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Analgesics used are determined by the severity of pain; pain may be postoperative or caused by metastasis.

Independent

Nurses can play a role in the early detection of testicular cancer. Patients should be taught how to do a testicular self-examination and should be encouraged to perform the examination monthly. Provide private time for the patient and his partner to ask questions, express concerns, and clarify information. Offer the patient an opportunity for sexuality and fertility counseling after discussing the impact of the surgery on his anatomy and function. Make sure the patient understands the need to perform coughing and deep-breathing exercises to limit pulmonary complications. Before surgery, instruct the patient on the use of an incentive spirometer.

Because stomatitis is a common occurrence, check the mouth regularly for open irritated areas and encourage the patient to use warm mouthwashes. If the patient becomes nauseated, offer small, frequent feedings and eliminate any noxious stimuli such as bad odors. In addition, have the patient drink at least 3 L of fluid per day to ensure adequate hydration. If the patient is receiving radiation, monitor for side effects. Avoid rubbing the skin near the site of radiation to prevent discomfort and skin breakdown.

Ask about pain regularly and assess pain systematically. Believe the patient and family in their reports of pain. Inform the patient and family of options for pain relief as proposed by the National Cancer Institute (pharmacologic, physical, psychosocial, and cognitive-behavior interventions) and involve the patient and family in determining pain relief measures. To manage the discomfort of chemotherapy in addition to medications, consider the use of biofeedback or other alternative relaxation techniques.

The diagnosis of testicular cancer is a devastating one to most men. Discuss the patient's concerns with him. Explain the role of hormonal replacement in maintaining the secondary sex characteristics. If the patient is at risk for sterility, explain sperm banking procedures before treatment if infertility and impotence may result from surgery. Refer the patient to a support group or ask that another man who has experienced a similar diagnosis and treatment share his experiences to provide support. If the patient or partner is struggling to cope with the diagnosis, arrange for a counselor.

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