Week 13: Chp 66: Benign Prostatic Hyperplasia

Question 1

What is Benign Prostatic Hyperplasia

Answer 1

an enlarged prostate

-not a form of cancer; can have BPH and prostate cancer simultaneously or independently of each other

Question 2

Primary control of the prostate gland

Answer 2

assist in controlling urine flow

• also mixes sperm with prostatic fluid and seminal fluid to be ejaculated during orgasm
• around the age of 25, the prostate begins to grow

Question 3

The clinical manifestations of BPH

Answer 3

related to lower urinary tract symptoms (LUTS)

• difficulty starting the flow of urine even with straining
• a weak stream of urine
• multiple interruptions during urination
• dribbling once urination is complete

Question 4

Symptoms related to changes in the bladder include?

Answer 4

urgency, frequency, the feeling that the bladder has not completely emptied after urination, and frequent awakening at night to urinate

Question 5

As the bladder becomes more sensitive to the retention of urine, what might result?

Answer 5

incontinence

-the patient may experience bet-wetting and the inability to respond quickly enough to the need to urinate

Question 6

A urethral obstruction or enlarged prostate that is left untreated may result in?

Answer 6

bladder outlet obstruction (BOO)
-includes acute urinary retention (AUR), bladder infection, bladder stones, and increasing pressure in the kidney, possibly resulting in hydronephrosis or postrenal acute kidney injury (AKI) or pyelonephritis

Question 7

Diagnostic Tests

Answer 7

• digital rectal examination (DRE)
• Urinalysis
• prostate-specific antigen (PSA)

Question 8

Digital rectal examination (DRE)

Answer 8

diagnosis of BPH is confirmed with DRE

-the enlarged prostate can be palpated on examination

Question 9

Urinalysis: Why?

Answer 9

is done to rule out the presence of an infection causing symptoms

Question 10

Prostate-specific antigen (PSA)

Answer 10

is a protein produced by the prostate gland and may be considered a tumor marker

• elevated PSA may be indicative of prostate cancer
• elevated PSA levels are also indicative of infection (PSA levels do not distinguish between cancer and BPH)

Question 11

Complications of BPH

Answer 11

• Acute urinary retention
• UTI
• Bladder stones
• Bladder damage
• Kidney damage

Question 12

Complications: acute urinary retention

Answer 12

blockage of urethra by enlarged prostate, obstructing urine flow; causing AUR

Question 13

Complications: UTI

Answer 13

secondary to urinary stasis

Question 14

Complications: Bladder stones

Answer 14

crystallization of mineral deposits in concentrated urine due to obstructed urine flow

Question 15

Complications: Bladder damage

Answer 15

stretching and weakening of the bladder wall muscles from incomplete emptying, resulting in the bladder no longer contracting properly

Question 16

Complications: Kidney damage

Answer 16

increased pressure in the kidney secondary to urinary retention and backflow of urine, causing hydronephrosis (swelling of urine-collecting structures in the kidney) and postrenal AKI
-pyelonephritis- UTI migrating from the bladder to the kidney

Question 17

Pharmacological management

Answer 17

• 5-alpha reductase inhibitor
• alpha-adrenergic blockers
• if has an overactive bladder, an anticholinergic is added such as oxybutynin to relax bladder smooth muscle

Question 18

Medications: alpha-adrenergic blockers

Answer 18

alpha blockers act on the alpha receptors in the prostate, causing smooth muscles of the prostate to relax

• relaxation of these muscles decreases the constriction of the urethra
• takes 2 weeks to 4 months to notice symptom improvement
• adverse effects: headache, nasal congestion, dizziness, drowsiness, postural hypotension, reflex tachycardia, and retrograde or delayed ejaculation

Question 19

Adverse effects of alpha-adrenergic blockers

Answer 19

headache, nasal congestion, dizziness, drowsiness, postural hypotension, reflex tachycardia, and retrograde or delayed ejaculation

Question 20

Medications: 5-alpha reductase inhibitors

Answer 20

act as antiandrogens

• 5-alpha reductase converts testosterone into DHT; Dihydrotestosterone stimulates the growth factors that encourage prostate hyperplasia while concurrently reducing the rate of cell death in the prostate; this imbalance results in enlargement of the prostate
• 5-alpha reductase inhibitors prevent testosterone from being converted to DHT, which causes enlarged tissues to shrink, thus reducing obstruction of the urethra
• take 3 to 6 months to take effect
• does not affect levels of circulating testosterone; reduces the chance of erectile dysfunction
• adverse effects: rash, breast enlargement, breast tenderness, reduced volume of ejaculate, decreased libido, ED
• reduction in male -pattern baldness

Question 21

Adverse effects in 5-alpha reductase inhibitors

Answer 21

rash, breast enlargement, breast tenderness, reduced volume of ejaculate, decreased libido, and erectile dysfunction (ED)

Question 22

What can be added to the medication regimen if the patient with BPH has an overactive bladder?

Answer 22

an anticholinergic to relax smooth muscle, such as oxybutynin, may be added

Question 23

Alternative Therapies if medication is not an effective treatment and is not a surgical candidate?

Answer 23

• intermittent catheterization
• indwelling urinary catheter
• saw palmetto (Serenoa repens), African plum (Pygeum africanum), Cernilton, and South African star grass (Hypoxis rooperi and some species of Pinus and Picea)

Question 24

Alternative Therapies: Indwelling catheter: how long can it stay?

Answer 24

can stay in place and be changed monthly per protocol

Question 25

Surgical Management Treatment Options

Answer 25

- Transurethral Resection of the Prostate (TURP) - Transurethral Incision of the Prostate (TUIP or TIP) - Open Prostatectomy - Laser Surgery - Transurethral Microwave Therapy (TUMT) - Transurethral Needle Ablation (TUNA) - Prostatic Stents - Water-induced thermotherapy and Transurethral Ethanol ablation

Question 26

Surgical Treatment Options: Transurethral Resection of the Prostate (TURP)

Answer 26

most common surgery for BPH - a lighted scope known as a resectoscope is passed into the urethra. A small cutting tool is used to remove the entire inner prostate, leaving the outer layer; symptoms are usually relieved quickly, resulting in a stronger flow of urine - a catheter may remain in place after surgery for 3 to 5 days to drain the bladder - recovery from a TURP may include a risk of bleeding and infection - permitted only light activity immediately postoperatively

Question 27

Treatment Options: Continuous Bladder Irrigation

Answer 27

Continuous bladder irrigation (CBI) is a procedure used to flush sterile fluid through a catheter and into the bladder. The irrigation helps remove and prevent blood clots from forming in the bladder. Catheter is to remain in place for 3-5 days

Question 28

Assessment and Analysis: Clinical manifestations of BPH are due to what?

Answer 28

caused by the obstruction of urine flow due to an enlarged prostate - difficulty starting flow of urine - a weak urine stream - multiple interruptions during urination - dribbling once urination is complete - urgency, frequency, the feeling that the bladder has not completely emptied after urination, and nocturia

Question 29

Nursing Diagnoses

Answer 29

- disturbed sleep pattern r/t nocturia | - risk for infection r/t urinary stasis

Question 30

Nursing Interventions: Assessments

Answer 30

- urinary symptoms - temperature - focused abdominal examination - bladder scan - urinalysis

Question 31

Assessments: Urinary symptoms

Answer 31

subjective data from the patient regarding the extent of urinary symptoms assist in diagnosis and aid in determining treatment options - mild symptoms that do not interfere with activities of daily living may require only watchful waiting - more severe symptoms that interfere with activities of daily living, such as nocturia and an ability to empty the bladder, may require more aggressive treatment

Question 32

Assessment: Temperature

Answer 32

an increase in temperature may indicate a UTI secondary to urinary stasis

Question 33

Assessment: Focused abdominal examination

Answer 33

a distended abdomen may signify bladder distention, thus indicating the patients inability to empty the bladder and risk for a UTI

Question 34

Assessment: Bladder scan

Answer 34

use of a bladder scanner to check postvoid residual (PVR) to determine the ability of the patient to empty his bladder and discovering any urinary stasis that may lead to infection

Question 35

Assessment: Urinalysis

Answer 35

the results will determine a possible infection from urinary stasis or related LUTS (lower urinary tract symptoms)

Question 36

Nursing Actions

Answer 36

- catheterization | - administer medication therapy; 5-alpha reductase inhibitor and/ or alpha-adrenergic blockers are ordered

Question 37

Actions: Catherterization

Answer 37

to check for PVR and to relieve distended bladder, decreasing the risk for bladder damage

Question 38

Actions: administer medication therapy; 4-alpha reductase inhibitor and/or alpha-adrenergic blockers as ordered

Answer 38

- 5-alpha reductase inhibitors limit the production of DHT, a substance that encourages prostate hyperplasia - alpha-adrenergic blockers relax the smooth muscle of the prostate

Question 39

Nursing Teachings

Answer 39

- watchful waiting - decreased liquid intake in the evening - medication therapy education - follow-up - information regarding surgical options - care of surgical/ invasive treatment sites

Question 40

Teaching: "watchful waiting"

Answer 40

explanation of the term "watchful waiting", including recognition of worsening symptoms, and when to seek further treatment help alleviate anxiety and ensure that the patient seeks treatment when necessary

Question 41

Teaching: Decrease liquid intake in the evening

Answer 41

decreased fluid intake in the evening may decrease nocturia

Question 42

A patient's orders include the placement of a catheter as a temporary treatment of his BPH. The nurse understands that rationales for this intervention is which of the following? (select all that apply) A. exact monitoring of intake and output B. retrieving a sterile sample for urinalysis C. to evaluate PVR volume D. to facilitate complete emptying of the bladder E. to avoid unnecessary surgical procedures

Answer 42

C. to evaluate PVR volume | D. to facilitate complete emptying of the bladder