Chapter 59: Male Reproductive Process Problems
Joe Smith, a 55-year-old patient, is admitted to the surgical unit after robotic-assisted laparoscopic radical prostatectomy with nerve sparring for early-stage cancerous tumors confined to the prostate. The client has six small incisions in the abdomen with small 4×4 dressings with clear dressing dry and intact. The client has a JP drain in place with clear, red-colored drainage with 50 mL present and an indwelling urinary catheter draining clear, red-colored urine. The surgeon ordered ketorolac (Toradol) for pain management and belladonna and opiate (B&O) suppository every 8 hours, as needed, for bladder spasms. (Learning Objective #5)
What nursing care should be provided to the patient in the immediate postoperative period?
The nurse must be monitoring urinary drainer and ensure that the catheter used by the patient is clean at all times. Secondly, the nurse needs to assess the patient for the presence of pain regularly. The nurse must check if the urethra is bleeding around the placed catheter. Fifth, he/she must administer medications to relieve spams. It is also essential to encourage the patient to take walks, and he should not sit for a prolonged period.
For what potential complications should the nurse observe, and what actions should the nurse take if the complication develops?
Complications
are infections, and thus, the nurse should notify the doctors if there are any complications. Other complications that the nurse should observe include shock, hemorrhage, venous thromboembolism, sexual dysfunction, and incontinence, as well as obstruction of the catheter. In case there is any, the patient must be put on antibiotics. During this time, the use of the aseptic technique is essential in preventing complications. The monitoring of lab values will also be useful.
The surgeon removes the JP drain the next day and discharges the patient with the indwelling urinary catheter to a leg bag. What discharge instructions should the nurse provide the patient? What is follow-up care anticipated for him?
The follow-up care anticipated for Joe Smith includes care for urinary drainage. The patient must also be able to recognize complications that may be caused by the installed catheter. Because of incontinence, the patient must get the information about regaining gradual control of the process. Also, he has to know that the dribbling of the penis may occur up to a year based on which type of surgery the patient underwent. As a result, he must perform the perineal exercise. During this period, he has to avoid straining, lifting heavy loads, long trips. Joe should also avoid alcohol, coffee, and foods that contain spices. Assessment for any sexual issues will be useful for the patient where he will get proper counseling.
The patient must be provided with vital information on how to dress the wound. Also, he has to be taught ways of cleaning the catheter to prevent bacterial infection. Also, the patient must learn about his medication and how to care for himself. He will have to visit the hospital for healthcare providers to remove the catheter (Lewis et al., 2016). Also, it is critical to teach the patient on means of emptying the catheter.
Joe Smith-67-year-old
Joe Smith, a 67-year-old man, is admitted with the diagnosis of adenocarcinoma of the penis. He presents with painless wartlike growth on the skin of the glans of the penis. (Learning Objective #7)
Explain the pathophysiology of cancer of the penis.
Several risk factors for penile cancer have been identified, including lack of circumcision, poor genital hygiene, phimosis, HPV, smoking, ultraviolet light treatment of psoriasis on the penis, increasing age (two-thirds of cases occur in men older than 65 years of age), lichen sclerosis, and balanitis xerotica obliterans. However, the exact cause remains unclear. Cancer begins as a painless lump, wart, or ulceration. If left untreated, cancer will spread to other areas of the penis. There is an abundant blood supply to the penis, so cancer can spread to adjacent areas and then enter the lymph system and metastasize.
Its starts will small lesions that appear on the penis surface. These lessons are painless, which will then spread to other areas, in case of any lesion, a patient should seek prompt treatment. There is a lateral growth on the surface and can cover the glans/prepuce, before spreading to the corpora and pineal shaft. The lessons may end up affecting nodal metastasis. If the condition is left untreated, it will result in auto amputation. The pineal cancers that are bigger than 5cm and those that have affected 75% of the shaft causes a high prevalence of metastases. There is also a reduced chance of survival n.
What are the early and late manifestations of cancer of the penis?
The early signs include ulcers, fatigue, lesions, masses, and lumps. The late symptoms include discharge, change in color of the penis, skin thickening, burning, and itching sensation.
What are the management goals for cancer of the penis?
The primary goal is to manage penis cancer to ensure that the patient is comfortable. Also, another goal is to see the elimination of the malignancy, while ensuring that the penis is still functional. For this to be achieved, there is a need for prompt diagnosis and treatment of cancer.
- Achieve cancer-free margins during surgery.
- Spare as much of the organ as possible to retain as much function as possible.
- The treatment used depends on the stage of cancer.
The patients may be enjoined in support groups/focused group discussions to state how they feel (Lewis et al., 2015). The treatment is based on how the cancer is progressing.
References
Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., Bucher, L., & Camera, I. (2015). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences.
Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences.