BENIGN PROSTATIC HYPERPLASIA

Question 1

It is a noncancerous enlargement or hypertrophy of the prostate

Answer 1

BENIGN PROSTATIC HYPERPLASIA

Question 2

presents as a uniform, elastic, nontender enlargement.

Answer 2

BPH

Question 3

❖ PATHOPHYSIOLOGY OF BPH

Answer 3

→ Enlarged prostate gland can compressed the urethra resulting to obstruction to flow of urine and there will be difficulties in urination.

Question 4

feels like a stony-hard nodule

Answer 4

Prostate Cancer

Question 5

release a whitish secretion that gives energy and nutrition to the sperm for it to move.

Answer 5

Prostate glands

Question 5

EXPLAIN

Urethra of female is shorter than male, and they are more prone to UTIs.

Answer 5

→ Vaginal secretion contains lactobacillus making the secretion acidic to prevent the entrance of microorganisms. However, old women is more prone to UTI because their vaginal secretion is no longer acidic so when caring for them, perineal care is a must (twice a day) and change of underwear to prevent UTIs; increase fluid intake, if there is urge to void assist them immediately

Question 5

➢ It is a critical mediator of prostatic growth which can cause enlargement of the prostate gland

Answer 5

▪ Dihydrotestosterone (DHT)

Question 6

➢ Elevated estrogen levels can cause BPH; and can cause breast cancer for females

Answer 6

▪ Estrogen

Question 6

Men feel like there is incomplete emptying of the bladder and may result to:

▪ Frequent urination

▪ Infection –

▪ Bladder Distention leading to

▪ Pyelonephritis and Hydronephrosis can cause

Answer 6

due to minimal amount of urine coming out.

Cystitis which can ascend to kidneys resulting to pyelonephritis (inflammation of the kidneys).

hydronephrosis

kidney damage

Question 7

❖ EXAMINATIONS
▪ The physician will insert a gloved, lubricated finger into the rectum through the anus to check for any abnormalities.
▪ Patient is in a left side-lying position.
➢ Left sim’s position and flex the knees.

Answer 7

→ Digital Rectal Exam (DRE)

Question 7

❖ EXAMINATIONS
→ Bend over the Examination Table

Answer 7

▪ Instruct the patient to breath thought his mouth as the doctor insert his finger.

Question 8

❖ EXAMINATIONS
▪ An ultrasound probe is inserted into the rectum to check the prostate.
➢ The probe bounces sound waves off body tissues to make echoes that form a sonogram (computer picture) of the prostate

Answer 8

→ Transrectal Ultrasound (TRUS)

Question 8

❖ MEDICAL MANAGEMENT
(incision into the bladder) may be needed to provide urinary drainage.

Answer 8

→ Cystotomy

Question 9

❖ MEDICAL MANAGEMENT
▪ A stylet (thin wire) is introduced by a urologist into the catheter to prevent the catheter from collapsing when it encounters resistance.
▪ If obstruction is severe, metal catheter with pronounced prostatic curve is used.

Answer 9

→ Catheterization.

Question 10

→ Surgical Management

involves the application of heat to prostatic tissue.
➢ The targeted tissue becomes necrotic
and sloughs.

Answer 10

▪ Transurethral Microwave Thermotherapy

Question 10

→ Surgical Management

uses low-level radiofrequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue.

Answer 10

▪ Transurethral Needle Ablation

Question 11

→ Surgical Management

is a combined visual and surgical instrument (resectoscope) is inserted through the urethra where it’s surrounded by prostate tissue.

➢ An electrical loop cuts away excess prostate tissue to improve urine flow.
* scrapes the enlarged prostate

➢ ___ Anesthesia is used.
➢ Postop: Foley catheter is inserted to
prevent _____

• Due to scrapping done by the TURP there is risk for ___ formation.
  ➢ Postop: ________ is used to remove clotted blood.

Answer 11

▪ Transurethral Resection of the Prostate (TURP)

Spinal

blood clotting which can obstruct again the bladder and to drain the urinary bladder

clot

Continuous Bladder Irrigation (CBI)

Question 12

→ Types of Prostatectomies
A surgical incision in the abdomen; used if the prostate gland is so enlarged and the doctors wants to know or evaluate the urinary bladder of the patient.

Answer 12

▪ Suprapubic Prostatectomy.

Question 12

→ Types of Prostatectomies
If the prostate gland is enlarged; not commonly done due to high risk of infection of the wound.

Answer 12

▪ Perineal Prostatectomy.

Question 13

→ Types of Prostatectomies
A low incision, but urinary bladder will not be incised.

Answer 13

▪ Retropubic Prostatectomy.

Question 13

❖ POSTOPERATIVE CARE
→ The patient is assisted to sit and dangle his legs over the side of the bed on the day of surgery.
→ He may ambulate the next day with assistance.
→ Continuous Bladder Irrigation (Cystoclysis)

Question 14

Continuous Bladder Irrigation (Cystoclysis)
→ Purpose

Answer 14

▪ To drain the bladder when acute urinary retention is present.
▪ To relieve bladder spasm.
▪ To free blockage in the urinary catheter or tubing.

Question 14

→ It is a type of irrigation wherein Saline Solution is introduced into the bladder:

▪ To prevent or treat clot formation and ensure drainage of bladder.

▪ Used to instill medications such as antibiotics for treating bladder infections

Answer 14

→ Continuous Bladder Irrigation (Cystoclysis)

Question 15

Continuous Bladder Irrigation (Cystoclysis)
→ Solution: Sterile Normal Saline

Answer 15

▪ The flow rate of the irrigation must be set so that the urine remains free from clots and remains red to pink.
▪ Saline must be 80 to 100 gtts/min, it should be fast.

Question 15

Continuous Bladder Irrigation (Cystoclysis)
→ Triple Lumen Irrigation Catheter

Answer 15

▪ The balloon is inflated to 35-45mm, it keeps the catheter in place, and puts pressure in the bladder neck to prevent bleeding.
▪ No. 18-22 Fr Catheter

Question 16

Continuous Bladder Irrigation (Cystoclysis)
→ Three-Way Catheter

Answer 16

▪ It has greater eyelets to facilitate evacuation of clots.
▪ A 30 to 45 mL retention balloon through the urethra into the bladder

Question 17

Continuous Bladder Irrigation (Cystoclysis)
→ Traction

Answer 17

▪ It is a method used to stabilize and secure a urinary catheter that has been inserted into the bladder through the urethra.

➢ The catheter is secured at the abdomen.

▪ The effectiveness of the traction will be assessed every 15-30 minutes.

▪ Notify the physician if the application of traction does not decrease bleeding within 30 minutes

Question 18

REMINDER FOR CBI
→ The inflated balloon is pulled down into the prostatic fossa and the catheter tubing is pulled and taped to the patient’s leg to apply pressure against the operative site to prevent bleeding.

▪ The balloon in CBI is big to prevent bleeding by applying pressure on the prostatic fossa.

▪ Tape the tube in the abdomen so that the pressure in the prostatic fossa is maintained.

Question 19

❖ COMPLICATIONS
→ Blood clots

Answer 19

are expected after prostate surgery for the first 24-36 hours.

▪ Urine Color:
➢ Bright red to pink and then to normal amber color.
➢ Rate of infusion is based on the color of drainage.
* If UO is still ketchupy in color at the 2nd postop day, rate of infusion increases.

Question 20

❖ COMPLICATIONS
→ Acute pain related to Bladder Spasms.

Answer 20

▪ Spasm will decrease intensity in 2 days.
▪ It occurs because of irritation of the bladder (insertion of resectoscope & catheter)
▪ Patient may feel:
➢ Urgency to void – educate the patient that he is with a catheter.
➢ A feeling of pressure or fullness in the bladder.
➢ Bleeding from the urethra around the catheter.

▪ Medications:
➢ To relax the smooth muscle to ease the spasms:
Oxybutynin (Priptane) – increases bladder capacity by diminishing bladder muscle contraction.

▪ Relaxation Techniques:
➢ Deep Breathing Exercises
➢ Distraction Therapy
* Music, TV, & Communicate the patient to allow her to reminisce happy moments in life.
➢ Visual Imagery

Question 21

❖ COMPLICATIONS
→ Signs of Blocked Catheter

Answer 21

▪ Irrigate catheter if occluded with blood clots as prescribed.
➢ UO should be more than intake (2400) because px has IV fluids, oral fluids, and foods. If UO is less or equal to intake, report to the physician.
▪ Check for patency, kinks, if patient is lying on it, clotted blood.

➢ Distilled water is used to flush the catheter and aspirate it. Do it several times until the solution is clear.
* Sterile technique
* Patient is in a dorsal recumbent position.
* Use linen saver pads
▪ The output should be at least 50mL/greater
than hourly flow of irrigation.
▪ Less urinary output indicates obstruction.

Question 22

❖ NURSING INTERVENTIONS FOR CATHETER OBSTRUCTION

Answer 22

→ Stop the irrigation flow to prevent severe bladder distention.
→ Check for kinks and patency of the tubes for obstruction.
→ If no output occurs, irrigate it with 30 to 50mL of normal saline/distilled water using a large piston syringe.
→ If the obstruction is not resolved, call the physician.

Question 23

❖ NURSING INTERVENTIONS FOR CBI

Answer 23

→ Monitor the color consistency and amount of urine output.
▪ If dark red colored, increase the flow rate of fluids.
▪ If ketchupy blood is present, obtain the BP and notify the physician.

→ Monitor vital signs closely for the first 24hours.
▪ ↓ BP & ↑PR
▪ Bleeding is the most common complication within the first 24 hours, and it is normal.

→ Monitor for hemorrhage evidenced by:
▪ Bloody Urinary Output
▪ Presence of large blood clots
▪ Decreased UO – Decreased blood volume triggers the SNS. It will stimulate the Adrenal Cortex to release Aldosterone and Posterior Pituitary Gland to release Antidiuretic Hormone. Aldosterone will promote sodium reabsorption and water retention, while ADH will promote water retention and prevent urine formation.
▪ Decreased Hemoglobin and Hematocrit.
➢ Normal: Female – 35% to 47%, Male –42% to 57%
▪ Tachycardia and Hypotension

→ Encourage patient to increase fluid intake of 2.5 to 3L to flush the urinary system, to prevent urinary stasis, and to prevent growth of bacteria.

→ Keep patient’s urine acidic to preventcalculus
formation, so advise patient to eat ascorbic acid rich foods such as citrus fruits, cranberry, green peppers, lemon water, strawberries, and pineapple.

→ Encourage patient to turn, cough, and deep breath every 2 hours to prevent atelectasis and pneumonia.

→ Advise patient to do Kegel’s Exercises, to strengthen the pelvic muscle (pubococcygeus muscles) to hold or control the bladder and prevent urinary incontinence.
▪ Exercises such as raising your hips, squats, crunches.
▪ Beneficial: urinary incontinence, premature ejaculation, vaginal and uterine prolapse.
▪ Incontinence can improve for up to 12 months.

Question 24

❖ DIETARY INTERVENTIONS AND STOOL SOFTENERS

Answer 24

→ Increase fluid intake, fibers, and ambulate to increase peristalsis.
▪ Fiber-rich foods: apples, whole grains, chico, guava, prune, pechay, kangkong, and malunggay.

→ Avoid bladder irritants such as coffee, alcohol, and citrus juice because these has a diuretic effect; therefore, patient won’t be trained.

→ If constipation occurs, call the physician and ask for a prescription.
▪ Administer laxative such as Psyllium.
➢ It is a bulk-forming laxative that promote large, soft tools by absorbing water into the intestine, increasing fecal bulk and peristalsis.
➢ Nursing interventions:
* Teach patient to mic the agent with water immediately before use to avoid GI obstruction.
* Advise patient not to swallow the agent in dry form because it can cause abdominal cramping.
* Advise patient to avoid inhaling the psyllium dust because it cancause watery eyes, runny nose, and wheezing,
* Counsel patient to avoid overuse of laxatives because it can lead to fluid and electrolyte imbalances and drug dependence; instead, suggest exercises to help increase peristalsis.
▪ Avoid enemas or suppository.

→ Prevent Abdominal and Perineal Pressure to avoid bleeding.
▪ Avoid sitting for long periods.
▪ Avoid heavy lifting of more than 5lbs.
▪ Avoid sexual activity for at least 3 weeks.
▪ Avoid driving for 2 weeks.