Med Surge

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Med Surge
2010-06-26 19:11:27
Disorders Male reproductive system

Ch 55
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  1. What is Cryptorchidism?
    a condition in which one or both testes fail 2 fall into the sac. the longer it takes for nuts 2 fall into the sac the greater the risk of shooting blanks. Usually by 2yrs old the seminiferous tublules atrophy and fribrose

    Medical interventions = tx with injections of human chorionic (hCG) 2wice wkly for 4wks after kid is 6months. If that doesn't work surgery called orchiopexy is performed between 1&2yrs of age.

    Nursing intervention = teach men to perform testicular self-examination to detect any abnormal mass in the scrotom. Clients should examine the sac monthly best in warm like in the shower.
  2. What is Torsion of the spermatic cord?
    It is the spermatic cord that twists, kinking the artery anc compromising blood flow to the testicle. Usually in prepubescent boys and in men whose junk is messed up.

    Signs &Symptoms= sudden, sharp testicular pain with swelling. Pain is usually so severe that nausea, vomiting, chills and fever occur. Torsion can occur after severe exercise, but it can occur sleeping, or just by crossing the legs.

    Medical interventions = Immediate surgery is necessary 2 prevent atrophy the spermatic cord and preserve fertility.

    Nursing Interventions = PREOPERATIVELY give pain meds to releive pain (if ordered). Nurse applies a scrotal support especially when the client is out of bed. Nurse inspects the dressing for signs of drainage and gives antibiotics if ordered and rpt sudden onset of pain.
  3. What is Phimosis and Paraphimosis?
    Conditions in uncircumcised male peeps when the opening of the foreskin is constricted. Phimosis means inablility to retract the foreskin (prepuce) Paraphimosis means strangulation of the glans penis from inability 2 replace the retracted foresking.

    Occurs cuz the foreskin is too small (LOL) or cuz poor hygiene or infection

    • Signs&Symptoms of Phimosis = pain w/ erection & intercourse, and difficulty cleaning under foreskin
    • Signs&Symptoms of Paraphimosis = painful swelling of the glans. If the condition continues severe edema & urinary retention may occur.

    Medical interventions = Circumcision is recommended but if they don't do surgery nurse should instruct them 2 wash under the foreskin daily & seek care if he cant retract the the tissue.
  4. What is Hydrocele, Spermatocele and Varicocele?
    • Cele=swelling.
    • Hydrocele, spermatocele & varicocle is swelling of the scrotum.

    Does not usually require tx
  5. What is Prostatitis?
    inflammation of the prostate gland and is mosto often caused by microorganisms the reach the prostate by urethra like Ecoli and STDs but sometimes no bacterial infection is found.

    Signs & Symptoms = glandular swelling and tenderness, genitourinary problems, perineal pain & discomfort, wierd sensation after blowin a wad. LOL. back pain, fever chills, dysuria and urethral discharge.

    Medical interventions = 30 days of antibiotics, pain meds, sitz bath

    Nursing Interventions = Stresses sexual partners need 2 be treated 2. Avoid caffeine, prolonged sitting, and constipation, and regularly 2 drain the prostate gland thru masturbation or intercourse. Nurse instructs client to comply w/ antibiotic therapy & mild anagesic 4 pain.
  6. What is Epididymitis & Orchitis?
    a inflammation of the epididymis (epididymitis) and testis (orchitis) occurs alone or @ the same time. Long term can in end in testicular atrophy and sterility or azoospermia (absence of sperm)

    Medical interventions = longterm epididymitis results in longterm indwelling catheter. Prosatectomy or cystoscopy.

    sign&symptoms = pain and swelling in the inguinal area and scrotum. Fever and chills occur with bacterial infections and the urine has pus and bacteria. Swollen balls that are red & tense. make sure its not torsion cuz thts a surgical emergency.

    Medical Interventions = bed rest, scrotal elevation, pain meds, anti-inflammatory agents, comfort measures like cold applications. If infected use antiobiotic therapy. Epididymectomy if chronic but results in shooting blanks.

    • Nurse Does = elevates scrotum w/ a folded towel, four-tail bandage, or adhesive tape across the upper thighs 2 relieve pain by lessening the weight of the testes. Place and ice bag under the tender balls, not on top of it or leaning against it. Avoids keeping cold bag constantly next to the skin cuz causes damage tissue, get routine like 60min on and 30min of. Encourage fluid intake.
    • Home care = take pain pills, sitz baths, apply local heat after scrotal swelling subsides, avoid lifting and sexual intercourse until sypmtoms r relieved. Nurses also advise for infants and childhood immunizations against infectious disease, like mumps cuz could cause orchitis later on in life.
  7. What is Erectile dysfunction?
    ED is also know as impotence= inability 2 achieve and erection 2) inability to achieve or maintain an erection that is sufficiently rigid 4 sexual activity 3) inability 2 sustain erection 4 satisfactory period of time. Has 2 be multiple or persistance incidences of failed erections 4 this disorder 2 be considered pathologic.

    Common causes = nuerological disorders, spinal cord injury, perineal therapy, side effects of drug therapy, atherosclerosis, hypertension, complications of DM, anxiety, depression

    Sign&Symptoms = rpts difficulty in achieving or maintaining an erections. A nocturnal penele tumescence & rigidity test can determine if the client gets a bonor during sleeping.

    Medical tx = drugs 1/2 to 1hr b4 sex, nasal spry 15-20min b4 sex safer 4 dudes w/ CAD, Vacuum device 2 penis, vascular surgery.

    Nurse does = inform the dude b4 surgery tht when a pumptype implant is inserted the erect penis tends 2 be shorter then b4 bcuz the cylinders don't fill the glans portion of the penis. If the client does self-inject nurse provides instruction & technique, frequency, side effects. If client does penile implant the nurse assesses 4 pain, swelling, bleeding, surgical complications 4 infections. READ pg 871
  8. What is Priapism?
    The penis bcomes engorged & remains persistently erect w/out sexual stimulations.

    Causes= vascular problem, medical condition that causes blood 2 thicken, or side effects of meds. If erection lasts longer than 6hrs the tissue can be damaged and result in impotence.

    Medical interventions = drugs like vasoconstrictive meds, or draining the trapped blood w/ a needle placed in side of penis, if those don't work an emergency surgery is performed 2 shunt blood terp ou of the corpora cavernosa.

    Nurse does= extend respect 4 clients feelings & understandable embarrassment thru interactions. and whatever medical interventions the client goes thru
  9. What is Benign Prostatic Hyperplasia?
    (BPH) indicates that the prostate gland contains more than the usual # of normal cells. When the gland enlarges tht is when its called (BPH)

    Causes = usually occurs as men age, interferes with emptying the bladder

    Signs&Symptoms = peep notices takes more effort 2 void, stream narrows, and has decreased force, urge 2 void more & nocturia occurs. then symptoms of cystitis (inflammation of bladder) may develop.

    Medical tx = digital rectal exam reveals the (BPH), Intravenous & retrtograde pylegrams & blood chemistry tests, PSA tests and Transrectal ultrasonography, Early stages BPH monitore periodic DRES, drug therapy 2nd, Surgeries TURP, TUIP, TULIP, TUNA but after TURP 66-75% of dudes get retrograde ejaculation(semen goes into bladder rather than discharging thru urethra @ time of orgasim

    Nurse does = teach client 2 maintain optimal bladder emptying, surgery client requires support & infor 4 anxiety & promote a postoperative period is free of complications. Teach deep breathing and leg excercises and tell peep will have continous bladder irrigation for @least 24hrs after surgery.

  10. What is cancer of the prostate?
    Prostate cancer is second 2 skin cancer in men.
  11. What is cancer of the prostate?
    Second to skin cancer in men. About 1 male in 6 will be diagnosed with prostate cancer, nad 1 in 35 will die of the disease.

    Cause= unknown. usually happens in peeps with family history of prostate cancer, increased testosterone levels and diet high in fat.

    Signs&symptoms = nothing @ first but then when the tumor grows large it compromises urinary flow and causes frequency, nocturia and dysuria hematuria and hemospermia (blood in sperm), ED, after it metastases back pain down the leg from nerve sheath involvement. When pain develops the disease is in advanced stage. Routine in 75+ yearly

    DX findings = DRE detects a prostatic nodule, PSA greater than 4ng/ml is the basis 4 doing more tests. PSA greater than 10ng indicates a prostatic malignancy. PSA greater than 80ng/ml indicates metastic disease but some dudes hv high levels and are cancer free.

    Medical interventions = depends on tumor size referred 2 as (Gleasons score), clients age and general health status. Tx are "watchful waitin", surgery, external radiation, or brachytherapy (sealed source radiation), hormone therapy, or combination of these. Surgeries= Suprapubic prostatectomy 1choice, Laparoscopically is less pain, less blood loss, shorter recovery period.

    Nurse does = pg 880 box 55-2 & 55-3
  12. What is cancer of the testes?
    Cancer of the testes is a malignancy seen in men btween 18-40yrs. Rare most common type in men btween 15&34yrs leading cause of death in ment between 25-34yrs.

    Causes = higher in crackers (LOL its a joke sheesh), w/ family hx, hx of cryptochidism, usually HIV/AIDS dudes develop it but exact reason unkown. testicular cancer spreads 2 lungs, bone, and brain by retroperitioneal lymph nodes or circulatory system

    Signs&Symptoms = gradual or sudden swelling of the balls or a lump felt on palpatation. Tumor usually hard, nontender nodule of the balls, 1st signs back pain, shortness of breath, elevations of alphafetoprotein and hCG, IVP may show lymph nod enlargement

    Medical interventions = surgery Orchiectomy if only one teste is removed sexual activity, libido and fertility usually is unaffected, chemotherapy , and radiation

    • Nursing does = peop period tend 2 clients emotional distress over life-threatening dx, unfamiliar surgical experience, body image and sexuality. Provide private opportunities 4 dude 2 ask questions and use therapeutic communication techniques 2 encourage client verbalize feelings.
    • Postoperative = nurse applies scrotal support, give prophylactic antibiotics 2 prevent infections, manage pain, READ PG885
  13. What is cancer of the PENIS??
    rare in more men who uncircumcised.

    Cause = unknown,

    Medical interventions = biopsy comfims CA, staged by MRI & CT, tx includes tumor excision, chemotherapy, external or intestitial radiation therapy or all three. Sometimes full amputation but requires permanent drainage tube 2 empty bladder. 5yr survival rate 4 penile cancer is 65%.
  14. What is a vasectomy?
    minor surgical procedure done in dr's office. permanent steralization (shooting blanks)

    Nurse does= informs dude 2 use reliable contraception cuz still can hv some soldiers in the line of fire :). provide client opportunity 2 express feelings, expect bruising and incisional soreness, apply ice pks 2 balls rmove after 20mins, take analgesics, wear athletic support, resume activities 2 to 3 days but avoid strenous exercise up to 5days, resume sex in 1wk, rpt sever pain, fever, or swelling @ top of testess.
  15. What is vasovasotomy?
    surgical attemtp 2 reverse vasectomy. May take 3 to 6 months b4 sperm counts & motility are normal. lack of success is result of scar formation or sperm leakage from surgical connection.