Showing posts with label male reproductive disorder. Show all posts
Showing posts with label male reproductive disorder. Show all posts

Prostatic Surgery

  1. General information
    1. Indicated for benign prostatic hypertrophy and prostatic cancer.
    2. Types
      1. Transurethral resection (TUR or TURP): insertion of a resectoscope into the urethra to excise prostatic tissue; good for poor surgical risks, does not require an incision; most common type of surgery for BPH
      2. Suprapubic prostatectomy: the prostate is approached by a low abdominal incision into the bladder to the anterior aspect of the prostate; for large tumors obstructing the urethra
      3. Retropubic prostatectomy: to remove a large mass high in the pelvic area; involves a low midline incision below the bladder and into the prostatic capsule
      4. Perineal prostatectomy: often used for prostatic cancer; the incision is made through the perineum, which facilitates radical surgery if a malignancy is found
  2. Nursing interventions: preoperative
    1. Provide routine pre-op care.
    2. Institute and maintain urinary drainage.
    3. Force fluids; administer antibiotics, acid-ash diet to eradicate UTI.
    4. Reinforce what surgeon has told client/significant others regarding effects of surgery on sexual function.
  3. Nursing interventions: postoperative
    1. Provide routine post-op care.
    2. Ensure patency of 3-way Foley.
    3. Monitor continuous bladder irrigations with sterile saline solution (removes clotted blood from bladder), and control rate to keep urine light pink changing to clear.
    4. Expect hematuria for 2-3 days.
    5. Irrigate catheter with normal saline as ordered.
    6. Control/treat bladder spasms; encourage short, frequent walks; decrease rate of continuous bladder irrigations (if urine is not red and is without clots); administer anticholinergics (propantheline bromide [Pro-Banthine]) or antispasmodics (B&O suppositories) as ordered.
    7. Prevent hemorrhage: administer stool softeners to discourage straining at stool; avoid rectal temperatures and enemas; monitor Hgb and hct.
    8. Report bright red, thick blood in the catheter; persistent clots, persistent drainage on dressings.
    9. Provide for bladder retraining after Foley removal.
      1. Instruct client to perform perineal exercises (stopping and starting stream during voiding; pressing buttocks together then relaxing muscles) to improve sphincter control.
      2. Limit liquid intake in evening.
      3. Restrict caffeine-containing beverages.
      4. Withhold anticholinergics and antispasmodics (these drugs relax bladder and increase chance of incontinence) if permitted.
    10. Provide client teaching and discharge planning concerning
      1. Continued increased fluid intake
      2. Signs of UTI and need to report them
      3. Continued perineal exercises
      4. Avoidance of heavy lifting, straining during defecation, and prolonged travel (at least 8-12 weeks)
      5. Measures that promote urinary continence
      6. Possible impotence (more common after perineal resection)
        1. discuss ways of expressing sexuality (massage, cuddling)
        2. suggest alternative methods of sexual gratification and use of assistive aids
        3. discuss possibility of penile prosthesis with physician
      7. Need for annual and self-exams

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Cancer of the Prostate

  1. General information
    1. Second most common cause of cancer deaths in American males over age 55
    2. Usually an adenocarcinoma; growth related to the presence of androgens
    3. Spreads from the prostate to the seminal vesicles, urethral mucosa, bladder wall, external sphincter, and lymphatic system
    4. Highest incidence is in African American men age 60 or over
    5. Cause is unknown
  2. Medical management
    1. Drug therapy: estrogens, chemotherapeutic agents
    2. Radiation therapy
    3. Surgery: radical prostatectomy
  3. Assessment findings: same as for BPH above but diagnostic test results are
    1. Elevated acid phosphatase (distant metastasis) and alkaline phosphatase (bone metastasis)
    2. Bone scan: abnormal in metastatic areas
  4. Nursing interventions
    1. Administer medications as ordered and provide care for the client receiving chemotherapy
    2. Provide care for the client receiving radiation therapy.
    3. Provide care for the client with a prostatectomy.

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Benign Prostatic Hypertrophy (BPH)

  1. General information
    1. Mild to moderate glandular enlargement, hyperplasia, and overgrowth of the smooth muscles and connective tissue
    2. As the gland enlarges, it compresses the urethra, resulting in urinary retention.
    3. Most common problem of the male reproductive system; occurs in 50% of men over age 50; 75% of men over age 75
    4. Cause unknown; may be related to hormonal mechanism
  2. Assessment findings
    1. Nocturia, frequency, decreased force and amount of urinary stream, hesitancy (more difficult to start voiding), hematuria
    2. Enlargement of prostate gland upon palpation by digital rectal exam
    3. Diagnostic tests
      1. Urinalysis: alkalinity increased; specific gravity normal or elevated
      2. BUN and creatinine elevated (if longstanding BPH)
      3. Prostate-specific antigen (PSA) elevated. (Normal is <4>
      4. Cystoscopy reveals enlargement of gland and obstruction of urine flow
  3. Nursing interventions
    1. Administer antibiotics as ordered.
    2. Provide client teaching concerning medications
      1. Terazosin (Hytrin) relaxes bladder sphincter and makes it easier to urinate. May cause hypotension and dizziness.
      2. Finasteride (Proscar) shrinks enlarged prostate.
    3. Force fluids.
    4. Provide care for the catheterized client.
    5. Provide care for the client with prostatic surgery.

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Prostatitis

  1. General information
    1. Inflammatory condition that affects the prostate gland
    2. Several forms: acute bacterial prostatitis, chronic bacterial prostatitis, or abacterial chronic prostatitis
    3. Acute and chronic bacterial prostatitis usually caused by E. coli, N. gonorrhoeae, Enterobacter or Proteus species, and group D streptococci
    4. Most important predisposing factor: lower UTIs
  2. Assessment findings
    1. Acute: fever, chills, dysuria, urethral discharge, prostatic tenderness, copious purulent urethral discharge upon palpation
    2. Chronic: backache; perineal pain; mild dysuria; frequency; enlarged, firm, and slightly tender prostate upon palpation
    3. Diagnostic tests
      1. WBC elevated
      2. Bacteria in initial urinalysis specimens
  3. Nursing interventions
    1. Administer antibiotics, analgesics, and stool softeners as ordered.
    2. Provide increased fluid intake.
    3. Provide sitz baths/rest to relieve discomfort.
    4. Provide client teaching and discharge planning concerning
      1. Importance of maintaining adequate hydration
      2. Antibiotic therapy regimen (may need to remain on medication for several months)
      3. Activities that drain the prostate (masturbation, sexual intercourse, prostatic massage)

Tuesday, May 20, 2008 | Labels: | 0 Comments  

Epididymitis

  1. General information
    1. Inflammation of epididymis, one of the most common intrascrotal infections
    2. May be sexually transmitted, usually caused by N. gonorrhoeae, C. trachomatis; also caused by GU instrumentation, urinary reflux
  2. Assessment findings
    1. Sudden scrotal pain, scrotal edema, tenderness over the spermatic cord
    2. Diagnostic test: urine culture reveals specific organism
  3. Nursing interventions
    1. Administer antibiotics and analgesics as ordered.
    2. Provide bed rest with elevation of the scrotum.
    3. Apply ice packs to scrotal area to decrease edema.

Tuesday, May 20, 2008 | Labels: | 0 Comments  

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