nsg 211 week 4

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nsg 211 week 4
2011-11-15 21:18:51
nsg 211

monday 11/14/11 ch.24-27
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  1. penis
    composed of three cylinder columns of erectile tissue

    two corpora cavernosa on dorsal side
  2. aging adult
    declining testosterone

    decreased sexual drive

    longer time to recover
  3. dysuria
    burning or pain when urinating

    cardiovascular issue

    kidneys function different
  4. nocturia
    urinating frequently

    feeling that you cannot wait to urinate

    awaken in middle of night to urinate
  5. inspection
    be aware of your position in regards to pt

    be very sensitive of terminology being used
  6. inguinal and femoral hernias on exam
    pg 707
  7. circumcision
    culturally based

    medical reasons pro circumcision

    less likely to contract viruses which live in foreskin
  8. urine color and discoloration
    pg 699
  9. gravida
    # of times preganant
  10. para
    # of live births
  11. penis
    composed of three cylinderic columns of erectile tissue:

    • 2 corpora cavernosa on dorsal side
    • corpus spongium ventrally expands into cone of erectile tissue "the glans"
  12. corona
    the shoulder where the the glans join the shaft
  13. urethra
    conduit for both the genitaland urinary systems

    it transverses the corpus spongium

    its meatus forms a slit at the glans tip
  14. foreskin "pupice"
    usually surgically removed shortly after birth by circumcision
  15. frenulum
    fold of the foreskin extending from the urethral meatus ventrally
  16. rugae
    thin skin folds forming the scrotal wall
  17. cremaster muscle
    controls the size of the scrotum by responding to ambient tempertature

    purpose is to keep the testes 3 degrees celsius below abdominal temperature

    ie: the best temperature for producing sperm

    muscle contracts when its cold raising the sac and bringing the testes closer to the body to absorb heat

    muscle relaxes when its warm to cool testes
  18. testis
    sac divided into two halves by septum

    each scrotal sac contains a testis which produces sperm

    solid oval shape

    compressed laterally and measures 4-5 cm wide in adult

    suspended vertically by spermatic cord

    left testi is lower then right because left spermatic cord is longer

    each testi covered by a double layered membrane

    tunica vaginalis separates testi from scrotal wall

    two layers lubricated by fluid allowing testis to slide a little within scrotum
  19. epididymus
    coiled duct system and main storage system of sperm

    comma shaped structure

    curved over the top and the posterior surface of the testis

    lower part is continuous with muscular duct called the vas deferens
  20. vas deferans
    consists of the lower part of the epididymus

    continuous muscular duct

    approximates with other vessels to form the spermatic cord

    approximates with the:

    arteries,veins,lymphatics, nerves
  21. spermatic cord
    -ascends along the the posterior border of the testis and runs through the tunnel of the inguinal canal to the abdomen where the vas deferans continue back and down behind bladder where it joins the duct of seminal vesicle to form ejaculatory duct which empties into urethra
  22. ejaculatory duct
    seminal vesicle

    empties into urethra
  23. inguinal area
    juncture of the lower abdominal wall and the thigh

    its diagonal borders are the anterior superior spine and symphysis pubis
  24. inguinal ligament

    "Poupart ligament"
    located between superior iliac spine and symphysis pubis
  25. inguinal canal
    -narrow tunnel passing obliquely betwen layers of abdominal muscle

    4-6 cm long in adults

    -openings are an internal ring located 1 to 2 cm above midpoint of the inguinal ligament, and external ring, located just above the pubis
  26. femoral canal
    potential space located 3 cm medial and parallel with the femoral artery

    may use artery as landmark to find this space
  27. dysuria
    pain or burning when urinating
  28. hesitancy and straining
    trouble starting urination

    change of force of stream (narrowing/weaker)


    feeling like still need to urinate after finishing

    past UTI?
  29. past genitourinary history
    difficulty controlling urine

    -accidentally urinating when sneezing, laughing, coughing

    history of kindey disease?

    kidney stones?

    flank pain?

    urinary tract infection?

    prostate trouble?
  30. penis subjective history


  31. scrotum self care behaviors
    lump or swelling

    change in size

    undescended testicle as infant





    heavy feeling in scrotum
  32. sexual activity and contraceptive use
    relationship involve sex?

    aspects of sex satisfying?

    satisfied with way you and partner communicate?

    change in ability to have an erection?
  33. STD contact
    any partners with STD?

    when was contact?

    did you contract STD?

    how was it treated?

    Any complications?

    Do you use condom?

    questions or concerns?
  34. testicular self-examination
    T= timing


    E=examination points
  35. herpes
    clusters of small vesicles with surrounding erythema

    often painful

    erupt on glands or foreskin

    initial infection lasts 7-10 days

    virus remains dormant indefinately

    -recurrent infections last 3-10 days with milder symptoms
  36. syphilitic chancre
    -begins with 2-4 weeks of infection as a small solitary silvery papule that erodes, red,round, oval, superficial ulcer with yellowish serous discharge

    -palpation reveals a nontender indurated base that can be lifted like a button between the thumb and the finger

    lymph nodes enlarge early but are nontender

    easily treated with penicillin G

    -untreated leads to cardiac and neurological problems and blindness

    almost eradicated in US in 1957

    epidemics recur cyclically every 7-10 years
  37. genital warts


    condylomata acuminata




    painless papules (single or multiple)

    cauliflower -like patch

    -gray, pale, yellow, pink in white males, gray in black males

    occur on shaft of penis behind corona

    around anus where they grow into grape like structurs

    caused by HPV
  38. carcinoma
    -begins as red, raised warty growth or as an ulcer with watery discharge

    may necrose and slough as it grows

    usually painless

    almost always on glans or inner lip of foreskin and following chronic inflammation

    enlarged lymph nodes common
  39. urethritis


    "urethral discharge and dysuria"
    infection of urethra

    painful burning while urinating or pruritus

    edges are reddened


    swollen with purulent discharge

    urine cloudy with discharge and mucus shreds

    caused determined by culture:

    1) gonococcal urehtritis has thick, profuse,yellow or gray brown discharge, mucoid discharge

    2) nonspecific urethritus (NSU) similiar discharge but often scanty, mucoid discharge

    50% caused by chlamydiainfection

    -important to differentiate because different antibiotics used to treat different types
  40. hypospadias
    -urethra meatus opens on ventral (under) side of glans, shaft, or at the penoscrotal junction

    groove extends from the meatus to the normal locationat the tip

    congenital defect, important to recognize at birth

    -newborn should not be circumcised because surgical correction may use foreskin tissue to extend urethral length
  41. epispadias
    meatus opens on dorsal (upper) side of glans or shaft above broad spadelike penis


    less common then hypospadias
  42. priapism
    prolonged painful erection without sexual stimulation

    unrelieved by sex or masturbation

    -when lasting 4 hours or longer may cause ischemia,fibrosis, and erectile dysfunction

    may be side effect of drugs or medications
  43. absent testis


    empty half scrotal half or absent altogether
  44. small testis
    may indicate atrophy as with cirrhosis, hypopituatarism,
  45. epididymitis
    • acute infection of epididymus
    • commonly caused by prostatitus
  46. hydrocele
    swelling of testes

    collection of serous fluid in tunica vaginalis surround testi

    may be caused by trauma, hernia, tumor
  47. indirect hernia (inguinal and femoral)
    sac herniates through internal inguinal ring

    may remain in canal or pass into scrotum

    pain with straining

    -soft swelling that increases with increased intra-dominal pressure

    may decrease when lying down

  48. direct inguinal hernia
    directly behind and through external inguinal ring

    above inguinal ligament, rarely enters scrotum

    usually painless

    round swelling close to the pubisin area of internal inguinal ring

    easily reduced when supine

    aquired weakness

    brought on by heavy lifting

    muscle atrophy


    chronic cough

  49. femoral hernia
    through femoral ring and canal

    below inguinal ligament

    more often on right side

    pain may be severe and may become strangulated

    least common of all hernias

    more common in women

    aquired because of increased abdominal pressure

    muscle weakness

    or frequent stooping