Nurs 5432 module 4: men's health and STDs Summary

Nurs 5432 module 4: men's health and STDs Summary 1. cryptorchidism: undescended testicles 2. Cryptorchidism treatment: orchiopexy typically at ages 6-18m 3. cryptorchidism risks later in life: testicular cancer 4. epididymitis: inflammation of the epididymis that is frequently caused by the spread of infection from the urethra or the bladder 5. Epididymitis S/S: o pain o dysuria o urgency/frequency o low back pain/perineal pain o fever/chills/malaise o scrotal edema!! 6. Epididymitis treatment for sexually active men under age 35: doxy 100mg BID x 10 days AND ceftriaxone 500mg IM once 7. epididymitis treatment for men over age 35 and you do not suspect STD: - Levfloxacin 500mg PO daily x 10 days OR Ofloxacin 300mg BID X 10 days 8. Epididymitis treatment for men who have sex with men: think they need to cover gram negative bacteria... e. coli lives in the colon so that is the likely cause. Ceftriaxone 500mg IM once AND Levofloxacin 500mg PO daily x 10 days 9. Epididymitis PE: Prehn's sign is positive normal cremasteric reflex possible urethral discharge enlarged and tender epididymis 10. epididymitis diagnosis: Ultrasound: shows enlarged epidydimis and increased testicular blood flow STD testing US if they have pyuria and/or hematuria elevated CBC CRP and sed rate will be elevated 11. hydrocele: scrotal swelling caused by a collection of fluid 12. are hydroceles in infants communicating or non-communicating?: commu- nicating 13. are hydroceles in adults communicating or non-communicating?: - non-communicating 14. what is the connection between testicular cancer and hydrocele: 10% of testicular malignancies present with a hydrocele 15. hydrocele assessment: PAINLESS swelling o Scrotum size will fluctuate with communicating hydrocele... because the opening is not closed...the fluid has somewhere to go o Scrotum feels heavy, especially after coughing, crying, and raising arms o Noncommunicating hydroceles do NOT change shape with crying or straining o Scrotum will transilluminate with both communicating and non-communicating 16. Hydrocele diagnostics: none needed, but you have to do an ultrasound to rule out a tumor! 17. Hydrocele management: The majority of infants born with hydroceles will have spontaneous resolution by the time they are 1 year old; thus reassurance and observation are the most appropriate forms of management. sx only if persist for >1 year 18. spermatocele: · Benign, cystic scrotal mass along spermatic cord, usually at head of epididymis. Measures over 2cm and may contain non-viable sperm 19. spermatocele assessment: o Palpable, painless, freely moveable cystic mass distinct from testis (pretesticular lesion) o Intratesticular lesions always require further workup o Size 2-5cm o Usually asymptomatic o Always located superior to testicle...hydrocele isn't. this is something that sepa- rates the 2 diagnosis 20. Spermatocele management: none needed unless it is painful aspiration will show non-viable sperm does not affect fertility 21. varicocele: enlarged veins of the spermatic cord 22. Varicocele grading: grade 1: only palpable with valsalva maneuver grade 2: cant see it, but can feel it when they stand grade 3: clearly visible 23. varicocele assessment: usually asymptomatic, they come in for fertility issues normally do a doppler US, IV pyelography to r/o renal tumor or venous obstruction 24. Varicocele management: grade 1: reassure grade 2-3 and there is <20% size difference in testicles: reassure and refer to urology if they desire fertility grade 2-3 and there is >20% size difference in the testicles: refer to urology scrotal support NSAIDS semen analysis q2 years 25. Testicular Torsion: · Urologic emergency that occurs when the spermatic cord twists and causes constriction of the vascular supply to the testicle 26. testicular torsion s/s: most commonly 10-20 year olds ACUTE onset of severe testicular pain does not have any voiding symptoms pain is made WORSE by prehn's sign no cresmeteric reflex noted affected testicle will have a 'high lie" 27. testicular torsion management: US surgical referral... they need surgery quick to save the testicle 28. hypospadias: abnormal congenital opening of the male urethra on the under- surface of the penis 29. hypospadias s/s: o dorsal hooded foreskin o their urine stream points downward o first degree: urethra located within the glans or sub corona o second degree: urethral opening on penile shaft o third degree: urethral opening within the scrotum or perineum o Chordee (penis bows down) 30. Hypospadias treatment: surgical reconstruction about 1 year old do NOT circumcise the babies... they use the skin in the repair 31. phimosis: stenosis or narrowing of foreskin so that it cannot be retracted over the glans penis 32. Physiologic phimosis: Present at birth Due to glans not separating from epithelium Resolves on its own in first 6 years of life, but usually by the 3rd birthday 33. Pathologic phimosis: Due to scarring, infection, inflammation