Although different staging schemas exist, three broad stages of Alzheimer dementia have been identified, each of which is characterized by progressive degenerative changes. The early stage is characterized by short-term memory loss, lack of spontaneity, and social withdrawal. The moderate stage of dementia is marked by extreme confusion, disorientation, and personal hygiene (ADLs) is neglected. During this stage, there are also changes in higher cortical functioning needed for language, spatial relationships, and problem solving. In severe Alzheimer disease, in the terminal stage, the person typically becomes incontinent.
Extreme confusion and disorientation |Need for direct supervision for ADLs |Inability to problem solve simple tasks
Incontinence of urine and bowel |Social withdrawal from all family and friends
There is presently no cure for Alzheimer disease. Medications do not directly address the physical manifestations of Alzheimer disease. Rather, drugs are used primarily to slow the progression and to control depression, agitation, or sleep disorders.
but we learned that it might prevent a bodily decline while she declines mentally.” |“I learned that if we are vigilant about her medication schedule
she may not experience the physical effects of her disease.”
“We're both holding out hope that this medication will cure her Alzheimer's.” |“I know that this won't cure her
“I'm really hoping these medications will slow down her mental losses.”
Vascular dementia is caused by brain injury resulting from ischemic or hemorrhagic damage. Smoking and hypertension are contributing factors, and slowness in psychomotor functioning is a main clinical feature of vascular dementia. The client's history and symptomatology are not characteristic of Alzheimer disease, FTD, or Wernicke-Korsakoff syndrome.
Alzheimer disease |Frontotemporal dementia (FTD) |Wernicke-Korsakoff syndrome
Among the numerous effects of testosterone are the promotion of musculoskeletal growth in particular and protein anabolism in general. LH and FSH precede the synthesis and release of testosterone, whereas prostatic hyperplasia is not a normal effect of testosterone.
Release of luteinizing hormone (LH)
When the male ejaculates, the smooth muscle in the wall of the epididymis contracts vigorously, moving sperm into the next segment of the ductal system, the ductus deferens, also called the vas deferens. A vasectomy severs this conduit, rendering the male effectively infertile within a few weeks of the procedure. The procedure has no hormonal effect and neither the epididymis nor the rete testis is altered.
“Sperm can no longer pass through the ductus deferens.”
“The rete testis becomes inhospitable to sperm.”
“Spermatozoa can no longer reach the epididymis and do not survive.”
“Spermatogenesis is inhibited because sex hormones no longer stimulate the Sertoli cells.”
Two gonadotropic hormones are secreted by the pituitary gland: FSH and luteinizing hormone (LH). In the male, LH also is called interstitial cell–stimulating hormone. The production of testosterone by the interstitial cells of Leydig is regulated by LH. FSH binds selectively to Sertoli cells surrounding the seminiferous tubules, where it functions in the initiation of spermatogenesis. FSH does not directly affect the production of LH, since both are produced by the anterior pituitary. FSH does not stimulate testosterone synthesis, and impaired detumescence is unlikely to be a direct consequence of changes in FSH synthesis and release.
Inhibition of testosterone synthesis
Overproduction of luteinizing hormone
Dysfunction of spermatogenesis
Parasympathetic innervation must be intact and nitric oxide synthesis must be active for erection to occur. Parasympathetic stimulation results in release of nitric oxide, a nonadrenergic–noncholinergic neurotransmitter, which causes relaxation of the trabecular smooth muscle of the corpora cavernosa. This relaxation permits inflow of blood into the sinuses of the cavernosa at pressures approaching those of the arterial system. The nicotinic acid in cigarette smoke can induce vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Nitroglycerine is a vasodilator that has no effect on trabecular smooth muscle. A norepinephrine action is vasoconstriction, rather than relaxation, as part of sympathetic nervous system response.
Common risk factors for generalized penile arterial insufficiency include hypertension, hyperlipidemia, cigarette smoking, diabetes mellitus, and pelvic irradiation. Cigarette smoking induces vasoconstriction and penile venous leakage because of its effects on cavernous smooth muscle. Cryptorchidism is a major risk factor for testicular cancer. Benign prostate hypertrophy (BPH) is a risk factor for ejaculatory pathway obstruction rather than erectile difficulties. With testicular torsion, testicular arterial perfusion is impaired.
Benign prostate hypertrophy
Balanitis xerotica obliterans is a chronic, sclerosing, atrophic process of the glans penis that occurs solely in uncircumcised men. As such, the uncircumcised state supersedes the influence of sexual behavior, prostatitis, or hormonal effects of not having a pituitary gland.
A male who has an uncircumcised penis
A client who has had their pituitary gland removed due to cancer
A homosexual male with a monogamous partner
A middle-aged male with history of chronic prostatitis
Peyronie disease involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (i.e., the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis. The manifestations of Peyronie disease include painful erection, bent erection, and the presence of a hard mass at the site of fibrosis. Approximately two thirds of men complain of pain as a symptom. Discharge and lesions from the penis is usually caused from infections or STDs. Thick, nonretractable foreskin of uncircumcised male is associated with balanitis xerotica obliterans.
Thick, nonretractable foreskin of uncircumcised male
Presence of a hard mass on the tunica albuginea of the penis
Papillary lesions on penis filled with serous-colored fluid
Thick, yellow discharge from the penis
Priapism is due to impaired blood flow in the corpora cavernosa of the penis. Priapism is classified as primary (idiopathic) or secondary to a disease or drug effect. Secondary causes include hematologic conditions (e.g., leukemia, sickle cell disease, polycythemia), neurologic conditions (e.g., stroke, spinal cord injury), and renal failure. Two mechanisms for priapism have been proposed: low-flow (ischemic) priapism, in which there is stasis of blood flow in the corpora cavernosa with a resultant failure of detumescence (diminution of swelling or erection), and Peyronie disease, which involves a localized and progressive fibrosis of unknown origin that affects the tunica albuginea (i.e., the tough, fibrous sheath that surrounds the corpora cavernosa) of the penis. Circumcision trauma to the penis and abnormal tightening of foreskin are external penile problems associated with phimosis rather than the internal vascular problem of priapism.
A sixth grade male returning to school following sickle cell crisis
A teenage cocaine abuser who has been “high” for the past 72 hours
A college student with complete spinal cord injury at T12 level following auto accident
A middle-aged adult male with recent history of myocardial infarction
An uncircumcised male with poor hygiene habits
The cause of penile cancer is unknown. Invasive squamous cell carcinoma of the penis usually begins as a small lump or ulcer on the glans or inner surface of the prepuce. Several risk factors have been suggested, including poor hygiene, human papillomavirus infections (rather than herpes simplex virus infections), ultraviolet radiation exposure, and immunodeficiency states. There is an association between penile cancer and poor genital hygiene and phimosis. Circumcision confers protection, and hence cancer of the penis is extremely rare in men circumcised at birth. It is thought that circumcision is associated with better genital hygiene, which, in turn, reduces exposure to carcinogens that may accumulate in smegma and decreases the likelihood of potentially oncogenic strains of HPV. Erectile dysfunction can be the result of depression, androgen level imbalance, systemic medications, or arterial insufficiency that are unrelated to squamous cell tissue changes.
Herpes ulcerations on the penile shaft
Erectile dysfunction with prolonged erection
Painless lump on the inner surface of the prepuce
Smegma accumulation in uncircumcised male requiring regular reminders about hygiene
Hydroceles are palpated as cystic masses that may attain massive proportions. If there is enough fluid, the mass may be mistaken for a solid tumor. Transillumination of the scrotum (i.e., shining a light through the scrotum to visualize its internal structures) or ultrasonography can help to determine whether the mass is solid or cystic and whether the testicle is normal. A dense hydrocele that does not illuminate should be differentiated from a testicular tumor. The fluid cannot be removed by diuretics or by trying to express the fluid out of the scrotum.
Prescribe diuretics like Lasix to help remove excess fluid.
Continue to monitor the client every 6 months to see if there is a change in size.
Gently try to express the fluid out of the scrotal sac.
Order an ultrasound or biopsy to rule out testicular cancer.
Although all of the noted health problems warrant monitoring and possible treatment, intravaginal testicular torsion is an emergency that requires prompt surgery to save the torsed testicle.
Benign prostatic hyperplasia (BPH)
Intravaginal testicular torsion
With testicular torsion, the testis rotates about the distal spermatic cord, obstructs perfusion through the testicular arteries and spermatic veins, and obstructs nerve conduction. The torsion obstructs venous drainage, with resultant edema and hemorrhage, and subsequent arterial obstruction. The dartos muscle separates the two testes and responds to changes in temperature by contracting when cold and relaxing when warm. Most squamous cell cancers of the scrotum occur after 60 years of age and are linked to poor hygiene, chronic inflammation, exposure to ultraviolet A radiation, or human papilloma virus (HPV). After descent of the testes, the inguinal canal normally closes almost completely; failure of this canal to close predisposes to the development of an inguinal hernia later in life.
Cancer of the scrotum
Apple App Storeで表示するTopgradeアプリを選択します。