Ch. 64 Flashcards
BPH stands for
benign prostatic hyperplasia
(enlarged prostate, pushes on the bladder, similar sx to UTI)
BPH unmodifiable risk factors
Race
- black men younger than 65 > white men
- asian are less at risk than black and white men
Genetic susceptibility: GATA3 gene
Family history of cancer (bladder not prostate cancer have higher risk of BPH)
age: BPH affects 50% of men between 51-60 years old; 80% of men > 70 years
BPH modifiable risk factors
obesity and metabolic syndrome
- glucose intolerance, dyslipidemia, HTN
Beverage consumption
- coffee and caffeine increase risk for progression of existing BPH
physical activity
- lower level increases risk
BPH health promotion and maintenance
- teach that BPH is common
- teach that addressing modifiable risk factors can improve overall health
BPH assessment: history
International Prostate Symptom Score (I-PSS)
- incomplete emptying
- frequency
- intermittency
- urgency
- weak stream
- straining
- nocturia
- pt perceived quality of life
scores of urinary system:
</= 7: mild
8-19: moderate
20-35: severe
*> 20 indicative of BPH
Elimination patterns
- Ask whether hematuria is present
BPH assessment: physical assessment
health care provider performs prostate gland examination
- digital rectal exam: HCP uses gloved, lubed finger into the rectum to feel for the prostate; patient lays on side during this
- normal prostate: walnut size and smooth
BPH dx assessments
- labs
- Transrectal ultrasound
- Cystoscopy
- Bladder ultrasound
BPH dx labs
- Urinalysis and culture
- CBC- WBC should NOT be elevated
- BUN/CREAT
- PSA
- Serum acid phosphatase
- Biopsy
- Culture and sensitivity of prostatic fluid
BPH patient problems
- Urinary retention due to bladder outlet obstruction (BOO)
- Decreased self-esteem due to overflow urinary incontinence and possible sexual dysfunction
potential complications of BPH
- prostatitis: inflammation and infection of the prostate)
*treat with broad spectrum ABT if prostatitis present - infections and bladder problems
BPH goal: improve urinary elimination
Nonsurgical management
- Behavioral modification: no drink fluids after dinner to help with nocturia
- Drug therapy
- Complementary and Integrative Health
Surgical management
- TURP Holep or TUIP
- Minimally invasive surgeries
BPH drug therapy
Alpha-Adrenergic Antagonists (tamsulosin, doxazosin)
- relaxes smooth muscle of bladder
- monitor BP for hypotension sx
5-alpha reductase inhibitor (5-ARI) (finasteride)
- decreases size of prostate
- orthostatic hypotensive
Saw Palmetto
- OTC med
- tell provider bc interactions w/ other drugs
- pt could be on both AAA and 5-ARI
BPH operative procedures
- HOLEP- GOLD STANDARD SURGERY
- TURP- previous gold standard surgery
- TUIP
- DONE WITH A SCOPE, NO INCISION MADE
- ALL PTS WITH HOLEP or TURP WILL HAVE AN INDWELLING URINARY CATHETER (all in patient surgeries, not option for outpatient)
holmium laser enucleation of the prostate (HoLEP) for BPH
- a surgical procedure where a scope is inserted through your urethra.
- Uses laser technology to remove/ enucleate, or core-out, the majority of prostate tissue.
- A separate instrument is then used to cut the prostate tissue into smaller fragments that are easily removed.
continuous bladder irrigation
- 3 WAY URINARY Catheter inserted during surgery
- Large 2-3L bags of NS with special tubing
- Three-way urinary catheter with a 30- to 45-mL retention balloon through the urethra into the bladder
- Traction via taping to patient’s abdomen or thigh
- Uncomfortable urge to void continuously
- Antispasmodic medications
- monitor I&Os closely
nursing care post-TURP
- Normal saline for bladder irrigation; Adjust rate per order usually rate based on keeping urine clear and free of clots***
- Check drainage tube frequently for kinks or blood clots (↓UO)**
- Irrigate manually if obstruction suspected with NS***
- Monitor closely for infection and bleeding
- Get patient OOB as soon as possible and older men may need help
- Assess patient’s pain Q2-3h and give pain medication/antispasmodics
- Safety – temporary change in mental status in older men so reorient frequently and watch tube
- Monitor color, consistency, and amount of UO
- Severe bladder spasm and ↓UO can mean obstruction
- Call HCP if irrigation doesn’t work
vesectomy
- Most effective method of male contraception
- Surgical interruption of vas deferens, small incision into scrotum
- Done with local anesthetic in an outpatient setting
vasectomy post-op management
- Pain, swelling
- Bruising
- Dressing
- Return to activity-Rest for 1-2 days, NO heavy lifting, sports or sexual activity for 1 week
- Post surgery sperm sample
- Use other method of birth control for 2-3 months
erectile dysfunction (ED)
Also called “impotence”, inability to maintain erection during sex
2 types:
1.Organic
- Psychogenic
ED dx tests
- bloodwork
- glucose, Hba1c to rule out DM
- doppler ultrasonography (bc its a blood flow problem)
ED treatment
- Lifestyle modifications: caffeine intake, reduce stress
- Management of medications that may cause ED
- Phosphodiesterase-5 (PDE-5) Drug therapy- pt education critical **
- Penile self-injection with prostaglandin
- Psychotherapy
- Surgery
- Vacuum-assisted erection devices
s/e of vasodilations
- HA
- hypotension
- facial flushing
meds that are contraindicated with vasodilation meds
- nitrate (nitroglycerin)
when does a patient take a vasodilator med?
15-30 min before sex
Phosphodiesterase-5 (PDE-5) Drug therapy: drugs
- sildenafil (viagra) *little blue pill
- vardenafil (levitra)
- taladafil (cialis)
