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adult 1 med surg > benign prostate hyperplasia > Flashcards

benign prostate hyperplasia Flashcards

1
Q

hormone that stimulates prostate growth

A

dihydrotestosterone (DHT)

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2
Q

what measurement can the prostate grow to where it starts narrowing the urethra

A

beyond 4x5cm

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3
Q

BPH growth is ______ while prostate cancer growth is _______

A

BPH growth = central
prostate cancer = peripheral (won’t see urinary symptoms as soon as bph)

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4
Q

what are some risk factors that can lead to BPH

A

obesity, inc waist circumference, sedentary lifestyle
diabetes, high red meat/processed meals and dairy

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5
Q

what diet helps prevent prostate growth

A

green and yellow veggies, tomatoes

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6
Q

what are bladder irritants to avoid consuming

A

caffeine and alcohol

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7
Q

what to avoid to prevent further urinary retention and symptoms

A

avoid OTC and cold medications + diet pills, anticholinergic drugs

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8
Q

what are some complications that can arise with prostate enlargement ( 4)

A
  1. retention/muscle thickening
  2. UTI due to urinary stasis
  3. pyelonephritis and kidney stones
  4. hydroureters, hydronephrosis, kidney failure
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9
Q

explain the relationship between luteinizing hormone and DHT

A

luteinizing hormone –> testosterone secretion –> 5a reductase converts testosterone into DHT –> DHT leads to prostate cell growth and production

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10
Q

subjective data that hint at BPH

A

inc frequency (not fulling emptying)
nocturia
change in stream (weak and thin, hard to start)
incomplete empyting feeling, intermittency, urgency, leakage

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11
Q

what is the prostate symptom index

A

scale used to rate and determine severity of symptoms to make tx plan

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12
Q

objective data/tests to do to screen for prostate growth

A

DRE: digital rectal exam
PSA: prostate specific antigen
TRUS: transurethral ultrasound

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13
Q

how should a BPH feel during a DRE

A

prostate is enlarged, firm, and smooth

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14
Q

normal and abnormal PSA levels

A

normal = <4
abnormal = > 4

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15
Q

significance of doing a urinalysis + urine culture when screening for BPH/prostate cancer

A

to rule out UTI

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16
Q

what other dx exams can you do to screen for BPH

A

residual urine/post void scan
cytoscopy
intravenous pyelogram

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17
Q

what is an intravenous pyelogram

A

using contrast dye to look at blood flow + structure through xray (abnormal blood flow = cancer??

18
Q

goals of prostate medical management (3)

A

slow prostate growth, relax prostate muscle, relieve retention

19
Q

what are some 5a reductase inhibitor medications

A

finasteride (Proscar), dutasteride (Avodart)

20
Q

finasteride (Proscar), dutasteride (Avodart)
C:
MOA:
I:
how long it takes to work?
SE:

A

C: 5a reductase inhibitors
MOA: inhib 5a reductase –> no DHT = no prostate growth
I: dec size of prostate gland
takes 3-6months to work, tell pt not overnight fix
SE: dec libido, dec vol of ejaculation, ED

21
Q

what are some alpha adrenergic receptor blocker medications

A

tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo)

22
Q

tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo)
C:
MOA:
I:
how long it takes to work?
SE:

A

C: alpha adrenergic receptor blockers
MOA: block alpha adrenergic receptors –> SM relax in prostate = help urinary flow
I: inc urinary flow
takes 2-3 weeks to work
SE: orthostatic hypotension, dizzy, retrograde ejaculation, nasal congestion, dec fertility

23
Q

when should a pt take tamsulosin and other alpha adrenergic blocker medications

A

take at night to prevent dizziness in the morning

24
Q

when to use invasive therapy for BPH

A
  1. dec in urine flow = discomfort
  2. persistent residual urine
  3. acute urinary retention
25
Q

explain transurethral balloon dilation (TUBD)

A

insertion of a balloon using saline and a guide wire to dilate the prostate and help with urinary flow
- not a permanent fix, temporary

26
Q

what is the gold standard procedure for BPH

A

transurethral resection of the prostate (TURP)

27
Q

explain transurethral resection of the prostate (TURP)

A

using a scope through the urethra into the prostate - cauterize and remove growth, pt usually under general anesthesia

28
Q

is TURP nerve sparing?

A

nerve sparing, no ED problems

29
Q

pre-op intervention before TURP

A
  • consent, what to expect, CBI
  • no incision, but some pain after (bladder spasms, pain mgmt)
  • cath will be bigger and stiffer, 30mL in balloon
  • TURP is nerve sparing = no ED
  • pre-op vitals, gown change, ID
30
Q

post op interventions after TURP

A
  • CBI
  • antispasmodics
  • kegel exercises
  • home education
  • follow up
31
Q

what is a CBI

A

continuous bladder irrigation; remove blood clots + ensure drainage and prevent another urinary obstruction

32
Q

what fluid to use in a CBI

A

0.9NS

33
Q

when to increase the rate of the CBI

A

urine is dark red

34
Q

when to decrease the rate of the CBI

A

urine is pink

35
Q

urine color goal of CBI

A

urine is clear with no redness or clots

36
Q

when to empty CBI bags

A

at 3/4 full to prevent exploding and to prevent output from traveling back up

37
Q

t/f: bladder spasms are an expected finding after TURP

A

true

38
Q

what is the #1 cause of bladder spasms

A

catheter and large balloon

39
Q

when to administer antispasmodics for bladder spasms

A

nurse should get order for manual irrigation first, then admin belladonna and opioid suppository (BNO)

40
Q

significance of kegel exercises

A

strengthen pelvic floor muscles

41
Q

pt education for discharge to home after TURP

A
  • s/s of uti, infection
  • 2-3L of fluid per day to prevent constipation
  • diet (avoid irritants + growth stimulating foods)
  • catheter care
  • avoid long sitting and heavy lifting
42
Q

appropriate follow up after TURP or other BPH procedure

A

yearly DRE

adult 1 med surg (5 decks)

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