Module 02 – Multidimensional Care Strategies
Nursing care of the patient experiencing reproductive disorders requires a collaborative approach. Nursing care is dependent on the type of disorder and treatment. A multidimensional care approach encompasses the physical, developmental, emotional, cultural, intellectual, and spiritual aspects of nursing care to ensure that all needs of the patient are being met. Patient and family education is ongoing throughout the patient’s stay to improve overall health following discharge.
Nursing care of a patient experiencing male reproductive disorders, as well as sexually transmitted infections, includes general nursing care interventions such:
- Monitoring vital signs.
- System focused assessment.
- Monitoring laboratory/other diagnostic study results and reporting abnormalities and providing prescribed treatment.
- Monitoring intake and output.
- Assessing for signs and symptoms of complications and adverse effects of treatment.
- Administration of prescribed medication, including chemotherapy.
- Specialized care must be taken when administering chemotherapy; chemotherapy precautions must be implemented to protect the patient, family, and staff. Specialized handling of chemotherapy agents is included in these precautions.
- Multidimensional patient care needs can be met by conducting the appropriate psychosocial, nutritional, spiritual, and cultural assessment. Based on the assessment findings, patient care can be tailored to meet the patient’s needs. Male reproductive disorders and sexually transmitted infections can result in emotional stress as well as anxiety. Early identification of these stressors will help to identify coping strategies for the patient and family.
Patient and family education play a vital role in the care of a patient. Identification of knowledge deficits and providing education on the disease process and treatment options will enable the patient and family to deal with the diagnosis and decide on an appropriate plan that meets their needs.
Some male reproductive disorders may require surgical interventions; nursing care includes preparing the patient for the surgical procedure as well as post-operative monitoring. Post-operative monitoring to reduce the incidence of complications includes encouraging coughing and deep breathing to prevent respiratory complications. Interventions such as early ambulation and venous thromboembolism (pharmacological or mechanical) prophylaxis can assist in the prevention of deep venous thrombosis. Pain assessment and management must be performed to ensure the pain is controlled to promote early ambulation, and coughing and deep breathing to prevent post-operative complications.
Benign Prostatic Hyperplasia
Nursing care of a patient diagnosed with benign prostatic hyperplasia includes conducting a focused assessment regarding urinary elimination, providing privacy and emotional support to the patient, preparing the patient for nonsurgical procedures, and performing post-procedure monitoring. Care for patients who require surgical intervention will include:
- Monitor urinary output to assure maintenance of fluid balance.
- Perform continuous bladder irrigation to maintain patency of the catheter.
- Educate the patient regarding the feeling of urgency related to urinary catheter placement is a normal feeling.
- Monitor pain and provide both non-pharmacological and pharmacologic interventions as prescribed.
- Monitor for bleeding.
- Monitor patient for bladder spasms.
- Monitor the urinary catheter for possible obstruction, follow appropriate orders if an obstruction is suspected.
- Educate the patient regarding the signs and symptoms of infection.
- Monitor for skin breakdown.
- Keep the area clean and dry.
- Prostate Cancer
Nursing care of the patient with prostate cancer is based on the treatment plan for the patient. Men diagnosed with prostate cancer are fearful and anxious regarding responsibilities and the impact of the disease process on their lives as well as sexual function. Early identification of these stressors will assist in finding the appropriate resources for the patient to cope. Surgical management of prostate cancer is the most common treatment. Nursing care is dependent on the type of surgical procedure the patient will undergo. General post-operative interventions include:
- Maintaining hydration to maintain adequate urine output.
- Wound care to assess for potential infection.
- Assessing and managing pain to assure the patient has adequate pain control.
- Monitor indwelling catheter.
- Provide patient education for post-discharge catheter care.
- Educate the patient on post-op complication of erectile dysfunction to include possible pharmacologic treatment such as phosphodiesterase – 5 (PDE-5) inhibitors as well as Kegel perineal exercises.
- Testicular Cancer
The care of the patient diagnosed with testicular cancer includes supporting the patient psychosocially. Men diagnosed at a young age often are faced with sexual dysfunction, which can result in depression. Identification of support systems for the patient is important. Other nursing care interventions are based on the treatment plan. The following nursing interventions pertain to care of the patient with testicular cancer:
- Educate the patient on the option of banking his sperm.
- Assess the surgical site for bleeding, redness, and swelling.
- Monitor indwelling urinary catheter.
- Assess pain level and provide non-pharmacologic and pharmacologic pain management options.
- Provide education to the patient and family on catheter care.
- Erectile Dysfunction
Erectile dysfunction is a common male reproductive disorder that can be related to another disease process or some other type of factor. Nursing care of these patient includes patient education on treatment options, such as medications and the use of a vacuum-assisted device.
Sexually Transmitted Infections
Nursing care of the patient diagnosed with genital herpes is based on symptoms and stage of the disease process. Disease-specific nursing interventions include:
- Administer oral analgesics to improve comfort.
- Apply local anesthetic sprays or ointments as prescribed to improve patient comfort.
- Apply ice packs or warm compresses to the patient’s lesions.
- Administer sitz baths three or four times a day.
- Urge an increase in fluid intake to replace fluid lost through open lesions.
- Encourage frequent urination.
- Pour water over the patient’s genitalia while voiding or encourage voiding while the patient is sitting in a tub of water or standing in a shower.
- Catheterize the patient as necessary.
- Encourage genital hygiene, and encourage keeping the skin clean and dry.
- Wash hands thoroughly after contact with lesions and launder towels that have had direct contact with lesions.
- Wear gloves when applying ointments or making any direct contact with lesions.
- Advise the patient to avoid sexual activity when lesions are present.
- Advise the patient to use latex or polyurethane condoms during all sexual exposures.
- Instruct the patient in use, side effects, and risks versus benefits of antiviral agents.
- Advise the patient to discuss the diagnosis of genital herpes with current and new partners.
Nursing care interventions for a patient diagnosed with syphilis include medication therapy to resolve the infection. Patient education should include the prevention of disease transmission to other sexual partners. Explain to the patient that it is required to report the diagnosis of the disease to their partner. Emotional support is important for patients diagnosed with syphilis. Provide support to the patient and encourage them to verbalize their feelings.
Nursing care of the patient diagnosed with genital warts includes medication therapy to treat warts with the ultimate goal to remove. Provide patient education regarding prevention of disease transmission and the importance of notifying other sexual partners. Provide emotional support to the patient diagnosed with this disease, provide resources on support groups to the patient.
Nursing care interventions for a patient diagnosed with chlamydia include education on the importance of adhering to the prescribed medication regimen. Educate the patient on the importance of contacting their sexual partners to enable them to seek testing and possible treatment. Detailed education on the disease process should include the following:
- Mode of transmission
- Incubation period
- The possibility that the patient may be asymptomatic
- List of possible symptoms
- Antibiotics for treatment and importance of completing the entire course
- Importance of abstaining from sexual intercourse until the course of treatment is complete
- Importance of re-screening for re-infection
- Possible complication such as pelvic inflammatory disease, infertility, and joint pain if untreated
Nursing care interventions for a patient diagnosed with gonorrhea include education on the importance of adhering to the prescribed medication regimen. Importance of following up with the provider if the symptoms continue following completion of the course of treatment. Educate the patient on the importance of contacting their sexual partners to enable them to seek testing and possible treatment. Encourage patients to verbalize their feelings regarding the disease and provide emotional support to include support groups. Detailed education on the disease process includes the following:
- Transmission of the disease
- Treatment of the disease
- Risk of complications such as pelvic inflammatory disease
- Importance of abstaining from sexual intercourse until the course of treatment is complete
- Pelvic Inflammatory Disease
Women experiencing pelvic inflammatory disease often have anxiety regarding the diagnosis. Providing emotional support, allowing the patient to express her feeling as well as being nonjudgmental, is important. Educate the patient on the importance of adhering to the medication regimen, monitoring temperature, and reporting of continued signs and symptoms to their provider. Continued symptoms may require additional medication as an inpatient. Promote patient comfort by administering prescribed analgesic and application of heat to the lower abdomen and back. Encourage the patient to increase fluid intake and consume a healthy diet to promote healing.