BPH Flashcards
BPH Collaborative Care
Goals: - Restore bladder drainage - Relieve symptoms - Prevent complications Watchful waiting Dietary changes Times voiding schedule
Nursing Assessment
Urinary urgency Diminution in calibre and force of urinary stream Hesitating in initiating voiding Post-void dribbling Incontinence Dysuria Sensation of incomplete voiding
Nursing Assessment
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
Nursing Assessment
Medications: - Estrogen or testosterone supplementation Surgery or previous treatment for BPH Voluntary fluid restriction Nocturia (3 or greater)
Collaborative Care
Drug therapy:
- 5a- Reductase inhibitors (Proscar)
- Reduce size of prostate gland
- Takes 3-6 months for improvement
- S/E decreased libido, decreased ejaculation, ED
Collaborative Care
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
Collaborative Care
Herbal therapy:
Saw palmetto
- Shown to improve urinary symptoms and flow
- Long term effectiveness and ability to prevent complications unknown
Collaborative Care
Invasive therapy indicated for:
- decrease in urine flow sufficient to cause discomfort
- persistent residual urine
- acute urinary retention
- hydronephrosis
Collaborative Care
Transurethral resection (TURP)
- Removal of prostate tissue using resectoscope inserted through urethra
Outcome for majority is excellent
Collaborative Care
Minimally invasive:
- Transurethral microwave therapy (TUMT)
- Transurethral needle ablation (TUNA)
Collaborative Care
Laser prostatectomy
- Delivers a beam that is used for cutting, coagulation, and vaporization of prostatic tissue
Takes several weeks to reach optimal results
Nursing Diagnoses
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
Planning
Goals of client having invasive procedure:
- Restoration of urinary drainage
- Treatment of UTI
- Understanding of procedure and complications
Planning
Goals for post-op:
- No complications
- Restoration of urinary control
- Complete bladder emptying
- Satisfying sexual expression
Nursing Implementation
Focus is early detection and treatment
Instruct client with obstructive symptoms to urinate q2-3 h and when first feeling urge
Nursing Implementation
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
Nursing Implementation
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
Nursing Implementation
Observe client for signs of infection
Dietary intervention
Stool softeners to prevent straining
Nursing Implementation
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
Evaluation
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
Prostate Cancer: Nursing Assessment
Health Hx, medications, family Hx, surgery
Symptoms
Possible findings of diagnostic tests
Risk factors
Prostate Cancer: Collaborative Care
• Whitmore-Jewett and tumor, node, metastasis (TNM) system used to stage prostate cancer
Prostate Cancer: Collaborative Care
Conservative therapy: Watchful waiting when:
• Life expectancy is less than 10 years
• Presence of significant comorbid disease
• Presence of low-grade, low- stage tumour
Surgery
Surgical therapy: - Radical prostatectomy - Nerve-sparing surgical procedure - Cryosurgery
Collaborative Care
Radiation therapy:
- External beam radiation
- Brachytherapy
Prostate Cancer: Collaborative Care
Drug therapy - Hormonal therapy: - Luteinizing hormone–releasing hormone agonists - Androgen receptor blockers - Estrogen Orchiectomy Chemotherapy
Prostate Cancer: Nursing Management
Nursing diagnosis:
- Decisional conflict
- Acute pain
- Urinary retention
- Impaired urinary elimination
- Constipation or diarrhea
- Sexual dysfunction
- Anxiety
Prostate Cancer: Nursing Management
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
Prostate Cancer: Nursing Management
Health promotion:
• Encourage DRE and PSA screenings
• Provide sensitive, caring support to client
and family
• Encourage joining a support group and to seek information
Prostate Cancer: Nursing Management
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
Testicular Cancer: Nursing and Collaborative Management
- 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
Testicular Self Exam
- 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.
