Deviations of reproductive health
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| Primary Amenorrhea | Absence of menses by the age of 14, with absence of growth and development of secondary sexual characteristics OR Absence of menses by age 16, with normal development of secondary sexual characteristics.
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| Secondary Amenorrhea | Absence of menses for three cycles OR
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| Primary Amenorrhea Etiology | Stress from a major life event; Turner syndrome; Chronic illness (diabetes, thyroid disease); Cushing’s disease; Extreme weight gain or loss; Hypothyroidism; Excessive exercise
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| Secondoary Amenorrhea Etiology | Pelvic or uterine pathology; Breast-feeding; Emotional stress; Malnutrition; Kidney failure; Colitis; Hyperthyroid or hypothyroid conditions; Chemotherapy; Vigorous exercise (long-distance running)
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| Amenorrhea Therapeutic and Nursing Management | Therapeutic: Depends on the cause; Nursing Assessment; Lab and diagnostic testing (ultrasound, CT scan, lab test for hormone levels).....Nursing: Counseling; Education.
Estrogen Replacement therapy for Amenorrhea as well.
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| Dysmenorrhea Primary or secondary Etiology | Primary—increased prostaglandin production; Secondary—pelvic or uterine pathology (Endometriosis most common cause of secondary dysmenorrhea)
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| Dysmenorrhea Therapeutic and Nursing Management | Therapeutic: Pain relief; Coping strategies ----- Nursing: Nursing assessment; Manifestations: pain, nausea, fatigue, fever; Comfort measures; Education; Administration of medications (NSAIDS, low dose contraceptives, selective estrogen modulators)
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| Tips for Managing Dysmenorrhea | Exercise to increase endorphines and to decrease prostaglandin release; Limit salty foods to prevent water retention; increase water consumption to serve as a natural diuretic. ADD MORE.
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| Add Table 4.1 from PP HERE |
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| Dysfunctional Uterine Bleeding | Irregular, abnormal bleeding that occurs with no identifiable anatomic pathology ---- Similar to and may overlap with other bleeding disorders: Oligomenorrhea, Menorrhagia, Metrorrhagia, Menometrorrhagia, Polymenorrhea
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| Dysfunctional Uterine Bleeding Etiology | Numerous causes: Hormonal imbalance; Fibroid tumors; Steroid therapy; Morbid obesity; Hypothyroidism; Endometrial polyps or cancer; Adenomyosis-uterine thickening with endometrial tissue and moves into the outter wall of the uterus.
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| Dysfunctional Uterine Bleeding Therapeutic and Nursing Management | Therapeutic: Medication; Surgery (used if unresponsive to medications)---Nursing:Assessment, Manifestations, irregular menstrual cycles,infertility,mood swings,hot flashes,diabetes,vag tend.: S&S of anemia: Lab and diag. tests; Education; Meds; Follow-up.
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| Dysfunctional Uterine Bleeding Therapeutic and Nursing Management Continued..... | Do CBCs, check for bleeding disorders, do they take a lot of aspirin, transvaginal ultrasound, D&C.
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| Premenstrual Syndrome | Wide range of recurrent symptoms---More severe variant: Premenstrual dysphoric disorder (PMDD)---Etiology: unknown---Therapeutic: Multidimensional; Vitamin supplements; Diet and life style changes; Medications
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| Treatment Options for PMS | Reduce stress, exercise three to five times each week, eat a balanced diet, use of benzodiazapines and nonbenzodiazapines.
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| PMDD | Mood disorder diagnosed with PMS; syclical occurance of symptoms; connected with the menses; starts in luteal phase up till cycle (that's when you notice PMS); interferes with life, stop smoking, decrease caffine intake.
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| Premenstrual Syndrome | Nursing: Assessment—irritability, tension, dysphoria most prominent and consistent symptoms----Categorize symptoms
A: anxiety
C: craving
D: depression
H: hydration
ACOG criteria: affective or somatic symptoms; mood disorders: main symptoms of PMDD.
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| PMS Nursing Management | Education
Diet, exercise
Medications
Counseling, stress management
Community resources and support
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| Endometriosis Risk Factors | Increasing age; Family hx of endometriosis in a first-degree relative; Short menstrual cycle (less than 28 days); Long menstrual flow (more than 1 week); High dietary fat consumption; Young age of menarche; Few (one or two) or no pregnancies
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| Endometriosis Etiology | Exact cause unknown
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| Endometriosis Therapeutic Management | Medications therapy—danazol, Lupron, Synarel (inhalant used to decrease growth of endometrial tissue), NSAIDS OR Surgery (laser or hysterectomy)
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| Endometriosis Nursing Management | Assessment—H&P; Manifestations—infertility and pelvic pain are two most common manifestations; Education; Healthy lifestyle habits; Support groups
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| Primary Infertility | Inability to conceive a child after 1 year of unprotected, regular sexual intercourse.
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| Secondary Infertility | Inability to conceive after a previous pregnancy.
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| Endometriosis | One of the top three reasons for infertility; Really painful, painful intercourse, urination or bowel movements; Effects quality of life.
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| Innfertility Facts | Widespread problem that has an emotional, social, and economic impact on couples; Impact of culture, ethnicity, and religion on perceptions and management of infertility
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| Infertility Risks for Men | Exposure to toxic substance;Cigarette and marijuana smoke;Heavy alcohol consumption;Hernia repair;Obesity associated with decreased sperm quality;STI’s;Frequent long-distance cycle or running;
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| Infertility Risks for Men....Continued | Undescended testicles;Mumps after puberty;Exposure of genitals to high temps.(tubs/saunas)
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| Infertility Risks for Women | Overweight/underweight; Hormonal imbalance; Uterine fibroids; Tubal blockages; Cervical stenosis; Endometriosis; Smoking and alcohol consumption; Multiple miscarriages; Exposure to chemotherapeutic agents; History of PID
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| Infertility—Therapeutic Management | Infertility—Therapeutic Management; Drugs; Clomid; Pergonal; Artificial insemination.
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| Infertility—Therapeutic Management.... Continued | Assisted reprod. technologies: In vitro fertilization (IVF);Gamete intrafallopian transfer (GIFT);Zygote intrafallopian transfer (ZIFT); Intracytoplasmic sperm injection (ICSI);Donor oocytes and sperm;Preimplantation genetic diagnosis (PGD);Surrogacy
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| To assist a woman in regaining control of the urinary sphincter for urinary incontinence, the nurse should teach the patient to do what? | Perform Kegal Exercises
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| Pelvic Support Disorders | Cystocele, Rectocele, Enterocele, Uterine prolapse
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| Cystocele | Bladder prolapse.
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| Rectocele | Rectum prolapse
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| Stage 0 of Uterine Prolapse | Stage 0: No descent of pelvic structure during straining
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| Stage I of Uterine Prolapse | Stage I: Prolapsed descending organ is >1 cm above the hymenal ring
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| Stage II of Uterine Prolapse | Stage II: The prolapsed organ extends 1 cm below the hymenal
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| Enterocele | Intestinal prolapse.
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| Stage III of Uterine Prolapse | Stage III: Prolapse extends to 2 to 3 cm below the hymenal ring
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| What does Pelvic Support Disorders include? | Includes pelvic organ prolapse and urinary and fecal incontinence
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| What does Pelvic Support Disorders cause? | Causes significant physical and psychological morbidity
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| Weakness of connective tissue and muscular support of pelvic organs related to: | Vaginal childbirth; Advancing age; Heavy work; Poor nutrition; Increasing body mass
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| Therapeutic Management of Pelvic Organ Prolapse | Kegel exercises; Hormone replacement therapy; Dietary and lifestyle modifications; Pessaries; Coplexin Sphere; Surgery (anterior or posterior colporrhaphy; vaginal hysterectomy)
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| Pelvic Organ Prolapse: Nursing Assessment | Health Hx (Respiratory): Risk factors;Clinical manif.(asymptomatic):feeling of dragging, lump in vagina, something “coming down”;Physical Exam (pelvic exam for obvious protrusion;bladder function);
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| Lab & Diagnostic Tests for Pelvic Organ Prolapse | Urinalysis, urine culture, post-void urine volume
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| Education for Pelvic Organ Prolapse Patients | Dietary/lifestyle changes; Pessary Use; Perioperative Care; Promote Prevention Strategies; Options—advantages/disadvantages
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| Pessaries | Synthetic device inserted into vagina to support rectum and organs.
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| Colpexin Sphere | Intervaginal device. Strengthens vaginal floor.
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| Anterior or Posterior Colporrhaphy | Tightens anterior and posterior vaginal wall with mild prolapse. Severe prolapse=vaginal hyserectomy.
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| Uterine Fibroids: Leiomyomas | Benign; Grow slowly; Cells don’t break away; Classified according to their position in uterus.
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| When do Leiomyomas have rapid growth & when do they generally start to shrink? | Rapid growth during childbearing years due to estrogen dependency; shrink during menopause
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| When do Leiomyomas peak? | Peak incidence around age 45
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| Uterine Fibroids Etiology | Age; Genetic predisposition; African American ethnicity higher risk; Hypertension; Nulliparity; Obesity
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| Medical Management of Uterine Fibroids | GnRH agonists; Progestin antagonist; Uterine artery embolization
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| Surgical Management of Uterine Fibroids | Myomectomy; Laser; Hysterectomy (abdominal, vaginal, laparoscopic)
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| Myomectomy | Performed as minor surgery; Uterus is preserved; Requires general anesthesia; New growth of fibroids occurs.
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| GnRH Agonists | Gonadatropin releasing hormones; lukron
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| Progestin antagonist | Mifepristone antogonist (blocks receptor site); help to reduce size of tumor befroe surgery; if medication works surgery may not be required; very expensive; some ppl cannot tolerate side effects as they mimic menopause (hot flashes, vag. dryness)
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| Uterine artery embolization | Inject polyvinal pellets to block circulation to fibroid in hopes of it shrinking; short-term fix; will need to be repeated.
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| Hysterectomy for treatment of fibroids | Complete removal of fibroids; immediate symptom relief.
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| Uterine Fibroid Nursing Assessment | Health history; signs and symptoms; Physical examination; ultrasound for confirmation
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| Other word for Uterine Fibroids | Leiomyomas
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| Difference between Endometriosis and Fibroids | Unlike Endometriosis, fibroids do NOT break away (they live around the uterine)
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| Intramural Fibroids | In muscular wall
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| Nursing Management of Uterine Fibroids | Preoperative teaching; Aftercare
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| Most follicular cysts regress and require no treatment... T OR F | True
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| Uterine Fibroid Embolization | Can cause decreased fertility; painful procedure; requires radiation and contrast dye; perm. implanted material; Min. invasive; dramatic decrease in symotoms; future fertilit is possible.
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| Types of Ovarian Cysts | Follicular; Corpus luteum; Theca-lutein; Polycystic ovarian syndrome (PCOS)
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| Follicular Cyst | Failure of an ovarian follical to rupture at the time of ovulation; no larger than 5cm; udually regress not requiring treatment; can be detected by vaginal ultrasound.
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| Corpus Luteum Cyst | Becomes Cystic or hemorragic and fails to breakdown after 14 days; can cause pain or delay of mensus; pelvic ultrasound can diagnose; appears after ovulation and usually resolves without intervention.
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| Theca-lutein Cyst | Rare; prolonged abnormally high levels of HCG cause these to form; may see with a hydatidiform mole; miscarry with this; can have coriocarcinoma from this; clomid therapy can cause this.
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| Polycystic Ovarian Sundrome (PCOS) | Multiple inactive follicle cysts that interfere with ovarian function.
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| PCOS Manifestations | Hirsutism (male-pattern hair growth); Sleep apnea; Amenorrhea; Infertility; Metabolic syndrome; Dyslipidemia; Elevated blood pressure
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| Hyperandrogenemia | These woman have facial hair (need to shave), receeding hairline, deep voice.
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| Hyperinsulinemia | Overweight (carry weight in the middle).
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| Hormone Treatment for Fibroids | Noninvasice; reduce size of fibroids; syptoms improved; serious side effects with long-term use; fibroids regrow when meds stop.
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| A post-menopausal woman with uterine prolapse is being fitted with a pessary. The nurse would be most alert for which side effect? | Vaginal Ulceration - can start to erode uterine tissue
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| When preparing a discharge teaching plan for the woman who had surgery to correct pelvic organ prolapse, what would the nurse include? | Care for the indwelling catheter at home.
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| Ovarian Cyst | Fluid filled sacs that forms on the ovary
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| PCOS | Most common medically treatable cause of infertility.
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| PCOS Therapeutic Management | Benign vs. solid ovarian malignancy: Transvaginal ultrasound; Laparoscopy; Oral contraceptives; Analgesics; May also be on drug or nondrug therapy (metoformin, glucagon, actose, clomid);need to make lifestyle changes (weight loss,exercise,low fat diet)
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| Ovarian Cyst Nursing Assessment | Health History; Signs and symptoms of PCOS; Physical Examination; Pelvic exam
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| Women with PCOS... | Increased risk for breast and ovarian cancer and endometriosis.
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| Ovarian Cyst Laboratory and Diagnostic Tests | Pregnancy test to rule out ectopic pregnancy; Ultrasound
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| Ovarian Cyst Nursing Management | Education about treatment options; Referral for surgery; Support and reassurance; Counseling and education for PCOS
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| Psychogenic Causes of Erectile Dysfunction (Emotional) | Anxiety; Fatigue; Depression; Negative body; Trust and relationship issues
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| Organic Causes of Erectile Dysfunction | Drugs; Cardiovascular disease; Endocrine disease (diabetes, pituitary tumors, testosterone deficiency, hyper or hypothyroidism, cerosis and drug abuse); Chronic renal failure; Neurological Disorders.
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| Drugs that may cause or worsen Erectile Dysfunction | Table 72.2 (page 1294 in Adams)
Antidepressants, antihypertensives, Nervous system agents, alcohol, anabolic steroids, chemotherapy agents, digoxin, methotrexate.
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| Assessment & Diagnostic Assessment of Erectile Dysfunction | Sexual and medical history; Analysis of presenting symptoms; Physical exam; Detailed assessment of all medications, alcohol, and drugs used; Lab studies (thyroxin levels); Nocturnal penile tumescence and rigidity (NPTR)
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| Medical Management of Erectile Dysfunction | Hormones (testosterone); PDE-5 inhibitors; Vasoactive agents; Psychotherapy; Surgical; Negative-pressure devices
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| Negative Pressure Devices | Vacuum placed over penis then place a ring at the base of the penis to maintain erection (cannot leave band on longer than 1 hour).
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| Psychotherapy | May need pharmacotherapy with counseling as well
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| Vasoactive Agents | Injected into the penis (papaverine or caverject) (can also be a mini suppository); side effects: pain, burning, abnormal erection).
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| PDE-5 Inhibitors | Maintains smooth muscle relaxation to improve blood flood to enhance erection; must take 1 hour before sexual activity; lasts 1-2 hours; can have headache, lightheadedness, diarrhea; ***should not take if they are taking nitrates.*** & retinopathy.
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| Surgical Treatment | Penile implants (semirigid rods or inflatable); done sometimes with pt's who are diabetic and/or when medications do not work; risk of infection, persistent pain, erosion of the prosthesis through the skin.
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| A nurse reviewing medical records of a patient. What would lead the nurse to suspect PCOS? | Elevated blood insulin levels; anovulation; triglyceride level of 175mg/dL
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| Nursing Management for Erectile Dysfunction | May require assistance from a sex therapist (if psychogenic); Support groups
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| Testicular Cancer | Most common cancer diagnosed in men 15-35 years of age; Second most common malignancy in men 35-39 years of age; Highly treatable and usually curable; 5-year survival rate: 95-99% if not spread outside of testes
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| Classifications of Testicular Cancers | Germinal tumors & nongerminal tumors & Secondary testicular tumors
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| Germinal Tumors | 90% of all cancers; Grow from germ cells that produce sperm; Called Seminomas; Nonseminomas
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| Nongerminal Tumors | Less than 10% of testicular cancers; Develop in supportive and hormone-producing tissues; if it matasticises it is not responsive to therapies.
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| Which systems contribute to erectile dysfunction? | Endocrine, Nervous, Cardiovascular
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| Risk Factors for Erectile Dysfunction | Undescended testicles (cryptorchidism); Family history of testicular cancer; Personal history of testicular cancer; Race and ethnicity (african american high risk); HIV-positive men; Occupational hazards
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| Assessment and Diagnostic Findings of Erectile Dysfunction | Annual testicular exam; History and Physical assessment; Blood chemistry; Tumor markers; Alpha-fetoprotein (AFP); Beta-human chorionic gonadotropin (beta-hCG); Chest x-ray; Transscrotal testicular ultrasound
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| Nocturnal penile tumescence and rigidity (NPTR) | Monitors number of erections during sleep; will determine whether cause is organic or psychogenic.
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| Medical Management of Testicular Tumors | Highly responsive to treatment;Goals (eradicate and cure)Therapy based on Cell type,Stage of disease,Risk of classification tables (good, intermediate, and good risk);Primary treatment—orchiectomy; Retroperitoneal lymph node dissection (RPLND);Radiation
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| Seminoma Tumor | Slow growing; can spread to lymphnodes but usually stay localized in testes
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| Nonseminoma Tumor | Grow quickly; made up of different cells
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| Most common cause of Secondary Testicular Tumors | Lymphoma
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| Assessment for Testicular Tumors | Assessment: Physical (look for enlarged testicals or testicular pain) and Psychological (self-esteem, etc.)
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| Nursing Management for Testicular Tumors | Monitor response to treatments; Pre- and post-operative teaching; Education—importance of adhering to follow-up care; TSE exam; Healthy lifestyle (quite smoking, limit alcohol). Can be monitored for long-term side effects during follow-up care.
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| Inguial Orchiectomy | Removing of the testes
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| Nursing DX's | Sexual dysfunction; Disturbed Body Image
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| Chemotherapy | Used with seminomas, nonseminomas; high results with chemotherapy; if not response to chemo it is probably incurable; Suggested to use birth control for first 18-24 months after last dose of chemo (not sure how it will effect fetus).
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| Long-term side effects of Chemotherapy | Renal insufficiency, hearing problems, gonadal damage, peripheral neropothy; can develope toxicity after chemo is complete; can have reoccurance as these pt's are at a higher risk for developing another tumor.
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