Male reproductive disorders from PrepU
Cryptorchidism
(failure of one or both testes to descend into the scrotum)
Cryptorchidism
(failure of one or both testes to descend into the scrotum) appears to play a role in testicular cancer, even when corrected surgically. Other significant history findings for testicular cancer include mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy. Testosterone therapy during childhood, sexually transmitted disease, and early onset of puberty aren't risk factors for testicular cancer.
A client is undergoing treatment for prostate cancer. He has chemotherapy sessions regularly. However, of late he is showing symptoms of food allergy and loss of appetite. He has lost considerable weight as a result. Which is an appropriate nursing task in this situation?
Ask the client to keep a diet diary.
As part of health teaching, the nurse knows to tell the patient that Cialis has a unique side effect which is:
Back pain Back pain is an anticipated side effect of Cialis but not of Viagra or Levitra. Refer to Table 34-2 in the text.
A client with Stage IV prostate cancer is to receive hormone therapy. The nurse would inform the client about possible adverse effects including which of the following?
Breast tenderness. Feminizing side effects occur with hormone therapy. The client's voice may become higher, hair and fat distribution may change, and breasts may become tender and enlarged. Libido and potency also are diminished.
Which nursing assessment finding is most significant in determining the plan of care in a client with erectile dysfunction?
Certain medications such as antihypertensive drugs, antidepressants, narcotics, etc. can cause sexual dysfunction in men. Impotence is not a normal part of aging. Undescended testicle is not indicative of ED. Sexual history is not indicative of ED.
medication classifications are associated with erectile dysfunction
Classes of medications associated with erectile dysfunction include antifungals, antipsychotics, beta blockers, antiseizure agents, and antispasmodics.
Reduce complications for orchitis
Ensure immunizations against infectious diseases such as mumps.
Which of the following may result if prostate cancer invades the urethra or bladder?
Hematuria may result if the cancer invades the urethra or bladder. Symptoms related to metastases include backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, and oliguria.
The nurse is preparing a presentation for a local community group about prostate cancer and possible dietary risk factors. Which of the following would the nurse most likely include?
High fat diet. Although the cause of prostatic cancer is unknown, there seems to be a relationship with increased testosterone levels and a diet high in fat. No other dietary links have been suggested.
After a radical prostatectomy for prostate cancer, a client has an indwelling catheter removed. The client then begins to have periods of incontinence. During the postoperative period, which intervention should be implemented first?
Kegel exercises are noninvasive and are recommended as the initial intervention for incontinence. Fluid restriction is useful for the client with increased detrusor contraction related to acidic urine. Artificial sphincter use isn't a primary intervention for post-prostatectomy incontinence. Self-catheterization may be used as a temporary measure but isn't a primary intervention.
a presentation for a men's community group about health promotion.
Monthly testicular self-examination (TSE) monthly TSE starting in adolescence and annual DRE for men older than 50 years.
Which assessment finding would cause the nurse to question the client's new prescription for the phosphodiesterase inhibitor sildenafil?
PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur. History of hypertension and diabetes does not interfere with the administration of PDE5 inhibitors. Use of diuretics is not significant.
PSA TESTING
PSA testing along with DRE are used to screen for prostate cancer in men with at least a 10-year life expectancy and for men at high risk, including those with a strong family history of prostate cancer and of African-American ethnicity.
Testicular self-examination
Perform monthly*
the reproductive system and normal age-related changes
Plasma testosterone levels decrease
Nursing students are reviewing information about the reproductive system and normal age-related changes. They demonstrate understanding of the topic when they identify which of the following as occurring?
Plasma testosterone levels decrease. With aging, plasma testosterone levels decrease, prostatic secretions increase, testes decrease in weight, and spermatogenesis continues.
A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer?
Prostate biopsy It can be diagnosed through an abnormal finding with the digital rectal examination (DRE), serum prostate-specific antigen (PSA), and ultrasound-guided transrectal ultrasound (TRUS) with biopsy. Detection is more likely with the use of combined diagnostic procedures. The diagnosis of prostate cancer is confirmed by a histologic examination of tissue removed surgically by transurethral resection of the prostate (TURP), open prostatectomy, or ultrasound-guided transrectal needle biopsy.
Consuming a diet high in which of the following has been found to increase the risk for prostate cancer?
Red meat
transurethral resection of the prostate.
TURP
Sildanefil (Viagra)
These agents are contraindicated in men who take organic nitrates (e.g., isosorbide [Isordil], nitroglycerin), because taken together, these medications can cause side effects such as severe hypotension.
A patient is having a DRE in the physician's office and the nurse is to assist in the examination. What can the nurse instruct the client to do to decrease the discomfort from the exam?
To minimize discomfort and relax the anal sphincter during the digital rectal examination, the patient is instructed to take a deep breath and exhale slowly as the practitioner inserts a finger. If possible, he should turn his feet inward so his toes are touching.
Priapism
an uncontrolled, persistent erection of the penis occurring from either neural or vascular causes.
medications that cause ED erectile dysfunction
antihypertensive agents (e.g. methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction.
Symptoms early indicate prostate cancer
backache, hip pain, perineal and rectal discomfort, anemia, oliguria, weight loss, weakness, nausea, and spontaneous pathologic fractures.
prostate cancer metastases
backache, hip pain, perineal and rectal discomfort, anemia, oliguria, weight loss, weakness, nausea, and spontaneous pathologic fractures.
S/S metastasis of prostate cancer are
backache, hip pain, perineal and rectal discomfort, anemia, weight loss, weakness, nausea, oliguria (decreased urine output), and spontaneous pathologic fractures.
A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate
continuous inflow and outflow of irrigation solution.
Serotonin blockers are administered to
control nausea and vomiting.
hormonal androgen deprivation therapy (ADT)
for prostate cancer
Gleason score
grading of prostate cancer. Score 8-10 is high grade cancer.
Teletherapy
involves 6 to 7 weeks of daily radiation treatments
Saw palmetto
is an herbal product used to treat symptoms associated with BPH.
High-dose ketoconazole (HDK)
lowers testosterone through its abilities to decrease both testicular and endocrine production of androgen.
Peyronie's disease
may require surgical removal of the plaques when the disease makes sexual intercourse painful, difficult, or impossible.
Testicular cancer
mumps orchitis, inguinal hernia during childhood, and maternal use of diethylstilbestrol or other estrogen-progestin combinations during pregnancy.
With aging
plasma testosterone levels decrease, prostatic secretions increase, testes decrease in weight, and spermatogenesis continues.
Alpha-adrenergic blockers
relax the smooth muscle of the bladder neck and prostate, improving urine flow and relieving BPH symptoms.
E. Coli causes???
rostatitis is an inflammation of the prostate gland and is most often caused by microorganisms that reach the prostate by way of the urethra. Escherichia coli and microbes that cause sexually transmitted infections often are responsible.
Serenoa repens (saw palmetto berry)
should not be used with finasteride.
symptoms of prostate cancer
slow urinary stream; hematuria, difficulty urinating; urinary hesitancy; incomplete bladder emptying; dysuria (painful urination).
Bowen's disease
squamous cell carcinoma in situ
Paraphimosis
strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans.
Hormone therapy for advanced prostate cancer
suppresses androgenic stimuli to the prostate by decreasing the level of circulating plasma testosterone or interrupting the conversion to or binding of DHT.
Brachytherapy
the implantation of interstitial radioactive seeds under anesthesia.
cryptorchidism,
torsion of the spermatic cord, phimosis, paraphimosis, hydrocele, spermatocele, and varicocele.
Following a vasectomy, which is the most important instruction to provide to the client?
use another form of birth control until further notice.
Sildanefil (Viagra)
Should take 30 minutes to 4 hours before intercourse
The nurse is obtaining a health history from a 58-year-old client stating that he is having difficulty obtaining an erection during sexual activity. The client asks how an "erectile medication" works and if there are any side effects to the medication. The nurse explains the action of the medication and directions for use and warns of which side effect related to the client's history?
No nitrates Due to the action of the medication on the smooth muscles and blood vessels, clients are advised not to take medications to treat erectile dysfunction when also prescribed a nitrate drug for chest pain or heart problems. Combining medication could result in a serious drop in blood pressure. Although all disease processes and medication therapy should be screened for interactions, hypotension with nitrate use the most serious side effects.
After having transurethral resection of the prostate (TURP), a client returns to the unit with a three-way indwelling urinary catheter and continuous closed bladder irrigation. Which finding suggests that the client's catheter is occluded?
Reports of bladder spasms and the urge to void suggest that a blood clot may be occluding the catheter. After TURP, urine normally appears red to pink, and normal saline irrigant usually is infused at a rate of 40 to 60 drops/minute or according to facility protocol. The amount of returned fluid (1,200 ml) should correspond to the amount of instilled fluid, plus the client's urine output (1,000 ml + 200 ml), which reflects catheter patency.
The client asks, "Which diagnostic test produces definitive results if cancer is present?" The nurse is most correct to state which of the following?
prostate biopsy
phosphodiesterase type 5 (PDE-5) inhibitor
S/E headache, flushing, dyspepsia, diarrhea, nasal congestion, and lightheadedness.
prostate-specific antigen (PSA).
The cells within the prostate gland produce a protein that can be measured in the blood
A client with erectile dysfunction who had a penile implant inserted has been taught how to identify malfunction of the device. Which of the following if stated by the client as indicative of malfunction would indicate to the nurse that the client has understood the teaching?
Malfunction of the device is characterized by the underinflation, bulging of the cylinders during inflation, and a loss of fluid from the implant. Erosion of penile or urethral tissue occurs due to a mis-sized implant, pressure, or friction of the implanted cylinders. Erosion of scrotal, bowel, or bladder tissue occurs if an implant with a fluid reservoir is used. Migration of the cylinders, pump, or reservoir from their intended location is accompanied by pain, tenderness, and dysfunction of components that are part of the device.
PSA
These include urinary retention, benign prostatic hyperplasia, or acute prostatitis. The increased level may indicate prostate cancer but the elevated level does not always indicate some degree of cancer. There will most likely be follow-up tests because of the elevated PSA level.
