyroidism), cirrhosis, chronic kidney disease, genitourinary conditions (radical pelvic surgery), hematologic conditions (Hodgkin disease, leukemia), neurologic disorders (neuropathies, parkinsonism, spinal cord injury, multiple sclerosis), trauma to the pelvic or genital area, alcohol, smoking, medications, and drug abuse. Anxiety and depression are considered to be psychogenic causes.

A 76-year-old with a diagnosis of penile cancer has been admitted to the medical floor. Because the incidence of penile cancer is so low, the staff educator has been asked to teach about penile cancer. What risk factors should the educator cite in this presentation? Select all that apply. A. Phimosis B. Priapism C. Herpes simplex infection D. Increasing age E. Lack of circumcision

ANS: A, D, E Rationale: Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two thirds of cases occur in men older than 65 years of age), lichen sclerosus, and balanitis xerotica obliterans. Priapism and HSV are not known risk factors.

A client has returned to the medical-surgical floor from the post-anesthesia care unit (PACU). Upon inspection, the nurse notes leakage around the suprapubic tube. Which action by the nurse is most appropriate? A. Cleanse the skin surrounding the suprapubic tube. B. Inform the urologist of this finding as it is abnormal. C. Remove the suprapubic tube and apply a wet to dry dressing. D. Administer antispasmodic drugs as prescribed.

ANS: B Rationale: After removal of the suprapubic catheter there may be urinary drainage from the stoma site. The urologist should be informed if there is significant leakage around a suprapubic catheter. Some leakage is expected, but larger amounts should be communicated to the care team. Cleansing the skin is appropriate but does not resolve the problem. Removing the suprapubic tube is contraindicated because it is unsafe. Administering drugs will not stop the leakage of urine around the tube.

A client who is scheduled for an open prostatectomy is concerned about the potential effects of the surgery on sexual function. What aspect of prostate surgery should inform the nurse's response? A. Erectile dysfunction is common after prostatectomy as a result of hormonal changes. B. All prostatectomies carry a risk of nerve damage and consequent erectile dysfunction. C. Erectile dysfunction after prostatectomy is expected, but normally resolves within several months. D. Modern surgical techniques have eliminated the risk of erectile dysfunction following prostatectomy.

ANS: B Rationale: All prostatectomies carry a risk of impotence because of potential damage to the pudendal nerves. If this damage occurs, the effects are permanent. Hormonal changes do not affect sexual functioning after prostatectomy.

A client presents to the emergency department with paraphimosis. The health care provider is able to compress the glans and manually reduce the edema. Once the inflammation and edema subside, the nurse should prepare the client for what intervention? A. Needle aspiration of the corpus cavernosum B. Circumcision C. Abstinence from sexual activity for 6 weeks D. Administration of vardenafil

ANS: B Rationale: Circumcision is usually indicated after the inflammation and edema subside. Needle aspiration of the corpus cavernosum is indicated in priapism; abstinence from sexual activity for 6 weeks is not indicated. Vardenafil is used for erectile dysfunction and would not be used for paraphimosis.

A 55-year-old client with a history of type 1 diabetes presents at the clinic reporting erectile dysfunction. The health care provider prescribes tadalafil to be taken 1 hour before sexual intercourse. The nurse reviews the client's history prior to instructing the client on the use of this medication. What disorder will contraindicate the use of tadalafil? A. Cataracts B. Retinopathy C. Diabetic neuropathy D. Diabetic nephropathy

ANS: B Rationale: Clients with cataracts, hypotension, or nephropathy will be allowed to take tadalafil and sildenafil, if needed. However, they are usually contraindicated with diabetic retinopathy.

A health care provider has explained to the client that they have an inflammation of the Cowper glands. Where are the Cowper glands located? A. Within the epididymis B. Below the prostate, within the posterior aspect of the urethra C. On the inner epithelium lining the scrotum, lateral to the testes D. Medial to the vas deferens

ANS: B Rationale: Cowper glands lie below the prostate, within the posterior aspect of the urethra. This gland empties its secretions into the urethra during ejaculation, providing lubrication. The Cowper glands do not lie within the epididymis, within the scrotum, or alongside the vas deferens.

A 75-year-old male client is being treated for phimosis. When planning this client's care, what health promotion activity is most directly related to the etiology of the client's health problem? A. Teaching the client about safer sexual practices B. Teaching the client about the importance of hygiene C. Teaching the client about the safe use of PDE-5 inhibitors D. Teaching the client to perform testicular self-examination

ANS: B Rationale: Poor hygiene often contributes to cases of phimosis. This health problem is unrelated to sexual practices, the use of PDE-5 inhibitors, or testicular self-examination.

A client has presented at the clinic with symptoms of benign prostatic hyperplasia. What diagnostic findings would suggest that this client has chronic urinary retention? A. Hypertension B. Peripheral edema C. Tachycardia and other dysrhythmias D. Increased blood urea nitrogen (BUN)

ANS: D Rationale: Hypertension, edema, and tachycardia would not normally be associated with benign prostatic hyperplasia. Azotemia is an accumulation of nitrogenous waste products, and kidney injury can occur with chronic urinary retention and large residual volumes.

A 35-year-old father of three tells the nurse that they want information on a vasectomy. What would the nurse tell the client about ejaculate after a vasectomy? A. There will be no ejaculate after a vasectomy, though the client's potential for orgasm is unaffected. B. There is no noticeable decrease in the amount of ejaculate even though it contains no sperm. C. There is a marked decrease in the amount of ejaculate after vasectomy, though this does not affect sexual satisfaction. D. There is no change in the quantity of ejaculate after vasectomy, but the viscosity is somewhat increased.

ANS: B Rationale: Seminal fluid is manufactured predominantly in the seminal vesicles and prostate gland, which are unaffected by vasectomy, thus no noticeable decrease in the amount of ejaculate occurs (volume decreases approximately 3%), even though it contains no spermatozoa. The viscosity of ejaculate does not change.

A client has been prescribed sildenafil (Viagra). What should the nurse teach the client about this medication? A. Sexual stimulation is not needed to obtain an erection. B. The drug should be taken 1 hour prior to intercourse. C. Facial flushing or headache should be reported to the health care provider. D. The drug has the potential to cause permanent visual changes.

ANS: B Rationale: The client must have sexual stimulation to create the erection, and the drug should be taken 1 hour before intercourse. Facial flushing, mild headache, indigestion, and running nose are common side effects of Viagra and do not normally warrant reporting. Some visual disturbances may occur, but these are transient.

A clinic nurse is providing preprocedure education for a man who will undergo a vasectomy. Which of the following measures will enhance healing and comfort? Select all that apply. A. Abstaining from sexual intercourse for at least 14 days' postprocedure B. Wearing a scrotal support garment C. Using sitz baths D. Applying a heating pad intermittently E. Staying on bed rest for 48 to 72 hours' postprocedure

ANS: B, C Rationale: Applying ice bags intermittently to the scrotum for several hours after surgery can reduce swelling and relieve discomfort, and is preferable to the application of heat. The nurse advises the client to wear snug, cotton underwear or a scrotal support for added comfort and support. Sitz baths can also enhance comfort. Extended bed rest is unnecessary, and sexual activity can usually be resumed in 1 week.

A man comes to the clinic reporting difficulty obtaining an erection. When reviewing the client's history, what might the nurse note that contributes to erectile dysfunction? Select all that apply. A. The client has been treated for a UTI twice in the past year. B. The client has a history of hypertension. C. The client is 66 years old. D. The client leads a sedentary lifestyle. E. The client drinks five to six alcoholic drinks per day.

ANS: B, E Rationale: Past history of infection and lack of exercise do not contribute to impotence. With advancing age, sexual function and libido and potency decrease somewhat, but this is not the primary reason for impotence. Vascular problems cause about half the cases of impotence in men older than 50 years; hypertension is a major cause of such problems. Heavy alcohol use can contribute to the problem as well.

An adolescent is identified as having a collection of fluid in the tunica vaginalis of their testes. The nurse knows that this adolescent will receive what medical diagnosis? A. Cryptorchidism B. Orchitis C. Hydrocele D. Prostatism

ANS: C Rationale: A hydrocele refers to a collection of fluid in the tunica vaginalis of the testis. Cryptorchidism is the most common congenital defect in males, characterized by failure of one or both of the testes to descend into the scrotum. Orchitis is an inflammation of the testes (testicular congestion) caused by pyogenic, viral, spirochetal, parasitic, traumatic, chemical, or unknown factors. Prostatism is an obstructive and irritative symptom complex that includes increased frequency and hesitancy in starting urination, a decrease in the volume and force of the urinary stream, acute urinary retention, and recurrent urinary tract infections.

A nurse is providing an educational event to a local men's group about prostate cancer. The nurse should cite an increased risk of prostate cancer in what ethnic group? A. Native Americans/First Nations B. White C. Black D. Asian

ANS: C Rationale: Black men have the highest high risk of prostate cancer.

A nurse is performing an admission assessment on a 40-year-old man who has been admitted for outpatient surgery on the right knee. While taking the client's family history, the client states, "My father died of prostate cancer at age 48." The nurse should instruct the client on which of the following health promotion activities? A. The client will need PSA levels drawn starting at age 55. B. The client should have testing for presence of the CDH1 and STK11 genes. C. The client should have PSA levels drawn regularly. D. The client should limit alcohol use due to the risk of malignancy.

ANS: C Rationale: PSA screening is warranted by the client's family history and should not be delayed until age 55. The CDH1 and STK11 genes do not relate to the risk for prostate cancer. Alcohol consumption by the client should be limited. However, this is not the most important health promotion intervention.

A nurse practitioner is assessing a 55-year-old male client who reports perineal discomfort, burning, urgency, and frequency with urination. The client states that he has pain with ejaculation. The nurse knows that the client is exhibiting symptoms of: A. varicocele. B. epididymitis. C. prostatitis. D. hydrocele

ANS: C Rationale: Perineal discomfort, burning, urgency, frequency with urination, and pain with ejaculation are indicative of prostatitis. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord). Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract; it may also develop as a complication of gonorrhea. A hydrocele is a collection of fluid, generally in the tunica vaginalis of the testis, although it may also collect within the spermatic cord.

An uncircumcised 78-year-old male client has presented at the clinic reporting that they cannot retract the foreskin over the glans. On examination, it is noted that the foreskin is very constricted. The nurse should recognize the presence of what health problem? A. Bowen disease B. Peyronie disease C. Phimosis D. Priapism

ANS: C Rationale: Phimosis is the term used to describe a condition in which the foreskin is so constricted that it cannot be retracted over the glans. Bowen disease is an in situ carcinoma of the penis. Peyronie disease is an acquired, benign condition that involves the buildup of fibrous plaques in the sheath of the corpus cavernosum. Priapism is an uncontrolled, persistent erection of the penis from either neural or vascular causes, including medications, sickle cell thrombosis, leukemic cell infiltration, spinal cord tumors, and tumor invasion of the penis or its vessels.

A nurse is caring for a 33-year-old male client who has come to the clinic for a physical examination. The client states not having a routine physical in 5 years. The health care provider's digital rectal examination (DRE) reveals "stony" hardening in the posterior lobe of the prostate gland that is not mobile. The nurse recognizes that the observation typically indicates what? A. A normal finding B. A sign of early prostate cancer C. Evidence of a more advanced lesion D. Metastatic disease

ANS: C Rationale: Routine repeated DRE (preferably by the same examiner) is important, because early cancer may be detected as a nodule within the gland or as an extensive hardening in the posterior lobe. The more advanced lesion is "stony hard" and fixed. This finding is not suggestive of metastatic disease.

A nursing student is learning how to perform sexual assessments using the PLISSIT model. According to this model, the student should begin an assessment by doing which of the following? A. Briefly teaching the client about normal sexual physiology B. Assuring the client that what they say will be confidential C. Asking the client if the client is willing to discuss sexual functioning D. Ensuring client privacy

ANS: C Rationale: The PLISSIT (permission, limited information, specific suggestions, intensive therapy) model of sexual assessment and intervention may be used to provide a framework for nursing interventions. By beginning with the client's permission, the nurse establishes a client-centered focus.

A nurse is assessing a client who presented to the ED with priapism. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what issue? A. Urinary tract infection B. Chronic pain C. Permanent vascular damage D. Future erectile dysfunction

ANS: C Rationale: The ischemic form of priapism, which is described as a nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been implicated in the development of UTIs, chronic pain, or erectile dysfunction.

A client has returned to the floor after undergoing a transurethral resection of the prostate (TURP). The client has a continuous bladder irrigation system in place. The client reports bladder spasms. What is the most appropriate nursing action to relieve the discomfort of the client? A. Apply a cold compress to the pubic area. B. Notify the urologist promptly. C. Irrigate the catheter with 30 to 50 mL of normal saline as ordered. D. Administer a smooth-muscle relaxant as ordered.

ANS: D Rationale: Administering a medication that relaxes smooth muscles can help relieve bladder spasms. Neither a cold compress nor catheter irrigation will alleviate bladder spasms. In most cases, this problem can be relieved without the involvement of the urologist, who will normally order medications on a PRN basis.

A client has just been diagnosed with prostate cancer and is scheduled for brachytherapy the following week. The client and spouse are unsure of having the procedure because their child is 3 months' pregnant. What is the most appropriate teaching the nurse should provide to this family? A. The client should not be in contact with the baby after delivery. B. The client's treatment poses no risk to the child or the infant. C. The client's brachytherapy may be contraindicated for safety reasons. D. The client should avoid close contact with the child for 2 months.

ANS: D Rationale: Brachytherapy involves the implantation of interstitial radioactive seeds under anesthesia. The surgeon uses ultrasound guidance to place about 80 to 100 seeds, and the client returns home after the procedure. Exposure of others to radiation is minimal, but the client should avoid close contact with pregnant women and infants for up to 2 months.

A client has been diagnosed with erectile dysfunction; the cause has been determined to be psychogenic. The client's interdisciplinary plan of care should prioritize which of the following interventions? A. Penile implant B. PDE-5 inhibitors C. Physical therapy D. Psychotherapy

ANS: D Rationale: Clients with erectile dysfunction from psychogenic causes are referred to a health care provider or therapist who specializes in sexual dysfunction. Because of the absence of an organic cause, medications and penile implants are not first-line treatments. Physical therapy is not normally effective in the treatment of ED.

A nurse is planning the postoperative care of a client who is scheduled for radical prostatectomy. What intraoperative position will place the client at particular risk for the development of deep vein thrombosis postoperatively? A. Fowler position B. Prone position C. Supine position D. Lithotomy position

ANS: D Rationale: Elastic compression stockings are applied before surgery and are particularly important for prevention of deep vein thrombosis if the client is placed in a lithotomy position during surgery. During a prostatectomy, the client is not placed in the supine, prone, or Fowler position.

A client confides to the nurse that he cannot engage in sexual activity. The client is 27 years old and has no apparent history of chronic illness that would contribute to erectile dysfunction. What does the nurse know will be ordered for this client to assess sexual functioning? A. Sperm count B. Ejaculation capacity tests C. Engorgement tests D. Nocturnal penile tumescence tests

ANS: D Rationale: Nocturnal penile tumescence tests may be conducted in a sleep laboratory to monitor changes in penile circumference during sleep using various methods to determine number, duration, rigidity, and circumference of penile erections; the results help identify whether the erectile dysfunction is caused by physiologic and/or psychological factors. A sperm count would be done if the client was experiencing infertility. Ejaculation capacity tests and engorgement tests are not applicable for assessment in this circumstance.

A 57-year-old male client reports that when having an erection the penis curves and becomes painful. The client's diagnosis is identified as severe Peyronie disease. The nurse should prepare the client for what likely treatment modality? A. Physical therapy B. Treatment with PDE-5 inhibitors C. Intracapsular hydrocortisone injections D. Surgery

ANS: D Rationale: Surgical removal of mature plaques is used to treat severe Peyronie disease. There is no potential benefit to physical therapy and hydrocortisone injections are not normally used. PDE-5 inhibitors would exacerbate the problem.

A public health nurse has been asked to provide a health promotion session for men at a wellness center. What should the nurse inform the participants about testicular cancer? A. It is most common among men over 55. B. It is one of the least curable solid tumors. C. It typically does not metastasize. D. It is highly responsive to treatment.

ANS: D Rationale: Testicular cancer is most common among men 15 to 35 years of age and produces a painless enlargement of the testicle. Testicular cancers metastasize early but are one of the most curable solid tumors, being highly responsive to chemotherapy.

The nurse is assessing urinary output 24 hours after a prostatectomy for a client with continuous bladder irrigation. What color of output should the nurse expect to find in the drainage bag? A. Red wine colored B. Tea colored C. Amber D. Light pink

ANS: D Rationale: The urine drainage following prostatectomy usually begins as a reddish pink, then clears to a light-pink color 24 hours after surgery