benign prostate hyperplasia Flashcards
hormone that stimulates prostate growth
dihydrotestosterone (DHT)
what measurement can the prostate grow to where it starts narrowing the urethra
beyond 4x5cm
BPH growth is ______ while prostate cancer growth is _______
BPH growth = central
prostate cancer = peripheral (won’t see urinary symptoms as soon as bph)
what are some risk factors that can lead to BPH
obesity, inc waist circumference, sedentary lifestyle
diabetes, high red meat/processed meals and dairy
what diet helps prevent prostate growth
green and yellow veggies, tomatoes
what are bladder irritants to avoid consuming
caffeine and alcohol
what to avoid to prevent further urinary retention and symptoms
avoid OTC and cold medications + diet pills, anticholinergic drugs
what are some complications that can arise with prostate enlargement ( 4)
- retention/muscle thickening
- UTI due to urinary stasis
- pyelonephritis and kidney stones
- hydroureters, hydronephrosis, kidney failure
explain the relationship between luteinizing hormone and DHT
luteinizing hormone –> testosterone secretion –> 5a reductase converts testosterone into DHT –> DHT leads to prostate cell growth and production
subjective data that hint at BPH
inc frequency (not fulling emptying)
nocturia
change in stream (weak and thin, hard to start)
incomplete empyting feeling, intermittency, urgency, leakage
what is the prostate symptom index
scale used to rate and determine severity of symptoms to make tx plan
objective data/tests to do to screen for prostate growth
DRE: digital rectal exam
PSA: prostate specific antigen
TRUS: transurethral ultrasound
how should a BPH feel during a DRE
prostate is enlarged, firm, and smooth
normal and abnormal PSA levels
normal = <4
abnormal = > 4
significance of doing a urinalysis + urine culture when screening for BPH/prostate cancer
to rule out UTI
what other dx exams can you do to screen for BPH
residual urine/post void scan
cytoscopy
intravenous pyelogram
what is an intravenous pyelogram
using contrast dye to look at blood flow + structure through xray (abnormal blood flow = cancer??
goals of prostate medical management (3)
slow prostate growth, relax prostate muscle, relieve retention
what are some 5a reductase inhibitor medications
finasteride (Proscar), dutasteride (Avodart)
finasteride (Proscar), dutasteride (Avodart)
C:
MOA:
I:
how long it takes to work?
SE:
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
what are some alpha adrenergic receptor blocker medications
tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo)
tamsulosin (Flomax), doxazosin (Cardura), silodosin (Rapaflo)
C:
MOA:
I:
how long it takes to work?
SE:
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
when should a pt take tamsulosin and other alpha adrenergic blocker medications
take at night to prevent dizziness in the morning
when to use invasive therapy for BPH
- dec in urine flow = discomfort
- persistent residual urine
- acute urinary retention
explain transurethral balloon dilation (TUBD)
insertion of a balloon using saline and a guide wire to dilate the prostate and help with urinary flow
- not a permanent fix, temporary
what is the gold standard procedure for BPH
transurethral resection of the prostate (TURP)
explain transurethral resection of the prostate (TURP)
using a scope through the urethra into the prostate - cauterize and remove growth, pt usually under general anesthesia
is TURP nerve sparing?
nerve sparing, no ED problems
pre-op intervention before TURP
- 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
post op interventions after TURP
- CBI
- antispasmodics
- kegel exercises
- home education
- follow up
what is a CBI
continuous bladder irrigation; remove blood clots + ensure drainage and prevent another urinary obstruction
what fluid to use in a CBI
0.9NS
when to increase the rate of the CBI
urine is dark red
when to decrease the rate of the CBI
urine is pink
urine color goal of CBI
urine is clear with no redness or clots
when to empty CBI bags
at 3/4 full to prevent exploding and to prevent output from traveling back up
t/f: bladder spasms are an expected finding after TURP
true
what is the #1 cause of bladder spasms
catheter and large balloon
when to administer antispasmodics for bladder spasms
nurse should get order for manual irrigation first, then admin belladonna and opioid suppository (BNO)
significance of kegel exercises
strengthen pelvic floor muscles
pt education for discharge to home after TURP
- 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
appropriate follow up after TURP or other BPH procedure
yearly DRE
