Flashcards in BPH Deck (32)
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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
