Exam (elaborations)
NUR 6111 Adv Nursing Practice 1 Case study 7 week 7.
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- William Paterson University
NUR 6111 Adv Nursing Practice 1
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Case study#71. A 43-year-old man is seen in the emergency department after he noticed scrotal swelling while
showering. Finding the enlargement alarming, he is unable to give a definitive answer when asked about
the pain. A physical examination reveals a mild swelling on the left side with no apparent discoloration.
The man explains that he was involved in a minor motor-vehicle accident approximately 2 weeks ago but
had no specific history of scrotal injury. During further examination and studies, a painless mass covering
the entire anterior surface of the testis is noted. The physician explains to the patient that he has:
1. Torsion of the testis: rotation of testis which twist blood vessels in the spermatic cord.
2. A spermatocele: benign cystic collections of fluid of the epididymis located between the head of the
epididymis and the testis.
3. A hydrocele: a collection of fluid within the tunica vaginalis.
4. Cryptorchidism: a condition of testicular maldescent
Explain you answer: The physician explains to the patient that he has a hydrocele. Hydrocele is a
collection of fluid within the tunica vaginalis. It is the most common cause of scrotal swelling. When
hydroceles occur in an adult it can be a result of an imbalance between the secreting and absorptive
capacities of scrotal tissue. It can also be caused by trauma or infection of the testis or epididymis or
from a testicular tumor. This is known as secondary hydrocele. Chronic hydroceles are more common
and occur in men older then 40, which this patient is. A painless, extra testicular mass that easily
transilluminates is found upon physical exam. The patient complained of swelling but no pain. He most
likely has chronic hydrocele. Since there is no physical discomfort, it is recommended that the fluid be
aspirated and an injection of sclerosing agent into the scrotal sac to prevent reoccurrence.
2. Although a multitude of tests are performed on the client, the physician does not order a PSA test.
The client is concerned that he may have prostate cancer and quizzes the physician about his decision.
The physician explained his reasoning.
1. Prostate cancer is virtually nonexistent is men under the age of 70 years.
2. Only a magnetic resonance image (MRI) or computed tomographic (CT) scan can actually confirm the
diagnosis of prostate cancer.
3. No compromise is evident in the urinary stream.
4. PSA is organ specific not cancer specific.
Explain you answer: PSA is only one screening for prostate cancer but it is organ specific not cancer
specific. This is why that test isn’t ordered. An MRI and CT scan are more important to be done in the
event that there is prostatic cancer. A man’s risk for prostate cancer increases when he reaches the age
50.
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