Introduction to Medical-Surgical Nursing, 6th ed.
50
Lesson Plans for
Male Reproductive Disorders
CHAPTER LESSON PLANS & OBJECTIVES
Lesson 50.1:
2. Identify data to be collected when assessing a male patient with a reproductive system disorder.
4. For selected disorders of the male reproductive system, explain the pathophysiology, signs and
symptoms, complications, medical diagnosis, and medical treatment.
6. Assist in developing a nursing care plan for a male patient with a reproductive system disorder.
CHAPTER TEACHING FOCUS
• In this chapter, the student will focus on the male reproductive system.
• A review of the anatomy and physiology is presented as an introduction to the topic, and the chapter
places additional focus on the diagnosis and treatment of common and serious disorders of the male
reproductive system.
• The chapter also places special emphasis on nursing assessment of the male reproductive system and
modifying nursing care plans for selected disorders, including cancer of the male reproductive tract.
CONCEPTS
The following conceptual themes and specific concepts match those presented in Giddens, J. R. (2013).
THEME: Homeostasis and Regulation
• Concept: Cellular Regulation
• Exemplar: Benign Prostatic Hyperplasia, p. 1147
• Complementary and Alternative Therapies, p. 1147
THEME: Sexuality and Reproduction
• Concept: Sexuality
• Exemplar: Erectile Dysfunction, p. 1155
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Introduction to Medical-Surgical Nursing, 6th ed.
CHAPTER PRETEST
Have the students answer these questions prior to covering this chapter to understand where they stand
in relation to the content.
1) Failure of the testes to descend into the scrotum from the abdomen is called __________.
a) orchitis
b) testicular retainment
c) cryptorchidism
d) epididymitis
2) Testosterone production decreases rapidly, resulting in male climacteric, after __________ years of
age.
a) 40
b) 50
c) 60
d) 70
3) Another term for impotence is __________.
a) sterility
b) premature ejaculation
c) hyperemia
d) erectile dysfunction
4) The nurse should instruct the patient requiring a semen analysis to abstain from sexual activity for
__________.
a) 24 to 48 hours
b) 2 to 3 days
c) 3 to 5 days
d) 1 week
5) Decreasing force of urinary stream, frequency, nocturia, and postvoid dribbling in older men are
symptoms of __________.
a) benign prostatic hypertrophy (hyperplasia)
b) urinary tract infection
c) testicular torsion
d) varicocele
6) A vasectomy only affects __________.
a) erection
b) ejaculation
c) intercourse
d) the presence of sperm in the semen
7) A blood test that should be done annually in older men to rule out prostatic cancer is a __________.
a) prostate-specific antigen (PSA) blood test
b) creatine phosphokinase (CPK) test
c) serum glutamic-oxaloacetic transaminase (SGOT) test
d) complete blood count (CBC)
8) Which of these medications would the nurse administer to a patient who has had his testicles
removed due to testicular cancer?
a) Diethylstilbestrol (DES)
b) Fluoxymesterone (Halotestin)
c) Estrone (Theelin Aqueous)
d) Alprostadil injection (Caverject)
9) The urine of a man who is 1 day postoperative transurethral prostatectomy would be __________.
a) yellow
b) clear
c) pink
d) orange
10) Priapism can be caused by __________.
a) sexual desire
b) certain drugs
c) plaque under the skin of the penis
d) poor hygiene of the foreskin
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Introduction to Medical-Surgical Nursing, 6th ed.
Chapter Pretest Answers
CHAPTER BACKGROUND ASSESSMENT
Discuss these questions with your students prior to covering this chapter to understand where they stand
in relation to the content.
Question: What are the major structures of the male reproductive tract? Briefly describe a function of
each.
Answer: The bladder is a triangular-shaped organ in the lower abdomen; it stores and empties urine.
Question: What are some common male reproductive disorders that are not related to sexually
transmitted infections? What is the definition of each disorder?
Answer: Impotence is the inability to produce and maintain a penile erection for sexual intercourse.
Introduction to Medical-Surgical Nursing, 6th ed.
Instructor Preparation
1. Describe the major structures and functions of the normal male reproductive system.
3. Discuss commonly performed diagnostic tests and procedures and the nursing implications of
each.
5. Identify common therapeutic measures used to treat disorders of the male reproductive system
and the nursing implications of each.
6. Assist in developing a nursing care plan for a male patient with a reproductive system disorder.
Lesson Preparation Checklist
• Prepare lecture from TEACH lecture slides available on Evolve.
• Guest speaker: urology nurse practitioner
Materials and Supplies
• computer and PowerPoint
projector
• token gifts for winner of video
contest
Key Terms
• sterile (p. 1148)
• corpus (pl. corpora)
cavernosa (p. 1159)
• prostatectomy (p. 1147)
• prostatitis (p. 1146)
Textbook Objectives Covered
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LESSON 50.1
Student Preparation
Assignments 2 hours
1
READ – Textbook (pp. 1136-1140)
REVIEW
• Figure 50-1: Male reproductive system (p. 1137)
• Figure 50-2: Basic structures of a testis (p. 1137)
ANSWER – Text
• Review Questions for the NCLEX Examination: 1, 2 (p. 1164)
ANSWER – Study Guide
• Part IA: 1-6 (p. 339)
• Part ID: 1-13 (p. 340)
• Part IIE: 1 (p. 341)
2
READ – Textbook (pp. 1140-1143)
REVIEW
• Figure 50-6: Appearance of the penis (p. 1141)
• Figure 50-7: Transillumination of the scrotum (p. 1142)
• Box 50-1: Assessment of the Male Reproductive System (p. 1143)
ANSWER – Study Guide
• Part IIE: 4, 6-8, 12 (pp. 341–342)
3
READ – Textbook (pp. 1142-1146)
REVIEW
ANSWER – Study Guide
• Part IIE: 5, 24 (pp. 341-342)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 50.1
4
READ – Textbook (pp. 1144-1163)
REVIEW
• Table 50-3: Factors Related to Erectile Dysfunction (p. 1155)
• Figure 50-8: Penile prostheses (p. 1156)
• Table 50-4: Drug Therapy: Disorders of the Male Reproductive System (p. 1153)
ANSWER – Text
• Review Questions for the NCLEX Examination: 3, 6, 7, 8, 10 (p. 1164)
ANSWER – Study Guide
• Part IA: 7, 8 (p. 339)
5
READ – Textbook (pp. 1153-1154)
• Table 50-3: Drug Therapy: Disorders of the Male Reproductive System (p. 1153)
ANSWER – Text
• Review Questions for the NCLEX Examination: 5 (p. 1164)
6
READ – Textbook (pp. 1144-1163)
REVIEW
• Nursing Care Plan 50-1: Patient with a Prostatectomy (p. 1150)
ANSWER – Text
• Review Questions for the NCLEX Examination: 4, 9 (p. 1164)
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 50.1
Lecture Outline 20 minutes
Slide 1
Chapter 50
Male Reproductive Disorders
1
Slide 2
Anatomy and Physiology of the Male Reproductive System
• Scrotum
• Testes
• Epididymis
• Vas deferens
TALKING POINTS:
• The scrotum is a thin pendulous sac on the outside of the body that encloses each of the
two testicles in separate compartments.
• The two testes (testicles) are the male reproductive organs.
• The vas deferens are tubes of secretory ducts that serve as the primary storage sites for
sperm, contribute to the fluid content of semen, and contract to help propel the mature
sperm into the urethra during ejaculation.
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LESSON 50.1
Slide 3
Anatomy and Physiology of the Male Reproductive System (cont.)
• Spermatogenesis
• Sperm are produced in seminiferous tubules of testes from about age 13 throughout
the remainder of life
• Erection
• Parasympathetic nerves release neurotransmitters that cause the cavernosal arteriole
TALKING POINTS:
• What hormone is believed to set in motion the division of germinal cells into
scrotum, may result in sterility.
Slide 4
Anatomy and Physiology of the Male Reproductive System (cont.)
• Emission and ejaculation
• Stimulation of internal and external sex organs initiates contractions of the vasa
Slide 5
Age-Related Changes in the Male Reproductive System
• Testosterone decreases rapidly after age 50
• Men in their late 40s and early 50s may be slower to arouse and have a longer refractory
period between erections, but in a healthy man, spermatogenesis and the ability to have
erections last a lifetime
TALKING POINTS:
2
Slide 6
Health History
• Present illness
• Complaints: weight loss, infertility, erectile dysfunction (impotence), alteration in self–
image, scrotal masses, penile discharge, skin lesions
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LESSON 50.1
Slide 7
Health History (cont.)
• Medical history
• Chronic health problems: diabetes, thyroid or pituitary dysfunction, cardiovascular
disease, neurologic injury or disease, and addictive behavior
• Trauma to the groin or perineum
TALKING POINTS:
• The medical history helps link the current problem with previous symptoms, injuries,
diseases, operations, or allergies and the treatments or medications prescribed for them.
• Why are spinal cord injuries significant related to male health history?
Slide 8
Health History (cont.)
• Review of systems
• Changes in appetite, weight, exercise, or activity level
• Changes in the skin, including lesions, drainage, bleeding, itching, or pain
• Circulatory and pulmonary systems for hypertension, cardiac/pulmonary disease,
exercise tolerance
• Fatigue, nervousness, heat or cold intolerance, polyphagia, polydipsia, polyuria, and
medications taken for pituitary or thyroid conditions
• Weakness, paralysis, coordination problems, joint pain or stiffness, mood changes,
and depression
TALKING POINTS:
• The patient should be encouraged to use descriptive terms, such as “stinging” or “aching.”
• What is the best technique to use when having the patient describe pain?
• The health history should note medications the patient is taking because many drugs,
including a number of antihypertensives, can impair sexual function.
Slide 9
Health History (cont.)
• Functional assessment
• Diet, usual activities, sleep and rest, medications, and the use of tobacco, alcohol,
and illicit drugs
Slide 10
Physical Examination
• Height, weight, vital signs recorded, and general appearance noted
• Skin inspected for lesions or discolorations and the breasts for gynecomastia
(enlargement)
• Skin of external organs and perineum should be warm, dry, and free of lesions, edema,
and odor
• The lower abdomen and groin are palpated for masses
TALKING POINTS:
• What distribution of pubic hair is expected?
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Introduction to Medical-Surgical Nursing, 6th ed.
LESSON 50.1
Slide 11
Physical Examination (cont.)
• Penis
• Normal flaccid penis is semisoft and straight
• Size, shape, and appearance are noted
• Palpated for nodules, swelling, and lesions
TALKING POINTS:
• What is smegma?
• If there is any discharge from lesions or the urethra, a specimen may be collected for
culture.
Slide 12
Physical Examination (cont.)
• Scrotum
• Skin should be slightly darker, wrinkled, and loose
• Palpate each side for the right and left testes, epididymis, and vasa deferentia
• Inspect for hernias
• Advanced practitioner/physician examines prostate by inserting finger into anus
TALKING POINTS:
• Because the scrotum is close to the body and may not be well ventilated, it is susceptible
to irritation from heat and moisture, fungal infections, abscesses, and parasites.
• What is a hydrocele?
3
Slide 13
Diagnostic Tests and Procedures
• Laboratory studies
• Semen analysis
• Endocrinologic studies
• Tumor markers
• General laboratory studies
• Urinalysis
• Complete blood cell count
• Alkaline phosphatase and serum calcium levels
• Thyroid function studies and tests for diabetes
Diagnostic Tests and Procedures (cont.)
• Radiologic imaging studies
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LESSON 50.1
4
Slide 15
Prostatitis
• Inflammation of the prostate gland
• Acute or chronic bacterial prostatitis
• Caused by bacterial infection
• Chronic prostatitis/chronic pelvic pain syndrome
TALKING POINTS:
• How long will antibiotics usually be taken for acute bacterial prostatitis? Chronic bacterial
prostatitis?
• Depending on the severity of the pain, antiinflammatory drugs or opioid analgesics may
be used.
• Stool softeners may be prescribed to prevent constipation, which is especially painful with
prostatitis.
Slide 16
Prostatitis (cont.)
• Signs and symptoms
• Acute prostatitis
• Swelling, warmth, and tenderness
Slide 17
Prostatitis (cont.)
• Diagnosis
• Complaints confirmed by lab studies of prostatic secretions
• Treatment
Slide 18
Epididymitis
• Inflammation of the epididymis
• Causes
• Infections, trauma, or the reflux of urine from the urethra through the vas deferens
• Signs and symptoms
• Painful scrotal edema, nausea, vomiting, chills, fever
• Treat with bedrest, ice packs, sitz baths, analgesics, antibiotics, antiinflammatory drugs,
and scrotal support
Slide 19
Epididymitis (cont.)
• Nursing care
• Monitor temperature, edema, and comfort
• Carry out prescribed treatments
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LESSON 50.1
Slide 20
Orchitis
• Inflammation of one or both testes
• Related to trauma or infections such as mumps, pneumonia, or tuberculosis
• Signs and symptoms
Slide 21
Orchitis (cont.)
• Nursing care
• Pain management, assistance with activities of daily living, patient teaching, and
anxiety reduction
4
&
5
Slide 22
Benign Prostatic Hyperplasia
• Enlargement of the prostate gland
• Common age-related change, but exact cause is unknown
• Signs and symptoms
TALKING POINTS:
• What factors may trigger urinary retention?
Slide 23
Benign Prostatic Hyperplasia (cont.)
• Medical diagnosis
• Based on rectal examination, laboratory and radiographic studies, endoscopy,
ultrasound, catheterization for residual urine, and sometimes urodynamic testing
Slide 24
Benign Prostatic Hyperplasia (cont.)
• Surgical/invasive treatments
• Types of prostatectomy
• Transurethral resection of the prostate
• Suprapubic prostatectomy
• Complications
• Urinary infection and incontinence, hemorrhage, urinary leakage, inflammation of
TALKING POINTS:
• How are the two types of prostatectomies different?
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LESSON 50.1
6
Slide 25
Benign Prostatic Hyperplasia (cont.)
• Assessment
• Urinary symptoms: frequency, urgency, hesitancy, a change in stream size or force,
and nocturia
TALKING POINTS:
• What should be included in patient education for benign prostatic hyperplasia?
Slide 26
Benign Prostatic Hyperplasia (cont.)
• Assessment of prostatectomy patient
• Compare vital signs with preoperative measurements
• Inspect urine, dressings, and wound drainage for excess bleeding
Slide 27
Benign Prostatic Hyperplasia (cont.)
• Interventions for prostatectomy patient
• Risk for deficient fluid volume
• Acute pain
• Risk for infection
Slide 28
Prostatic Cancer
• Cause is unknown
• Risk factors
• Age >50 years, African American, overweight, high-fat diet, and family history
• Medical diagnosis
• Typically slow-growing; confined to prostatic capsule
TALKING POINTS:
• Cancer of the prostate is found on postmortem examination in 30% of men older than 50
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LESSON 50.1
Slide 29
Prostatic Cancer (cont.)
• Medical treatment
• “Watchful waiting”
• Conventional radiotherapy
• Brachytherapy
• Cryosurgery
TALKING POINTS:
• The treatment of prostatic cancer is controversial because of the difficulty in staging
Slide 30
Prostatic Cancer (cont.)
• Nursing care
• Encourage annual screening for prostate cancer
• Stress value of early diagnosis and treatment
4
&
5
Slide 31
Erectile Dysfunction (Impotence)
• Inability to produce and maintain an erection for sexual intercourse
• Erection requires intact neurologic function, sufficient inflow of blood to fill the corpus
cavernosa, leakproof storage mechanism for maintaining the erection. Factors are
• Vascular disorders
TALKING POINTS:
• Systemic or local changes in blood flow can impair the ability to achieve an erection.
• Patients with diabetes mellitus are at risk for erectile dysfunction due to atherosclerosis
and autonomic neuropathy.
Erectile Dysfunction (Impotence) (cont.)
• Drug therapy