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Nursing Theory IV > BPH > Flashcards

BPH Flashcards

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1
Q

BPH Collaborative Care

A 
Goals:
- Restore bladder drainage
- Relieve symptoms
- Prevent complications
Watchful waiting
Dietary changes
Times voiding schedule
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2
Q

Nursing Assessment

A 
Urinary urgency
Diminution in calibre and force of urinary stream
Hesitating in initiating voiding
Post-void dribbling
Incontinence
Dysuria
Sensation of incomplete voiding
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3
Q

Nursing Assessment

A

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

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4
Q

Nursing Assessment

A 
Medications:
- Estrogen or testosterone supplementation
Surgery or previous treatment for BPH
Voluntary fluid restriction
Nocturia (3 or greater)
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5
Q

Collaborative Care

A

Drug therapy:

  • 5a- Reductase inhibitors (Proscar)
  • Reduce size of prostate gland
  • Takes 3-6 months for improvement
  • S/E decreased libido, decreased ejaculation, ED
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6
Q

Collaborative Care

A

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
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7
Q

Collaborative Care

A

Herbal therapy:
Saw palmetto
- Shown to improve urinary symptoms and flow
- Long term effectiveness and ability to prevent complications unknown

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8
Q

Collaborative Care

A

Invasive therapy indicated for:

  • decrease in urine flow sufficient to cause discomfort
  • persistent residual urine
  • acute urinary retention
  • hydronephrosis
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9
Q

Collaborative Care

A

Transurethral resection (TURP)
- Removal of prostate tissue using resectoscope inserted through urethra
Outcome for majority is excellent

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10
Q

Collaborative Care

A

Minimally invasive:

  • Transurethral microwave therapy (TUMT)
  • Transurethral needle ablation (TUNA)
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11
Q

Collaborative Care

A

Laser prostatectomy
- Delivers a beam that is used for cutting, coagulation, and vaporization of prostatic tissue
Takes several weeks to reach optimal results

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12
Q

Nursing Diagnoses

A

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

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13
Q

Planning

A

Goals of client having invasive procedure:

  • Restoration of urinary drainage
  • Treatment of UTI
  • Understanding of procedure and complications
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14
Q

Planning

A

Goals for post-op:

  • No complications
  • Restoration of urinary control
  • Complete bladder emptying
  • Satisfying sexual expression
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15
Q

Nursing Implementation

A

Focus is early detection and treatment

Instruct client with obstructive symptoms to urinate q2-3 h and when first feeling urge

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16
Q

Nursing Implementation

A

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
Q

Nursing Implementation

A

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
Q

Nursing Implementation

A

Observe client for signs of infection
Dietary intervention
Stool softeners to prevent straining

19
Q

Nursing Implementation

A

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
Q

Evaluation

A

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
Q

Prostate Cancer: Nursing Assessment

A

Health Hx, medications, family Hx, surgery
Symptoms
Possible findings of diagnostic tests
Risk factors

22
Q

Prostate Cancer: Collaborative Care

A

• Whitmore-Jewett and tumor, node, metastasis (TNM) system used to stage prostate cancer

23
Q

Prostate Cancer: Collaborative Care

A

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
Q

Surgery

A 
Surgical therapy:
- Radical prostatectomy
- Nerve-sparing surgical
procedure
- Cryosurgery
25
Q

Collaborative Care

A

Radiation therapy:

  • External beam radiation
  • Brachytherapy
26
Q

Prostate Cancer: Collaborative Care

A 
Drug therapy
- Hormonal therapy:
- Luteinizing hormone–releasing hormone agonists
- Androgen receptor blockers
- Estrogen 
Orchiectomy
Chemotherapy
27
Q

Prostate Cancer: Nursing Management

A

Nursing diagnosis:

  • Decisional conflict
  • Acute pain
  • Urinary retention
  • Impaired urinary elimination 
  • Constipation or diarrhea
  • Sexual dysfunction
  • Anxiety
28
Q

Prostate Cancer: Nursing Management

A

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
Q

Prostate Cancer: Nursing Management

A

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
Q

Prostate Cancer: Nursing Management

A

Evaluation:

  • Actively participate in treatment plan
  • Have satisfactory pain control
  • Follow therapeutic plan
  • Accept effect of treatment on sexual function
  • Find satisfactory way to manage impact on bladder or bowel function
31
Q

Testicular Cancer: Nursing and Collaborative Management

A
  • Testicular self-exam
  • Orchiectomy
  • Meticulous follow-up and regular exams
  • Goal is to detect relapse when tumour burden is minimal
  • Discuss fertility and sperm banking before treatment
32
Q

Testicular Self Exam

A
  • Just after a shower or bath is the best time to examine the testes. Warm temperatures make the testes hang lower in the scrotum.
  • Stand in front of a mirror. Look for any swelling on the skin of the scrotum.
  • Hold your scrotum in the palms of your hands so that you can feel the size and weight of each testicle. It is normal for one testicle to be larger and hang lower than the other.
  • Gently roll each testicle between your thumb and your fingers. Feel for lumps or bumps. If you feel a soft, tender tube cord leading upward from the back of each testicle, that is normal.
  • Notify the health care provider at once if any abnormalities are found.

Nursing Theory IV (12 decks)

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