Right Testicular Pain - Case Study Example

Nursing: Right Testicular Pain Number Introduction A 16-year-old male patient is presented with an acute onset of right testicular pain. He is nauseated, but is not vomiting and with an oral temperature of 101. The patient denies recent trauma or illness. On physical examination, a descended testicle that is red, swollen, and tender to palpation is noted. Interestingly, the cremasteric reflex is also absent. Determining This Patient’s Diagnoses From the foregoing, it will be important to consider the need for differential diagnosis. Differential diagnosis of testicular pain is meant for broad-based purposes and variegated factors such as testicular torsion, epididymitis and torsion of the testicular appendage, among a host of other testicular complications. This is because, apart from the aforementioned four, other complications that are accompanied by acute testicular pain include gangrene, hydrocele, idiopathic testicular pain, orchitis, scrotal masses, testicle injury, testicular cancer, inguinal cancer, varicocele and Henoch-Schonlein purpura. It is important that testicular conditions with symptoms that are not matching a descended testicle that is red, swollen and tender to palpation are ruled out to save time and allow for timely medical intervention. All the same, Ringdahl and Teague (2006) contends that it will be important to first determine whether the testicular complication is anatomical or physiological. If the testicular complication is physiological, then symptoms such as discharges and blood or droplets of blood in semen may be seen. Diagnosis may therefore be done in light of these complications. Conversely, if the problem is anatomical, then morphological complications such as overly descendent testis, intense and unbearable pain and change in the appearance of the affected testis may be noted. Just as Brown-Guttovz (2007) states, to eradicate chances for misdiagnosis, I may have to: observe the patient’s gait and resting position; the natural position of the testis in the scrotal sac when the patient is standing; the presence or absence of cremasteric reflex; determine whether the swelling is reducible; check and compare the palpitation of the scrotum, scrotal contents of the affected hemiscrotum against the affected hemiscrotum; and analyze palpitations in the lower abdomen and the inguinal and cord canals. The Meaning of the Absent Cremasteric Reflex Nevertheless, from the foregoing, the absence of the cremasteric reflex make it clear that the patient is suffering from testicular torsion and not any other testicular conditions that are also accompanied with pain, My Immediate Intervention The evaluation, diagnosis and treatment of the patient is required and should be done very fast because if testicular torsion goes untreated for 6 hours, the affected testis may be lost. In this respect, blood tests will not be considered at this stage. Radionuclide scanning is very accurate but may not be applicable at this stage since time will be of the essence. In light of the recommendation put forth by Somani, Watson and Townell (2010), droppler tests (for assessing blood flow and anatomy by an aid of color Droppler flow ultrasound) may be used to identify the absence of the patient’s blood flow in the affected or twisted testicle. The droppler ultrasound scan on the scrotum is 90% accurate in detecting testicular torsion and differentiating testicular torsion from other sources of testicular pain and complications such as epididymitis. In regard to the foregoing, I may try to manually rotate the testicle outward and toward the patient’s thigh and in the opposite direction. What informs this decision is the simple fact that during testicular torsion, the surface of the torsion rotates towards the patient’s body. Failure to achieve the desired result, together with the team, I will try to use forced manual rotation in the opposite direction so as to correct the situation. In light of the recommendation put forth by Sells, Moretti and Burfield (2002), in the event that the two moves do not work, I will have to book the patient for an emergency surgical intervention. The patient’s guardians or parents will have to give their informed consent for the 16-year-old patient since he has not attained the legal age or the age of consent. As part of the preparation for the surgical intervention, the patient is to be kept on fast to facilitate easier surgical intervention. According to Cox, Patel and Gelister (2012), surgical intervention will be applicable if the two manual approaches above fail so as t restore the patient’s blood flow. The crux of the mater behind the need to observe time is that treatment within 6 hours brings about much higher chances of rescuing the testis. Chances of rescuing or recovering the article diminish constantly as time goes by. Within the aforementioned and recommended 6 hours, there is 90% and above chances of preserving the testicle. At 12 hours, the chances fall to 50% and after 24 hours, to 10%. After 24 hours, the chances for preserving the testicle have dropped to 0 (zero). My Future Plan for Work Up There is sufficient need to have chances for the recurrence of the incident (testicular torsion). After successfully restoring the testis back to its position through surgical intervention and restoring blood flow, it will be important to take measures to prevent future cases of the same incident. In this light, the testicle may be surgically sewn to the scrotum to ward chances for a relapse into similar cases. Conclusion: Whether Or Not This Patient at Risk of Any Future Complications Indeed, there are chances for the recurrence of testicular torsion on patients who have been treated for the same. In a study by Sells, Moretti and Burfield (2002), 20 cases of recurrent conditions after surgical intervention were considered and described. From the study, it was found that higher recurrent incidences were concomitant to the use of absorbable sutures in lieu of the non-absorbable ones. The main explanation behind this is that the use of non-absorbable sutures is characterized with a lower recurrence rate because it is much less predisposed to the formation of abscesses. In this light, an important factor for adhesion formation appears to be the aversion of tunica vaginalis. It is therefore recommended that this is observed during all cases of testicular fixations. References Brown-Guttovz, H. (2007). Testicular torsion. Nursing, 37 (10), 72 Cox, A. M., Patel, H. & Gelister, J. (2012). Testicular torsion. British journal of hospital medicine, 73 (3), 34 - 36 Ringdahl, E. and Teague, L. (2006). Testicular torsion. American family physician, 74 (10), 1739 Sells, H., Moretti, K. L. & Burfield, G. D. (2002). Recurrent torsion after previous testicular fixation. US National Library of Medicine National Institutes of Health, 72 (1), 46-8. Somani, B. K., Watson, G. & Townell, N. (2010). Testicular torsion. BMJ (Clinical research) 341 (1), 3213 Read More