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Med-Surg Ch 47/48/50

Male Reproductive Disorders and STIs

Male sex hormones (Androgens) Testosterone
Erectile Dysfunction Inability to attain and maintain an erection (great variations), May or may not effect libido
Risk Factors for ED Age-related changes in anatomy (Collagen, Elasticity) and Chronic Illnesses (Diabetes, Kidney disease, Vascular disease, Smoking, Medications)
ED Medications Viagra, Levitra, Cialis, Injectables, Hormone Replacements
Sildenafil citrate (Viagra), vardenafil hydrochloride (Levitra) 1/day, No more than 1 hr before sex
Tadalafil (Cialis) 36 hour
Contraindications of Viagra, Levitra, and Cialis Nitrates, Alpha blockers, certain antibiotics or antifungals can cause issues with meds, Persons at risk for priapism (sustained, painful erection)
ED Injectables Papaverine and Prostaglandin E (Urethra gel), Alprostadil (Caverject)(Suppository), Relaxes smooth muscles, allows engorge, 30 min to 4 hours
ED Hormone Replacement Testosterone injections or topical patches
Other ED treatments Mechanical devices (Vacuum constriction device), Surgery (Revascularization, Placement of prosthetic devices)
Client/partner teaching for ED Diet/exercise, Disease management, Psychological (Sexual counseling)
3 Ejaculatory Dysfunctions Retrograde ejaculation, Premature ejaculation, Delayed ejaculation
Retrograde ejaculation Ejaculate goes back into bladder (Aging, Cancer, Enlarged prostate)
Premature ejaculation Psychological in nature, Less control, Not always a problem, Antidepressants may help (SSRIs), Guided imagery, Condom decreases sensitivity
Delayed ejaculation May be medically related
Medical management of Ejaculatory Dysfunctions Wearing condoms, relaxation, guided imagery, mechanical devices, Referral to specialist if problem persists
Phimosis of the Penis Constriction of the foreskin
Paraphimosis Retracted foreskin, probably for cleaning, but left, does not go back, Circumcision required
Priapism Involuntary, sustained, painful erection, not associated with sexual arousal, Results in ischemia (cell death), Assess ability to urinate and pain.
Cancer of the penis Rare among Jewish and Muslim, More rare among circumcised, Squamous cell carcinoma in 95% of cases
Cancer of the penis Risk factors Age >60, Phimosis, Poor hygiene, HPV, HIV, UV exposure
Diagnostics of Penile Cancer Biopsy of lesion/lymph nodes
Treatment of Penile Cancer Flourouracil cream, Radiation, Laser therapy, Surgical removal (penectomy) (Urinate sitting), Chemo if metastasis
3 types of Benign Scrotal Masses Hydrocele, Spermatocele, Varicele
Hydrocele fluid filled mass in the scrotum, Usually from trauma or tumor, If it becomes painful or too large it can be drained
Spermatocele Cystic mass on epididymis. Typically mobile and painless. Caused by trauma or infection. No treatment necessary.
Varicele Dilation of spermatic cord vein. Usually on the left side. Causes decreased blood flow to the testes. Worry about infertility. If it is small may only intervene with scrotal support. Support with briefs, jock strap, or even pillow.
Epidiymitis Infection or inflammation of epididymis. Sexually-active men <35. Usually r/t STI (that has travelled up to epididymis). May be related to unprotected anal sex. In men >35: associated /c UTI or prostatitis, Chemical epidiymitis r/t reflux of urine.
Manifestations of Epididymitis Localized pain and edema. May progress to erythema and edema of the entire scrotum.
Complications of Epididymitis Abscess formation (Nodule, may have pus), Infarction of testis (Death of testicle), Infertility.
Epididymitis Diagnostics Specimen culture, Urine, Epididymal smear (aspiration)
Epididymitis Treatment Severe is IV Antibiotics and hospitalization. Mild is outpatient antibiotic therapy. Treat STI (also in partner).
Epididymitis Nursing care Symptom relief (Ice packs, scrotal support). Information about the possibility of infertility.
Orchitis Acute inflammation or infection of the testes. Complication of systemic illness: most common cause is mumps. Extension of epidiymitis.
Orchitis Manifestations High fever, > WBC’s, Unilateral or bilateral scrotal redness, swelling, and pain, If both testes involved sterility may result.
Treatment for Orchitis Antibiotic therapy based on urine culture. Bed rest, scrotal support and elevation. Hot or cold compresses. Analgesics for pain.
Testicular torsion Medical emergency! Twisting of the spermatic cord with scrotal swelling and pain (Usually found with ultrasound). Decreased or absent testicular circulation with vascular engorgement and ischemia (death). Less common after 20.
Treatment for Testicular Torsion Determined by history and physical exam. Scanning to determine blood flow pattern. Surgical detorsion. Orchiectomy (removal of testicle).
Testicular Cancer Most common in men ages 15-40. Improved outcomes with newer therapies. Cause unknown: Some congenital component (Exposures when infant), Cryptorchidism (undescended testicals). Affects white/American men 5 times more than others.
Testicular Cancer Signs & Symptoms Slight enlargement. May have some discomfort or heaviness. Dull ache in pelvis. Painless nodule on testicle.
Testicular Cancer Risk Factors Age, Family Hx, Previoius cancer, Other.
Staging of Testicular Cancer Stage I-confined to the testicle. Stage II-limited to the testicle and regional lymph nodes. Stage III-Metastasis above the diaphragm or extensive visceral involvement.
Testicular Cancer Treatment Radical orchiectomy all stages (Modified retroperitoneal lymph node dissection, preserves nerves needed for ejaculation). Combo chemo. Radiation (“clam-shell device” shield/save opposite testicle, Monitor redness/bleeding, Ice, Sperm bank).
Testicular exam Monthly, Shower, soapy water
Prostatitis Inflammatory disorders of the prostate
Prostatitis Types Acute bacterial, Chronic bacterial, Chronic Prostatitis/ Chronic Pelvic Pain Syndrome, Benign Prostatic Hypertrophy (BPH)
Acute bacterial Manifestations Onset abrupt. Painful voiding and frequency. Malaise low back/pelvic pain, possible rectal pain, fever. Positive culture for infection. Painful ejaculations. Prostate is enlarged and painful. May be caused from an ascending infection (urinary), back flow.
Chronic bacterial Manifestations Urinary symptoms except less sudden or may often be vague. Occurs over a chronic longer time. History of recurrent UTI.
Chronic prostatitis Manifestations AKA Chronic pelvic pain syndrome. Negative cultures. Back, genital, suprapubic pain possible. Irritation with voiding. Post ejaculatory pain.
Manifestation of any type of Prostatitis Common to all types: pain upon voiding, low back pain. Onset and symptoms may vary depending on type of prostatitis.
Prostatitis Diagnosed by urine and prostatic secretion
Prostatitis Medications Antibiotics, long-term with chronic forms. NSAID’s for pain. Anticholinergics to relieve frequency/urgency.
Nursing care for postatitis Focus on symptom management. Increase fluids. Maintain regular BM’s. Local heat from Sitz baths. Finish ATB.
Benign Prostatic Hyperplasia (BPH) Age-related, non-malignant enlargement of the prostate gland. Increase in number of cells. Begins at age 40-45.
BPH Manifestations Weak urine stream. Hesitancy, urgency. Incomplete bladder emptying. Post void dribble. Incontinence possible nocturia. May cause overflow incontinence.
Possible BPH Complications If symptoms are not severe condition is often monitored. If it becomes too large and urine is retained causing bladder pressure resulting in: Bladder distention, Diverticula, Retained urine.
BPH Diagnosis Subjective history. Digital rectal exam(DRE)(Will be asymmetrical and enlarged). Urine (WBCs, RBCs, Bacteria)(Post residual void; Void, bladder scan to determine residual). Prostate specific antigen (PSA)(> than 10, worry about prostate cancer)
BPH Medications Finasteride (Proscar), Dutasteride (Avodart): < prostate. SE: Impotence, < libido, < ejaculate, Pregnant women not handle. Terzosin (Hytrin), doxazosin (Cardura), tamsulosis (Flomax): Dilates smooth muscle, Better urine stream, Hypotension: stand slowly.
Invasive Treatment for BPH Transurethral microwave thermotherapy and Transurethral needle ablation: heat kills some prostate, <s/s. Transurethral resection of the prostate (TURP): Clean out prostate. Transurethral incision of the prostate (TUIP): 0 tissue removed, <pressure.
Other Invasive Treatment for BPH Laser. Stent. Complementary therapies to treat symptoms. Open prostatectomy (not done often, may cause erectile problems)
Urinary retention BPH care Double voiding. Avoid OTC decongestants they increase urinary retention. Increase fluids over the day not all at one time. No liquids that stimulate voiding (coffee/alcohol).
BPH Discharge Avoid strenuous lifting for 4-6 weeks. Bleeding up to 48 hrs. Don’t strain to void/eliminate. No Sex for 6 weeks. Call the Dr. with fever/pain or swollen scrotum.
Prostate Cancer Risk factors Heredity. Vasectomy due to increased circulating testosterone. Diet: High fat, Excessive vitamin A.
Prostate Cancer Manifestations Often asymptomatic. Same as BPH but may also have blood in urine or ejaculate. Abnormal digital rectal exam.
Prostate Cancer Diagnosis Prostate biopsy. Will see elevated PSA over short period of time (>10). Abnormal DRE (digital rectal exam) (nodule). MRI, CT for metastasis.
Prostate Cancer Treatment Surgery. Radiation. Hormone manipulation. Prostatectomies.
Prostatectomies Radical (prostate, seminal vesicles, part of bladder. = ED). Retropubic (Favored. Nerve-sparing.) Perineal (For older men. <bleeding/pain/hospital stay. Incision for lymph nodes). Suprabubic (Rare, usually /c bladder problems. > bleeding.)
Gyenecomastia Abnormal enlargement of man breast tisses. Unilateral may be breast cancer.
Male Breast Cancer % 1% is male
Sexually Transmitted Infections Risk Factors Unprotected sexual intercourse. Risky sexual activity or with multiple partners. Drug use. 1:2 by 25.
STI Complications PID, chronic pelvic pain. Ectopic pregnancy. Infertility. Neonatal illness and death. Genital cancers. Some STI’s, like genital herpes, remain with the client throughout life.
STI Prevention and Control Education. Condoms. Abstinence 100%. Being informed. Understanding of sexual history: Partners, Prevention of pregnancy, Protection from STI’s, Practice, Past history of STI’s
Genital Herpes Herpes simplex, HSV-1 or HSV-2. 1:5. Within 10 days of exposure papule (raised) lesions. Become vesicular (little fluid filled blisters), contain viral particles. Contagious even during latency. Prodromal symptoms: Burning, itching, tingling, throbbing.
Genital Herpes Manifestations Herpetic lesions. Lymphadenopathy. Headache. Fever. Malaise. Dysuria. Urinary retention. Vaginal or urethral discharge.
Treatment of genital herpes Medications (-vir, antiviral): Acyclovir (Zovirax), Foscarnet (Foscavir), Valcyclovir (Valtrex), Famcyclovir (Famvir). Dealing with chronic illness. Cesarean section to prevent transmission of infection to infant.
Care for Genital Herpes Stiz baths. Warm water. Decrease acidity in urine. No sex until 10 days after lesions appear (outbreak 4-5 days).
Genital Warts Human Papilloma Virus (HPV). Usually from early sex and multiple sexual partners. May only be on cervix or in vagina, not visible. Incubation. Spread by contact with lesions or secretions. Gardisil. Normally not symptomatic. Can cause cervical cancer.
Treatment and prevention of Genital Warts Diagnosed by appearance or on PAP smear. Treated by topical agents. Podophyllin (Podofin, Condylox). Removal through cryotherapy, electrocautery, or surgical excision. Hand washing and condom use.
Vaginal Infections Bacterial Vaginosis, Candidiasis, Trichomoniasis
Bacterial Vaginosis (BV) Gardnerella vaginalis. Thin grey-white milky fishy foul odor, clue cells under microscope. Can cause PID, can cause minor vaginal irritation. Treated with oral or vaginal antibiotics: Flagyl, Vaginal cream.
Candidiasis (the yeast infection) Candida Albicans. Little-0 odor, thick cheesy vaginal discharge. White patches may be on cervix and vagina walls. Dysuria, dyspareunia, itching, vulva irritation. Uncircumcised men too. Treated with oral or topical agent: Gynelotramin, Diflucan, Monistat.
Trichomoniasis Trichomonas vaginalis. Protozoa. Symptoms 5-28 days after infection. Women's vagina or men's urethra. Women have green, yellow or white frothy vaginal discharge with fishy odor, burn and itch. Men asymptomatic. Treated with metrodiazole (Flagyl), oral.
Care of vaginal infections Diagnosed by culture of vaginal secretions, microscopic exam, wet prep. Partners treated. Avoid intercourse until all meds complete. Unscented toilet paper.
Chlamydia (Chlamydia trachomatis) Incubation period 1-3 wk., but may be present for months to years without symptoms. Reportable.
Chlamydia Symptoms in Women dysuria, urinary frequency, discharge, can cause PID and infertility.
Chlamydia Symptoms in Men Invades urethra. Epididymitis, prostatitis, sterility, Reiter’s syndrome (arthritic process).
Chlamydia Treatment Cultures of tissue, antibody tests. Medications: Zithromax or Doxycycline. Referral for partners to be examined and treated.
Gonorrhea (GC) Neisseria gonorrhoeae. Reportable. Incubation period 2-7 days after exposure. Pyogenic bacteria. Targets female cervix, male urethra.
Manifestations of Gonorrhea Inflammation with milky purulent discharge. Dysuria, dyspareunia, possible gonococcal pharyngitis.
Gonorrhea Complications Women: PID, endometritis, salpingitis, pelvic peritonitis , infertility. Men: Painful inflammation of prostate, epididymis, periurethral glands, and sterility. Anal and oral sexual implications. Increased susceptibility to and transmission of HIV.
Care of the patient with gonorrhea Fluid analysis, urinalysis, gram stain. Sexual abstinence until infection is cured. Referral of partners for treatment.
Gonorrhea Medications Ciprofloxacin, Ceftriaxone, levofloxacin. (Roecefin).
Syphilis Treponema pallidum. Transmitted by lesions during sexual activity. Reportable. Organism can survive for days in fluids. Incubation period ranges from 10-90 days. If not treated can lead to blindness, paralysis, mental illness, cardiovascular damage, death
Stages of Syphilis Primary, Secondary, and Latent (or tertiary)
Primary syphilis Painless chancre 3-4 weeks after exposure. Highly contagious.
Secondary syphilis Skin rash on palms of hands, soles of feet, mucous patches in oral cavity, flu-like symptoms, and alopecia. Highly contagious.
Latent or tertiary syphilis No apparent symptoms. Not transmitted through sex, but is through blood.
Treatment of Syphilis VDRL and RPR (looks at antibody production). Fluorescent treponemal antibody absorption looking for T. pallidum. Draw blood, look at under light.
Pelvic Inflammatory Disease (PID) Salpingitis, Oophoritis, Cervicitis, Endometritis, Pelvic peritoneum, Pelvic vascular system. Polymicrobial, may enter vagina via intercourse, childbirth, abortion, surgery. From multiple partners and douching.
Pelvic Inflammatory Disease Manifestations Fever, purulent vaginal discharge. Severe lower abdominal pain. Painful cervical movement but may only have mild s/s. Eventually effects all female organs.
Pelvic Inflammatory Disease Complications Pelvic abscess, infertility, ectopic pregnancy.
Pelvic Inflammatory Disease Diagnostics CBC, Sedimentation rate(inflammation), Laparoscopy.
Pelvic Inflammatory Disease Medications Combination antibiotic therapy with at least two broad spectrum antibiotics. Analgesics. IV fluids.
Pelvic Inflammatory Disease Surgery Drain abscess, remove adhesions. Hysterectomy, if indicated.
Teaching for Pelvic Inflammatory Disease Tampons, change every 4 hrs. No IUD if had. Wash hands. Perineal care. Condoms. Teach to report abnormalities.
Cure for Herpes and Warts No, no cure. All other STIs have cure.
Syphilis Medications Penicillin G given IM. Monitor for Jarisch-Herxheimer reaction. Abstinence until current episode is cured.
Created by: nimeggs