Chapter 43 Nursing Care of Male Patients with Genitourinary Disorders

Answers CHAPTER 43 NURSING CARE OF MALE PATIENTS WITH GENITOURINARY DISORDERS AUDIO CASE STUDY Mr. Poole and Transurethral Resection of the Prostate 1. To monitor bleeding. 2. Lifting, activity, straining for a bowel movement, use of aspirin, NSAIDs, or anticoagulants. 3. Reduce pain from bladder spasms. VOCABULARY 1. retrograde 2. priapism 3. Phimosis 4. Smegma 5. circumcision 6. Cryptorchidism 7. orchitis 8. erectile dysfunction 9. varicocele 10. vasectomy DISORDERS OF THE MALE REPRODUCTIVE SYSTEM 1. (3) 2. (5) 3. (1) 4. (2) 5. (10) 6. (7) 7. (4) 8. (6) 9. (8) 10. (9) ERECTILE DYSFUNCTION REVIEW 1. medication 2. stress 3. hypertension 4. TURP (transurethral resection of the prostate) 5. heart failure 6. multiple sclerosis CRITICAL THINKING 1. Use the WHAT’S UP? format to assess Mr. Washington’s symptoms. The most important question is what he means by “can’t pass water” and how long it has been since he last urinated. If he truly can pass no urine, the situation is an emergency. You can also observe for bladder distention, but palpation may be best done by the physician because of the risk for injury. Ask if he has ever been told he has prostate problems. If it has been a long time since he urinated last or the bladder appears distended, have the physician see the patient as soon as possible. 2. In an older man, prostate enlargement is a common cause of urinary problems and inability to urinate. Benign prostatic hypertrophy and cancer of the prostate gland are two possibilities. 3. Be prepared to assist with Foley catheter insertion. It may be difficult to insert the catheter past an enlarged prostate, so the physician may need to be involved. The catheter can maintain urine flow until Mr. Washington is transferred to the hospital for further diagnostic tests and possible surgery. Find out how Mr. Washington got to the urgent care center and arrange a ride to the hospital if needed. 4. If urine flow continues to be blocked, hydronephrosis, infection, and rupture of the bladder can occur. 5. “A special scope will be inserted into your penis that will chip away the enlarged parts of your prostate gland. You will be anesthetized so you won’t feel it. Afterward, you can expect to have a catheter in your bladder for several days.” 6. The catheter has several purposes. It allows urine to drain, places pressure on the resected gland to minimize bleeding, and provides a route to irrigate the bladder so blood clots can be removed. When totaling intake and output, irrigation solution should be included in the intake measurement because it is impossible to separate urine from solution in the output. 7. Bladder spasms are very painful, and the patient will inform you if they are occurring. Spasms may also cause leakage of urine around the catheter. Anesthetics and antispasmodic medications such as belladonna and opium suppositories can help the discomfort. Irrigation of the catheter can flush out clots that can increase spasms. Relaxation exercises may also help. 1 2 Chapter 43 Answers 8. Tell Mr. Washington that some episodes of incontinence may occur but that they should subside in a few weeks. Teach him to do Kegel exercises to increase sphincter tone. He should not restrict fluids because this can increase risk for urinary tract infection. A condom catheter or penile pad may help catch urine until incontinence improves. His panic could have been prevented by careful discharge teaching, letting Mr. Washington know what to expect and what to do about it. REVIEW QUESTIONS—CONTENT REVIEW The correct answers are in boldface. 1. (3) is correct. Always replace the foreskin to prevent impairment of circulation and the possibility of not being able to replace it later. (1) is incorrect. Never leave the foreskin retracted. (2) is incorrect. The foreskin should be retracted if possible to wash the area. (4) is incorrect. Mild soap, not alcohol, should be used. 2. (1) is correct. Monthly testicular self-examination is one method to detect testicular cancer. (2) is incorrect. Digital rectal examination is used to detect prostate enlargement. (3) is incorrect. An annual physical examination is advised, but it does not take the place of monthly checks for early detection. (4) is incorrect. Ultrasound is not done routinely to detect testicular cancer. REVIEW QUESTIONS—TEST PREPARATION The correct answers are in boldface. 3. (1, 3, 6) are all correct. (2) is incorrect. Erectile dysfunction is not a symptom of benign prostatic hyperplasia. (4, 5) are signs of kidney disease or metastasized cancer. 4. (3) is correct. Sexual function is only occasionally affected. (1) does not answer his question. (2, 4) imply that dysfunction is expected, which is not true. 5. (2) is correct. The belladonna and opium suppository will relieve bladder spasms. (1) is incorrect. Morphine relieves pain but not spasms. (3) is incorrect. Warming the solution is not recommended. (4) is incorrect. Notifying the physician STAT is not necessary; bladder spasms are an expected occurrence. 6. (3) is correct. The catheter needs to be kept free of clots so that it drains the bladder. (1) is incorrect. Irrigation does not stop bleeding. (2) is incorrect. Antibiotics are not normally in the irrigating solution. (4) is incorrect. Irrigation does not affect urine production. 7. (2) is correct. Kegel exercises will help strengthen sphincter tone. (1) is incorrect. Restricting fluids increases risk of infection. (3) is incorrect. Reinserting the catheter will only delay the problem. (4) is incorrect. Incontinence may last several weeks. 8. (4) is correct. Asking an open-ended question will help the patient share his concerns at his level of comfort. (1) is incorrect. The information provided does not support a diagnosis of impaired communication. (2) is incorrect. Not all patients are helped by verbalizing concerns. (3) is incorrect. This does not allow the patient to identify his own concerns. 9. (2) is correct. The scrotum will be painful and swollen. (1, 3, 4) are not symptoms of epididymitis. 10. (2) is correct. A respiratory rate of 36 indicates respiratory distress and is the first priority. (1, 3, 4) are all important and should be addressed once breathing has been stabilized. 11. (1) is correct. Male hormones continue to be produced after a vasectomy and levels do not need to be checked; this statement indicates need for further teaching. (2) is incorrect. The patient should be encouraged to continue using another birth control method for about 3 months after surgery to be sure there are no sperm left in the tract above the surgical site. (3) is incorrect. There should be no major change in the way the ejaculate looks or feels following the procedure. (4) is incorrect. A semen sample should be sent to be evaluated for the absence of sperm before the procedure is considered successful.