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CASE STUDY

L.D. has come for an evaluation of a firm nodule he noticed about 6 months ago attached to his testicles. He states he had not been concerned because he was hit in the testicles with a baseball shortly before he noticed the nodule.

PRESENTING COMPLAINT
A firm nodule attached to patients testicles. Nodule first noted about 6 months ago.

COMPREHENSIVE HEALTH HISTORY
SUBJECTIVE DATA:
BIOGRAPHICAL DATA: AGE: 30 OCCUPATION: SEX: M MARITAL STATUS: Married

MALE GENITALS (REVIEW SYSTEM R\T PRESENTING COMPLAINT) EXAMINAMINOR ASKS: •How are you feeling today? •Did you discover this firm lump on your testicle during a testicular self-examination? •Do you do testicular self-examinations regularly?
•has the lump changed in size, shape or firmness since you first noticed it? • any pain associated with the lump?( frequency, severity , area it radiates from and to, how long it presist, is it intermittent or during attivity and is it relieved through the use of pain medication) •note any change in the size of your scotum? (swelling or heavy,dragging feeling) •any problems with your penis? (pain,lesions or discharge) •any change in your sexual activity and contraceptive use? (ability to have an erection, sexual satification for you and your partner)

•any problems with urination? (frequency, urgency, waking at night to urinate, burning upon urination, hesitancy or straining, difficulty controlling your urine , cloudy, foul-smelling or blood tinged urine ) •have you had any STI contact? (when, did you become infected, how was it treated and do you use condoms) •are you currantly taking any prescribed or over-the -counter medications?

OBJECTIVE DATA
GENERAL SURVEY: the examiner makes a visual assessment of the patient during the interview noting (appears stated age, level of consciousness, skin colour, nutritional status, posture, mobility and gait, facial expression, mood and effect, speech, hearing and personal hygiene) VITAL SIGNS: pulse, respirations,blood pressure ,temperature MALE GENITALIA: •inspect and palpate the penis •inspect and palpate the srcotum •tranilluminate hard node on testicle •palpate for an inguinal hernia •palpate inguinal lymph nodes

DOCUMENTATION OF THE PHYSICAL EXAM
GENERAL SURVEY: L.D. is a 30 year old male, well norished and developed, appears stated age, he is alert and orientated,behavior and speech appropriate,ambulates without difficultly and is in no distress. VITAL SIGNS: within normal limits. MALE GENITALIA : penis - no lesions, no inflamation or discharge, scrotum - testes descended, symmetrical, found upon examination -Palpation- small hard nodule ,free moving, lying between testies, denies pain, "I,m not concerned, i t happened 6 months ago, when I was hit with a baseball", no hernias.

NURSING DIAGNOSIS & HEALTH PROMOTION
At risk for Testicular Cancer due to testicular mass . At risk for Testicular Cancer due to age (most common cancer in young men 15 and 35 years old) HEALTH PROMOTION - arrange a biopsy of testicular hard nodule.

Pain due to testicular mass HEALTH PROMOTION - educate the patient to the possibility of pain and the availabilities of pain medication and the importance of informing his health team of changes in his condition.

Anxiety due to biopsy R\T testicular mass HEALTH PROMOTION - reassure patient that the biopsy procedure is simple and quickly preformed by professionals. follow-up pain medication available if necessary

Risk for wellness due to deficient knowledge -skill R|T testicular hard nodule HEALTH PROMOTION - educate patient to self examine his testicles monthly while in the shower. Check for changes and report them immediately.