BPH and Male Reproductive Disorders Flashcards by Amber Goucher

Benign Prostatic Hyperplasia/hypertrophy

enlarged prostate gland- prostate gland enlarges and extends inward, causes bladder outlet obstruction
50% if men over 60 are affected

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Causes BPH

Unclear
likely result of aging and the influence of androgens (male hormones) that are present in the prostate tissue

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Risk factors of BPH

Obesity
DM
Testosterone and androgen supplements
Inactivity

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Prevention of BPH

Avoid any drugs that can cause urinary retention
ex: anti-cholinergics, antihistamines, and decongestants.

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BPH assessment

history, clinical manifestations and physical assessment by provider

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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

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clinical manifestations of BPH

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Physical assessment completed by the provider for BPH

inspection, palpation, and percussion of the abdomen
Digital rectal exam (DRE)

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Digital Rectal Exam (DRE)

BPHis uniform, elastic non-tender enlargement versus hard nodule with prostate cancer

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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

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Prostate specific antigen (PSA)

can be elevated in BPH but also other prostate issues

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BPH imaging

transabdominal ultrasound
transrectal ultrasound
tissue biopsy
cystoscopy
bladder ultrasound scan

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BPH Interventions- Medications

5 alpha reductase inhibitor
alpha 1 selective blocking agents

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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

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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.

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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

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Non invasive techniques to destroy excess prostate tissue

prostate artery embolization, transurethral needle ablation, transurethral microwave therapy, interstitial laser coagulation, electrovaoraization of the prostate

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surgical interventions for BPH

transurethral resection of the prostate (TURP), Holmium laser enucleation of the prostate (HoLEP), open prostatectomy

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transurethral resection of the prostate (TURP)

gold standard, enlarged portion of the prostate is removed, epidural and spinal anesthesia are typically used.

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Holmium laser enucleation of the prostate (HoLEP)

minimally invasive and newer procedure

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Open prostatectomy

entire prostate removed

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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

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prostate cancer

second most common type of cancer in men and if found early, has near 100% cure rate. slow growing

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causes of prostate cancer

number of factors

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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

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

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

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)