College of Allied Medicine Lucban, Quezon A.Y. 2013-2014 Testicular Enalrgement
A Case Study Presented to The Faculty of College of Allied Medicine Southern Luzon State University Lucban, Quezon
Submitted to: Mrs. Carolina Pedrido (Clinical Instructor)
In Partial Fulfillment of the Requirements for the Subject Related Learning Experience
Submitted by: Jonar V. Siudad BSN III A Group 2
I. GENERAL OBJECTIVES After establishing Nurse-Patient Interaction, thorough physical assessment, providing care to the client and study of the clients condition, student will gain knowledge, develop skills and enhance attitude through the utilization of the nursing process on the care and management of the patient with Testicular Enlargement.
Specific Objectives On completion of this case study the student will be able to: Understand what Coronary Artery Disease is. Identify its clinical manifestations. Determine the health status of the patient through: o General and Demographic Data o History of Present Illness o Past Medical History o Family Health History o Physical Examination Build trusting relationship with both the patient and significant others. Utilize skills in performing physical examination to the patient. Analyze laboratory results and correlate it with patients present condition. Familiarize self to some medical and diagnostic procedures related to the patients present condition. Trace the pathophysiology of the disease. Determine the relevance of the drugs or medication to the patient. Formulate nursing diagnosis and provide necessary nursing management and interventions. Determine the rationale behind the applied nursing interventions. Render quality-nursing care through implementation of the Nursing Care Plan. Evaluate effectiveness of Nursing Care Plan and medical management. Provide continuity of care by giving health teachings not only to patient but also as well the Significant Others.
III. ANATOMY AND PHYSIOLOGY Male Reproductive System The male reproductive system includes the scrotum, testes, spermatic ducts, sex glands, and penis. These organs work together to produce sperm, the male gamete, and the other components of semen. These organs also work together to deliver semen out of the body and into the vagina where it can fertilize egg cells to produce offspring
Scrotum The scrotum is a sac-like organ made of skin and muscles that houses the testes. It is located inferior to the penis in the pubic region. The scrotum is made up of 2 side-by-side pouches with a testis located in each pouch. The smooth muscles that make up the scrotum allow it to regulate the distance between the testes and the rest of the body. When the testes become too warm to support spermatogenesis, the scrotum relaxes to move the testes away from the bodys heat. Conversely, the scrotum contracts to move the testes closer to the bodys core heat when temperatures drop below the ideal range for spermatogenesis.
Testes The 2 testes, also known as testicles, are the male gonads responsible for the production of sperm and testosterone. The testes are ellipsoid glandular organs around 1.5 to 2 inches long and an inch in diameter. Each testis is found inside its own pouch on one side of the scrotum and is connected to the abdomen by a spermatic cord and cremaster muscle. The cremaster muscles contract and relax along with the scrotum to regulate the temperature of the testes. The inside of the testes is divided into small compartments known as lobules. Each lobule contains a section of seminiferous tubule lined with epithelial cells. These epithelial cells contain many stem cells that divide and form sperm cells through the process of spermatogenesis.
Epididymis The epididymis is a sperm storage area that wraps around the superior and posterior edge of the testes. The epididymis is made up of several feet of long, thin tubules that are tightly coiled into a small mass. Sperm produced in the testes moves into the epididymis to mature before being passed on through the male reproductive organs. The length of the epididymis delays the release of the sperm and allows them time to mature.
Spermatic Cords and Ductus Deferens Within the scrotum, a pair of spermatic cords connects the testes to the abdominal cavity. The spermatic cords contain the ductus deferens along with nerves, veins, arteries, and lymphatic vessels that support the function of the testes. The ductus deferens, also known as the vas deferens, is a muscular tube that carries sperm superiorly from the epididymis into the abdominal cavity to the ejaculatory duct. The ductus deferens is wider in diameter than the epididymis and uses its internal space to store mature sperm. The smooth muscles of the walls of the ductus deferens are used to move sperm towards the ejaculatory duct through peristalsis. Seminal Vesicles The seminal vesicles are a pair of lumpy exocrine glands that store and produce some of the liquid portion of semen. The seminal vesicles are about 2 inches in length and located posterior to the urinary bladder and anterior to the rectum. The liquid produced by the seminal vesicles contains proteins and mucus and has an alkaline pH to help sperm survive in the acidic environment of the vagina. The liquid also contains fructose to feed sperm cells so that they survive long enough to fertilize the oocyte. Ejaculatory Duct The ductus deferens passes through the prostate and joins with the urethra at a structure known as the ejaculatory duct. The ejaculatory duct contains the ducts from the seminal vesicles as well. During ejaculation, the ejaculatory duct opens and expels sperm and the secretions from the seminal vesicles into the urethra. Urethra Semen passes from the ejaculatory duct to the exterior of the body via the urethra, an 8 to 10 inch long muscular tube. The urethra passes through the prostate and ends at theexternal urethral orifice located at the tip of the penis. Urine exiting the body from the urinary bladder also passes through the urethra. Prostate The prostate is a walnut-sized exocrine gland that borders the inferior end of the urinary bladder and surrounds the urethra. The prostate produces a large portion of the fluid that makes up semen. This fluid is milky white in color and contains enzymes, proteins, and other chemicals to support and protect sperm during ejaculation. The prostate also contains smooth muscle tissue that can constrict to prevent the flow of urine or semen. Cowpers Glands The Cowpers glands, also known as the bulbourethral glands, are a pair of pea-sized exocrine glands located inferior to the prostate and anterior to the anus. The Cowpers glands secrete a thin alkaline fluid into the urethra that lubricates the urethra and neutralizes acid from urine remaining in the urethra after urination. This fluid enters the urethra during sexual arousal prior to ejaculation to prepare the urethra for the flow of semen. Penis The penis is the male external sexual organ located superior to the scrotum and inferior to the umbilicus. The penis is roughly cylindrical in shape and contains the urethra and the external opening of the urethra. Large pockets of erectile tissue in the penis allow it to fill with blood and become erect. The erection of the penis causes it to increase in size and become turgid. The function of the penis is to deliver semen into the vagina during sexual intercourse. In addition to its reproductive function, the penis also allows for the excretion of urine through the urethra to the exterior of the body. Semen Semen is the fluid produced by males for sexual reproduction and is ejaculated out of the body during sexual intercourse. Semen contains sperm, the male reproductive gametes, along with a number of chemicals suspended in a liquid medium. The chemical composition of semen gives it a thick, sticky consistency and a slightly alkaline pH. These traits help semen to support reproduction by helping sperm to remain within the vagina after intercourse and to neutralize the acidic environment of the vagina. In healthy adult males, semen contains around 100 million sperm cells per milliliter. These sperm cells fertilize oocytes inside the female fallopian tubes.
IV. OVERVIEW OF THE DISEASE Review of Related Literature Definition An enlarged testicle is a common symptom of injury, inflammation or infection. Testicle enlargement results from swelling, a lump, or a cyst within the testicle. Other conditions that cause swelling in the scrotum may appear to be an enlarged testicle. Injury leading to swelling is a common cause of enlarged testicle, and inflammation of the testicle for any reason can also cause swelling. Depending on the cause, enlargement may occur in one or both testicles, and may be accompanied by pain, swelling or fever.
Infections of the epididymis or testicle itself are common causes of enlarged testicle. A scrotal cyst (spermatocele) or varicose veins (varicocele) can also result in the appearance of an enlarged testicle. In rare cases, enlargement of the testicle is a symptom of testicular cancer, a condition that is commonly associated with a painless lump. Mumps, a viral infection, can lead to an enlarged testicle along with other symptoms, such as swollen salivary glands, sore throat, and fever. An inguinal hernia, when the abdominal contents protrude into the groin, can be mistaken for an enlarged testicle.
Causes Enlarged testicle is a common symptom of injury, inflammation or infection. Testicle enlargement results from swelling of the soft tissues, a lump, or a cyst within the testicle. Injury leading to swelling is a common cause of an enlarged testicle.
Depending on the cause, enlargement may occur in one or both testicles, and it may be accompanied by pain, swelling or fever. Infections of the epididymis or testes can cause enlarged testicles. In rare cases, enlargement of the testicle is a symptom of testicular cancer, a condition commonly associated with a painless lump. Common causes Cancer of the testicle Epididymitis (inflammation of the epididymis) Inguinal hernia, which may be mistaken for an enlarged testicle Mumps (viral infection that can cause inflammation of the testicle) Orchitis (inflammation of the testicle) Scrotal sac infection Spermatocele (cyst in the scrotum) Testicular torsion Trauma or injury Varicose veins in the scrotum (varicocele), which may appear as an enlarged testicle
Risk Factors
Symptoms Abdominal pain or pressure Difficult or painful urination, or burning with urination (dysuria) Discharge or pus from the end of the penis Fever Pain associated with ejaculation Pain in the testicle Scrotum that feels swollen or heavy Testicle lump
Laboratory Studies These tests may include: ultrasound: an imaging technique that uses sound waves to create an image of the testicles, scrotum, and abdomen blood test: a small amount of blood can be tested for the presence of tumor cells, infections, and more biopsy: involves removing a small tissue sample from the testicle with specialized equipment; the sample is then sent to a laboratory for testing
V. CASE STUDY PROPER Patient Data Name: Patient X Case number: 0024425 Ward: Surgery Department/ General Male Ward Bed no.: 225 Address: Purok Antipolo Brgy. Canda Ilaya, Lopez, Quezon Age: 52y/o Sex: Male Nationality: Filipino Religion: Roman Catholic Birthday: March 26,1961 Status: Married Place of birth: Lopez, Quezon Chief Complaint: Difficulty Of Breathing Admission date: August 26,2013 Discharge Date: Unknown Diagnosis: Left Testicular Tumor Attending Physician: Dr. Combalicer, Mario Donato M.
A. General Study General Assessment Conscious and coherent Not in respiratory distress Febrile With body malaise Body Structure Body parts look equal bilaterally and are in relative proportion to each other Stout Body wt: 66kg
Vital Signs: Body Temperature
Pulse Rate
Respiratory Rate
Blood Pressure Day 1 36.1 C 103bpm 30 breaths/min 130/90mmHg Day 2 38.0 C 109bpm 27 breaths/min 160/110mmHg Day 3 37.3 C 105bpm 28 breaths/min 110/90mmHg
Physical Assessment Integumentary With good skin turgor With fair skin color
HEENT Head symmetrical with rounded skull contour with long black hair lice were noted on the head
Eyes eyelashes are short, evenly spaced and slightly curled outward. no swelling noted With slightly pale conjunctiva With whitish sclera Ears auricle is of equal size and similar in appearance no discharges noted Nose same color as the face, symmetrical in appearance no changes in nares upon respiration nasal septum is intact and on midline no redness or swelling noted on the nasal mucosa nasal discharges noted, whitish in color, scanty in amount Mouth pale and dry lips gums are pinkish in color, moist tongue is in central position, moves freely and has no tenderness Neck no palpable neck mass noted no neck rigidity noted Thorax and Lungs chest is symmetrical with skin intact chest wall is intact with wheezing breath sounds are heard on both lung fields upon auscultation Heart with normal heart rhythm. Abdomen soft and non-tender upon palpation no palpable mass noted no complaints of abdominal pain Extremities Upper well-flexed with fresh lesions/wounds noted has normal sensation with pinkish nail beds and a capillary refill time of 1-2 seconds Lower with slightly pale nail beds with capillary refill time of 1-2 seconds upon blanching with edema noted on both legs, grade 1
History of Present Illness Few hour prior to admission that patient experienced sudden difficulty of breathing upon gathering some coconuts. According to the patient, at the same time she had notice her both feet edematous and made her less conscious and dizzy.
Past Medical History According to the patient, she had been hospitalized 2 years ago for complaint of hypertension. But she only took 3 days in the hospital and went home to continue the treatments. But right after her medications, she hasnt continue all her medications due to financial problems.
Family Health History According to the patient, their family has no history of heart attack but had show present hypertension on her father side. Personal and Social History: The patient is a plain housewife. She had stopped smoking for about 2 years ago after her last hospitalizations but a heavy alcoholic drinker with her friends and her daughters friends. She eats alot of rice and more on meat and vegetables including street foods.