Primary Nursing Diagnosis

Pain (acute) related to inflammation, tissue damage, tissue compression, or nerve irritation from tumor metastasis in the perineum, groin, or abdomen

OUTCOMES. Pain control; Pain: Disruptive effects; Well-being

INTERVENTIONS. Analgesic administration; Pain management; Meditation; Transcutaneous electric nerve stimulation (TENS); Hypnosis, Heat/cold application

U PLANNING AND IMPLEMENTATION Collaborative

SURGICAL. The initial treatment for testicular cancer is surgical resection of the involved testicle (orchiectomy). A testicular prosthesis can be placed if the patient so desires. If a bilateral orchiectomy is performed, the patient may need hormonal replacement. It is controversial whether or not the retroperitoneal nodes should be resected or treated with

882 Testicular Cancer chemotherapy. Surgical resection carries with it the likelihood of impotence. To preserve fertility, nerve-sparing retroperitoneal lymph node surgery protects the nerves and allows for normal ejaculation.

Postoperatively, edema and intrascrotal hemorrhage are the two most common problems. Monitor the patient closely for swelling and bleeding. Elevate the scrotum on a rolled towel, and apply ice to assist with discomfort and decrease swelling. Observe for signs of infection. Encourage the patient to wear an athletic supporter during ambulation to minimize discomfort. Usually, the patient is encouraged to do so within 12 hours of surgery.

RADIATION AND CHEMOTHERAPY. Depending on staging of the disease, radiation or chemotherapy may also be used. Tumors classified as seminomas are especially radiosensitive. External beam radiation is usually given after surgery if the peritoneal lymph system is disease-positive or if the pelvis and mediastinal and supraclavicular lymph nodes are involved. Inform the patient that, although the unaffected testicle is shielded during radiation, it does receive some radiation that is scattered, which may decrease spermatogenesis. Nonseminomatous tumors are not radiosensitive, and chemotherapy is the preferred treatment.

Pharmacologic

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