Chapter 67: Male Reproductive

A client has continuous bladder irrigation after surgery yesterday. The amount of bladder irrigating solution that has infused over the past 12 hours is 1100 mL. The amount of fluid in the urinary drainage bag is 1950 mL. The nurse records that the client had ________ mL urinary output in the past 12 hours. Fill in the blank.

850 mL

The nurse is planning care for a patient who is considering radiation therapy options for the treatment of his prostate cancer. Which of the following problems does the nurse anticipate regardless of the type of radiation therapy chosen? A. Decreased activity tolerance r/t radiation therapy associated fatigue B. Risk for infection r/t tissue contact with intestinal bacteria C. Sexual dysfunction related to inability to maintain erection. D. Risk for injury r/t orthostatic hypotension

A. Decreased activity tolerance r/t radiation therapy associated fatigue Rationale: Fatigue is the most common complaint associated with any type of radiation therapy. Risk for infection, or sexual dysfunction vary among types of therapy, and orthostatic hypotension is not commonly associated with radiation therapy.

Critical Rescue

After a TURP, monitor the patient's urine output every 2 to 4 hours and vital signs (including pain assessment) every 4 hours for the first postoperative day or according to agency or surgeon protocol. Assess for postoperative bleeding. Patients who undergo a TURP are at risk for severe bleeding or hemorrhage after surgery. Although rare, bleeding is most likely within the first 24 hours. Bladder spasms or movement may trigger fresh bleeding from previously controlled vessels. This bleeding may be arterial or venous, but venous bleeding is more common. If arterial bleeding occurs, the urinary drainage is bright red or ketchup-like with numerous clots. Notify the surgeon immediately and irrigate the catheter with normal saline solution per surgeon or hospital protocol. Surgical intervention may be needed to clear the bladder of clots and stop bleeding. If the bleeding is venous, the urine output is burgundy, with or without any change in vital signs. Inform the surgeon of any bleeding. Closely monitor the patient's hemoglobin (Hgb) and hematocrit (Hct) levels for anemia as a result of blood loss.

1. The nurse is teaching a client with erectile dysfunction about taking sildenafil to achieve an erection. Which client statement demonstrates an understanding of this drug? A. "I can have sex up to 8 hours after taking the drug." B. "I might get a headache or stuffy nose when this drug is used." C. "Taking this with a drink or two of alcohol will enhance my performance." D. "If one pill doesn't work, it is acceptable for me to quickly take another pill."

B. "I might get a headache or stuffy nose when this drug is used."

2. A client with a history of BPH calls the telehealth nurse reporting the sudden onset of testicular pain after moving heavy furniture. What is the appropriate nursing response? A. "Taking ibuprofen may help alleviate the pain." B. "Please go to your closest emergency department right away." C. "This is a common reaction when performing labor; the pain will go away." D. "Your BPH is probably giving you difficulty because you were moving furniture."

B. "Please go to your closest emergency department right away."

The nurse is caring for a client who has just been prescribed sildenafil for erectile dysfunction. Which teaching will the nurse provide? A. Take four hours before intercourse B. Be cautious when standing up quickly C. Perform handwashing before giving injection D. Taking with grapefruit juice will hasten the effects

B. Be cautious when standing up quickly Rationale: Phosphodiesterase-5 inhibitors can lower blood pressure so the nurse will teach the client to use caution when standing up quickly. This drug, which comes in pill form, must be taken approximately 15 minutes before intercourse and should not be taken with grapefruit juice.

While assessing a sixteen-year-old who began having severe testicular pain during football practice, to which of the following would the nurse alert the provider immediately? A. A temp of 100.2 B. The clients left testicle is noticeably higher in the scrotum than his right C. The client reports having taken a knee to the groin area during practice D. The client reports having occasional nocturnal emission of semen

B. The clients left testicle is noticeably higher in the scrotum than his right Rationale: Testicular torsion is associated with sudden, severe pain in the scrotum and a testicle that's positioned higher than normal . Since time is tissue, the provider should be alerted immediately if suspected.

When preparing a 73-year-old African American man for his annual physical, the nurse learns that the patient plans to refuse digital rectal exam. Which statement by the nurse provides the best rationale for allowing the exam?" A. ...because your increasing age places you at increased risk for prostate cancer." B. "... because your race places you at increased risk for prostate cancer." C. "...because when detected early, prostate cancer has nearly a 100% cure rate." D. "...because prostate cancer is slow growing assessment for subtle changes is needed each year."

C. "...because when detected early, prostate cancer has nearly a 100% cure rate." Rationale: Early detection and intervention is key to cure.

The nurse notes bright red urinary drainage from a client who had a transurethral resection of the prostate (TURP) with continuous bladder irrigation yesterday. What is the appropriate initial nursing action? A. Calculate intake and output. B. Monitor hemoglobin and hematocrit. C. Increase the rate of the bladder irrigation. D. Document findings in the electronic health record.

C. Increase the rate of the bladder irrigation.

The nurse is reviewing a patient's history to determine interventions to reduce risk for worsening BPH. Which of the following is a modifiable risk factor for BPH? A. African American B. Family history of prostate cancer C. Drinking 4 - 6 Colas per day D. Family history of bladder cancer

Colas are high in sugar and caffeine, and glycemic control and caffeine intake are modifiable risk factors. Race and family history are nonmodifiable risk factors. Rationale: Colas are high in sugar and caffeine, and glycemic control and caffeine intake are modifiable risk factors. Race and family history are nonmodifiable risk factors.

What priority question will the nurse ask when taking a history of a client with BPH? A. "Do you have high blood pressure?" B. "Have you had a recent urinary tract infection?" C. "Do you have a family history of kidney disease?" D. "Do you have difficulty starting and continuing urination?"

D. "Do you have difficulty starting and continuing urination?" Rationale: BPH can lead to chronic urinary retention causing a backup of urine with gradual dilation of the ureters (hydroureter) and kidneys (hydronephrosis). These problems can lead to chronic kidney disease.

When teaching about the management of overflow urinary incontinence r/t BPH, which of the following responses from the patient indicates a need for further clarification by the nurse? A. "I will hit the head whenever the urge first occurs." B. "I will use a small pad to keep the surrounding area clean and dry." C. "I will take my time and ensure that I have emptied as much as possible." D. "I will schedule bathroom breaks every 4 hours to train my bladder to hold more."

D. "I will schedule bathroom breaks every 4 hours to train my bladder to hold more." Rationale: Overflow incontinence is due to retention, so there is no need to train the bladder to hold more. All of the other options are correct.

A nursing student asks how the treatment regimen will be selected for a patient diagnosed with testicular cancer. Which statement by the nurse best explains how the course of treatment for testicular cancer is selected? A. The testicle will be surgically removed B. Treatment will be agreed upon by the patient and provider. C. There are protocols for the treatment of various types of cancer. D. Biopsy will guide the choice of therapy evidenced to be most effective.

D. Biopsy will guide the choice of therapy evidenced to be most effective. Rationale: Biopsy will guide the choice of therapy that is evidenced to be most effective.

When a client asks about the cause of his erectile dysfunction, which of the following findings in the patient's history does the nurse eliminate as a possible cause of the dysfunction? A. Smoking and polysubstance abuse B. Poorly controlled DM type 2 C. Cardiovascular Disease D. Long work hours

D. Long work hours Rationale: Cardiovascular Disease, Poorly controlled DM type 2,, Smoking and polysubstance abuse have been identified as risk factors for ED.

Which assessment finding will the nurse report to the health care provider for a client who had an orchiectomy and laparoscopic radical retroperitoneal lymph node dissection this morning? A. BP 130/80 mm Hg, T 98.9°F, R 16, P 70 B. Urinary catheter draining clear yellow urine C. Expresses fearfulness of inability to perform sexually D. Reports pain of 9 on a 0-10 scale after receiving pain medication

D. Reports pain of 9 on a 0-10 scale after receiving pain medication

When reviewing a patient's medication list and planning care related to dutasteride (Avodart) for the treatment of BPH, which hypothesis does the nurse recognize as a safety priority? A. Impaired urine elimination related to urinary outlet obstruction. B. Sexual dysfunction related to inability to maintain erection. C. Impaired social interaction related to decreased libido. D. Risk for injury related to orthostatic hypotension.

D. Risk for injury related to orthostatic hypotension. Rationale: Risk for injury is a safety priority.

Drug Alert

Instruct patients taking PDE-5 inhibitors to abstain from alcohol before sexual intercourse because it could impair the ability to have an erection. Common side effects of these drugs include dyspepsia (heartburn), headaches, facial flushing, and stuffy nose. If more than one pill a day is being taken, leg and back cramps, nausea, and vomiting also may occur. Teach men who take nitrates to avoid PDE-5 inhibitors because the vasodilation effects can cause a profound hypotension and reduce blood flow to vital organs

Drug Alert

Remind patients taking a 5-ARI for BPH that they may need to take it for as long as 6 months before improvement is noticed. Remind them to keep all follow-up appointments for laboratory testing, because liver damage can occur. Teach about possible side effects including erectile dysfunction (ED), decreased libido, and dizziness due to orthostatic hypotension. Remind them to change positions carefully and slowly! Teach patients taking a 5-ARI to keep these drugs stored away from pregnant women or women who may become pregnant. These drugs are absorbed through the skin, and are teratogenic.

Drug Alert

Teach patients taking LHRH agonists that side effects include "hot flashes," which usually decrease as treatment progresses. The subsequent reduction in testosterone may contribute to erectile dysfunction and decreased libido (desire to have sex). Some men also develop gynecomastia (abnormal enlargement of the breasts in men.). These drugs can also increase the patient's risk for osteoporosis and fractures. Teach the patient to take calcium and vitamin D and to engage in regular weight-bearing exercise. Bisphosphonates can be prescribed to prevent bone fractures.

Care of the Patient After an Open Radical Prostatectomy

• Encourage the patient to use patient-controlled analgesia (PCA) as needed. • Help the patient get out of bed into a chair on the night of surgery and ambulate by the next day. • Maintain the sequential compression device until the patient begins to ambulate. • Monitor the patient for venous thromboembolism and pulmonary embolus. • Keep an accurate record of intake and output, including drainage from a Jackson-Pratt or other drainage device. • Keep the urinary meatus clean using soap and water. • Avoid rectal procedures or treatments. • Teach the patient how to care for the urinary catheter because he may be discharged with the catheter in place. • Teach the patient how to use a leg bag. • Emphasize the importance of not straining during a bowel movement yet to avoid suppositories or enemas. • Remind the patient about the importance of follow-up appointments with the surgeon and oncologist to monitor progress.

Care of the Patient After Transurethral Resection of the Prostate

• Monitor the patient closely for signs of infection. Older men undergoing prostate surgery often also have underlying chronic diseases (e.g., cardiovascular disease, chronic lung disease, diabetes). • Help the patient out of the bed to the chair as soon as permitted to prevent complications of immobility. Provide assistance, especially for patients with underlying changes in the musculoskeletal system (e.g., decreased range of motion, stiffness in joints). These patients are at high risk for falls. • Assess the patient's pain every 2 to 4 hours and intervene as needed to control pain. • Provide a safe environment for the patient. Anticipate a temporary change in mental status for the older patient in the immediate postoperative period as a result of anesthetics and unfamiliar surroundings. Reorient the patient frequently. Keep catheter tubes secure. • Maintain the rate of the continuous bladder irrigation to ensure clear urine without clots and bleeding. • Use normal saline solution (which is isotonic) for the intermittent bladder irrigant unless otherwise prescribed. • Monitor and document the color, consistency, and amount of urine output. • Check the drainage tubing frequently for external obstructions (e.g., kinks) and internal obstructions (e.g., blood clots, decreased output). • Assess the patient for reports of severe bladder spasms with decreased urinary output, which may indicate obstruction. • If the urinary catheter is obstructed, irrigate it per agency or surgeon protocol. • Notify the surgeon immediately if the obstruction does not resolve by hand irrigation or if the urinary return looks like ketchup.

Sperm Banking

• You may want to investigate sperm storage (called "cryopreservation") in a sperm bank as a way to preserve your sperm for future use. • No one knows how long sperm can be stored successfully, but pregnancies have resulted from sperm stored for longer than 40 years (Szell et al., 2013). • Check with the sperm bank to see how much it charges to process and store your sperm and whether you must pay when the service is provided. • Investigate whether your health insurance company will reimburse you for sperm collection and storage.