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Chapter 66 reproductive
Chapter 66: Patients With Reproductive and Breast Disorders
Learning Outcomes
Describe epidemiology of male reproductive disorders.
Correlate clinical manifestations to pathophysiological processes of conditions including:
Benign prostatic hyperplasia (BPH)
Erectile dysfunction (ED)
Prostate cancer
Testicular cancer
Breast cancer
Testicular trauma
Describe diagnostic results used to confirm diagnosis of male reproductive disorders.
Discuss interprofessional management for:
BPH
ED
Prostate cancer
Testicular cancer
Breast cancer
Testicular trauma
Develop a comprehensive nursing care plan for patients with male reproductive disorders.
Design a teaching plan incorporating pharmacological, dietary, and lifestyle considerations for patients with male reproductive disorders.
Key Concepts
Caring
Cellular Regulation
Elimination
Medication
Perioperative Care
Reproduction and Sexuality
Trauma
Essential Terms
Benign prostatic hyperplasia (BPH): Non-cancerous enlargement of the prostate gland.
Bladder outlet obstruction (BOO): Blockage of the urethra preventing urine from passing.
Brachytherapy: A form of radiation therapy where radioactive seeds are placed inside or near the tumor.
Breast cancer type 1 susceptibility protein (BRCA1): A gene that can increase the risk of breast cancer.
Breast cancer type 2 susceptibility protein (BRCA2): Another gene associated with increased breast cancer risk.
Digital rectal examination (DRE): A clinical examination to check the state of the prostate gland and rectum.
Ductal carcinoma in situ (DCIS): A non-invasive breast cancer.
Erectile dysfunction (ED): The inability to achieve or maintain an erection.
Human epidermal growth factor receptor 2 (HER2): A protein that can affect the growth of cancer cells.
Lower urinary tract symptoms (LUTS): Symptoms affecting the bladder and urethra.
Medicated urethral system for erection (MUSE): A treatment for ED involving a pellet.
Nocturia: Frequent urination at night.
Pagetβs disease: A type of breast cancer affecting the skin, specifically the nipple area.
Phosphodiesterase type 5 (PDE-5) inhibitors: Medications used to treat ED.
Prostate-specific antigen (PSA): A protein level used to check prostate health.
Transurethral resection of the prostate (TURP): A procedure to remove prostate tissue.
Watchful waiting: A treatment strategy for certain conditions, where monitoring is done without immediate intervention.
Benign Prostatic Hyperplasia (BPH)
Epidemiology
Affects approximately 50% of men aged 51 to 60 and around 90% of men over 80.
Occurs equally among all races.
Pathophysiology
The prostate is about the size of a walnut and surrounds the urethra.
Prostate enlargement is theorized to relate to hormonal changes involving testosterone and estrogen.
Enlarged prostate pinches the urethra interfering with urine flow.
Clinical Manifestations
Symptoms of BPH often relate to lower urinary tract symptoms (LUTS).
Symptoms include:
Difficulty starting urination
Weak urine stream
Interrupted flow of urine
Dribbling after urination
Urgency and frequent urination
Nocturia
Complications
Untreated BPH can lead to:
Bladder outlet obstruction (BOO)
Acute urinary retention (AUR)
Urinary tract infections (UTIs)
Bladder stones
Kidney damage
Diagnosis
Based on symptoms and confirmed with:
Digital rectal examination (DRE)
Urinalysis
PSA testing
Management
Non-pharmacological
Watchful waiting for mild symptoms.
Avoid fluid intake before bedtime to minimize nocturia.
Pharmacological
Medications include:
5-alpha-reductase inhibitors: Shrink the prostate by inhibiting DHT production.
Alpha-adrenergic blockers: Relax smooth muscles to ease urination.
Anticholinergics: Help relax bladder smooth muscle if overactive.
Surgical
Procedures like TURP are considered if medications are ineffective.
Nursing Interventions
Assess urinary symptoms and hydration status.
Educate about medication adherence and lifestyle modifications.
Monitor for signs of complications like UTIs.
Erectile Dysfunction (ED)
Epidemiology
Affects 30 to 50 million men in the U.S.
Incidence increases with age:
52% of men aged 40 to 70
70% of men over 70.
Pathophysiology
ED is the inability to achieve or maintain an erection.
Can stem from physical conditions like cardiovascular disease, diabetes, or neurological disorders, as well as psychological issues.
Management
Diagnosis
Based on patient complaints and medical history.
Treatment Options
Medications include:
Phosphodiesterase type 5 inhibitors (e.g., Viagra, Cialis).
Alprostadil (MUSE) for urethral insertion.
Intracavernosal injections for direct penile administration.
Surgical Management
Penile implants if conservative measures fail.
Nursing Interventions
Assess health history and emotional state.
Educate on medication use and side effects.
Prostate Cancer
Epidemiology
Commonly diagnosed cancer among men, particularly in North America.
One in eight men diagnosed, averaging diagnosis age is 66.
Increased risk factors include family history and high red meat and calcium diet.
Pathophysiology
Typically slow-growing, often asymptomatic in early stages.
Symptoms may present if tumor compresses surrounding structures.
Diagnosis
Prostate-specific antigen (PSA) testing remains controversial due to risks of overdiagnosis.
DRE can provide insights into prostate health.
Treatment
Options
Radiation therapy, hormone therapy, chemotherapy, or surgery.
Surgical Options
Radical prostatectomy and laparoscopic techniques are available.
Nursing Interventions
Educate regarding treatment options and potential side effects.
Testicular Cancer
Epidemiology
Relatively rare but increasing incidence, typically affecting younger males around 33 years.
Most common types: seminoma and non-seminoma.
Clinical Manifestations
Painless mass in the testicle, possible secondary symptoms like pain, back pain, or gynecomastia if metastasis occurs.
Diagnosis and Management
Diagnosis often requires ultrasound and tumor markers.
Management typically involves surgical removal followed by chemotherapy or radiation as applicable.
Nursing Interventions
Encourage self-examination and provide education on treatment and symptoms of recurrence.
Male Breast Cancer
Epidemiology
Rare, average diagnosis age is 60 to 70 years.
Risk factors include BRCA mutations and increased estrogen exposure.
Symptoms
Swelling or a lump in the breast, skin changes, discharge from the nipple, or axillary adenopathy.
Diagnosis and Treatment
Requires imaging studies and biomarker assessments for treatment planning.
Treatment options include surgery (mastectomy or lumpectomy), chemotherapy, and hormone therapy.
Nursing Interventions
Educate on self-examinations, wound care, and signs of infection.
Testicular Trauma
Epidemiology
Can involve blunt or penetrating trauma, often from sports injuries.
Management depends on the severity and location of the injury.
Nursing Interventions
Assess for pain, swelling, and bleeding.
Provide support and education on physical care surrounding recovery.
Conclusion
Understanding reproductive health disorders is essential for providing effective patient care and education on management options.
Chapter 66: Patients With Reproductive and Breast Disorders
Learning Outcomes
Describe epidemiology of male reproductive disorders and their impact on population health.
Correlate clinical manifestations to pathophysiological processes of conditions including:
Benign prostatic hyperplasia (BPH): Non-cancerous enlargement of the prostate which can lead to significant urinary issues.
Erectile dysfunction (ED): Affects a large proportion of men and can have psychological impacts.
Prostate cancer: Increasing incidence and the importance of screenings like PSA.
Testicular cancer: Awareness of self-examinations for early detection.
Breast cancer in males: Although rare, understanding risk factors is crucial.
Testicular trauma: Potentially serious, often needs urgent assessment.
Describe diagnostic results, including imaging and lab results, used to confirm diagnosis of male reproductive disorders.
Discuss interprofessional management for:
BPH: Lifestyle changes, medication options, and surgical interventions.
ED: Psychological support and treatment advancements.
Prostate cancer: Options for active surveillance versus aggressive treatment models.
Testicular cancer: Role of chemotherapy and support post-diagnosis.
Breast cancer: Current research into male breast cancer management.
Testicular trauma: Treatment protocols based on injury severity.
Develop a comprehensive nursing care plan that includes assessment, diagnosis, intervention, and evaluation for patients with male reproductive disorders.
Design a teaching plan incorporating pharmacological, dietary, and lifestyle considerations tailored specifically for patients with male reproductive disorders.
Key Concepts
Caring: The importance of compassionate care in addressing sensitive health issues.
Cellular Regulation: Understanding how cellular changes affect reproductive health.
Elimination: Management of urinary symptoms and its implications for overall wellness.
Medication: Awareness of pharmacological treatments and their side effects.
Perioperative Care: Importance of pre- and post-operative care in surgical patients.
Reproduction and Sexuality: Addressing sexual health openly and knowledgeably.
Trauma: Understanding trauma's impact on reproductive health.
Essential Terms
Benign prostatic hyperplasia (BPH): Non-cancerous enlargement of the prostate gland that can disrupt urinary function.
Bladder outlet obstruction (BOO): A condition resulting from BPH leading to significant urine passage issues.
Brachytherapy: An effective localized treatment option in selected cancer cases where radioactive seeds are implanted.
Breast cancer type 1 susceptibility protein (BRCA1) and BRCA2: Gene mutations significantly increasing the risk of breast cancer in both genders.
Digital rectal examination (DRE): A valid diagnostic tool for assessing prostate health, crucial in early detection.
Ductal carcinoma in situ (DCIS): A form of localized breast cancer with a favorable prognosis when caught early.
Erectile dysfunction (ED): A condition affecting sexual performance; understanding its multifaceted causes can aid treatment.
Human epidermal growth factor receptor 2 (HER2): Important in determining treatment for some breast cancers.
Lower urinary tract symptoms (LUTS): Symptoms indicative of underlying issues, crucial for diagnosis.
Medicated urethral system for erection (MUSE): A treatment option that offers an alternative to oral medications.
Nocturia: A symptom requiring assessment and management to improve sleep quality.
Pagetβs disease: A distinct type of breast cancer with unique presentations.
Phosphodiesterase type 5 (PDE-5) inhibitors: A first-line treatment for ED, requiring patient education on proper use.
Prostate-specific antigen (PSA): Key biomarker for prostate health monitoring.
Transurethral resection of the prostate (TURP): A common surgical treatment for refractory BPH.
Watchful waiting: Important management strategy that allows for controlled observation of conditions.
Benign Prostatic Hyperplasia (BPH)
Epidemiology
Affects approximately 50% of men aged 51 to 60 and around 90% of men over 80.
Seemingly occurs equally among all races, but prevalence can vary based on geographical and lifestyle factors.
Pathophysiology
The prostate, similar in size to a walnut, surrounds the urethra.
Enlargement theorized to involve a complex interplay between androgens and estrogens, particularly involving dihydrotestosterone (DHT).
Resultant pressure from the enlarged prostate leads to obstruction, causing uncomfortable urinary symptoms.
Clinical Manifestations
Symptoms often relate to lower urinary tract symptoms (LUTS), with frequent complaints of:
Difficulty initiating urination.
Weak urine stream and interrupted flow.
Post-urination dribbling.
Increased urgency and frequency of urinations, including nocturia.
Complications
Untreated BPH may cause:
Bladder outlet obstruction (BOO).;
Acute urinary retention (AUR), requiring immediate management;
Urinary tract infections (UTIs) and potential kidney damage.
Diagnosis
Diagnosis typically relies on both patient symptoms and clinical examination.
Confirmatory testing may include DRE, urinalysis, and PSA testing.
Management
Non-pharmacological
Monitoring of symptoms, with watchful waiting being a formal approach for mild manifestations.
Minimizing fluid intake in the evening to prevent nocturia.
Pharmacological
Treatment modalities include:
5-alpha-reductase inhibitors: Effective for reducing prostate size by limiting DHT.
Alpha-adrenergic blockers: Help in easing symptoms by relaxing urethral smooth muscles.
Anticholinergics: Beneficial in cases of bladder overactivity.
Surgical
Surgical options like TURP considered if pharmacological measures fail.
Nursing Interventions
Regular audits of urinary symptoms, hydration, and understanding patient adherence.
Educate patients on lifestyle modifications and medication management.
Regular monitoring for potential complications such as UTIs.
Erectile Dysfunction (ED)
Epidemiology
Affects 30 to 50 million men in the U.S.
Incidence increases with age, affecting 52% of men aged 40 to 70 and 70% of men over 70.
Pathophysiology
A multifactorial condition that includes both physical domains (like cardiovascular and diabetes conditions) and psychological factors such as stress and anxiety.
Management
Diagnosis
Based on thorough patient history and presenting symptoms to identify potential underlying conditions.
Treatment Options
Pharmacological treatments such as phosphodiesterase type 5 inhibitors (Viagra, Cialis), and alprostadil (MUSE) for urethral insertion are common.
Intracavernosal injections present another option.
Surgical Management
In cases where conservative measures fail, penile implants may be considered.
Nursing Interventions
Understanding and assessing patient health history, including emotional and relational aspects.
Providing thorough education regarding medication options, usage, and potential side effects.
Prostate Cancer
Epidemiology
One of the most commonly diagnosed cancers among men, particularly in North America, affecting 1 in 8 men on average at age 66.
Increased risk associated with family history, dietary influences, and ethnic background.
Pathophysiology
Characterized by often slow growth with minimal initial symptoms; more advanced cases may present significant local symptoms due to tumor expansion.
Diagnosis
PSA testing remains a cornerstone for diagnosis, despite its limitations and the ongoing debate over its usage due to possible overdiagnosis.
The DRE remains an essential tool aiding in evaluation.
Treatment Options
Treatment options include radiation therapy, hormone therapy, chemotherapy, and surgical approaches like radical prostatectomy.
Nursing Interventions
Critical patient education regarding the diverse treatment choices and their potential impacts on quality of life and health outcomes.
Testicular Cancer
Epidemiology
Testicular cancer is relatively rare but the incidence is increasing, with the average diagnosed patient around 33 years old.
The most common types are seminoma and non-seminoma.
Clinical Manifestations
Typically manifests as a painless testicular mass; can also include secondary symptoms such as back pain or gynecomastia.
Diagnosis
Ultrasound assessment along with tumor marker evaluations are key diagnostic strategies.
Management
Surgical intervention typically includes orchiectomy, followed by chemotherapy or radiotherapy as indicated.
Nursing Interventions
Emphasizing the importance of self-examinations; educating patients about treatment regimens, potential side effects, and signs of recurrence.
Male Breast Cancer
Epidemiology
An exceptionally rare form of cancer diagnosed predominantly in men aged 60 to 70 years; linked to BRCA mutations and hormonal exposures.
Symptoms
Presentations may include swelling, lumps, skin changes in the breast area, or discharge from the nipple.
Diagnosis and Treatment
Essential imaging studies and biomarker assessments to guide treatment protocols; options include mastectomy or lumpectomy and additional therapies such as hormonal treatments.
Nursing Interventions
Education on the importance of self-examinations, wound care, and awareness of infection signs post-surgery.
Testicular Trauma
Epidemiology
Can occur due to blunt or penetrating mechanisms, commonly observed in sports injuries.
Management
Treatment strategies range according to injury severity, from conservative management to surgical options.
Nursing Interventions
Focus on careful assessment of pain, swelling, and any signs of bleeding; provide adequate education and support surrounding recovery processes.
Conclusion
Understanding reproductive health disorders is essential for providing effective patient care and education on management options, ensuring that patients are well-informed and supported throughout their journey.
