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110 Cards in this Set

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When interviewing a male concerning male genitalia the should should keep in mind?
very sensitive topic

the nurse should be aware of his/her own views on sexuality, body image, and fears about cancer.
Pain in the penis, scrotum, testes, and groin could indicate?
hernia and inflammatory process.
Lesions on the penis or the genital areas could be ?
STD

or

Cancer
If a client notices a discharge from the penis, a discharge could indicate a ?
Inflammation
Lumps, swelling, or masses in the scrotum, genital, or groin area could be signs of ?
infection

hernia

or cancer
What does a heavy dragging feeling in the scrotum mean?
testicular tumor

scrotal hernia
difficulty urinating: hesitancy, frequency, or difficulty starting a stream could be indications of ?
an infection of the prostrate

a blockage, including prostrate enlargement.
A change in color, odor, or amount of urine is a sign of?
indicate an infection.
Blood in the urine
should be referred to a M.D. asap, it could be a sigh of benign prostatic hypertrophy (BPH), or cancer.
A decreased amount of urine could mean?
prostate enlargement or kidney problems
Do you feel pain or burning when urinating

think about 3 processes
this could be a sign of urinary tract infection, prostatitis, or an STD .
Urinary incontinence or dribbling are signs of ???
Incontinence=could be from prostatectomy

Dribbling=sign of overlfow incontinence
Has there been a change in the clients sexual activities or desire?
should be investigated to determine cause.
If there is difficulty attaining or maintaining an erection, or problems with ejaculation, the nurse should assess for?
alcohol use, drug use, depression, hypertensive medications.
What age group has an increase in the frequency of erectile dysfunction?
Increases in frequency with age.
At what age, and how often should a male client do a testicular exam?
for asymptomatic cleints age 20-39= every three years.

for asymptomatic clients age 40 and older=every year.
Heavy lifting or strenuous activities could predispose a client to what type of hernia.
inguinal
A hernia could limits a clients ability to do what activites?
perform regular exercise or work
How often should a male perform a self testicular exam?
monthly starting at age 15
What should the client do first before the nurse starts the physical exam?
Use the restroom, remove all his clothes including his underwear, and remain standing.
What should the nurse do to distract the client during the genital examination?
describe the importance of testicular self examinations and how to perform the self exam while the nurses is performing it
Normal male pubic hair would look like?
cover the entire groin area and be free of excoriation, erythema an infestation.
pediculosis pubis
lice or nit infestation at the base of the penis or pubic hair AKA "crabs"
Hardness along the ventral surface of the penis could indicate?
cancer or urethral stricture. tenderness may indicate inflammation or infection.
In an uncircumcised male the foreskin covers what part of the penis?
glans, in a normal penis and should be uniform in color with the penis.
Discolration of the foreskin could indicate?
scarring or infection
chancers are common if the patient has what STD?
syphillis
Pimple like lesions could be ..?
herpes or venereal warts
Characteristics of normal foreskin are?
retracts easily, a small amount of smegma under the foreskin is normal.
phimosis
tight foreskin that cannot be retracted.
paraphimosis
a foreskin that was once retracted but cannot be returned to cover the glans.
hypospadias
urinary meatus located on the ventral side of the penis. not as significant as epispadias
epispadias
displacement of the urinary meatus to the dorsal side of the penis
The male urinary meatus should be free
of
discharge
a yellow discharge from the urinary meatus is a sign of.
gonorrhea
a clear white discharge from the urinary meatus is a sign of ?
urethritis and should be cultured
In a normal finding, which testical should hang lower than the other? and why?
The left one, because the spermatic cord on the left side is longer.
the apex of the heart
What is a hernia ?
a protrusion of loops of bowel through weak areas of the musculature.
An enlarged scrotal sac could be caused by what?
from fluid=hydocele
blood=hematocele
bowel=hernia
tumor=cancer
Are sebaceous cysts on the scrotal sac a normal or abnormal finding?
NORMAL
What is a sebaceous cyst?
a small, yellowish, firm, non-tender, benign nodules
What is Reiter's syndrome ?
an idiopathic inflammatory disorder affecting the skin, joints, and mucous membranes
What could be a diagnosis for a finding of inflammation and swelling of the penis and scrotum?
Reiter's syndrome
what is cryptorchidism
an undescended testical
painLESS nodules within the testicle could indicate ?
cancer ***swollen painless nodes= cancer
Normal testicles are what shape, size, and consistency?
shape=ovioid
size=3.5-5cm long 2.5cm wide and 2.5 deep
equal bilaterally is size and shape
smooth, firm, rubbery, mobile,tender to pressure.
Describe the epididymis.
non-tender, smooth, and softer than the testes.
Do testes get smaller with normal aging?
NO, they may decrease in size with long-term illness.
How should the spermatic cord and van- deferens feel in a normal finding ?
feel uniform on both sides. the spermatic cord should feel non-tender and ropelike.
If bowel sounds are heard over the scrotal area this would indicate?
hernia
What should the nurse do if he/she palpates a mass within the scrotal sac?
have client lie down, if the mass does not return to the abdomen by itself place your fingers above the scrotal mass. IF you can get your finger above the mass that would indicate = hydrocele of the spermatic cord
IF abnormal masses or swelling are noted what should the nurse do to further assess the finding?
TRANSILLUMINATION should be performed.
Perform by shinning a light from the back of the scrotum through the mass.

Look for a red glow.
In a normal finding do scrotal contents transilluminate?
No, swellings or masses that contain serous fluid=hydrocele,spermatocele light up with a red glow.
Do swellings or masses that are solid or filled with blood light up with transillumination?
NO. tumors, hernias, or varicoceles do not light up with a red glow.
When assessing the inguinal or femoral area the nurses should assess for?

What should the nurse ask the client to do at this time?
bulges. ask the client to bear down while inspecting the area.
Bulges within the external inguinal ring or at the femoral canal may signal the presence of ?
a hernia
What is the most common hernia?
Inguinal hernia is the most common
Bulges within the external inguinal ring or at the femoral canal may signal the presence of ?
a hernia
Syphilitic chancre
small silvery-white papule that develops into a red oval ulceration.

painless

sign of primary syphilis
herpes progenitalis
cluster of pimple-like clear vesicles that erupt and become ulcers

painful

recurrance can be minimal or frequent
genital warts
single or multiple, moist, fleshy papules.

painless

caused by human papillomavirus
cancer of the glans penis looks like what?
appears as hardened nodules or ulcer on the glans.

painless

occurs primarily in non-circumcised men
testicular tumor
small firm non tender nodule on the testis. as it grows the scrotum appears enlarged and the client may complain of heaviness.
When palpated the testis will feel smooth and enlarged-tumor replaces testis
epididymitis
infection of the epididymis. client complains of sudden pain. scrotum appears enlarged, reddened, and swollen
associated with prostatitis or bacterial infection
torsion of spermatic cord

requires immediate m.d. attention
painful condition caused by twisting of spermatic cord. scrotum appears enlarged and reddened. palpation reveals thickened cord and swollen tender testis. testis may be higher in the scrotum than normal. requires MD ASAP
small testes indicate atrophy, which may result from?
cirrhosis, hypopituitarism, estrogen administration, extended illness, or the disorder may occur after orchitis.
small firm testes may indicate what disorder ?
Klinefelter's syndrome.
orchitis of the testes is often associated with what virus?
mumps....c/c pain, heaviness, and fever. scrotum appears enlarged and reddened. swollen tender testis is palpated. examiner may have difficulty differentiating between the testis and the epididymis
varicocele

abnormal
abnormal dilation of veins of the spermatic cord. c/c discomfort and testicular heaviness. tortuous veins feel like a soft, irregular mass or bag of worms which collapses when the client is supine. infertility may be associated with this condition
spermatocele
sperm filled cytic mass located on epipidymis. palpable as small nontender and movable above the testis.
mass will appear on transillumination
three types of hernia associated with the male.
indirect hernia

direct inguinal hernia

femoral hernia
F I D
indirect hernia and does it travel into the scrotum? who would have a higher rate of this type of hernia?
bowel herniates through internal inguinal ring and remains in the inguinal canal or travels down into the scrotum. most common. can occur in adults but most often in children
direct inguinal hernia

most common in what age group
bowel herniates from behind and through the external inguinal ring.
rarely travels into the scrotum.

occurs more in adult men older than 40 y.o.
femoral hernia

occurs most often in what group?
bowel herniates through the femoral ring and canal. NEVER travels into scrotum, and the inguinal canal is empty .
least common type.
occurs mostly in women
not just for men
male
assessment
PENIS assessment what should you do?
What do you palpate?
INSPECT the pubic hair, base, the skin of the shaft, foreskin, glans,
PALPATE the shaft, and glans( to observe for discharge from the urinary meatus.
ASSESSING the scrotum what are you looking at?
What do you palpate?
inspect the size, shape, an location, inspect the scrotal skin.
PALPATE each testis and epididymis, spermatic cord.
Auscultate unusual masses
Transilluminate unusual masses
Would auscultating with a stethoscope be done as part of a male genital examination if masses or tumors are not noted?
no auscultating is done only if masses or tumors are present
ASSESSING the inguinal area.

PALPATING the inguinal area.
inspect the inguinal area for masses or bulges.

PALPATE the right and left ingunial areas, palpate inguinal lymph nodes,front of the thigh in the femoral canal.
epididymis
immature sperm is stored here, 20” large, coilded on top of testicle
Prostate gland
surrounds the urethra, secrets alkaline fluid transported in ejaculatory ducts that pass through prostate - helps maintain sperm motility by producing an alkaline fluid - contributes to ejaculation
Function of the prostate gland
1.Produces spermatozoa Semen
- consists of sperm secretions
- 2-4 ML semen with 100 million sperm cells
2.Manufactures Male Hormones
3. Sexual pleasure
Cystoscopy
- lighted optical instrument inserted into urethra
- inspect bladder and size of prostate
- can cause infection and bleeding
- antibiotic, prophylatic to to ¯ post procedure infection
- following encourage drinking lots of fluids
Transrectal Ultrasonography (SONOGRAM)
to detect prostate problems
- lubricaed probe inserted into rectum
- prep with fleets enema 1-2hours preop
Biopsy
- prostate or testicle
- perineal approach = incision made through perineum
- rectal approach = needle guided through rectum wall into prostate
- testicular biopsy = local or general anesthesia
Laboratory test
- total urine estrogens = testicular cancer
- Prostate specific antigen (PSA) - for prostate ca.
- Pituitary hormone levels and testosterone
Epididymo-Orchitis
- from infection in vas deferens
- GC, Mumps, bacteria, virus, parasite
- reflux of urine
- assoc with STDs under 40
- over 40 UTIs
- Severe pain, fever, chills
- testicle is swollen and red
- antibiotics
- four tail sling, ice bag, bed rest
- immunization against mumps
- temp relief when scrotum above symphysis pubis
Testicular Torsion
- tissue ischemia and damage
- severe pain, nausea and vomiting
- elevation increases pain
- immediate surgery necessary
Hydrocele
- Fluid in testicular sac
- sometimes infection or unknown
- asymptomatic
- diagnosis made by transillumination
- fluid can be dained, may or may not come back
Varicocele
- swelling of the internal spermatic veins above the testicle
- almost always occurs in the left side
- because the lf spermatic vein empties into lf renal vein
- right empties into IVC
- swelling should diminish or disappear as pt lies down
- fertility is a big problem
- surgery corrects
Testicular Cancer
- affects men between 15-39 most
- commonest tumor 15-35 men
- risk factors = undescended testicle
??? environmental estrogens, warm baths, virs
Signs and symptoms of testicular cancer.
Signs and Symptoms
- painless mass felt by man
- heaviness in scrotum
- entirely curable when found early
- men delay going to doc
- must be taught TSE
advanced - urethral obstruction, abd mass, elevated HCG
most important factor in success of tx is type & stage of tumor
- Treatment = removal of testicle, radiation, chemotherapy
- sterility
Prostatitis
- usually results from enlarged prostate, stricture,
- E Coli
- non bacterial = Chlamydia
- symptoms = perianal pain, most common low back pain, fever, chills,
burning, Nocturia
Diagnosis of prostatitis
Diagnosis = DRE causes a lot of pain, gland is massaged = prostatic fluid, urine culture, ultrasound, cbc
Treatment = antibiotics, no sexual intercourse, rest, ASA <
pain meds. stool softeners, sitz bath
Avoid sitting for prolonged periods
Cancer of prostate gland
the prostate malignancy is spread by the blood stream and lymphatic to the pelvic lymph nodes and bones
- most common in older men
- very slow growing
- stimulated by testosterone
Signs and symptomes of prostate gland cancer
Sx
- none for years
- nodule on prostate
- elevated PSA
- frequency, noturia, cystitis
- back pain and leg pain = mets
Diagnosis of Prostate gland cancer
Dx
- DRE
- biopsy, ulrasound
- PSA above 4 - test for early detection of prostatic cancer
- IVP, MRI, CT
treatment for cancer of the prostate gland
the most common reason for performing a orchiectomy is to eliminate the production of testosterone

Surgical removal of prostate, capsule and seminal vesicle
- abdominal approach or perineal
- a cath in place for 14 days
- impotence and poor urinary control
- bilateral orchiectomy to remove testosterone
- TURPs may be necessary to relieve obstructions as tumor return + laster
ablation
- combined with hormone therapy and or radiation etc.

Hormonal Therapy
- Estrogen Therapy = palliation
- inoperable and metatases
- may provide relief for 5 years
- higher voice, breast enlargement
Antiandrogens and gonadotropin releasing hormone
are used when estrogen and removal testicles can’t be done

Antineoplastic drugs
External radiation therapy
Interstitial radiation therapy (implanted radioactive seeds)
Benign prostatic hyperplasia
Sx - narrowing of the urinary system, urinary frequency
- hyperplasia = extra growth of normal tissue
- hypertrophy = enlargement around urethra
- no risk factor
Signs and symptoms of BPH
Signs and Symptoms
- urinary retention, UTI
- increased difficulty in urination
- diff in start stream, hesitancy, urgency, frequent small amounts, nocturia
- residual = UTIs
Diagnosis of BPH
- DRE
- IVP, creatinine, residual cath and PSA
Medical/Surgical Management
- DRE
- Proscar = an androgen
- Watchful waiting
- Alpha adrenergic blocking drugs = Hytrin
Prostatectomy
Transurethral prostatectomy (TURP)
surgical resection of prostate gland under endoscopic control cystoscope inserted into urethra and bladder
- tissue is removed and cauterized
- some bleeding
- easiest, good for older men etc.
Prostatectomy

Suprapubic prostatectomy
post op - pt may have two catheters - cystostomy and a urethral. The urethral has a balloon filled with 30 cc of water
- will have abd. dsg. - keep these dry
- When irrigating the urethral catheter you must follow the orders exactly to prevent over zealous irrigation that can cause bladder spasms and further bleeding
Retropubic prostatectomy
- may have less discomfort
- will have retention catheter - observe for hemorrhage
Perineal prostatectomy
removal of part or all of prostate gland through perineal incision

The retention catheter must remain patent at all times

To differentiate between bladder spasms and urethral catheter obstruction check to see if urine is draining from the catheter
Preop measures for a patient undergoing Prostatectomy
- catherization for retention = remove urine over 2 hours
- do not push
- prep and enemas
Post-Op Care and General Principles for he patient undergoing Prostatetomy?
Bleeding
- normal but not frank blood with clots
- report
- clots can obstruct, cath must be patent
- check for frequent drainage
- surgeon may apply traction on neck of bladder for up to 6 hours
Catheter Drainage and Irrigation
- may or may not have irrigation attached to drainage
- triple lumen
- follow instructions when or not to irrigate
Pain post-op prostatectomy ?
check if it is from obstructions or spasm
General care post-op prostatectomy
Avoid constipation/ straining
Infections
- drugs
- dressings
Read Client and Family Teaching