LAST PEDS TSET

Chapter 41
Male reproductive system

Male reproductive system Spermatogenesis

Testes-
o located in scrotum
o Temp slightly lower than body temp
Necessary for viable
sperm
o @ 5cm long- 3 cm wide
o Contains seminiferous tubules
Spermatogenesis
(meiosis) takes place
FSH (follicle stimulating
hormone) stimulates
spermatogenesis
continues thru life
Oogenesis starts at
puberty and is on a cycle
LH (luteinizing hormone)
stimulates testosterone,
which matures the sperm
Inhibin is stimulated by
testosterone, it decreases
secretion of FSH, helps
keep spermatogenesis
constant
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Epididymis, ductus deferens, & ejaculatory o Sexual stimulation causes arterioles to

ducts dilate, sinuses to fill with blood, and
Ducts that lead sperm into and thru penis becomes erect and firm
the pelvic cavity where secretions are o PARASYMPATHETIC impulses
added, semen leaves body thru o Culmination of sexual stimulation is
urethra called ejaculation- peristalsis of
Epididymis- comma shaped tube about reproduction ducts and contraction of
6 meters long the prostate gland.
o Coiled around posterior side of Spermatozoa
testes o Head of sperm contains 23
o Smooth muscle in the walls propel chromosomes
sperm into the ductus deferens o Mid piece connects head to the
(vas deferens) flagellum
Vas deferens- extends thru the o Formed in seminiferous tubules and
epididymis in the scrotum to the stored in the epididymis
ejaculatory ducts within the pelvic AGING
cavity o Testosterone secretion and sperm
Two ejaculatory ducts receives sperm production diminish but do not stop
from the ductus deferens and the o Most common problem is the
secretion of the seminal vesicle enlargement of the prostate, called
bilaterally. benign prostatic hyperplasia
Both ejaculatory ducts propel semen
thru the urethra
Seminal vesicles, prostate gland, and
bulbourethral glands
o Alkaline secretions of the male
reproductive glands make sure sperm
remains viable in the acidic
environment of the vagina
o Sperm PH is 7.4
Urethra and penis
o Last male reproductive duct
o Longest portion in the penis
o Penis called glans penis, has prepuce
(foreskin) when uncircumcised
o 3 areas of erectile or cavernous tissue
o Minimal blood flow = flaccid penis
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o Self-palpation
o You may be sensitive to changes when
done regularly and thorough, you may
notice something HCP does not
o Monthly
o One week after menses
o Swelling and edema are at a minimum
o Report
o Differences btwn breasts
o Change in size of one
o Puckering or dimpling of skin
o Asymmetrical movement
o Different pointing position of the
nipples
o Include tail of spence that goes up into
axilla
o Parallel lines, spiral formation, or
wedge pattern
o Look for swelling, lumps, skin changes,
nipple exudate

Breast Self-Examination

Mammography Mammogram
o X-ray exam of breasts
o Special machine that spreads and
flattens breast tissue very thin to see
benign or malignant growths
o 2 radiographs of each breast
o Compress top-bottom, and side-side
o If suspicion or unclear spots are seen
they will take more
o Now can be done digital, computerized
so they can look more closely at
problem areas
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The American Cancer Society (2013) Optional BSE, start in 20s,

Screening mammogram age 40 and
yearly
Clinical breast exam by HCP every 3
years during 20s and 30s; yearly by
HCP age 40 and thereafter
MRI and mammogram every year for
women at high risk of breast cancer
o BRCA1 and BRCA2 genetic
mutations and strong family
history

Testicular Self-Examination
o Do monthly

According to the ACS, which women should

have a mammogram?
1. Women age 40 and older, yearly
Which men should do testicular self-
examination?
1. All men after puberty
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o Simple- removing the breast tissue

from one or both breast
o Radical- removing breast tissue,
underlying muscle, and surrounding
lymph nodes]
o Can be disfiguring have effects on the
persons body image and self esteem
o Do not use affected arm for venous
punctures or BP or injections
o Empty drain device PRN
o Measure circumference of arms daily
and compare (swelling causes
decreased circulation)
o Elevate effected arm if swelling occurs
to increase venous return to the heart
o Items close, do not make pt extend
more than 90 degrees
o Post mastectomy exercise
Nursing Diagnoses: Mastectomy
o Anxiety
o Risk for Ineffective Breathing Pattern
r/t chest pain when moving
o Risk for Ineffective Tissue Perfusion
and Integrity r/t damage of blood and
Chapter 42 lymph vessels and tension at the
surgical site
Breast Cancer Prevention o Risk for Ineffective Coping
o Prevention
Caution(moderate)
Fat Intake
Alcohol Intake
Use non hormonal
methods of birth control
and menopausal
symptoms
Breastfeeding
Early Identification
Test for genetic mutation BRCA1
& BRCA 2
Bilateral prophylactic
mastectomy
o Diagnosis
BSE
Clinical Breast Exam
Mammography
Biopsy
Mastectomy
o Partial- removing only part of the
breast
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Mastectomy reconstruction
o Tissue from buttock or abd may be
grafted onto a mastectomy site
without a pedicle
o Pedicle (little foot)- tissue
moved from one are of the body
to another, graft remains
attached to a stalk ( contains
blood vessels and nerves), it
resembles a little leg with a foot
Premenstrual Syndrome- exact cause
unknown, ovarian hormones, aldosterone,
neurotransmitters ( monoamine
oxidase/serotonin) may play a role
o Signs and Symptoms
o Water Retention
o Headache
o Discomfort in joints, muscles,
and breasts
o Change in Affect
o Change in Concentration,
coordination
o Sensory changes
Premenstrual dysphoric disorder- s/s of
depression , irritability, and tension before
menstruation more severe than PMS.
PMDD must have 5 of the following s/s
including one mood related symptom
o s/s
o no interest in daily activities
and relationships
o fatigue or low energy
o feelings of sadness and
hopelessness, possible suicidal
thoughts
o feelings of tension or anxiety
o feeling out of control
o food cravings or binge eating
o mood swings with periods of
crying
o panic attacks
o irritability or anger that effects
other people
o physical s/s such as bloating,
breast tenderness, headaches,
joint pain, muscle pain
o problems sleeping
o trouble concentrating
o Interventions
o Medications- drugs that effect
prostaglandin production,
hormonal balance, and
neurotransmitter production
and reuptake (antidepressants),
diuretics, calcium, Magnesium,
vit E vit B6
o Exercise- regular, eat healthy
o Stress Management
o Limitation of
Alcohol
Caffeine
Nicotine
Salt
Simple Sugars
o Discuss that suicidal thought
and increased depression can
occur during the second half of
the menstrual cycle
Disorders of the Vagina and Vulva
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o Ph less than 4.2 r/t lactic acid and
hydrogen peroxide produced by the
cells in the vagina
o Acidic Ph helps protects against
growth of organisms
Overgrowth of Organisms (normally present
nonpathogenic microorganisms)
Candidiasis
Bacterial Vaginosis- overgrowth
Cytolytic Vaginitis- inflammation
Trichomoniasis included
because it can be transmitted
by fomites on toilet seats
Predisposing conditions
o Poor nutrition ( diet high in simple
sugars)
o Inconsistent blood glucose levels
o Diabetic
o Stress
o Pregnant
o Hormonal fluctuations
o Ph changes
o Prolonged heating of the vaginal
area with little aeration
Sitting still for long times,
tight clothes
o Change in vaginal flora
Abx
Douching
o Compromised immune system
o Infections make you more susceptible
to STIs and HIV
Medications
Oral- may come in partner pack
r/t males can reactivate the
infection in females
Cream- apply meds when
patient is lying down ready for
sleep r/t meds run out when ppt
sits or stands
Vaginal slope is about a
finger length running
toward anus
Suppository
Medicated Douche- admin on
bedpan with bed in semi-fowlers
May self admin if sitting
on toilet
Use all meds and wear pad to
stop staining of clothes
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Change Tampon Every 4 hrs

Toxic Shock Syndrome (TSS)- Substitute Pads
Systemic Infection Wash Hands
Staphylococcus aureus- produce Caution with Barrier
epidermal toxin Contraceptives do not leave in
Effects liver, kidneys, and place longer than needed
circulatory system Do not use tampons or barrier
Streptococcus contraceptives for the first 12
Causes weeks after birth
Highly Absorbent Tampons Report Symptoms Promptly
Other Packing (nasal) Fertility Disorders
Signs and Symptoms Male
Fever Anatomic
Sore Throat Hormonal
Headache Genetic Defect
Dizziness Inflammatory
Confusion Immune
Redness of Palms and Soles Sexual Dysfunction
Skin Rash Psychological
Blisters Exogenous
Petechiae Female
Followed by peeling of skin Ovulation
Muscle pain-weakness Tubal
GI upset Uterine
Toxic Shock Syndrome Other
Prevention
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Infertility continued
o First day of menses is the day one on
basal temp chart
o May take a few months to clearly
identify her pattern
o Endometrial biopsy- done 2-3 days
before expected menses ( you may
assist)
o UPT done before endometrial
biopsy
o May receive pain meds and
paracervical block anesthesia
o Assess pulse and BP
o Vaso vagal reaction kit ( if
vasovagal reflex occurs during
procedure)
Epi/atropine
tourniquet
syringe
o Vasovagal reflex can occur
when cervix. Larynx, or trachea
is manipulated
slows heart, decreases
cardiac output, and
markedly decrease in
blood pressure
o sperm washing avoids antigen
antibody reactions, changes ph of
sperm, increases motility,
o fertility drugs
o clomiphene citrate
o intrauterine insemination- places
semen closer to ovum by using a small
catheter
o in vitro fertilization- sperm and ova are
brought together outside of the body
o gamete micromanipulation- sperm
penetration is done under microscope
o artificial insemination- donor sperm is
inserted into female tract
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o ova maybe harvested and

fathers sperm implanted
o surrogacy- couple embryo implanted
in host mother
o with IVF- more embryos than needed
are implanted r/t the expectation that
all will not survive, this could cause
multiple pregnancies, you may have to
choose to reduce(abort) the amount of
pregnancies or to have more babies
Review Question: Which foods should the
nurse teach women with premenstrual
syndrome to avoid?

1. Alcohol, Caffeine

Review Question : What can the nurse teach

women to help prevent displacement
disorders?

1. Perform Kegel exercises

Review Question : Which virus is associated

with cervical cancer?

1. Human papilloma virus

Review question: What should the nurse

teach a patient about preventing toxic shock
syndrome?

1. Change tampon every 4 hrs

2. Substitute pads for tampons
3. Wash hands before and after handling
tampons

Chapter 43
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Prostatitis
o Inflammation of the prostate gland
o Can occur any time after puberty
o Prostate provides alkaline
secretions to semen and aids in
ejaculation
o Does not contain hormones
o Can be chronic, or single acute
episode
o Causes swelling, pain especially when
standing.
o Can lead to dysuria
Etiology
Acute Bacterial
Chronic Bacterial
Chronic Prostatitis/Chronic
Pelvic Pain Syndrome
Asymptomatic Inflammatory
Prostatitis
Common bacterias- e coli, staph
Stis
How infection occurs
Prevention
o Regular complete emptying of bladder
o Avoid excess etoh ( more than 2-3 oz a
day)
o Etoh is a bladder irritant
o Avoid high risk sex acts, multiple
partners
Signs and Symptoms
Pain (LOWER BACK, PERINEUM,
AND AFTER EJACULATING)
Urgency
Frequency
Hesitancy
Dribbling
Dysuria
Urine Retention if prostate is
swollen
Temporary problem with
erections
Fever, Chills
Ascending infections, prostatic
abscess, epididymitis, prostatic calculi
(stones) are other complications
Diagnosis
Digital Rectal Exam (DRE)-
insert gloved finger in rectum
May find a swollen,
irregular, warm, painful
prostate gland
Urine Culture
EPS- gently massage gland,
expressed prostate secretion
test. May have bacteria and
WBCs
cystoscopy
Interventions
Antibiotics
Anti-inflammatory Agents
Stool Softeners
Sitz Baths
Prostatic Massage
Dietary Changes
Decrease spicy food and
etoh
Surgery
Alpha-adrenergic blockers can
help relax bladder neck and
reduce pain on urination
Alfuzosin(uroxatral)
AVOID ALPHA-ADRENERGIC
AGONIST AND
ANTICHOLINERGICS WHICH CAN
CAUSE URINARY RETENTION
Nursing Diagnoses
Urinary Retention
Knowledge deficit related to
cause, treatment and
prevention of prostatitis
Acute Pain
Anxiety
TURP (transurethral resection of the
prostate)
o Treatment to relieve obstruction
caused by enlarged prostate
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o Lay down if bright red blood or

clots
o Kegel exercise for urine
retention onbce cath is removed
o Serial urines
o Save each time pt urinates or
the cath is emptied
o Save on a shelf in bathroom,
o Each new sample goes to the
right of the previous cup
o Retrograde ejaculation- semen doesnt
fully ejaculate and falls back into the
bladder. Causes no harm but is
excreted the next time pt urinates
TURP cont- ( treatment for benign prostatic
hyperplasia)
o Pt is anesthetized
o Done with resectoscope
o Inserted in urethra
o Prostate gland is chipped
away a piece at a time
o Instruments vaporize or
microwave pieces to decrease
amount of bleeding
o Chips are flushed out using
irrigation solution then sent to
lab to be analyzed for cancer
o Not completely removed
o Tissue left may grow back and
cause obstruction again
o Have yearly exam
o 3 way cath
o 30-60 ml of saline in balloon
o Balloon is overfilled and secured
tightly to leg or abd to
tamponade ( compress) the
prostate to stop bleeding
o Solution flows continuously
o Manual irrigation for first 24
hours to remove clots and chips
and keep cath patent Epididymis- small tube along the back of the
o Cath removed after risk of testicles where sperm are matured for 10-12
hemorrhage has passed days before it is ready to be ejaculated
o Some blood after turp is normal. Epididymitis
Notify md if suddenly gets Inflammation
worse Infection
o Drink upto 2500 ml day, no Caused by
citrus, no caffine, no etoh Bacteria
o Avoid constipation and heavy Viruses
lifting(>10lbs) Parasites
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Chemicals Testicular Cancer

Trauma Therapeutic Interventions
Risk factors Surgery
Sexual or nonsexual contact Radiation
STI Chemotherapy
Complication of some urological Testicular Cancer
procedure Nursing Care
Reflux (backflow of urine) Teach Testicular Self-
Prostate infections Examination
s/s Provide Emotional Support
pain Discuss Sperm Bank Deposit
scrotal skin tender, red, and Offer Cancer Support Group
warm to touch Infertility
Causes
Pretesticular
treatment Endocrine
abx Testicular
partner also treated if it Varicocele
was sexually transmitted Idiopathic
bed rest, scrotum elevated, Post-testicular
icepacks, analgesics Surgery
pain will go away in about week Infertility
swelling can last for several weeks Diagnosis
complications Sexual Practices
chronic epididymitis Lifestyle Practices
abscess formation Occupation
sterility Medical-Surgical History
Testicular Cancer Physical Examination
Risk Factors Semen Analysis
Cryptorchidism Infertility
Family History Therapeutic Interventions
DES Use by Mother Changes in Lifestyle Practices
Caucasian Surgery if Indicated
High Socioeconomic Status In Vitro Procedures
Testicular Cancer Review Question Answer
Signs and Symptoms 1. BP 135/80, Pulse 88, Respirations 20,
Early Temp 98.0
Painless Lump 2. Client states his pain is a level 6 out of
Swelling 10
Late 3. The catheter bag contains bright
cherry red urine
Symptoms of Metastasis
4. The catheter tubing is secured to his
Testicular Cancer
abdomen
Diagnosis
A client has returned from a transurethral
Ultrasound
prostatectomy with a continuous bladder
Chest X-Ray irrigation. Which of the following assessment
Blood for Tumor Markers findings should the LPN/LVN report to the
Biopsy registered nurse?
Staging