Care Of The Adult Male Patient With Disorders Of Sexuality PDF

Care of the Adult Male Patient with Disorders of Sexuality  Presented by Mrs. K. Jones-Fraser RN, BScN, Cert. Nsg. Ed. MScN, PhD Candidate  Objectives  At the end of the lesson students should be able to:  i...

Care of the Adult Male Patient with Disorders of Sexuality  Presented by Mrs. K. Jones-Fraser RN, BScN, Cert. Nsg. Ed. MScN, PhD Candidate  Objectives  At the end of the lesson students should be able to:  identify correctly the structures of the male reproductive system based on class discussion  state four main functions of the male reproductive system as outlined in the text  explain correctly the management of the adult patient with disorders of sexuality (male) based on class discussion  outline correctly the nursing management of the adult patient with disorders of sexuality (male) using the nursing process Male Reproductive System   Structures of the Male Reproductive system   Testes  Ducts - ductus deferens, ejaculatory ducts and urethra  Accessory sex glands – seminal vesicles, prostate glands and bulbourethral glands  Supporting structure – scrotum and penis  Functions of the Male Reproductive System   Testes – produces sperm and the male sex hormone testosterone  Ducts – transport, store and assist in maturation of sperm  Accessory sex glands – secrete most of the liquid portion of semen  Penis – contains the urethra, a passageway for ejaculation of semen and excretion of urine  Scrotal Problems   Hydrocele  Orchitis  Hydrocele   Hydrocele is a swelling of the scrotum caused by accumulation of fluid, especially in the tunica vaginalis surrounding the testes (Wells & Weller, 2004)  Hydrocele  Signs and symptoms There are two types  Painless swelling to of hydroceles: scrotum 1. communicating 2. non-communicating  Hydrocele  Communicating hydroceles - are present at birth and occur because of the failure of the "tail" end of the process vaginalis to completely close off. Non- communicating hydrocele – are also present at birth and in older males. The tail end of the process vaginalis has closed. The fluid surrounding the testicle is created by the lining cells of the process vaginalis and is unable to either drain or be reabsorbed efficiently and thus accumulates.  Hydrocele   Process vaginalis sac or hallow organ of the peritoneal membrane that during embryonic development extends through the inguinal canal.  In males it descends into the scrotum to form the tunica vaginalis testis Normal Anatomy  Communicating Hydrocele  Non –Communicating Hydrocele   Hydrocele  Diagnostic investigation  History  Physical examination  Otoscope - the fluid filled nature of the hydrocele side is distinctly different from the non-involved side of the scrotum.  Ultrasound or X-ray  Hydrocele   Management  Surgery - a hydrocelectomy is performed  Nursing management  Assessment  Problem identification  Interventions  Orchitis  Definition Orchitis is inflammation of the testes  Etiology  Viral mumps infection  sexually transmitted diseases (STD), such as gonorrhea or chlamydia.  Orchitis  Signs and symptoms  Blood in the semen  Discharge from penis  Fever  Groin pain  Pain with intercourse or ejaculation  Dysuria  Scrotal swelling  Tender, swollen, heavy feeling in the testicle  Orchitis  Diagnosis  History  Physical examination  Tests may include:  Complete blood count  Testicular ultrasound  Tests to screen for chlamydia and gonorrhea (urethral smear)  Urine culture -- may need several samples, including initial stream, midstream, and after prostate massage  Orchitis  Management  Antibiotics  Anti-inflammatory medications  Bed rest with the scrotum elevated and ice packs applied to the area  Prostatitis   Prostatitis is an inflammation of the prostate gland (Brunner & Suddarth’s, 2008) Etiology  Infectious agents – bacteria, fungi  Urethral stricture, benign prostatic hyperplasia  Prostatitis  Types of prostatitis  Acute bacterial prostatitis  Chronic bacterial prostatitis  Chronic nonbacterial prostatitis/chronic pelvic pain syndrome.  Asymptomatic inflammatory prostatitis  Prostatitis  Clinical manifestations  Hyperthermia  Dysuria  Nocturia  Frequent urination  Lower abdominal pain  Prostatitis  Diagnosis  History  Physical examination  A digital rectal exam - to determine if prostate gland is enlarged or tender  Prostate fluid analysis -for signs of infection  Transrectal ultrasound  Biopsy  Voiding studies - to determine which part of the urinary system is infected.  Prostatitis   Management  Pharmacologic agents - Anti-inflammatory, antibiotic medication and muscle relaxants.  Surgery - surgical removal of the infected portions of the prostate.  Prostatitis  Nursing management  History  Physical assessment  Problem identification  Interventions  Benign Prostatic Hyperplasia   Benign prostatic hyperplasia (benign prostatic hypertrophy, BPH)- is enlargement of the prostate gland Causes  Genetics  Age  Changes in hormone balance and in cell growth  Benign Prostatic Hyperplasia  Clinical manifestations  Trouble getting a urine stream started and completely stopped (dribbling).  Often have an urge to pass urine  A weak urine stream.  A sense that the bladder is not completely empty after you urinate.  Benign Prostatic Hyperplasia  Investigations  History  Physical examination  Urinalysis  Blood test - serum creatinine  Digital rectal exam - feel the size of the prostate.  A prostate-specific antigen (PSA) test is done to rule out prostate cancer  Benign Prostatic Hyperplasia  Complications  Acute urinary retention  Urinary tract infections (UTIs  Bladder stones.  Benign Prostatic Hyperplasia  Management  Medication therapy  Alpha blockers -relax bladder neck muscles and muscle fibers in the prostate itself and make it easier to urinate. Example doxazosin (Cardura), tamsulosin (Flomax),  5 alpha reductase inhibitors - shrink the prostate by preventing hormonal changes that cause prostate growth, e.g finasteride (Proscar)  Surgery - prostatectomy  Benign Prostatic Hyperplasia  Nursing management  History  Physical examination  Nursing process  Cancer of the Prostate   Prostate cancer is a Risk factors: malignant (cancerous)  Black men are twice disease that consists of cells from the prostate likely as Caucasian gland. to get it Etiology  Family history  Unknown  Obesity  Mutations in the  Smoking abnormal cells' DNA  Sedentary lifestyle cause the cells to grow and divide  Cancer of the Prostate  Clinical manifestations  Trouble urinating  Decreased force in the stream of urine  Blood in the urine  Blood in the semen  Swelling in the legs  Discomfort in the pelvic area  Bone pain  Cancer of the Prostate   Diagnosis  Digital rectal exam  Prostate-specific antigen (PSA) test  Transrectal ultrasound  Sample of prostate tissue  Bone scan – to determine the extent of the cancer  Computerized tomography (CT) scan - to determine the extent of the cancer  Magnetic resonance imaging (MRI)- to determine the extent of the cancer  Cancer of the Prostate  Management  Radiation therapy  Hormone therapy  Surgery  Vasectomy   Vasectomy is the surgical excision of part of the vas deferens (Wells & Wellers, 2004)  A vasectomy is considered a permanent method of birth control. It prevents the release of sperm when the man ejaculates.  Vasectomy  Advantages Disadvantages  A vasectomy does not  Vasectomy is a permanent protect against sexually method of birth control. transmitted diseases(STDs).  Once your semen does not  It is expensive contain sperm, there is no  It should be used with a need to worry about using condom to prevent the other birth control transfer of infections methods.  It may take a few months  Vasectomy is a safe before the semen is free procedure from sperm.  Vasectomy   Management  Before procedure  Counseling  Education  Stop taking aspirin or other blood-thinning medications  Wash your genital area thoroughly  Vasectomy   After procedure  Counseling  Education  Support the scrotum  Limit activity  Use an ice pack  Avoid blood-thinning medications for three to seven days after surgery  Refrain from bathing or swimming  Avoid any sexual activity for a week  Keep appointment  Report signs of infection  Erectile Dysfunction   Erectile dysfunction (ED) is the inability to achieve or sustain an erection suitable for sexual intercourse.  Erectile Dysfunction  Etiology - can be both physical and psychological  Physical causes  Chronic illnesses - hypertension, high cholesterol and diabetes  Hormonal problems  Ineffective blood flow to penis  Surgery or injury  Psychological causes  Anxiety  Depression  Relationship problems  Erectile Dysfunction  Signs and symptoms  Inability to get and maintain an erection for satisfactory intercourse.  Erectile Dysfunction  Diagnostic investigations  History  Physical examination  Digital rectal examination  Blood investigation – hormone level of testosterone  Psychological assessment  Erectile Dysfunction   Management  Medication- hormone replacement  Psychological treatment  Surgery  Disorders of Sexuality (male)   Testicular cancer  Cancer of the penis  References   Smeltzer, S.C., Bare, B.G., Hinkle, J.L., & Cheever, K.H, (2008). Textbook of medical and surgical nursing. Philadelphia PA: Lippincott Williams & Wilkins.  Tortora, G.J, & Grabowski, S., (2002). Principles of anatomy and physiology. USA: John Wiley & Sons.  www.medicinenet.com/prostate_cancer/ article.htm