NURSING 701 FINAL STUDY GUIDE Chapter 59: Assessment and Management of Problems Related to Male Reproductive Processes

 Male Reproductive System:  Assessment: • Symptoms related to urinary obstruction: o Increased urinary frequency o Decreased force of stream o “Double or triple” voiding  2-3x voiding over a few minutes. o Nocturia (at night), dysuria, (painful urination) hematuria (blood in urine), and hematospermia (blood in semen). • Conditions that may affect sexual function: o Diabetes  affects circulation o Cardiac disease o MS o Stroke (CVA)  Diagnostic Tests: • PSA (Prostate specific antigen) o Elevated w/ Prostate Cancer o BPH, acute urinary retention, acute prostatitis may elevate. o Less than 4 ng/mL = normal. • Ultrasounds  TRUS • Prostate fluid analysis • Tests of Male sexual function  Erectile Dysfunction: (ED) Release of nitric oxide into the corpus cavernosum during sexual stimulation. • Impotence • Psychogenic cause  Due to mental situation; stress, depression • Organic Cause  Physiologic cause; cardiovascular disease, diabetes, tumors, hematologic causes, neuro.  Medical Management: • Oral Medications: Sildenafil (Viagra) o Side Effects: ▪ Vasculature of eyes ▪ C/I w/ nitrates due to sudden drop in BP (hypotension). ▪ HA, flushing, dyspepsia • Injected vasoactive agents o Priaprism – persistent erection over 4 hours. • Urethral suppositories • (-) pressure devices – Penis pumps (pulls blood into penis)  Prostatitis- Inflammation of the prostate gland that is often associated with lower urinary tract symptoms and symptoms of sexual discomfort and dysfunction. • Due to infection or blockage.  S/S: • Perineal discomfort • Burning • Urgency • Frequency • Pain w/ voiding  Medical Management: • Antibiotics • Ejaculation  decreases prostate fluid.  Nursing Management: • Promote adherence • Patient teaching • DO NOT push fluids  dilutes medication. • Avoid catheters  Benign Prostatic Hyperplasia: noncancerous enlargement or hypertrophy of the prostate. • Obstructs bladder from being able to empty.  S/S: • Increased frequency • Nocturia • Urgency • Difficulty in starting urination • Decrease in volume or force • Dribbling • Sensation that the bladder has not emptied  Medical Management: • Medications – Flomax (maximizes flow of urine) o Hytrin – Relaxes prostate muscle • TUIP  decreases swelling • Transurethral needle ablation  destroys the prostate. • Microwave thermotherapy  heat w/ probe through the urethra that destroys the prostate. • Saw palmetto  OTC medication  Prostate Cancer: Testosterone dependent • DRE (digital rectal exam) over age 50 screenings. • Over 40 if considered at risk  Risk factors: • Increasing age • Family predisposition • AA race  Manifestations: • Barely any s/s • Urinary obstruction • Blood in urine or semen. • Painful ejaculation • Symptoms of metastasis (pain, anemia, fatigue)  Medical Management: • Prostatectomy  Primary treatment; removal of prostate • Radiation therapy • Hormonal therapy  ADT (androgen deprivation therapy) • Chemotherapy • Cryosurgery  freezing tissue via a probe (destroys urethra) o Only if prostatectomy is not tolerated.  Complications w/ surgery: • Hemorrhage and shock: o Highest priority!! • Infection • DVT  due to immobility • Catheter obstruction  continuous bladder irrigation • Sexual dysfunction  Nursing Management: • Maintain fluid balance • Pain relief o Bladder spasms • Patient teaching: o Drainage devices  catheter o Incontinence o Avoid straining and heavy lifting o Avoid long car trips  avoid sitting for 2 months. o Diet = increase fluids, avoid coffee, ETOH  Continuous Bladder Irrigation: 3 way foley • Fluid swishes in bladder and drains out into foley. • Purpose = prevent blood clots. o Pink tinged urine o Increase rate if getting lots of red drainage / clots. o Less red the next day • Document how much is going in and what is going out: o Expect that there is more output than what is going in.  Epididymitis: Infection of the epididymis • #1 cause is E.Coli.  antibiotics • May be r/t UTI. • May take a while to recover • Risks: STI history, recent urinary tract surgery, lack of circumcision, history of enlarged prostate, indwelling catheter. • Keep penis away from anal area.  Testicular Cancer: • Highly treatable and curable. • Risk Factors: o Undescended testes o (+) family history o Cancer of one testicle o Caucasian  Manifestations: • Painless lump in the testes. • Screening  Monthly self-exams (TSE). • Annual testicular exam  Treatment: • Orchidecttomy  removal of the testis • Lymph node dissection • Radiation  shield other testicle that does not have cancer. • Chemotherap