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Chapter 41
Male reproductive system

Male reproductive system Spermatogenesis

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

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

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
o Include tail of spence that goes up into
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

The American Cancer Society (2013) Optional BSE, start in 20s,

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

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
Fat Intake
Alcohol Intake
Use non hormonal
methods of birth control
and menopausal
Early Identification
Test for genetic mutation BRCA1
& BRCA 2
Bilateral prophylactic
o Diagnosis
Clinical Breast Exam
o Partial- removing only part of the

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
o feelings of tension or anxiety
o feeling out of control
o food cravings or binge eating
o mood swings with periods of
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
Mastectomy reconstruction o problems sleeping
o Tissue from buttock or abd may be o trouble concentrating
grafted onto a mastectomy site o Interventions
without a pedicle o Medications- drugs that effect
o Pedicle (little foot)- tissue prostaglandin production,
moved from one are of the body hormonal balance, and
to another, graft remains neurotransmitter production
attached to a stalk ( contains and reuptake (antidepressants),
blood vessels and nerves), it diuretics, calcium, Magnesium,
resembles a little leg with a foot vit E vit B6
Premenstrual Syndrome- exact cause o Exercise- regular, eat healthy
unknown, ovarian hormones, aldosterone, o Stress Management
neurotransmitters ( monoamine o Limitation of
oxidase/serotonin) may play a role Alcohol
o Signs and Symptoms Caffeine
o Water Retention Nicotine
o Headache Salt
o Discomfort in joints, muscles, Simple Sugars
and breasts o Discuss that suicidal thought
o Change in Affect and increased depression can
o Change in Concentration, occur during the second half of
coordination the menstrual cycle
o Sensory changes Disorders of the Vagina and Vulva

o Ph less than 4.2 r/t lactic acid and Douching

hydrogen peroxide produced by the o Compromised immune system
cells in the vagina o Infections make you more susceptible
o Acidic Ph helps protects against to STIs and HIV
growth of organisms Medications
Oral- may come in partner pack
Overgrowth of Organisms (normally present r/t males can reactivate the
nonpathogenic microorganisms) infection in females
Candidiasis Cream- apply meds when
Bacterial Vaginosis- overgrowth patient is lying down ready for
Cytolytic Vaginitis- inflammation sleep r/t meds run out when ppt
Trichomoniasis included sits or stands
because it can be transmitted Vaginal slope is about a
by fomites on toilet seats finger length running
Predisposing conditions toward anus
o Poor nutrition ( diet high in simple Suppository
sugars) Medicated Douche- admin on
o Inconsistent blood glucose levels bedpan with bed in semi-fowlers
o Diabetic May self admin if sitting
o Stress on toilet
o Pregnant Use all meds and wear pad to
o Hormonal fluctuations stop staining of clothes
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

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

o Vasovagal reflex can occur

Infertility continued when cervix. Larynx, or trachea
o First day of menses is the day one on is manipulated
basal temp chart slows heart, decreases
o May take a few months to clearly cardiac output, and
identify her pattern markedly decrease in
o Endometrial biopsy- done 2-3 days blood pressure
before expected menses ( you may o sperm washing avoids antigen
assist) antibody reactions, changes ph of
o UPT done before endometrial sperm, increases motility,
biopsy o fertility drugs
o May receive pain meds and o clomiphene citrate
paracervical block anesthesia o intrauterine insemination- places
o Assess pulse and BP semen closer to ovum by using a small
o Vaso vagal reaction kit ( if catheter
vasovagal reflex occurs during o in vitro fertilization- sperm and ova are
procedure) brought together outside of the body
Epi/atropine o gamete micromanipulation- sperm
tourniquet penetration is done under microscope
syringe o artificial insemination- donor sperm is
inserted into female tract

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

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

1. Change tampon every 4 hrs

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

Chapter 43

Prostatitis Ascending infections, prostatic

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

o Lay down if bright red blood or

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
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

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
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
A client has returned from a transurethral
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?