BPH and Male Reproductive Disorders Flashcards
Benign Prostatic Hyperplasia/hypertrophy
enlarged prostate gland- prostate gland enlarges and extends inward, causes bladder outlet obstruction
50% if men over 60 are affected
Causes BPH
Unclear
likely result of aging and the influence of androgens (male hormones) that are present in the prostate tissue
Risk factors of BPH
Obesity
DM
Testosterone and androgen supplements
Inactivity
Prevention of BPH
Avoid any drugs that can cause urinary retention
ex: anti-cholinergics, antihistamines, and decongestants.
BPH assessment
history, clinical manifestations and physical assessment by provider
clinical manifestations of BPH
urinary frequency and urgency
nocturia
difficulty in starting (hesitancy) and continuing urination
reduced force and size of the urinary stream (“weak” stream)
sensation of incomplete bladder emptying
straining to begin urination
post-void (after voiding) dribbling or leaking
hematuria
clinical manifestations of BPH
urinary frequency and urgency
nocturia
difficulty in starting (hesitancy) and continuing urination
reduced force and size of the urinary stream (“weak” stream)
sensation of incomplete bladder emptying
straining to begin urination
post-void (after voiding) dribbling or leaking
hematuria
Physical assessment completed by the provider for BPH
inspection, palpation, and percussion of the abdomen
Digital rectal exam (DRE)
Digital Rectal Exam (DRE)
BPHis uniform, elastic non-tender enlargement versus hard nodule with prostate cancer
Lab assessments for BPH
UA and culture
Prostate specific antigen (PSA)
Other Labs to rule out other causes: CBC, BUN, serum Creatinine, culture and sensitivity of prostatic fluid
Prostate specific antigen (PSA)
can be elevated in BPH but also other prostate issues
BPH imaging
transabdominal ultrasound
transrectal ultrasound
tissue biopsy
cystoscopy
bladder ultrasound scan
BPH Interventions- Medications
5 alpha reductase inhibitor
alpha 1 selective blocking agents
5 alpha reductase inhibitor
ex: finasteride and dutasteride
decreases dihydrotestoerone which reduces size of the prostate
may need to take for as long as 6 months before improvement noticed
AE: erectile disfunction, decreased libido, dizziness due to orthostatic hypotension
Alpha 1 selective blocking agens
tamsulosin
relaxes smooth muscles in the prostate gland, creating less urinary resistance and improved urine flow
also cause vasodilation and reduce peripheral vascular resistance
side effects: assess for orthostatic hypotension, tachycardia, syncope
most effective drug therpay approach is a combination of the two.
BPH Interventions- non pharmaceutical
avoid drinking large volumes of fluid at one time
avoid alcohol, caffeine, and diuretics
void as soon as they feel the urge to
avoid drugs that cause urinary retention (anticholinergics, antihistamines, and decongestants)
noninvasive techniques to destroy excess prostate tissue
Non invasive techniques to destroy excess prostate tissue
prostate artery embolization, transurethral needle ablation, transurethral microwave therapy, interstitial laser coagulation, electrovaoraization of the prostate
surgical interventions for BPH
transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), open prostatectomy
transurethral resection of the prostate (TURP)
gold standard, enlarged portion of the prostate is removed, epidural and spinal anesthesia are typically used.
Holmium laser enucleation of the prostate (HoLEP)
minimally invasive and newer procedure
Open prostatectomy
entire prostate removed
Post TURP care
continuous bladder irrigation in place after surgery, assess color, consistency and amount of urine output, check the drainage tube frequently, after catheter is removed, may experience burning on urination, urinary frequency, dribbling and leakage, increase fluid, monitor for infection, prevent complications of immobility, assess pain and VS q 2-4 hours
prostate cancer
second most common type of cancer in men and if found early, has near 100% cure rate. slow growing
causes of prostate cancer
number of factors
prostate cancer risk factors
over the age of 65, race (African American males are more often affected) family history of prostate cancer
prostate cancer health promotion and maintenance
screening (consider screening at age 50)
healthy balanced diet (decrease animal fats in diet especially, red meats. increased fruits, vegetables, and high fiber foods)
prostate cancer assessment
history, clinical manifestations, labs, other diagnostic assessments
early clinical manifestations of prostate cancer
urinary rentention, frequent bladder infections, difficulty starting urination
advanced disease symptoms of prostate cancer
hematuria, swollen lymph nodes (especially in groin), pain, unexpected weight loss
labs for prostate cancer
prostate specific antigen, early prostate cancer antigen, elevated serum acid phosphatase
Prostate specific antigen (PSA)
normal is less than 2.5 ng/mL for age less than 50 and increases with age (possibly up to 6.5 ng/mL). used as a screening lab because other prostate problems can increase the level
Early prostate cancer antigen (EPCA-2)
can detect changes in the prostate gland early and is very sensitive
elevated serum acid phosphatase
with advanced disease
Other diagnostics for prostate cancer
transrectal ultrasound
biopsy
prostate cancer interventions
active surveillance, surgery, nonsurgical management
active surveillance for prostate cancer
after initial diagnosis will monitor and only purse active treatment if the symptoms become bothersome
usually done if cancer is in the early state because it is very slow growing cancer
surgeries for prostatic cancer
laparoscopic radial prostatectomy- removal of entire prostate
open radial prostatectomy- removal of entire prostate
bilateral orchiectomy- removal of both testicles
nonsurgical interventions for prostate cancer
can be used as an adjunct to surgery or alternate intervention- used if the cancer is widespread or the patient’s condition or age prevents surgery, radiation, drug therapy (hormone or chemo)
prostatitis
inflammation of the prostate gland
acute bacterial prostatitis
occurs with urethritis or an infection of the lower urinary tract. organisms may reach the prostate via bloodstream or urethrea
symptoms of acute bacterial prostatits
fever, chills, dysuria, urethral discharge, boggy and tender prostate
chronic bacterial prostatitis
occurs in older men, symptoms less dramatic
chronic bacterial prostatitis symptoms
hesitancy, urgency, dysuria, difficulty initiating and terminating the flow of urine and decrease strength and volume of urine/ discomfort in the perineum, scrotum and penis
prostatitis treatments
antibiotics, acute bacterial prostatitis may require hospitalization with aggressive IV antibiotics.
prostatitis complications
epididymitis- inflammation of the epididymis
cystitis- inflammation of the bladder
testicular cancer
rare cancer, most often affecting men between 20 and 35 years of age
common manifestations of testicular cancer
painless, hard swelling or enlargement of the testicle
lab assessment for testicular cancer
Alpha- fetoprotein (AFP)
beta human chorionic gonadotropin (hCG)
lactate dehydrogenase (LDH)
other diagnostics assessments for testicular cancer
ultrasonography- identify fluid or solid mass and benign versus malignant
CT and MRI- check for metastasis
surgical management for testicular cancer
radical unilateral orchiectomy
radical retroperitoneal lymph node dissection may also be done
non surgical management of testicular cancer
chemotherapy- may be used as adjuvant therapy or as primary treatment
external beam radiation therapy (EBRT)- may be used after orchiectomy for localized disease
Hemorrhage is a possible complication of
transurethral resection of the prostate
(TURP). If hemorrhage occurred, shock could
develop.
* Which signs of shock might be assessed if
hemorrhage occurred? (Select all that apply)
– A. Decreased blood pressure
– B. Increased heart rate
– C. Lower abdominal pain
– D. Pallor
– E. Elevated temperature
– F. Restlessness
ABDF
Beside assessing for hemorrhage, it is
also important to assess for TURP
syndrome. What blood test is done to
evaluate for this complication?
–A. Arterial blood gas
–B. Hematocrit
–C. White blood cell
–D. Serum sodium
D
Mr. Bahr complains of severe “cramping and tightness” in his abdomen. Which actions should the nurse implement? (Select all that apply)
– A. Apply gentle massage over the lower abdomen
– B. Have him lie in the fetal position
– C. Encourage him to use relaxation techniques he learned preoperatively
– D. Notify the HCP immediately
– E. Check the urinary drainage tube for kinks and clots
– F. Check the HCP’s prescription to see if medication is prescribed for relief of spasms
CEF
Mr. Bahr’s urinary catheter has been
removed. Plans are made for discharge
if he is able to void. How would you
assess for urinary retention (Select all
that apply)?
–A. Inspect for edema of the penis
–B. Inspect the suprapubic area for
distention
–C. Palpate the suprapubic area for
distention
–D. Percuss the suprapubic area for tympany
BC
A teaching plan is developed for Mr. Bahr immediate needs after discharge from TURP surgery. Which needs should be included in the plan? (Select all that apply)
–A. Need for high fluid intake
–B. Use of enemas as needed
–C. Regular walking
–D. Immediate resumption of aerobic exercise
–E. Perineal exercises
–F. Immediate resumption of sexual activity
–G. Need to avoid heavy lifting
ACEG
Mr. Bahr needs instructions about the
signs and symptoms of complications
of the TURP that should be reported
to the HCP. What signs and symptoms
should be reported?
–A. Urine dribbling
–B. Gross hematuria
–C. Pale urine
–D. Cloudy urine after intercourse
B
A client is interested in learning about
the risk factors for prostate cancer.
Which factors does the nurse include in
the teaching? (Select all that apply.)
A. Family history of prostate cancer
B. Smoking
C. Obesity
D. Advanced age
E. Eating too much red meat
ADE
A patient is diagnosed with acute
bacterial prostatitis. What assessment
findings does the nurse expect to
find? (Select all that apply)
–A. Fever
–B. Chills
–C. Dysuria
–D. Urinary incontinence
–E. Decreased strength of urine stream
–F. Boggy and tender prostate
ABCF
A 34-year-old client comes to the
clinic with concerns about an
enlarged left testicle and heaviness in
his lower abdomen. Which diagnostic
test would the nurse expect to be
ordered to confirm testicular cancer?
–A. Alpha-fetoprotein (AFP)
–B. Prostate-specific antigen (PSA)
–C. Prostate acid phosphatase (PAP)
–D. C-reactive protein (CRP)
A
