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Male Reproductive System

Glands
 Testes
- scrotum (one testis in each
compartment)
- composed of tiny tubules
(seminiferous tubules) embedded
in connective tissue containing
interstitial cells
- ducts emerge to enter the head
of epididymis
- Seminiferous tubules carry on
spermatogenesis (formation of
spermatozoa – male sex cells)
- Interstitial cells secrete
testosterone, increases protein
synthesis, induces growth of
secondary sexual characteristics &
promotes development of brain in
fetus
Male Reproductive System
Accessory glands
 Seminal vesicles
- secrete nutrient-rich fluid (30%
of semen)
 Prostate gland
- secretes 60% of semen
- prostatic secretion is alkaline
(increases sperm motility
- contains enzyme acid
phosphatase
 Bulbourethral glands (Cowper’s
glands)
- secrete alkaline fluid that
lubricates urethra prior to
ejaculation
Male Reproductive System
Ducts
 Epididymis
- conducts seminal fluid (semen)
from testes to vas deferens
- sperm mature while semen is
stored prior to ejaculation
 Vas deferens (seminal ducts)
- conduct sperm & small amount
of fluid from each epididymis to
an ejaculatory duct
 Ejaculatory ducts
- ejaculate semen into urethra
 Urethra
Male Reproductive System
External Supporting structures
 Scrotum
- contains testes, epididymis &
first part of seminal duct
- allows sperm to develop at 2-
3 degrees below body
temperature
 Penis
- contains large vascular spaces
that when filled with blood
causes erection
- contains urethra
Male Reproductive System
Internal Supporting structures
 Spermatic cords
- fibrous tubes located in each
inguinal canal
* testicular torsion results in
twisting of spermatic cords
URETHRAL DISORDERS
 1. Which of the following terms is used to describe the
opening of the urethra on the dorsum of the penis?

 A. Epispadias
 B. Hypospadias
 C. Urethral stricture
 D. Urethritis
 Epispadias
 Epispadias is a congenital anomaly in which the urethral
opening is on the dorsum of the penis and is usually repaired
through plastic surgery when the boy is very young.

 Hypospadias
 Hypospadias is a congenital anomaly in which the urethral
opening is on the underside of the penis and is usually repaired
through plastic surgery when the boy is very young.

 Urethral stricture
 Urethral stricture is a condition in which a section of urethra is
narrowed.

 Urethritis
 Urethritis refers to inflammation of the urethra and is
commonly associated with sexually transmitted disease.
 Pathology: developmental anomalies or inflammatory process
 Risk: congenital, instrumentation, improper hygiene
 Dx: PE and clean catch UA
 Cardinal sign:
Hypospadia: urethral meatus on lower(ventral) aspect
Epispadia: urethral meatus on upper(dorsal) aspect
Phimosis: unretractable foreskin
Balanitis: infection of foreskin and dysuria
Urethritis: dysuria and penile discharges
 DOC: oral or topical ABx or steroids/ surgical correction for
congenital anomaly
 Nurse concern: IEC on males with intact foreskin to retract
foreskin prior to voiding and penile hygiene after voiding or sex.
PROSTITIS
 Pathology: ascending infection
 Risk: instrumentation,alcohol,caffeine, spicy foods
 Dx: UA and PE
 Cardinal sign: Acute: dysuria, fever, discharges
pain during ejaculation
Chronic: asymptomatic or nocturia
 \DOC: ABx
 Nurse concern: IEC on avoiding alcohol and caffeine
BPH
1. Nursing assessment of the patient with BPH would
most likely reveal:

a. Dysuria, urinary hesitancy & dribbling


b. Flank pain, and decreased caliber of
urine stream
c. Urinary frequency, nocturia &
decreased force of urine stream
d. Hematuria, urinary hesitancy & pyuria
2. The physician schedules Mr. Sammy for a
transurethral resection of the prostate (TURP) under
spinal anesthesia. Before surgery, the nurse should tell
the patient that:

a. He may receive continuous bladder irrigation


after the procedure
b. The procedure may cause impotency
c. Sterility is a common complication of this
procedure
d. The physician will remove the entire prostate
during the procedure
3. Because of the position Mr. Sammy must assume
during TURP, the nurse should assess post-op for:
a. Infection of the incision site
b. Thrombophlebitis
c. Atelectasis
d. Water intoxication
4. On the 4th day after the procedure, the physician
removes Mr. Sammy’s foley catheter. Without the
catheter, he complains of wetting his pajamas to the
nurse. Which nursing intervention is most
appropriate?

a. Advising the patient to contract his perineal


muscles periodically
b. Restricting his fluid intake
c. Applying condom catheter
d. Suggesting that the patient voids as soon as the
urge occurs
5. The physician inserts a foley catheter to relieve
Mr. Sammy’s urine retention. Which nursing
instruction would NOT help maintain the patency
of the drainage system?

a. Taping the catheter to the inner aspect


of the thigh
b. Forcing fluids more than 3000 ml/day
c. Keeping the drainage bag below the bladder
level
d. Positioning the tubing without dependent
loops
6. He is scheduled for suprapubic prostatectomy and
is unable to empty his bladder completely.
Indwelling catheter should be inserted if the
amount of residual urine is more than:

a. 25 – 75 ml
b. 10 – 25 ml
c. 75 – 100 ml
d. 5 – 10 ml
7. Constant bladder irrigation is performed during
the first few days after his surgery. The rationale
for doing this is to:

a. Prevent calculi formation


b. Prevent the bladder from bacterial
formation
c. Prevent hemorrhage
d. Prevent blood clot formation
8. While the indwelling catheter is in place, Toni
complains of a continuous urge to void. His nurse
discuss that this sensation is due to:

a. The flow of the fluid from the


cystoclysis bottle
b. The calculi formation
c. The clogged catheter
d. The catheter and bladder spasms
9. What is the common complication likely to occur
2 weeks post TURP?

a. Bladder spasm
b. Urinary bleeding
c. Dribbling of urine
d. Fever
 Pathology: hypertrophy of prostate from decrease testosterone
and increase estrogen which increases sensitivity to
dihydrotestosterone(DHT)decrease urethral diameter.
 Risk: age above 40
 Dx: Prostate biopsy and USG
 Cardinal sign: asymptomatic to difficulty starting voiding, weak
stream, nocturia, and dribbling.
 \DOC: finasteride ( proscar) to inhibit the action of DHT
 Nurse concern: IEC on prostatectomy, CBI, post op bladder
spasms, avoidance of NSAIDs 10 days prior to operation.
PROSTATE CANCER
Prostate Cancer
 Slow malignant change in
the prostate gland that
spreads by direct invasion of
surrounding tissues &
metastasizes to the bony
pelvis & spine
 Most common site of cancer
in men (21%)
 Dihydrotestosterone – only
factor clearly associated with
development of prostate
cancer
1. Incidence of prostate cancer in Asian countries is
rising rapidly as reported by health bulletins,
why is this?

a. increasing adoption of western lifestyle


b. Promiscuous behavior of men
c. Increase in drinking & smoking habits
d. Early detection
2. With this awareness of prostate cancer, what is
the good screening method that a nurse can
suggest:

a. Annual physical check-up


b. Weight loss watching
c. X-rays & ultrasound analysis every 2
years
d. PSA analysis once a year
3. Decisions for the treatment of prostate cancer
depends on:

a. Nurse assessment advice to patients


b. Attending physician and his management
staff
c. Pathology of the cancer & impact on
quality of life
d. Age & health status of the person
4. One of the latest discovery in the treatment of
prostate cancer is:

a. Surgery
b. Anti-androgen
c. Chemotherapy
d. Radiation
 Pathology: similar to BPH
 Risk: age, ethnicity, chemical exposures
 Dx: PSA more than 4.0; DRE, USG
 Cardinal sign: depends on stage:
A1= asymptomatic
B2= enlarged prostate
C3= urinary symptoms, rectal or pelvic pain
D4= ++ lymph, bone, liver, lung area pain
 \DOC: Hormone therapy and chemo-radiation Tx
Other Tx: TURP
 Nurse concern: testosterone dependent at early stage; client will become
impotent if abdominal prostatectomy is done; age of client at diagnosis is
usually 65; assess mouth for stomatitis, for signs of dehydration, and for
suicidal tendencies; Support for body image or sexual issues.
TESTICULAR CANCER
 1. Which of the following terms refers to surgical
removal of one of the testes?

 A. Orchiectomy
 B. Circumcision
 C. Vasectomy
 D. Hydrocelectomy
 Rare form of cancer
 Most common cancer in
young men (15 – 35 y/o)
 Unknown cause
 High incidence in
cryptorchidism or
atrophic testis
 Pathology: germ or stromal cell carcinoma, seminoma
replacing parenchymal tissues.
 Risk: Hx of cryptorchidism, trauma, DES exposure, low
birth weight, prematurity
 Dx: HCG, AFP, LDH
 Cardinal sign: painless, hard nodule on one side of testes.
Usual metastases on lymph, lung, bone and GI.
 \DOC: Etopside (Vepesid) plus cisplatin chemo.
Other Tx: orchiectomy
 Nurse concern: IEC on sperm banking if client desires
fertility and on TSE.
DYSFUNCTIONAL UTERINE
BLEEDING
 Pathology: lack of progesterone, adenomyosis, fibroid tumors (
intramural, submucosal, subserosal)
 Risk: age( adolescent, 30-40s), family history, stress, weight
changes, oral contraceptive, IUD, PID, polyps, athletic activity,
blood dyscrasias.
 Dx: CBC, HCG, pelvic USG, pap smear, hysteroscopy
 Cardinal sign: Amenorrhea, oligomenorrhea, menorrhagia,
metrorrhagia, post menopausal bleeding.
 \DOC: hormones ( Progesterone) , oral contraceptive
( 3-6mos), iron supplements
 Other Tx: myomectomy, hysterectomy.
 Nurse concern: Diagnosis is confirmed thru response to meds or
thru biopsy; use of bleeding calendar.
DYSMENORRHEA
 1. A 15 year old client complains of persistent
dysmenorrhea. The nurse would encourage her to:

 A. maintain normal activities


 B. have a gynecologic exam
 C. eat a nutritious diet containing iron
 D. practice relaxation of abdominal muscles
 Pathology: Primary: excessive prostaglandin causing strong
contraction leading to ischemia and pain as exagerrated by
anxiety and stress.
Secondary: from scarring or injury
 Risk: smoking, early menarche, non-use of oral contraception,
STDs, instrumentation.
 Dx: History, pelvic exam, FSH-LH
 Cardinal sign: abdominal pain with onset of menses or 12-48
hours after menses starts; headache, diarrhea, syncope.
 \DOC: Norethindrone and ethinyl estradiol ( brevicon) to
decrease length and amountbof menses; NSAIDs and analgesics
 Nurse concern: symptoms decline/ disappear after first
pregnancy or as aging; Hydrate; Increase Calcium in diet; Apply
heat to lower abdomen; knee-chest position.
PID
 1. The most therapeutic position for a client with PID
would be the:

 A. Sim’s position
 B. Fowler’s position
 C. Lithotomy position
 D. Supine position with knees flexed
 Pathology: ascending infection during ovulation, menstruation,
douching, birthing, abortion and surgery. Common pathogen:
neisseria gonorrhea, Chlamydia tracomatis, E. coli, Gardnerella
vaginalis.
 Risk: IUD, oral contraceptive, STDs, multiple sex partners, 15-24
women who are nulliparous.
 Dx: History, C&S, Pap smear
 Cardinal sign: low abdominal pain, vaginal discharges,
dysmenorrhea, dyspareunia, dysuria
 \DOC: ABx and anti-protozoal( metronidazole-flagyl)
 Nurse concern: Completion of ABx, avoiding douching; IEC on
complications ( infertility, ectopic pregnancy, pelvic abscess)
ENDOMETRIOSIS
 Pathology: growth of endometrial tissue outside uterus which
responds to hormonal mechanism of menstrual cycle blood &
tissue cannot shed off causing inflammation, scarring, further
growth and infertility.
 Risk: nulliparity, family history
 Dx: Laparoscopy and history
 Cardinal sign: dysmenorrhea, dyspareunia, dysuria, painful BM
during menses.
 \DOC: Hormone therapy ( Lupron), NSAIDs to inhibit
prostaglandin synthesis, synthetic GRH to raise estrogen and
progesterone
 Nurse concern: Common side effect of meds are hot flashes,
fluid retention, gall stone and withdrawal bleeding; Provide
support on fertility issues.
CERVICAL CANCER
 1. When the results of a Pap smear are reported as
class 5, the nurse recognizes that the common
interpretation is:

 A. malignant.
 B. normal.
 C. probably normal.
 D. suspicious.
 malignant.
 A class 5 Pap smear, according to the Bethesda
Classification, indicates squamous cell carcinoma.

 normal.
 A class 1 Pap smear is interpreted as normal.

 probably normal.
 A class 2 Pap smear is interpreted as probably normal.

 suspicious.
 A class 3 Pap smear is interpreted as suspicious.
 2. For women aged 19-39 years, recommended health
screening diagnostic testing includes which of the
following?

 A. Pap smear
 B. Mammography
 C. Cholesterol and lipid profile
 D. Bone mineral density testing
 Pap smear
 A Pap smear is recommended for women aged 19-39 years, as
well as for women aged 40 and older.

 Mammography
 Mammography is recommended for health screening for women
aged 40 years and older.

 Cholesterol and lipid profile
 Cholesterol and lipid profile is recommended for women aged
40 years and older.

 Bone mineral density testing


 Bone mineral density testing is recommended for women aged
40 years and older.
 Pathology: ductal or lobular breast carcinoma that is
hormone dependent can be in-situ or invasive;
inflammatory or Paget’s.
 Risk: family history, chest area radiation, americans,
menarche before age 12 or menopause after 50, hormone
therapy for 5 years, nulliparity, first pregnancy after 30,
never breastfed, daily alcohol use, obesity.
 Dx: mammography, BSE, fine needle biopsy.
 Cardinal sign: hard irregular painless, fixed mass or thickening
in breast area; red, scaly patchy breast skin; nipple invertion and
peau d’ orange ( inflammatory).
 For paget’s type: itching, burning crusting or ulceration
of nipple.
 \DOC: estrogen antagonist( tamoxifen) and other chemo drugs.
Other Tx: Lumpectomy or mastectomy with axillary node
dissection followed by radiation.

 Nurse concern: Drainage tube care; ROM exercises; ways to


prevent complications. Screening for women.
BREAST CANCER
 1. Breast self examination is an important tool in
detecting early stages of Breast Cancer. What is being
checked when doing BSE?

 A. Thickness and Lumps


 B. Malignant or Benign Tumors
 C. Calcification of Breast
 D. Cancerous Lesions
 2. The nurse puts a folded towel under the Left shoulder of
the Client to be examined for clinical BSE. Why is this so?

 A. To make the left shoulder nearer to the hands of the


clinician for palpation
 B. To make the pectoralis muscle prominent, toning the
breast tissue for better palpation
 C. To put the breast in a more lateral position to better
ease the palpation
 D. To balance the breast in the client’s chest to better
eases the palpation
 3. Anita is performing BSE and she stands in front of
the Mirror. The rationale for standing in front of the
mirror is to check for:

 A. Unusual discharges coming out from the breast


 B. Any obvious malignancy
 C. The Size and Contour of the breast
 D. Thickness and lumps in the breast
 4. An emerging technique in screening for Breast
Cancer in developing countries like the Philippines is:

 A. Mammography once a year starting at the age of 50


 B. Clinical BSE Once a year
 C. BSE Once a month
 D. Pap smear starting at the age of 18 or earlier if
sexually active
 5. The most common complication associated post op
mastectomy is:

 A. Hemorrhage
 B. Lymphedema
 C. Self esteem disturbance
 D. Pain
 6. Post op mastectomy, The nurse would do the
following to prevent unnecessary injury to the Arm of
the client except:

 A. BP taking from the affected arm


 B. No IM Injection to the affected arm
 C. Elevating the affected arm
 D. Preventing trauma and injury to the affected arm
 7. Stage 3 of breast development, according to Tanner,
occurs when:

 A. the areola (a darker tissue ring around the nipple)


develops.
 B. breast budding begins.
 C. the areola and nipple form a secondary mound on
top of breast tissue.
 D. the breast develops into a single contour
 the areola (a darker tissue ring around the nipple) develops.
 Stage 3 also involves further enlargement of breast tissue.

 breast budding begins.


 Breast budding is the first sign of puberty in a female.

 the areola and nipple form a secondary mound on top of breast


tissue.
 In stage 4, the nipple and areola form a secondary mound on top
of breast tissue.

 the breast develops into a single contour


 In stage 5, the female demonstrates continued development of a
larger breast with a single contour.
 Pathology: squamous cell carcinoma
 Risk: low socio-economic status, early 1st marriage, early and
frequent intercourse, multiple sex partners, high parity, poor
post partum care and hygiene, HPV, teen age smoking
 Dx: Pap smear, colposcopy, endocervical curettage, conization,
schiller’s test.
 Cardinal sign: vaginal bleeding post coital and post menstrually;
foul discharges, pelvic pain
 DOC: cisplatin; radiatio therapy
 Surgical Tx: TAH-BSO or pelvic exenteration with permanent
ileostomy or colostomy
 Nurse concern: nuns and jews have lowest incidence; IEC on
annual gynecologic exam
MENOPAUSE
 1. Aling Maria is nearing menopause. She is habitually
taking cola and coffee for the past 20 years. You
should tell Aling Maria to avoid taking caffeinated
beverages because:

 A. It is stimulating
 B. It will cause nervousness and insomnia
 C. It will contribute to additional bone
demineralization
 D. It will cause tachycardia and arrhythmias
 2. Aling Maria, age 35 is a premenopausal woman. In
teaching premenopausal woman about breast self
examination, you will instruct her to perform monthly
BSE:

 A. After Menstruation
 B. First day of menstruation
 C. Last day of menstruation
 D. During Menstruation
 Physiology: ending of ovarian function ccuring on 40-50’s.
 Dx: History
 Cardinal sign: From decrease estrogen levels: absence of menses,
hot flashes, stress incontinence, vaginitis, dry skin, weight gain,
osteoporosis.
From psychologic effects: normal sexual urges,
seen as end of womanhood, nervousness, dizziness.

 DOC: Low dose estrogen with progesterone


 Nurse concern: Encourage expression of feelings; low fat diet;
routine exercise; oils and lotion for dry skin; use lubricants for
vaginal atrophy; Yearly PE
OTHER DISORDERS
 1. Which of the following terms refers to difficult or painful sexual
intercourse?

 A. Dyspareunia
 Dyspareunia is a common problem of the aged female.

 B. Amenorrhea
 Amenorrhea refers to absence of menstrual flow.

 C. Dysmenorrhea
 Dysmenorrhea refers to painful menstruation.

 D. Endometriosis
 Endometriosis is a condition in which endometrial tissue seeds in other
areas of the pelvis.
 2. The opening into the vagina on the perineum is termed the:

 A. introitus.
 The introitus is the vaginal orifice.

 B. adnexa.
 Adnexa is a term used to describe the fallopian tubes and
ovaries together.

 C. cervix.
 The cervix is the bottom (interior) part of the uterus that is
located in the vagina.

 D. hymen.
 The hymen is a tissue that may cover the vaginal opening
partially or completely before vaginal penetration.
 3. An opening between the bladder and the vagina is called a:

 A. vesicovaginal fistula.
 A vesicovaginal fistula may occur because of tissue injury sustained
during surgery, vaginal delivery, or a disease process.

 B. cystocele.
 A cystocele is a downward displacement of the bladder toward the
vaginal orifice.

 C. rectocele.
 A rectocele is a bulging of the rectum into the vagina.

 D. rectovaginal fistula.
 A rectovaginal fistula is an opening between the rectum and the vagina.
 THANK YOU!!!

 DIANNE MAYDEE MANDAL, RN, USRN, REMT-B,


AREMT-B

 http://stuffednurse.blogspot.com

 eye_contact_poor@yahoo.com

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