Male Repro - Med Surg

Card Set Information

Author:
mthompson17
ID:
244046
Filename:
Male Repro - Med Surg
Updated:
2013-11-03 16:44:09
Tags:
male reproductive disorders
Folders:

Description:
male reproductive disorders - Wake
Show Answers:

Home > Flashcards > Print Preview

The flashcards below were created by user mthompson17 on FreezingBlue Flashcards. What would you like to do?


  1. BPH?
    benign enlargement of the prostate gland
  2. In what part of the prostate does BPH develop?
    inner part of the prostate
  3. Does BPH predispose a pt to prostate CA?
    no
  4. The etiology of BPH is not completely understood - what is the most likely etiology?
    endocrine changes associated with aging
  5. 2 endocrine changes occur r/t aging that may contribute to the development of BPH?
    1. excessive accumulation of dihydroxytestosterone (androgen)

    2. decreased testosterone which leads to a greater proportion of estrogen to testosterone
  6. Severity of the s/s of BPH are more r/t _____ than the size of the enlargement.
    location of the enlargement
  7. 7 risk factors for BPH?
    • 1. family Hx
    • 2. obesity- especially large waste
    • 3. decreased physical activity
    • 4. DM
    • 5. age >50
    • 6. smoking
    • 7. drinking
  8. 2 ways alcohol effects the development of BPH?
    1. increases fat & --> fat stores estrogen --> increased estrogen

    2. acts as a diuretic --> dehydration
  9. How does smoking effect the development of BPH?
    constricts smooth muscle (muscle in BVs & urinary system) -->issues with the urinary system & blood flow to the urinary system
  10. Manifestations of BPH are a result of _____ _____.
    urinary obstruction
  11. What usually brings a pt with BPH to the MD office?
    altered urination pattern
  12. 2 types of s/s that occur in BPH?
    obstructive s/s & irritative s/s
  13. 4 s/s of BPH that occur r/t obstructive s/s?
    • 1. decreased size/force of urinary stream
    • 2. hesitancy - difficulty initiating
    • 3. intermittency - stopping & starting
    • 4. dribbling at the end of urination
  14. irritative s/s of BPH?
    • 1. frequency
    • 2. retention
    • 3. urgency
    • 4. dysuria
    • 5. nocturia
    • 6. incontinence - stress incontinence
    • 7. bladder pain
  15. What are the s/s of UTI with BPH?
    • 1. WBC, bacteria, hematuria on UA
    • 2. other s/s of UTI:  burning, fever, etc
  16. complications of BPH?
    • 1. acute urinary retention
    • 2. UTI
    • 3. pyelonephritis
    • 4. sepsis
    • 5. calculi
    • 6. bladder damage r/t calculi or retention
    • 7. renal failure r/t hydronephrosis -
  17. Tx for acute urinary retention?
    • catheter insertion to drain the bladder -
    • surgery may be required
  18. Pathophysiology of UTI r/t BPH?
    incomplete bladder emptying --> residual urine --> favorable conditions for bacterial growth
  19. Pathophysiology of renal failure r/t hydronephrosis?
    urinary retention --> urine backs up into the kidneys --> distention of pelvis & calyces of the kidney
  20. Dx of BPH?
    • 1. H & P
    • 2. DRE - digital rectal exam
    • 3. UA with C&S
    • 4. PSA - prostate specific antigen
    • 5. serum creatinine
    • 6. postvoid residual
    • 7. transrectal ultrasound - TRUS
    • 8. uroflowmetry
    • 9. cystoscopy
    • 10. AUA symptom index
  21. Who conducts DRE & what will results be in BPH?
    MD does it

    prostate will be enlarged, firm, and symmetrical
  22. Priority consideration during DRE?

    Nursing intervention?
    may cause vagal response:  HR & BP drop --> may pass out or change cardiac rhythm

    monitor & educate patient
  23. Normal PSA?

    What is PSA mostly testing for?

    What other conditions may cause increased PSA?
    0-4

    prostate cancer

    BPH & other prostate problems
  24. What will serum creatinine show with BPH?
    if kidney had been effected
  25. How is the post-void residual test performed?

    What is it testing for?
    tests for urinary retention

    usually done with a TRUS - transrectal ultrasound
  26. Uses for transrectal ultrasound (TRUS) in BPH?

    What test may be done with TRUS?
    gives accurate assessment of prostate size & differentiates BPH from prostate cancer

    may do a biopsy during the ultrasound
  27. What is measured by uroflowmetry?

    How is the test performed?
    measures volume of urine expelled from the bladder per second

    watch the person pee using radiography
  28. Why is postvoid residual urine volume measured?
    to show extent of urine flow obstruction/ urine retention
  29. What is the purpose of cytoscopy?

    How is it performed?

    When will it be done?
    internal visualization of the urethra & bladder

    a camera is put up through urethra & into the bladder

    will be done if Dx is uncertain & in pt who are scheduled for prostatectomy
  30. 3 goals of Tx for BPH?
    • 1. restore bladder drainage
    • 2. relieve s/s
    • 3. prevent or Tx complications of BPH
  31. 5 things to educate about with BPH?
    • 1. yearly DRE
    • 2. adequate fluids
    • 3. avoid alcohol, caffeine, & smoking
    • 4. nutrition:  avoid irritating foods:  spicy, acidic, artificial sweeteners
    • 5. weight mgmt/loss
    • 6. s/s to report
  32. 2 things to monitor during post-procedure care for a transrectal ultrasound (TRUS)?
    • 1. v/s r/t vagal response
    • 2. bleeding & irritation
  33. 4 things to monitor post-cytoscopy?
    • 1. hematuria
    • 2. pain
    • 3. v/s for hypovolemia r/t bleeding
    • 4. make sure pt can pee
  34. interventions for BPH?
    • 1. "watchful waiting" -
    • 2. meds
    • 3. transurethral microwave therapy
    • 4. transurethral needle ablation
    • 5. laser prostatectomy
    • 6. intraprostatic urethral stents
    • 7. transurethral resection of the prostate (TURP)
  35. When is "watchful waiting" Tx used?

    4 interventions involved in watchful waiting?
    used when no-mild s/s

    • 1. dietary changes:  decreasing caffeine & artificial sweeteners & limiting spicy/acidic
    • 2. avoiding some meds:  decongestants & anticholinergics
    • 3. restricting evening fluid intake
    • 4. timed voiding scedule
  36. 2 types of drugs that may be used to Tx BPH?
    • 1. 5 alpha-reductase inhibitors
    • 2. alpha adrenergic receptor blockers
  37. 5 alpha-reductase inhibitor action in BPH?

    What are two 5 alpha-reductase inhibitors?
    proscar & avodart

    blocks enzyme(5 alpha-reductase) that is needed for conversion of testosterone to dihydroxytestosterone --> suppresses androgens --> causes prostate to reduce in size
  38. When is proscar an appropriate Tx for BPH?
    moderate to severe s/s
  39. Education with proscar?
    • 1. takes about 6 mo to be effective
    • 2. if used with ED meds may cause orthostatic hypotension
    • 3. women of child-bearing age who may become pregnant or are pregnant should not handle tablets
  40. Adverse effects of 5 alpha reductase inhibitors (proscar & avodart)?
    • 1.decreased libido
    • 2. decreased volume of ejaculate
    • 3. ED
  41. How may 5 alpha-reductase inhibitors (proscar & avodart) affect a man's chances of getting prostate cancer?
    decreases PSA levels & lowers the risk of low-grade early-stage prostate cancer
  42. 6 alpha-adrenergic blockers that may be used for BPH?
    • (zosins/osins)
    • 1. silodosin/Rapaflo
    • 2. alfuzosin/Uroxatral
    • 3. doxazosin/Cardura
    • 4. prazosin/Minipress
    • 5. terazosin/Hytrin
    • 6. tamsulosin/Flowmax
  43. Action of alpha-adrenergic blockers in BPH?

    What are they effective?
    Tx s/s of BPH by promoting smooth muscle relaxation in the prostate --> facilitates urinary flow through the urethra (do not Tx hyperplasia just the s/s)

    effective b/c there are many adrenergic receptros in the prostate that are increased when the prostate is enlarged
  44. When will improvement of BPH occur using alpha-adrenergic blockers?
    2 to 3 wks
  45. 4 AE of alpha-adrenergic drugs?
    • 1. orthostatic hypotension
    • 2. dizziness
    • 3. retrograde ejaculation
    • 4. nasal congestion
  46. What is retrograde ejaculation?
    ejaculate goes into the urinary bladder instead of out the urethra
  47. Saw palmetto?

    Effect on BPH?
    herbal remedy

    some ppl think it helps but it has no effect
  48. What 4 procedures for BPH are considered minimally invasive?
    • 1. transurethral microwave thermotherapy
    • 2. transurethral needle ablation
    • 3. laser prostatectomy
    • 4. intraprostatic urethral stents
  49. 2 advantages of most of the minimally invasive procedures for BPH?

    Disadvantage?
    • do not require hospitalization or catheterization usually
    • have few adverse effects

    less effective than invasive procedures at improving urine flow
  50. What is transurethral microwave thermotherapy (TUMT)?

    2 advantages?

    3 disadvantages
    use of microwave radiating heat to produce coagulative necrosis tissue death) of the prostate

    • 1. outpatient
    • 2. ED & retrograde ejaculation are rare

    • 1. potential for damage to surrounding tissue r/t heat
    • 2. urinary catheer needed post-procedure
    • 3. may need retreatment
  51. How is TUMT performed?

    How are surrounding tissues protected from heat?
    transurethral probe is used to deliver microwaves to prostate while rectal temperature is taken during the procedure to be sure temperature is kept below 110 F to prevent rectal tissue damage
  52. Post-op complication with TUMT?

    Intervention?
    post-op urinary retention - pt will be sent home with indwelling catheter for 2 to 7 days to maintain urinary flow & facilitate passing of small clots or necrotic tissue
  53. Pre-op teaching for TUMT?
    pt should stop anticoagulants 10 days before procedure
  54. 4 AE (adverse effects) of TUMT?
    • 1. bladder spasm
    • 2. hematuria
    • 3. dysuria
    • 4. retention
  55. Transurethral needle ablation (TUNA)?
    low-wave radiofrequency (electricity) used to heat the prostate & cause necrosis

    (same as TUMT except use different method to heat the tissue)
  56. 4 advantages of TUNA for BPH?
    • 1. outpatient
    • 2. ED & retrograde ejaculation are rare
    • 3. greater precision in removal of the target tissue
    • 4. very little pain experienced
  57. 4 disadvantages of TUNA?
    • 1. urinary retention is common
    • 2. irritative voiding s/s
    • 3. hamaturia
    • 4. may need retreatment
  58. What kind of anesthesia is used for a TUNA procedure?
    local anesthesia & IV or oral sedation
  59. How long does the TUNA procedure last?
    30 minutes
  60. Pain experienced with TUNA?
    very little pain with early return to regular activities
  61. 4 AE of TUNA?

    Will the pt need a urinary catheter?
    • 1. urinary retention
    • 2. UTI
    • 3. irritative voiding s/s
    • 4. hematuria for up to a week

    some pt requre urinary cath for a short period
  62. What is laser prostatectomy?

    How is the laser guided?
    procedure that uses a laser beam to cut or destroy part of the prostate

    use visual or ultrasound guidance
  63. How does the laser beam reach the prostate?
    through the urethra
  64. 3 ways laser is used in laser prostatectomy?
    • 1. cutting
    • 2. coagulation
    • 3. vaporization of prostatic tissue
  65. 4 types of laster prosatectomy that may be used?
    • 1. visual laser ablation of prostate (VLAP)
    • 2. contact laser technique
    • 3. photovaporization of prostate (PVP)
    • 4. interstitial laser coagulation (ILC)
  66. 4 advantages of laser prostatectomy procedures?
    • 1. short procedure
    • 2. comparable results to TURP - very effective
    • 3. minimal bleeding
    • 4. rapid s/s improvement
  67. 4 disadvantages of laser prostatecotomy procedures
    • 1. catheter needed for up to 7 days after procedure r/t edema & urinary retention
    • 2. delayed sloughing of tissue
    • 3. takes severa weeks to reach optimal effect
    • 4. retrograde ejaculation
  68. Visual laser ablation of the prostate (VLAP)?
    laser beam produces deep coagulation necrosis of the prostate which gradually sloughs in the urinary stream
  69. 2 disadvantages VLAP?
    • 1. takes several weeks to reach full effect
    • 2. need urinary catheter to allow for drainage post-op
  70. Contact laser techniques?
    direct contaxct of the laser to the prostate tissue with immediate vaporization of the prostate tissue
  71. 4 advantage s of contact laser techniques for BPH?
    • 1. bleeding is rare b/c laser cauterizes blood vessels on contact
    • 2. catheter is only needed for a short time post-op:  6 to 8 h
    • 3. faster recovery time
    • 4. may be done on a pt taking anticoagulants
  72. Photovaporization of the prostate (PVP)?
    uses high-power green laser light to vaprozie prostate tissue
  73. 3 advantages of photovaporization of the prostate (PVP)?
    • 1. bleeding is minimal
    • 2. catheter only needed for 24 to 48 h post-op
    • 3. effective with larger prostate glands
  74. Interstitial laser coagulation (ILC)?
    prostate viewed through a cytoscope & a laser is used to treat precise areas by placement of interstititial light guides directly into the prostate tissue
  75. Intraprostatic urethral stents?

    How is it performed?
    stents placed directly into the prostatic tissue

    self-expandable metallic stent is inserted into the urethra where enlarged area of prostate occurs
  76. 3 complications of intraprostatic urethral stents?
    • 1. chronic pain
    • 2. infection
    • 3. encrustation
  77. Why are intraprostatic urethral stents usually ineffective?
    tissue will continue to grow --> grows over stents
  78. Transurethral electrovaporization of prostate (TUVP)?
    electrosurgical vaporization & desiccation are used together to destroy prostatic tissue
  79. 2 advantages of TUVP?
    minimal risks

    minimal bleeding & sloughing
  80. 2 disadvantages of TUVP?
    retrograde ejaculation 

    intermittent hematuria
  81. Intraprostatic urethral stents 2 advantages/
    safe & effective

    low risk
  82. 2 disadvantages of intraprostatic urethral stents?
    • 1. stent may move
    • 2. long-term effect is unknown
  83. 2 invasive procedures used for BPH?
    transurethral resection of the prostate (TURP)

    transurethral incision of the prostate (TUIP)
  84. Invasive Tx of symptomatic BPH primarily involves _____ or _____ of the prostate.
    resection or ablation- (removal of material from the surface of an object by vaporization, chipping, or other erosive processes)
  85. When is invasive therapy indicated in BPH?

    What may be used to temporarily relieve these issues until surgery is done?
    • 1. decrease in urine flow sufficient to cause discomfort
    • 2. persistent residual urine
    • 3. acute urinary retention
    • 4. hydronephrosis

    intermittent or indwelling catheterization
  86. Why is invasive surgery for BPH perferred to long-term catheterization?
    risk for infection in catheterization
  87. What surgical procedure has been considered the "gold standard" in BPH Tx?
    TURP- transurethral resection of the prostate
  88. Transurethral resection of the prostate (TURP)?
    removal of prostate tissue using a resectoscope inserted through the urethra
  89. How is TURP performed?
    • 1. pt will be under spinal or general anesthesia
    • 2. resectoscope inserted through urethra to excise & cauterize obstructing prostatic tissue
    • 3. lg 3-way indwelling cath with a 30-mL balloon is inserted
    • 4. bladder is irrigated continuously or intermittently for 1st 24h approx.
  90. Is there an external surgical incision with TURP?
    no - through urethra
  91. 4 post-op complications of TURP?
    • 1. bleeding
    • 2. clot retention
    • 3. hypo or hypervolemia r/t irrigation
    • 4. dilusional hyponatremia r/t irrigation
  92. Pre-op teaching for pt undergoing TURP?
    • 1. discontinue aspirin or warfarin several days before surgery
    • 2. sexual functioning may be affected by surgery
    • 3. Ejaculate may be decreased or absent r/t retrograde ejaculation
    • 4. retrograde ejaculation is not harmful:  semen is eliminated during the next urination
  93. TURP pre-op care?
    • 1. urinary drainage must be restored before surgery
    • 2. ABX (prophylactic or if have UTI)
    • 3. Find out about pt sexual activities r/t sexual function affected by surgery
    • 4. Educate
    • 5. dietary:  NPO
    • 6. make sure consents are signed
    • 7. labs:  CBC, CMP, creatinine/BUN, clotting function, platelets, UA with C&S
  94. How is urinary drainage restored pre-op TURP?
    catheter is inserted:  may require a coude (curved tip) catheter or urologist may insert a filiform catheter (rigid enough to pass the obstruction)
  95. What is usually done prior to inserting a coude catheter?

    3 reasons?
    2% lidocaine gel is injected into the urethra before insertion

    • 1. lubrication
    • 2. local anesthesia
    • 3. opens urethral lumen
  96. 3 interventions that will be done if a pt has a UTI pre-op TURP?
    • 1. ABX
    • 2. restoring urinary drainage
    • 3. encouraging a high fluid intake of 2 to 3 L/day if not contraindicated
  97. What issues may occur r/t sexual functioning post-op TURP?
    • 1. some degree of retrograde ejaculation
    • 2. decreased orgasmic sensations
  98. Post-op TURP care?
    • 1. bladder irrigated intermittently/manually or via continuous bladder irrigation (CBI) with steril NS
    • 2. monitor inflow & outflow of catheter
    • 3. Catheter care
    • 4. Monitor for hemorrhage, bladder spasms, urinary incontinence, infection, & DVT
    • 5. Meds:  Tx bladder spasms, ABX
    • 6. monitor VS for hypo/hypervolemia s/s
    • 7. Teach pt to practice Kegel exercises 10 to 20 times per hour while awake
    • 8. diet (high fiber) & stool softeners to prevent straining
    • 9. prevent increased abd pressure:  straining, sitting or walking for prolonged periods, sneezing, coughing, etc
  99. How is manual bladder irrigation performed?
    instill 50mL NS then withdraw with a syringe to remove clots
  100. Nursing consideration when doing manual irrigation of the bladder?
    may cause painful bladder spasms
  101. What is the rate of infusion of the TURP irrigation catheter based on?

    Ideal urine drainage appearance post-op TURP?
    the appearance of the drainage

    light pink without clots  (blood clots are expected for the first 24 to 36 hours)
  102. What type of catheter is used for a TURP procedure?
    3-way 18 to 22 french foley catheter with a 30mL bulb that is used to drain & irrigate the bladder

    • large balloon provides hemostasis at the surgery site & irrigating facilitates urinary drainage by preventing obstruction from mucus & blood/blood clots
  103. How long will the bladder by irrigated after a TURP?
    about 24 h
  104. What should the nurse's first action be if the outflow of the post-op TURP catheter is less than the inflow?
    check the catheter patency for kinks or clots
  105. What should the nurse do after discovering that the post-op TURP catheter is clogged with a clot & patency cannot be reestablished by manual irrigation
    must stop CBI (cont irrigation) & call the MD

    cannot replace the catheter!
  106. Catheter care post-op TURP?
    • 1. aseptic technique to prevent infection
    • 2. prevent urethral irritaion & minimize risk of bladder infection by securing the catheter to the leg
    • 3. connect to a closed-drainage system & do not diconnect unless it is being removed, changed, or irrigated
    • 4. cleanse secretions around meatus with soap & water daily
  107. If a post-TURP pt reports pain/bladder spasms what should the nurse's first action be?
    check the catheter for clots & remove by irrigation
  108. S/S of hemorrhage in Post-TURP pt?
    • 1. s/s of hypovolemia
    • 2. lg amnts of bright red blood in the urine
  109. 3 causes of hemorrhage in a post-TURP pt?
    • 1. displacement of catheter
    • 2. dislodging a lg clot
    • 3. increases in abd pressure
  110. Intervention that may be done for post-TURP bleeding?

    Complication that may occur r/t to this intervention?
    may apply traction on the catheter to provide counterpressure (tamponade) to the bleeding site

    local necrosis can occur if pressure is applied for too long
  111. How is necrosis r/t pressure on bleeding post-TURP site prevented?
    pressure is relieved on a sceduled basis
  112. Education for pt experiencing bladder spasms post-TURP?
    teach pt not to urinate around the catheter because it increases likelihood of spasms
  113. Tx for post-TURP bladder spasms/pain?
    • 1. make sure urine is flowing freely from catheter
    • 2. meds: belladonna & opium suppositories or other antispasmotics (oxybutynin/Ditropan)
    • 3. relaxation techniques
  114. When is the catheter removed post-TURP?
    2 to 4 days after surgery
  115. When should the pt urinate after catheter is removed post-TURP?

    What will be done if the pt cannot urinate at this time?
    within 6 hours

    reinsert a catheter for a day or 2 - if problem continues will instruct pt in clean intermittent self-catheterization
  116. Why may urinary incontinence/dribbling occur post-TURP?

    Interventions?
    sphincter tone is decreased by the surgery

    • 1. 10-20 kegel exercises per hour while awake
    • 2. practice starting & stopping the stream several times during urination
    • 3. use a penile clamp, condom catheter, or incontinence pads/briefs
    • 4. may implant an occlusive cuff that acts as an artificial sphincter
  117. How long does it take a pt to regain urinary continence after TURP?

    How long may incontinence improve?
    may take several weeks or may never be regained

    can improve for up to 12 months
  118. What special care must be taken post-TURP if a perineal incision has been made?
    • 1. increased risk for infection r/t proximity of anus
    • 2. rectal procedures should be avoided:  temp, enemas
    • 3. insertion of well-lubricated belladonna & opium suppositories is acceptable
  119. Instructions for home care post-TURP?
    • 1. caring for indwelling catheter if still in place
    • 2. managing urinary incontinence
    • 3. maintaining oral fluids b/t 2-3L per day
    • 4. observing for s/s of UTI & wound infections
    • 5. preventing constipation
    • 6. avoiding lifting heavy objects (>10lb)
    • 7. refraining from driving or intercourse after surgery
    • 8. continue to have yearly DRE unless complete prostate removal has been performed
  120. What is the cause of retrograde ejaculation?

    What are some s/s?
    trauma to the internal urethral sphincter

    • 1. semen is decreased or absent
    • 2. urine is cloudy when urinating after orgasm
  121. Why may ED occur in post-TURP pt?
    nerves may be cut/damaged during surgery
  122. Nursing consideration for a pt who experiences ED r/t surgery?
    anxiety may occur r/t change in sex role, self-esteem, & quality of sexual interaction with his partner
  123. How long may it take post -TURP for complete sexual functioning to return?
    up to 1 year
  124. How long does it take the bladder to return to its normal capacity post-TURP?

    Interventions/teaching?
    takes up to 2 months

    • 1. drink at least 2L fluid per day
    • 2. avoid bladder irritants:  caffeine, citrus juices, alcohol, artificial sweeteners
  125. What complication may occur post -TURP/BPH surgeries r/t instrumentation or catheterization?

    interventions?
    urethral strictures

    teaching intermittent clean self-cath or having a urethral dilation
  126. Transurethral resection syndrome?
    excess absorption of irrigation fluid --> FVE
  127. S/S of transurethral resection syndrome?
    • 1. altered LOC/confusion
    • 2. agitation
    • 3. decreased HR
    • 4. increased RR & BP
    • 5. vomiting
    • 6.  HA
    • 7.  tremors
  128. If s/s of transurethral resection syndrome occur what is the nurse's action?
    report to MD immediately
  129. Transurethral incision of the prostate (TUIP)?
    surgical procedure done under local anesthesia that is done for men with small prostates & moderate to severe symptoms that are not a condidate for TURP

    is as effective as TURP
  130. 3 types of invasive resections used in BPH?
    • 1. suprapubic
    • 2. retropubic
    • 3. perineal
  131. Prostate cancer is an _____-dependent _____carcinoma that is usually _____ (fast/slow) growing.
    • androgen-dependent
    • adenocarcinoma

    slow growing
  132. 3 routes by which prostate cancer may spread?
    • 1. direct extension
    • 2. lymph system
    • 3. bloodstream
  133. If prostate cancer spreads by direct extension areas affected include _____ _____, ______ ____, ______ _____, & ______ ____.

    What will later occur?
    • seminal vesicles (secrete seminal fluid)
    • urethral mucosa
    • bladder wall
    • external sphincter

    will later spread through lymph system
  134. If prostate cancer spreads through the bloodstream where does it commonly spread to?
    • 1. bones: pelvic, head of femur, & lower lumbar spine
    • 2. liver
    • 3. lungs
  135. 4 risk factors for prostate cancer?
    • 1. age: rise after age 50 then again after age 65
    • 2. ethnicity:  higher in african americans:  more agressive tumors with higher mortality
    • 3. family Hx
    • 4. diet:  high in red meat & high-fat dairy & low in veggies & fruits
  136. What drug may prevent prostate cancer?
    proscar
  137. Progression of s/s in prostate cancer?
    • 1. may be asymptomatic in early stages
    • 2. will progress to s/s similar to BPH
    • 3. pain in lumbosacral area that readiates down to hips or legs indicates metastasis to bones
  138. Once the prostate tumor metastasizes the priority intervention is r/t ____.

    Why?
    pain

    bone cancer causes severe pain especially in the back & legs r/t compression of the SC & destruction of bone
  139. At what age should men be screened for prostate cancer?

    What screening is performed?
    age 50 to age 75 (after age 75 there is little benefit to screening/Tx)

    annual DRE & PSA
  140. Dx of prostate cancer?
    • 1. DRE:  hard, nodular, & asymmetric
    • 2. PSA:  elevated
    • 3. prostatic acid phosphatase (PAP):  elevated r/t bone metastasis
    • 4. if DRE or PSA are abnormal -> do PAP & if that is elevated -> will do biopsy for definitive DX
    • 5. CT, bone scan, & MRI to see location & extent of spread
    • 6. TRUS
  141. If a person is Dx with prostate CA using biopsy what will be the next testing done?
    radiography (MRI & CT) to test for metastasis
  142. 6 causes of increased PSA?
    • 1. aging
    • 2. BPH
    • 3. recent ejaculation
    • 4. chronic prostatitis
    • 5. long bike rides
    • 6. prostate cancer - will be higher than others usually
  143. What may cause decreases in PSA>?
    proscar or avodart
  144. What lab may be used to monitor the success of Tx in prostate CA?
    PSA level:  should fall if Tx is successful

    can also monitor for return of CA
  145. How is prostate biopsy normally done?
    use TRUS to visualize prostate & find abnormalities --> biopsy needle inserted into prostate
  146. How is an MRI of prostate performed?
    using an endorectal probe
  147. 2 ways to stage & grade prostate cancer?
    • 1. Whitmore-Jewett
    • 2. TNM
  148. Whitmore-Jewett staging classification of prostate cancer stage A, B, C, & D?

    Stage A1, A2, B1, B2, C1, C2, D1, D2?
    • Stage A:  clinically unrecognized
    • * A1:  <5% of prostatic tissue neoplastic
    • *A2:  >5% of prostatic tissue neoplastic
    • Stage B:  clinically intracapsular
    • B1:  nodule <2cm & surrounded by palpably normal tissue
    • B2:  nodule >2cm or multiple nodules
    • Stage C:  clinically extracapsular
    • C1:  minimal extracapsualr extension
    • C2:  large tumors involving seminal vesicles, adjacent structures, or both
    • Stage D:  metastatic disease
    • D1:  pelvic lymph node metastases
    • D2:  distant metastases to bone, viscera, or other soft tissue structures
  149. How is the prostate tumor graded?
    graded on basis of tumor histology using the Gleason scale that grades from 1 to 5 based on degree of glandular differentiation - the 2 most commonly occurring patterns of cells are graded & grades are added together to get Gleason score of 2-10

    grade 1 is most well-differentiated
  150. What is the Gleason scale used for?
    to predict how quickly cancer will progress
  151. Location of development of BPH & prostate cancer?
    BPH develops on the inside of the prostate & prostate cancer develops on the outside
  152. Tx of prostate cancer?
    • 1. "watchful waiting"
    • 2. surgery
    • 3. radiation & chemo
    • 4. drug therapy
  153. 2 reasons may take "watchful waiting" approach with prostate cancer?
    1. life expectancy <10 years = low risk of dying of the cancer

    2. presence of a low-grade, low-stage tumor:  monitor progress with DRE & PSA
  154. Stage A prostate cancer Tx?
    • 1. watchful waiting with annual PSA & DRE
    • 2. radical prostatectomy
    • 3. radiation therapy :  external beam & brachytherapy
  155. Stage B prostate cancer Tx?
    • 1. radical prostatectomy
    • 2. radiation therapy
  156. Stage C prostate cancer Tx?
    • 1. radical prostatectomy
    • 2. radiation therapy
    • 3. hormone therapy
    • 4. orchiectomy
  157. Stage D prostate cancer Tx?
    • 1. hormone therapy
    • 2. orchiectomy
    • 3. chemotherapy
    • 4. radiation therapy to metastatic bone areas
  158. Radical prostatectomy?
    entire prostate gland, seminal vesicles, & part of the bladder neck(ampulla) are removed with lymph node dissection usually done as a separate procedure
  159. In what stage of cancer is radical prostatectomy not considered an option unless it is to relieve s/s associated with an obstruction?
    stage D
  160. 3 surgical approaches for a radical prostatectomy?

    Surgeries that may be performed?
    • 1. retropubic
    • 2. perineal
    • 3. laparoscopic

    • 1. radical prostatectomy
    • 2. cryotherapy
    • 3. orchiectomy
    • 4. nerve-sparing procedure
  161. Retropubic approach to radical prostatectomy?
    low midline abd incision made --> access prostate gland & disect pelvic lymph nodes
  162. Perineal resection approach to radical prostatectomy?
    incision made b/t scrotum & anus - cannot remove lymph nodes
  163. Laparoscopic approach to radical prostatectomy?

    Advantages?
    4 small incisions made in abd & surgeon uses computer & cameras

    • 1. less bleeding
    • 2. less pain
    • 3. faster recovery
  164. Nursing care with a radical prostatectomy?
    • similar to TURP care:
    • 1. will have same catheter as with TURP
    • 2. monitor for infection, bleeding, hypovolemia, DVT, & PE
    • 3. monitor incision site
    • 4. ABX
  165. How is removal of drainage aided during post-radical prostatectomy?
    drains are left in surgical site & usually removed after a couple of days
  166. What is the increased risk associated with perineal approach to radical prostatectomy?

    Intervention?
    increased risk for infection r/t proximity to anus

    careful dressing changes & perineal care after each BM
  167. Length of hospital stay post- radical prostatectomy?
    1 to 3 days depending on type of surgery
  168. 8 complications that may occur post-radical prostatectomy?
    • 1. ED
    • 2. urinary incontinence
    • 3. infection complications:  hemorrhage, DVT/PE, infection
    • 4. wound dehiscence
    • 5. urinary retention
  169. 4 factors that effect whether ED occurs during radical prostatectomy?
    • 1. pt age
    • 2. preoperative sexual functioning
    • 3. whether nerve-sparing surgery was performed
    • 4. expertise of the surgeon
  170. How long does it take sexual functioning to return post - radical prostatectomy?

    Intervention?
    returns gradually over at least 24 months or more

    may give meds like viagra
  171. Nerve-sparing prostatectomy?

    When is this contraindicated?
    prostate removed while preserving neurovascular bundles that maintain erectile function that are in close proximity to the prostate

    CI for pt with cancer outside of the prostate gland
  172. If nerve sparing prostatectomy is performed will the man retain potency?
    if the pt is younger than 50 & has low-stage prostate cancer return of potency is expected but not guaranteed
  173. Cryotherapy for prostate cancer?
    surgical technique - destroys cancer cells by freezing the tissue
  174. How is cryotherapy performed?
    • 1. transrectal ultrasound probe is inserted to visualize the prostate
    • 2. probes containing liquid nitrogen are inserted into prostate & freeze the prostate --> destroys the tissue
  175. How long does cryotherapy surgery last?

    What type of anesthesia is used? 

    Incision?
    takes about 2 h under general or spinal anesthesia

    no abd incision is made
  176. Orchiectomy?

    When is orchiectomy used for prostate cancer?

    What is the purpose of it?
    surgical removal of testes

    used for stage D advanced prostate cancer for cancer control & rapid relief of bone pain

    may also shrink the prostate
  177. AE of orchiectomy?
    • loss of testosterone:  altered physical appearance
    • 1. weight gain
    • 2. loss of muscle mass

    can affect SE & lead to grief & depression
  178. complications of cryotherapy surgery for prostate cancer?
    • has more AE than other surgeries
    • 1. damage to the urethra
    • 2. urethrorectal fistula (opening b/t urethra & rectum)
    • 3. urethrocutaneous fistula (b/t urethra & skin)
    • 4. tissue sloughing
    • 5. ED/nerve damage
    • 6. urinary incontinence
    • 7. prostatitis
    • 8. hemorrhage
  179. 2 means of delivering raidation therapy?
    external beam radiation- applied to skin

    brachytherapy- place radioactive seed implants into the cancerous area (prostate gland)
  180. How is external beam radiation administered?
    few minutes of outpatient Tx for 5 days/week X 4 to 8 wks
  181. When may AE of external beam radiation occur?

    What is the main AE?
    immediately to years


    burns skin wherever it is used
  182. AE of external beam radiation?
    • 1. skin:  dryness, irritation, redness, pain
    • 2. GI:  diarrhea, abd cramping, bleeding
    • 3. GU:  dysuria, frequency, hesitancy, urgency, nocturia
    • 4. sexual functioning:  ED
    • 5. fatigue
    • 6. bone marrow suppression:  decreased RBC, WBC, & platelets
  183. When do AE of radiation therapy usually resolve?
    withing 2 to 3 weeks after completion of therapy
  184. Effectiveness of external beam radiation in pt with prostate cancer?
    as effective as prostatectomy in localized prostte cancer
  185. Special considerations for pt receiving brachytherapy r/t radiation exposure?
    depending on the implant the pt may have minimal radiation precautions or more:

    • 1. limit time spent with pt
    • 2. tell pt why you have to limit time with them to decrease anxiety
    • 3. use shielding & must wear film badge that indicates cumulative radiation exposure
    • 4. urine contains radiation
  186. Advantages of brachytherapy?
    can deliver higher doses of radiation directly to tissue while sparing surrounding tissue
  187. How is brachytherapy performed?

    Admin schedule?

    Advantages over external beam radiation?
    radioactive seeds placed in prostate gland via a needle through a grid template guided by TRUS

    one-time outpatient procedure

    more convenient than external beam & does't affect adjacent tissues
  188. Brachytherapy is best suited for stage ___ or ____ prostate cancer.
    A or B
  189. Most common AE of brachytherapy ?


    Other AE that may occur?
    development of urinary irritative or obstructive problems

    ED
  190. Drug therapy involves _____, _____ & combo of both.
    hormones, chemotherapy
  191. Rationale for the use of hormones for prostate cancer?
    prostate cancer is largely depndent on presence of androgens - androgen deprivation therapy (ADT) is used
  192. What is hormone refractory?

    First sign that it is occurring?
    resistance to ADT therapy that occurs withing a few years of therapy

    elevated PSA levels?
  193. What 2 types of drugs are anti-androgen therapy?

    HOw are they administered?
    1. LHRH agonist & 2. LHRH antagonsists

    admin SQ or IM injections & must take indefinitely  - Viadur is an implant placed SQ for 1 year
  194. What types of drugs are used in ADT?
    • 1. drugs that interfere with androgen production:  LHRH agonists (orchiectomy has same effect)
    • 2. androgen receptor blockers
  195. 4 drugs that are LHRH agonists?
    leuprolide, goserelin, triptorelin, buserelin
  196. Action of LHRH agonists?
    reduce secretion of LH & FSH --> decreases testosterone production

    (LH & FSH are reduced by increasing LHRH release until down-regulation of LHRH receptors occurs at the pituitary)
  197. What is the body's initial reaction to LHRH agonists?
    increase in LH, FSH, & testosterone - called a "flare"
  198. 5 AE of LHRH agonists?
    • 1. hot flashes
    • 2. gynecomastia
    • 3. decreased libido
    • 4. ED
    • 5. depression & mood chages
  199. 2 LHRH antagonists?
    degarelix & abarelix
  200. When is degarelix given for prostate cancer?

    How is it given?
    advanced prostate cancer

    SQ injection
  201. Action of LHRH antagonists?
    blocks LH receptors --> immediate testosterone suppression
  202. 2 AE of LHRH antagonists?
    • 1. pain, swelling, redness at injection site
    • 2. elevated liver enzymes
  203. 3 androgen receptor blockers?
    • 1. bicalutamide
    • 2. flutamide
    • 3. nilutamide
  204. Action of androgen receptor blockers?

    Admin?
    block action of testosterone by competing at receptor sites

    admin po daily
  205. AE of androgen receptor blockers?
    similar to LHRH agonists
  206. Estrogen medications?
    diethylstibuestrol (DES)
  207. 3 actions of diethylstibuestrol (DES)?
    • 1. inhibits LH secretion
    • 2. decreases testosterone production
    • 3. blocks circulating testosterone
  208. AE of estrogen?
    • 1. breast enlargement
    • 2. CV complications:  MI, DVT, cerebrovascular disease
  209. Why may hormone therapy cause more harm than good in men with prostate cancer?
    unlikely to be compliant with hormone therapy r/t side effects
  210. When is chemo used for prostate cancer?
    used in hormone refractory prostate cancer in late-stage disease usually for palliation

    hormone refractory (HRPC) - progresses despite Tx with hormones
  211. What drugs are the standard of care for HRPC?
    docetaxel combined with prednisone, estramustine, or mitoxantrone
  212. 4 AE of docetaxel?
    • 1. N
    • 2. alopecia
    • 3. reduced L ventricular ejection
    • 4. bone marrow suppression
  213. Vaccine for prostate cancer?

    When is it given?

    Action?
    provenge - given in advance prostate cancer

    stimulates pt system against the cancer
  214. What 3 actions may an LPN do for a pt receiving bladder irrigation?
    • 1. monitor catheter drainage for increased blood or clots
    • 2. increase flow of irrigating solution to maintain light pink color in outflow
    • 3. admin antispasmodics & analgesics prn
  215. What 2 actions may the nursing assistive personnel perform for the pt receiving bladder irrigation?
    • 1. clean around catheter daily
    • 2. record I & O
  216. 7 nursing diagnoses for prostate cancer?
    • 1. decisional conflict r/t alternatives in Tx options
    • 2. acute pain
    • 3. urinary retention
    • 4. impaired urinary elimination
    • 5. constipation or diarrhea r/t Tx
    • 6. sexual dysfunction
    • 7. anxiety
  217. When should African American & other men with family Hx of prostate cancer begin to have annual DRE & PSA?
    45 years old
  218. 4 Education for pt going home after prostate surgery?
    • 1. catheter care:  clean meatus daily with soap & water;  keep bag below bladder; anchored to inner thigh or abd
    • 2. adequate fluid intake
    • 3. s/s of bladder infection - report bladder spasms, fever, or hematuria
    • 4. kegel exercises at every urination & throughout the day
  219. 6 common problems experienced by pt with advanced prostate cancer?
    • 1. fatigue
    • 2. bladder outlet obstruction
    • 3. ureteral obstruction
    • 4. severe  bone pain & fractures
    • 5. spinal cord compression
    • 6. leg edema:  lymphedema, DVT, etc
  220. Chordee
    painful downward curve o the penis during erection
  221. What is a very important aspect of care for palliative Tx of prostate cancer?
    pain mgmt
  222. Prostatitis?
    book pg 1392 - group of inflammatory & noninflammatory conditions affecting the prostate gland

    Mrs. Wake:  inflammation of the prostate
  223. 4 categories of prostatitis?
    • 1. acute bacterial prostatitis
    • 2. chronic bacterial prostatitis
    • 3. chronic prostatitis/chronic pelvic pain syndrome
    • 4. asymptomatic inflammatory prostatitis
  224. Cause of acute & chronic bacterial prostatitis?

    3 ways this may occur?
    organisms reaches prostate gland by these routes:

    • 1. ascends from urethra
    • 2. descends from bladder
    • 3. via bloodstream or lymph
  225. Difference b/t chronic & acute bacterial prostatitis?
    chronic involves recurring episodes of infection
  226. Chronic prostatitis/chronic pelvic pain syndrome?

    When may it occur?
    syndrome of prostate & urinary pain in the absence of an obvious infectious process


    may occur after having a virus or with STI's
  227. 2 lab results with Chronic prostatitis/chronic pelvic pain syndrome?
    culture shows no causative organisms

    may have leukocytes in prostatic secretions
  228. Asymptomatic inflammatory prostatitis?

    Labs?
    pt has no s/s but has inflammatory process in the prostate:  leukocytes are present in seminal fluid but cause is unclear
  229. 6 S/S of acute bacterial prostatitis?
    • 1. flu-like s/s: fever, chills, back pain
    • 2. perineal pain
    • 3. acute urinary s/s:  similar to BPH s/s
    • 4. cloudy urine
    • 5. acute urinary retention r/t prostate swelling
    • 6. DRE:  swollen, very tender, & firm
  230. 3 Complications that may occur with acute bacterial prostatitis?
    • 1. epididymitis & cystitis
    • 2. sexual functioning affected:  postejaculation pain, libido probs, & ED
    • 3. prostatic abscess (uncommon)
  231. S/S of chronic bacterial prostatitis & chronic pelvic pain syndrome?
    • similar s/s to acute bacterial prostatitis but milder - obstructive s/s are uncommon
    • DRE:  enlarged, firm, & slightly tender
  232. The 2 types of chronic prostatitis predispose pt to what problem?
    recurrent UTIs
  233. What medical condition may mimic the s/s of prostatitis?
    UTI - but acute cystitis is not common in men
  234. 5 Dx of prostatitis?
    • 1. UA with C&S:  usually has WBC & bacteria
    • 2. blood:  WBC & cultures for infection
    • 3. PSA to rule out prostate cancer:  may be elevated r/t prostatitis
    • 4. microscopic eval & culture of expressed prostate secretion
    • 5. transabdominal ultrasound or MRI to rule out an abscess on the prostate
  235. How is prostate secretion expressed?
    use pre-massage & post-massage test:  void into a specimen cup just before & just after prostate is massaged
  236. When is prostate massage contraindicated?

    Why?
    when there is an acute bacterial prostatitis b/c it is very painful and cause spread of infection
  237. 9 Tx of prostatitis?
    • 1. ABX
    • 2. pain mgmt:  antiinflammatory meds, opioids
    • 3. physical therapy
    • 4. warm baths
    • 5. alpha-adrenergic blockers to relax muscles
    • 6. bladder drainage with suprapubid catheter if urinary retention develops
    • 7. repetitive prostatic massage (except acute bacterial)
    • 8. ejaculation to drain prostate
    • 9. adequate fluids to prevent UTI & prevent dehydration r/t fever & infection
  238. 5 ABX that are commonly used for prosatitis?
    • 1. bactrim
    • 2. cipro
    • 3. floxin
    • 4. doxycycline
    • 5. tetracycline (doxycycline & tetracycline given if pt has mult. sex partners)
  239. How are ABX admin in acute & chronic bacterial prostatitis?
    Acute:  po for up to 4 weeks OR if high fever etc. will be hospitalized with IV ABX

    Chronic:  po for 4 to 12 weeks - may have lifetime therapy if pt is immunocompromised
  240. When will pain from prostatitis begin to resolve?
    when the infection is treated
  241. 2 alpha-adrenergic blockers that may be used for prostatiits?
    tamsulosin/Flomax & alfuzosin/Uroxatral
  242. Why is suprapubic catheterization used in a pt with acute urinary retention r/t acute prostatitis?
    catheterization through an inflamed urethra in acute prostatitis is contraindicated
  243. Intervention for preventing infection or further infection of the prostate?
    adequate fluid intake
  244. Hypospadias?
    • urethral meatus on ventral/underside of the penis
    • b/t glans & scrotum
  245. Is surgery necessary for hypospadias?
    not unless associated with chordee or if it prevents intercourse or normal urination

    may also be done for cosmetic reasons
  246. Epispadias?
    complex birth defect usually associated with other genitourinary tract defects:  urethral meatus on dorsal/top of penis
  247. Does epispadias require surgery?
    corrective surgery will be done to place the urethra in a normal position - usually in early childhood
  248. 3 What problems can be prevented by circumcision?
    • 1. phimosis
    • 2. paraphimosis
    • 3. cancer of the penis
  249. Phimosis?
    foreskin becomes tight around the head of the penis -> retraction becomes difficult
  250. Cause of phimosis?
    edema or inflammation of the foreskin usually r/t poor hygiene that allows bacterial & yeast organisms to become trapped under the foreskin

    can also be caused by external beam radiation r/t tissue damage & adhesions
  251. Paraphimosis?
    unable to pull forskin back from a retracted position
  252. Cause of paraphimosis?
    may occur if forskin is pulled back (when bathing, inserting catheter, or intercourse) & not placed back in the forward position
  253. 3 Tx for paraphimosis?
    • 1. ABX
    • 2. warm soaks
    • 3. circumcision or dorsal slit may be needed
  254. Prevention of paraphimosis?
    careful cleaning & replacement of forskin over glans
  255. Complication of paraphimosis?
    ulcer can develop if the foreskin remains contracted
  256. Priapism?

    7 Causes?
    painful erection lasting longer than 5 h

    • obstruction of the venous outflow in the penis: 
    • 1. thrombosis of the corpora cavernasal veins
    • 2. leukemia
    • 3. sickle cell anemia
    • 4. DM
    • 5. degernative lesions of the spine
    • 6. neoplasms of the brain or spinal cord
    • 7. vasoactive meds injecting into the corpora cavernosa & meds
  257. 3 Meds that may cause priapism?
    • 1. sildenafil
    • 2. cocaine
    • 3. trazodone
    • others
  258. 4 Tx of priapism?
    • 1. sedatives
    • 2. injection of smooth muscle relaxants into penis
    • 3. aspiration & irrigation of corpora cavernosa with a lg-bore needle
    • 4. surgical creation of a shunt to drain
  259. 3 Complications of priapism?
    • 1. penile tissue necrosis r/t lack of blood flow
    • 2. hydronephrosis from bladder distention
    • 3. after episode of priapism pt may be unable to achieve normal erection
  260. Peyronie's disease?
    curved or crooked penis caused by plaque formation in one of the corpora cavernosa of the penis (plaque prevents adequate blood flow into the spongy tissue --> curvature)
  261. S/S of Peyronie's disease?
    palpable, nontender, hard plaque usually found on posterior surface of penis
  262. Causes of Peyronie's disease?
    • 1. usually r/t trauma to penil shaft
    • 2. can occur spontaneously
  263. 3 Problems that occur with Peyronie's disease?
    • 1. painful erections
    • 2. ED
    • 3. embarrassment
  264. Tx for Peyronie's disease?
    surgery may be needed
  265. 2 risk factors for cancer of the penis?
    • 1. HPV
    • 2. uncircumcized
  266. How may cancer of the penis appear?
    may appear as a superficial ulceration or pimple-like nodule (could be mistaken for venereal wart)
  267. What type of malignancies are majority of penis cancers?
    well-differentiated squamous cell carcinomas
  268. Tx of cancer of the penis?
    • 1. surgery:laser removal of the growth (early stages); radical resection of penis (if cancer has spread)
    • 2. radiation
    • 3. chemo
  269. 3 most common skin conditions of the scrotum?
    • 1. fungal infections
    • 2. dermatitis
    • 3. parasitic infections:  scabies, lice
  270. Epididymitis?
    acute, painful inflammatory process
  271. 3 common causes of epididymitis?
    • 1. infection (STI or other)
    • 2. trauma
    • 3. urinary reflux down the vas deferens
  272. Most common cause of epididymitis in men <35?

    Tx?
    sexual transmission of gonorrhea or chlamydial infection

    use of ABX in both partners
  273. Tx of epidiymitis?
    • 1. no sex during acute phase
    • 2. use a condom if have sex
    • 3. bed rest with elevation of the scrotum:  ambulation puts scrotum in dependent position & increases pain
    • 4. ice packs
    • 5. analgesics
  274. When does tenderness subside with epididymitis?  Swelling?
    tenderness usually within 1 week but swelling may last for weeks or months
  275. Orchitis?
    acute inflammation of the testis
  276. S/S of orchitis?
    1. testis is painful, tender, & swollen
  277. What may bring on an episode of orchitis?
    generally occurs after bacterial or viral infection: mumps, pneumonia, tuberculosis, or syphilis

    may also occur as an AE of epididymitis, prostatectomy, trauma, infectious mononucleosis, influenza, catheterization, or complicated UTI
  278. Complication of mumps orchitis?

    Prevention?
    can cause infertility

    childhood vaccination against mumps
  279. Tx of orchitis?
    • 1. ABX - if organism known
    • 2. same Tx with epididymitis:  bed rest, elevate scrotum, ice packs, pain meds
  280. Cryptorchidism?
    congenital prob:  undescended testes bilaterally or unilaterally
  281. 2 Complications of cryptorchidism?
    • 1. infertility if not surgically corrected by age 2
    • 2. increased risk for testicular cancer if not corrected before puberty
  282. Tx for cryptorchidism?
    surgery is done to locate & suture testis or testes to the scrotum
  283. Hydrocele?
    nontender, fluid-filled mass r/t interfenrence with lymphatic dranage of the scrotum & swelling of the tunica vaginalis that surrounds the testis
  284. Dx of hydrocele?
    transillumination - can see mass by shining a flashlight through the scrotum
  285. Tx of hydrocele?
    no Tx needed unless swelling very lg & uncomfortable - will aspirate or surgically drain
  286. Spermatocele?

    Cause?
    firm, sperm-containing, painless cyst of the epididymis that may be visible with transillumination

    unknown  cause
  287. Tx of spermatocele?

    Teaching?
    surgical removal

    important for pt to see MD if he feels any scrotal lumps b/c they are indistinguishable from cancer
  288. Varicocele?
    dilation of the veins that drain the testes
  289. S/S of a varicocele?

    Cause?
    scrotum feels wormlike when palpated - usually located on left side of scrotum r/t retrograde blood flow from the left renal vein

    cause unknown
  290. Tx of varicocele?
    surgery if pt is infertile
  291. 2 types of surgeries used to repainr a varicocele?
    • 1. injection of a sclerosing agent
    • 2. surgical ligation of the spermatic vein
  292. Testicular torsion?
    twisting of spermatic cord that supplies blood to the testes & epididymis - ***EMERGENCY***
  293. tESTICULAR TORSION IS MOST COMMONLY SEEN IN MALES YOUNGER THAN AGE ____.
    20
  294. S/S of testicular torsion?
    • 1. severe scrotal pain, tenderness, & swelling
    • 2. pain does not usually subside with rest
    • 3. NV
    • 4. cremasteric reflex is absent
  295. How may testicular torsion be differentiated from other male repro conditions?
    no urinary s/s, fever, or WBC/ bacteria in the urine
  296. Cremasteric reflex?
    light stroking of inner thign in downward direction causes contraction of the cremaster muscle that pulls up the scrotum & testis on the side stroked
  297. Dx of testicular torsion?
    nuclear scan of the testes or dopplar ultrasound to assess blood flow - decreased or absent blood flow confirms the Dx
  298. Tx of testicular torsion?
    unless resolves spontaneously must have surgery to untwist the cord immediately to restore BF
  299. Complication of testicular torsion?
    if blood supply is not restored within 4 to 5 h ischemia to testis will occur -> necrosis & possible need for testicular removal & infertility
  300. Testicular cancer is the most common type of cancer in young men b/t ___ & ___ years of age.


    Occurs more commonly in which testicle?
    15 to 34
  301. Risk factors for testicular cancer?
    • 1. age 15 to 34
    • 2. white
    • 3. cryptorchidism
    • 4. family Hx
    • 5. orchitis
    • 6. HIV
    • 7 maternal exposure to DES
    • 8. testicular cancer in the other testicle
  302. 2 types of germ cell cancers that occur in testicles?
    seminoma & nonseminomas
  303. Seminoma germ cell cancers?
    most common & least aggressive
  304. Nonseminoma testicualar cancer?
    rare but very aggressive
  305. 2 types of non-germ cell tumors that arise fom other testicular tissue?
    Leydig cell & Sertoli cell tumors
  306. 5 S/S of testicular cancer?
    • 1. slow or rapid onset depending on type of tumor
    • 2. painless lump in scrotum
    • 3.. scrotal swelling & feeling of heaviness
    • 4. dull ache or heavy sensation in lower abd, perianal area, or scrotum
    • 5. acute pain may be initial s/s
  307. S/S of testicualar cancer metastasis?
    • 1. back pain
    • 2. cough
    • 3. hemptysis
    • 4. dyspnea
    • 5. dysphagia
    • 6. alterations in vision or mental status
    • 7. papilledema (swelling of optic disc caused by increased intracranial pressure)
    • 8. seizures
  308. Dx of testicular cancer?
    • 1. palpation of scrotal contents
    • 2. ultrasound
    • 3. blood/CBC: tested for tumor markers, anemia, & liver function
    • 4. CXR
    • 5. CT scan of abd & pelvis to detect metastasis
  309. What does testicular cancer mass feel like?
    firm, does not transilluminate (differentiates it from other masses)
  310. What 3 tumor markers are associated with testicular cancer?
    • 1. alpha-fetoprotein AFP
    • 2. lactate dehydrogenase LDH
    • 3. human chorionic gonadotropin hCG
  311. Tx of testicular cancer?
    • 1. surgery:  orchiectomy or radical orchiectomy
    • 2. retroperitoneal lymph node dissection & removal may also be done
  312. Postorchiectomy Tx ?
    surveillance, radiation therapy, or chemo
  313. Primary route for testicular cancer metastisis?
    retroperitoneal lymph nodes
  314. Complications of testicular cancer?

    Intervention?
    Mostly relate to toxicity from Tx:  infertility & ejaculatory dysfunction

    need careful follow-up & regular phys exams, CXR, CT scans, & hCG/AFP levels to detect relapse and secondary malignancies r/t chem or radiation
  315. Intervention for prevention of testicular cancer?
    testicular self-exam starting at puberty done every month

    should perform frequently at first until familiar with the procedure
  316. How is a testicualar self-exam performed?
    • 1. Use both hands to feel each testis.  Roll b/t thumb & first 3 fingers covering entire surface.  Palpate each one separately.
    • 2. ID the structures:  testes, epididymis, & spermatic cord

    testes feel round & smooth like a hard-boiled egg - differentiate from epididymis b/c it is not as smooth; locate spermatic cord:  usually firm & smooth & gos up toward the groin

    3. Check for lumps, irregularities, pain, or a dragging sensation
  317. When is the best time to do a testicular self exam?
    during a shower or bath b/c testes hang lower in scrotum

    should choose a consistent day of the month that is easy to remember
  318. What should pt do if he finds that one of his testicles is bigger than the other during testicular self-exam?
    this is normal
  319. Major complication r/t testicular cancer?

    What Tx may cause infertility?

    Intervention?
    infertility or impaired fertility

    may be caused by chemo with cisplatin and/or pelvic irradiation

    spermatogenesis can return, but should suggest pt cryopreserve sperm before Tx
  320. Vasectomy?
    bilateral surgical ligation or resection of the vas deferens performed for purpose of sterilization

    considered permanent
  321. How long does vasectomy take to perform?

    Anesthesia used?

    Out/In patient?
    15 to 30 minutes

    local anesthesia

    outpatient
  322. Pt education with vasectomy?
    • 1. permanent
    • 2. need alternative contraception until semen exam revels no sperm:  usually requires at least 10 ejaculations or 6 wks for no sperm
    • 3. sperm cells are still produced but are absorbed by the body
  323. 3 complications of vasectomy?
    • 1. post-op hematoma & swelling of scrotum can occur
    • 2. psychological:  ED or more sexually active r/t feeling castrated
  324. Nursing intervention r/t psych issues with vasectomy?
    Discuss procedure & outcome with pt & determine pt attitude toward it
  325. Erectile dysfunction?
    inability to attain or maintain an erect penis that allows satisfactory sexual performance
  326. Risk factors for ED?
    • 1. increasing age
    • 2. substance abuse (usually in younger men)
    • 3. medical conditions
    • 4. physical inactivity
    • 5. anything that decreases blood flow
  327. Causes of ED?
    • 1. most common cause is vascular disease
    • 2. DM
    • 3. AE from meds or surgery
    • 4. trauma:  spinal cord injuries, etc
    • 5. chroniic illness
    • 6. decreased gonadal hormone secretion
    • 7. stress
    • 8. relationship probs
    • 9. depression
  328. ED may be3 a significant s/s of undiagnosed ___ _____.
    cardiovascular disease.
  329. Gradual onset of ED is usually ____, and a sudden onset of ED is usually _____ in etiology.
    physiologic

    psychological
  330. Complications of ED?
    • 1. distress & altered self-concept
    • 2. anger
    • 3. depression
  331. Dx of ED?
    • 1. H&P:  focus on secondary sex char
    • 2. questionnaries
    • 3. DRE
    • 4. BP & palpation of femoral arteries & peripheral pulses
    • 5. serum glucose & lipid profile to rule out DM
    • 6. hormone levels:  for testosterone, prolactin, LH, & thyroid
    • 7. blood chemistries:  PSA, CBC
    • 8. nocturnal penile tumescence & rigidity testing
    • 9. vascular studies:  penile areteriography, blood flow study & duplex dopploer ultrasound studies to assess penile blood flow
  332. How may we differentiate b/t phys & psych causes of ED & also track progress of ED Tx?

    How is the test performed?
    nocturnal penile tumescence & rigidtiy testing

    noninvasive method - continuous measurement of penile circumference & axial rigidity during sleep
  333. Can ED Tx restore ejaculation or tactile sensations?
    no
  334. 2 factors that increase satisfaction in results of ED Tx?
    • 1. both partners are involved
    • 2. realistic expectations of the Tx
  335. It is important to determine what before ED Tx is initiated?
    if ED is reversible
  336. Tx for ED?
    • 1. HRT if hypogonadism is prob
    • 2. counseling for psych probs
    • 3. oral drug therapy
    • 4. devices & implants
    • 5. sexual counceling before & after Tx:  recommended for man and partner
  337. 3  erectogenic meds that may given as oral drug therapy for ED?
    • 1. viagra
    • 2. cialis
    • 3. levitra
  338. Action of erectogenic drugs?

    Admin?
    smooth muscle relaxation & increased blood flow into the corpus cavernosum

    should be taken orally about 1h prior to sex no more than once per day
  339. AE of erectogenic drugs?
    • 1. HA
    • 2. dyspepsia
    • 3. flushing
    • 4. nasal congestion
    • Rare:
    • 5. blurred or blue-green visual disturbances
    • 6. sudden hearing loss
  340. Drug interaction with erectogenic drugs?
    nitrates:  nitroglycerin

    potentiates hypotensive effects of nitrates
  341. Vacuum Constriction devices (VCD)?
    suction devices applied to flaccid penis -> produce erection by pulling blood up into corporeal bodies

    penile ring or constrictive band placed around base of penis to retain venous blood
  342. Intraurethral devices?
    vasoactive drugs admin onto or into penis that enhance lood flow into the penile arteries
  343. How may intraurethra devices be administered?
    • 1. topically as a gel
    • 2. injection into penis
    • 3. pellet inserted into the urethra using a MUSE device
  344. Current vasoactive drugs that may be used via intraurethral devices?
    • 1. papaverine - topical gel
    • 2. caverject - topical gel, transurethral pellet, or injection
    • 3. vasomax
  345. Penile implants?
    implants of semirigid or inflatable penile prostheses - highly invasive with potential complications
  346. 3 Complications that may occur with penile implants?
    • 1. mechanical failure
    • 2. infection
    • 3. erosions
  347. Interventions for psych issues r/t ED?
    • 1. reassure pt that confidentiality will be maintained
    • 2. counseling & therapy
    • 3. be caring & provide them with answers (will be highly motivated & expect immediate solutions)
  348. Andropause?
    gradual decline in androgen secretion that occurs in most men as they age - can start as early as age 40
  349. 3 S/S of andropause/
    • 1. loss of libido
    • 2. fatigue
    • 3. ED
  350. 2 long-term effects of andropause?
    • 1. osteoprosis
    • 2. decreased muscle mass & strength
  351. Dx of andropause?
    • 1. H&P
    • 2. serum total testosterone - normal = 280 to 1100
  352. Tx for andropause?

    When is Tx initiated?
    testosterone replacement therapy

    when testosterone is <250
  353. Complications of testosterone replacement therapy (TRT)?
    • 1. lowered HDL
    • 2. increased Hct
    • 3. worsening sleep apnea
  354. Contraindications for TRT?

    Intervention?
    pt with BPH or prostate cancer

    will have DRE & PSA before TRT begins
  355. Admin of TRT?
    • 1. IM injection (depo-testosterone & delatest)
    • 2. transdermal:  patches & gels:  androderm, testim
  356. AE of IM TRT?
    create a cyclic rise & fall in serum teststerone levels -> mood swings with these flutuations
  357. AE of transdermal TRT?

    Intervention?
    skin irritation

    may apply triamcinolone cream (amcort, kenalog) to skin before application of the patch to decrease irritation
  358. Infertility?
    inability to achieve conception X 1 year of frequent unprotected intercourse
  359. 3 Causes of infertility?
    • 1. disorders of hypothalamic-pituitary system
    • 2. disorders of the testes
    • 3. abnormalities of the ejaculatory system
  360. Physical causes of infertility are divided into what 3 categories?

    Which is the most common?
    pretesticular, testicular, & post-testicular

    testicular
  361. Pretesticular causes?
    endocrine causes - 3% of cases
  362. 7 Examples of testicular causes of infertility?
    • varicocele (most common cause)
    • 2. infection
    • 3. congential anomalies
    • 4. meds
    • 5. radiation
    • 6. substance abuse
    • 7. environmental hazards
  363. 3 Infections that can cause testicular infertility?
    • 1. mumps
    • 2. STDs
    • 3. bacterial infections
  364. 3 Posttesticular causes of infertility?
    • 1. obstruction
    • 2. infection
    • 3. result of surgical procedure
  365. Starting point in Dx of infertility?  Factors included?
    • starting point is Hx:
    • 1. age
    • 2. occupation
    • 3. past injury, surgery, or infections to the genital tract
    • 4. lifestyle
    • 5. sexual practices
    • 6. frequency of intercourse
    • 7. emotional factors:  stress & desire for children
    • 8. use of drugs
  366. Lifestyle issues that can cause infertility?
    • 1. hot tubs
    • 2. weight training
    • 3. wearing tight undergarments
  367. Drugs that may be involved in infertility?
    • 1. chemo drugs
    • 2. anabolic steroids - testosterone
    • 3. sulfasalazine/Azulfidine
    • 4. cimetidine/Tagamet
    • 5. recreational drugs:  can reduce sperm count
  368. First test in an infertility study?

    Additional testing?
    semen analysis:  sperm concentration, motility, and morphology

    • 1. plasma testosterone
    • 2. serum LH & FSH
    • 3. test for sperm penetration abilities
  369. Nursing interventions r/t infertility?
    • 1. be concerned & tactful
    • 2. be sensitive to gender identity
    • 3. refer to marriage counceling prn (can strain marriage)
  370. Tx of infertility?
    • 1. meds
    • 2. lifestyle changes:  avoid scrotal heat, substance abuse, & high stress
    • 3. in vitro fertilization
    • 4. corrective surgery

What would you like to do?

Home > Flashcards > Print Preview