Download Understanding Medical Surgical Nursing, 4th Edition Prostate

Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Chapter 43
Nursing Care of Male Patients
with Genitourinary Disorders
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Prostate Disorders
 Prostatitis
 Benign Prostatic Hyperplasia
 Prostate Cancer
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Prostatitis
 Etiology
 Signs and Symptoms
 Acute Bacterial
 Chronic Bacterial
 Chronic
Prostatitis/Chronic
Pelvic Pain Syndrome
 Asymptomatic
Inflammatory Prostatitis
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Pain
Urgency
Frequency
Dysuria
Urine Retention
Fever, Chills
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Prostatitis (cont’d)
 Interventions (cont’d)
 Diagnosis
 Digital Rectal Exam
 Urine Culture
 EPS
 Interventions
 Antibiotics
 Anti-inflammatory
Agents
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Stool Softeners
Sitz Baths
Prostatic Massage
Avoid Alcohol and
Spicy Foods
 Surgery
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnoses: Prostatitis
 Urinary Retention
 Risk for Ineffective Self-Health
Management
 Acute Pain
 Anxiety
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Benign Prostatic Hyperplasia
(BPH)
 Increase in Number of  Diagnosis
Cells
 DRE
 BUN, Creatinine
 Signs and Symptoms
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Urinary Retention
Dribbling
Nocturia
Dysuria
Urgency
 PSA
 Urodynamic Flow
Studies
 Transrectal Ultrasound
 Cystoscopy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
 Symptom Control
 Catheterization
 Fluids
 Antibiotics
 Intervention
 Watchful Waiting
 Alpha-Adrenergic
Antagonists
 Hormone Blockers
 TUMT, TUMA
 Surgery
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Transurethral Resection of the
Prostate
 Resectoscope into
Urethra
 Overgrown Tissue
Chipped Away
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Prostatectomy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Prostate Surgery
 Pre-op Nursing Diagnoses
 Impaired Urinary Elimination
 Knowledge Deficit
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Postoperative Nursing Diagnoses
 Risk Bleeding
 Monitor Urine Output and Bleeding
 Encourage Fluids
 Teach Patient to Avoid
 Constipation
 Lifting
 Aspirin and NSAIDS
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Acute Pain: Bladder Spasm
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Monitor Pain
Irrigate Catheter as Ordered
Administer Analgesics, Antispasmodics
Teach Relaxation and Deep Breathing
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Urge Urinary Incontinence
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Teach Kegel Exercises
Offer Condom Catheter or Pads
Encourage to Continue Fluids
Discuss Prolonged Incontinence with
Physician
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Risk for Ineffective Self-Health
Management
 Teach to Avoid (About 6 Weeks)
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Heavy Lifting
Stairs
Driving
Strenuous Exercise
 Straining
 Sexual Activity
 Aspirin and NSAIDS
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Bladder Irrigation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Ineffective Therapeutic Regimen
Management
 Teach Patient
 Catheter Care
 Report Signs and Symptoms of UTI
 Report Increase in Bleeding
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Anxiety: Sexual Function
 Explain
 Retrograde Ejaculation
 Talk with Physician if Erectile Dysfunction
Occurs
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Prostate Cancer
 Risk Factors
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Over 65
High Testosterone
High Fat Diet
Family History
Occupational Exposures
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
 Rare in Early
Stages
 Later Stages
 Advanced
 Urinary Obstruction
 Hematuria
 Urinary Retention
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Bone Pain
Anemia
Weakness
Weight Loss
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis

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DRE
PSA
PAP
Transurethral Ultrasound with Biopsy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
 Early
 Testosterone-Suppressing Medications
 Later Stages
 TURP or Open Prostatectomy
 Radiation Therapy
 Metastatic
 Orchiectomy, Estrogen Therapy
 Chemotherapy, Radiation
 Radical Prostatectomy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Penile Disorders
 Peyronie’s Disease
 Penis Curved – Fibrous Bands
 Priapism
 Prolonged Painful Erection
 Phimosis/Paraphimosis
 Foreskin not Retractable
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Cancer of the Penis
 Risk Factors
 Not Circumcised as Baby
 HPV
 Therapeutic Interventions
 Surgery
 Radiation
 Chemotherapy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Testicular Disorders
 Cryptorchidism
 Epididymitis
 Undescended Testes
 Hydrocele
 Fluid in Scrotal Sac
 Varicocele
 Varicose Veins of
Scrotum
 Inflammation
 Infection
 Orchitis
 Testicular Inflammation
or Infection
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Testicular Cancer
 Risk Factors
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Cryptorchidism
Family History
DES Use by Mother
Caucasian
High Socioeconomic Status
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Signs and Symptoms
 Early
 Painless Lump
 Swelling
 Late
 Symptoms of Metastasis
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
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Ultrasound
Chest X-Ray
Blood for Tumor Markers
Biopsy
Staging
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
 Surgery
 Radiation
 Chemotherapy
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Care
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Teach Testicular Self-Examination
Provide Emotional Support
Discuss Sperm Bank Deposit
Offer Cancer Support Group
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Vasectomy
 Interruption of Vas Deferens
 Provides Permanent Birth Control
 Effective About 3 Months Following
Surgery
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Vasectomy (cont’d)
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Erectile Dysfunction
 Problem Obtaining or Maintaining Erection
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Pathophysiology/Etiology
 Physical
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 Psychosocial
Circulation
Nerve Supply
Hormone Balance
Limbic System
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Stress
Illness
Fatigue
Alcohol/Drugs
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis
 History
 Blood Tests
 Glucose
 Testosterone
 Evaluation of Circulation
 Psychosocial Evaluation
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
 Medication Changes
 Oral Medication
 Tadalafil
 Sildenafil
 Vardenafil
 Medication
 Injection
 Transurethral
 Devices
 Surgery
 Hormone Therapy
 Herbal Remedies
 Implants
 Vascular Surgery
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Penile Implants
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Nursing Diagnosis
 Risk for Ineffective Self Health
Management
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Infertility
 Causes
 Pretesticular
 Post-testicular
 Surgery
 Endocrine
 Testicular
 Varicocele
 Idiopathic
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Diagnosis

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Sexual Practices
Lifestyle Practices
Occupation
Medical-Surgical History
Physical Examination
Semen Analysis
Copyright © 2011. F.A. Davis Company
Understanding Medical Surgical Nursing, 4th Edition
Linda S. Williams / Paula D. Hopper
Therapeutic Interventions
 Changes in Lifestyle Practices
 Surgery if Indicated
 In Vitro Procedures
Copyright © 2011. F.A. Davis Company