BPH

Question 1

BPH Collaborative Care

Answer 1

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

Question 2

Nursing Assessment

Answer 2

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

Question 3

Nursing Assessment

Answer 3

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

Question 4

Nursing Assessment

Answer 4

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

Question 5

Collaborative Care

Answer 5

Drug therapy:

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

Question 6

Collaborative Care

Answer 6

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

Question 7

Collaborative Care

Answer 7

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

Question 8

Collaborative Care

Answer 8

Invasive therapy indicated for:

• decrease in urine flow sufficient to cause discomfort
• persistent residual urine
• acute urinary retention
• hydronephrosis

Question 9

Collaborative Care

Answer 9

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

Question 10

Collaborative Care

Answer 10

Minimally invasive:

• Transurethral microwave therapy (TUMT)
• Transurethral needle ablation (TUNA)

Question 11

Collaborative Care

Answer 11

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

Question 12

Nursing Diagnoses

Answer 12

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

Question 13

Planning

Answer 13

Goals of client having invasive procedure:

• Restoration of urinary drainage
• Treatment of UTI
• Understanding of procedure and complications

Question 14

Planning

Answer 14

Goals for post-op:

• No complications
• Restoration of urinary control
• Complete bladder emptying
• Satisfying sexual expression

Question 15

Nursing Implementation

Answer 15

Focus is early detection and treatment

Instruct client with obstructive symptoms to urinate q2-3 h and when first feeling urge

Question 16

Nursing Implementation

Answer 16

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

Question 17

Nursing Implementation

Answer 17

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

Question 18

Nursing Implementation

Answer 18

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

Question 19

Nursing Implementation

Answer 19

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

Question 20

Evaluation

Answer 20

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

Question 21

Prostate Cancer: Nursing Assessment

Answer 21

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

Question 22

Prostate Cancer: Collaborative Care

Answer 22

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

Question 23

Prostate Cancer: Collaborative Care

Answer 23

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

Question 24

Surgery

Answer 24

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

Question 25

Collaborative Care

Answer 25

Radiation therapy: - External beam radiation - Brachytherapy

Question 26

Prostate Cancer: Collaborative Care

Answer 26

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

Question 27

Prostate Cancer: Nursing Management

Answer 27

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

Question 28

Prostate Cancer: Nursing Management

Answer 28

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

Question 29

Prostate Cancer: Nursing Management

Answer 29

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

Question 30

Prostate Cancer: Nursing Management

Answer 30

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

Question 31

Testicular Cancer: Nursing and Collaborative Management

Answer 31

* Testicular self-exam * Orchiectomy * Meticulous follow-up and regular exams * Goal is to detect relapse when tumour burden is minimal * Discuss fertility and sperm banking before treatment

Question 32

Testicular Self Exam

Answer 32

* Just after a shower or bath is the best time to examine the testes. Warm temperatures make the testes hang lower in the scrotum. * Stand in front of a mirror. Look for any swelling on the skin of the scrotum. * Hold your scrotum in the palms of your hands so that you can feel the size and weight of each testicle. It is normal for one testicle to be larger and hang lower than the other. * Gently roll each testicle between your thumb and your fingers. Feel for lumps or bumps. If you feel a soft, tender tube cord leading upward from the back of each testicle, that is normal. * Notify the health care provider at once if any abnormalities are found.