BPH Flashcards Preview

Nursing Theory IV > BPH > Flashcards

Flashcards in BPH Deck (32)
Loading flashcards...
1

BPH Collaborative Care

Goals:
- Restore bladder drainage
- Relieve symptoms
- Prevent complications
Watchful waiting
Dietary changes
Times voiding schedule

2

Nursing Assessment

Urinary urgency
Diminution in calibre and force of urinary stream
Hesitating in initiating voiding
Post-void dribbling
Incontinence
Dysuria
Sensation of incomplete voiding

3

Nursing Assessment

Anxiety of sexual dysfunction
Older adult male
Distended bladder on palpation; smooth, firm, elastic enlargement of prostate on rectal exam
U/A findings, enlargement on ultrasound

4

Nursing Assessment

Medications:
- Estrogen or testosterone supplementation
Surgery or previous treatment for BPH
Voluntary fluid restriction
Nocturia (3 or greater)

5

Collaborative Care

Drug therapy:
- 5a- Reductase inhibitors (Proscar)
- Reduce size of prostate gland
- Takes 3-6 months for improvement
- S/E decreased libido, decreased ejaculation, ED

6

Collaborative Care

a- Adrenergic receptor blockers (Flomax, Hytin)
- Promote smooth muscle relaxation in prostate
- Facilitates urinary flow
- Improvement in 2-3 weeks
- S/E orthostatic hypotension and dizziness

7

Collaborative Care

Herbal therapy:
Saw palmetto
- Shown to improve urinary symptoms and flow
- Long term effectiveness and ability to prevent complications unknown

8

Collaborative Care

Invasive therapy indicated for:
- decrease in urine flow sufficient to cause discomfort
- persistent residual urine
- acute urinary retention
- hydronephrosis

9

Collaborative Care

Transurethral resection (TURP)
- Removal of prostate tissue using resectoscope inserted through urethra
Outcome for majority is excellent

10

Collaborative Care

Minimally invasive:
- Transurethral microwave therapy (TUMT)
- Transurethral needle ablation (TUNA)

11

Collaborative Care

Laser prostatectomy
- Delivers a beam that is used for cutting, coagulation, and vaporization of prostatic tissue
Takes several weeks to reach optimal results

12

Nursing Diagnoses

Acute pain r/t surgery, prostate enlargement, bladder spasms
Risk for infection r/t urinary retention, urinary catheter
Fear r/t uncertain outcome
Urge urinary incontinence r/t poor sphincter control
Hemorrhage r/t surgery

13

Planning

Goals of client having invasive procedure:
- Restoration of urinary drainage
- Treatment of UTI
- Understanding of procedure and complications

14

Planning

Goals for post-op:
- No complications
- Restoration of urinary control
- Complete bladder emptying
- Satisfying sexual expression

15

Nursing Implementation

Focus is early detection and treatment
Instruct client with obstructive symptoms to urinate q2-3 h and when first feeling urge

16

Nursing Implementation

Teach client need for adequate fluid intake
Use aseptic technique when using urinary catheter
Administer antibiotics pre-op
Provide client opportunity to express concerns of alterations in sexual function

17

Nursing Implementation

Inform client of possible complications of procedure
Post-op bladder irrigation to remove blood clots and ensure drainage of urine
Administer antispasmotics
Teach Kegel exercises

18

Nursing Implementation

Observe client for signs of infection
Dietary intervention
Stool softeners to prevent straining

19

Nursing Implementation

Discharge instructions on indwelling catheter
Managing incontinence
2-3L fluid qd
S&S of UTI
Sexual counselling if ED because chronic or permanent problem
Avoid bladder irritants
Yearly digital rectal exam

20

Evaluation

No complaints of pain
No evidence of UTI or other infection
Decreased fear of effect of surgery on sexuality
No post-op bleeding from performing activities increasing abdominal pressure
Absence of or satisfactory control of dribbling

21

Prostate Cancer: Nursing Assessment

Health Hx, medications, family Hx, surgery
Symptoms
Possible findings of diagnostic tests
Risk factors

22

Prostate Cancer: Collaborative Care

• Whitmore-Jewett and tumor, node, metastasis (TNM) system used to stage prostate cancer

23

Prostate Cancer: Collaborative Care

Conservative therapy:  Watchful waiting when:
• Life expectancy is less than 10 years
• Presence of significant comorbid disease
• Presence of low-grade, low- stage tumour

24

Surgery

Surgical therapy:
- Radical prostatectomy
- Nerve-sparing surgical
procedure
- Cryosurgery

25

Collaborative Care

Radiation therapy:
- External beam radiation
- Brachytherapy

26

Prostate Cancer: Collaborative Care

Drug therapy
- Hormonal therapy:
- Luteinizing hormone–releasing hormone agonists
- Androgen receptor blockers
- Estrogen
Orchiectomy
Chemotherapy

27

Prostate Cancer: Nursing Management

Nursing diagnosis:
- Decisional conflict
- Acute pain
- Urinary retention
- Impaired urinary elimination 
- Constipation or diarrhea
- Sexual dysfunction
- Anxiety

28

Prostate Cancer: Nursing Management

Planning: Overall goals
- Will be active participant in therapeutic plan
- Will have satisfactory pain control
- Will follow therapeutic plan on sexual dysfunction
- Will find a satisfactory way to manage impact on bladder or bowel function

29

Prostate Cancer: Nursing Management

Health promotion:
• Encourage DRE and PSA screenings
• Provide sensitive, caring support to client
and family
• Encourage joining a support group and to seek information

30

Prostate Cancer: Nursing Management

Evaluation:
- Actively participate in treatment plan
- Have satisfactory pain control
- Follow therapeutic plan
- Accept effect of treatment on sexual function
- Find satisfactory way to manage impact on bladder or bowel function