Chapter 66: Benign Prostatic Hyperplasia Flashcards
As an adult male ages, the prostate gland enlarges. When the enlargement of the gland begins to cause ______, it is called benign prostatic hyperplasia (BPH).
urinary dysfunction
BPH is a very common condition of the ______ adult male.
older
BPH can significantly impair the outflow of urine from the bladder, making a client susceptible to infection and _______.
retention
Excessive amounts of urine retained can cause _____ of urine into the kidney, dilating the ureter and causing kidney infections.
reflux
Risk Factors for BPH
Increased age smoking, chronic alcohol use sedentary lifestyle, obesity western diet (high fat, protein, carb, low fiber) diabetes mellitus, heart disease
The _______ or I-PSS is an assessment tool used to determine the severity of manifestations and their effect on the client’s quality of life.
International Prostate Symptom Score
With the I-PSS the client rates the severity of lower urinary tract manifestations using a _____ scale and also rates his quality of life as affected by urinary tract manifestations.
0 to 5
Clients who have BPH typically report urinary frequency, urgency, hesitancy, or incontinence; ______ emptying of the bladder; dribbling post-voiding; nocturia; diminished force or urinary stream; straining with urination; and _____.
incomplete
hematuria
Urinary _____ and persistent urinary retention leads to frequent UTIs.
stasis
If PBH persists, back flow of urine into the ureters and kidney can lead to _______.
kidney damage
With BPH you can use a urinalysis and culture to see if there is an elevated level of ______ and bacteria present with UTIs.
white blood cells
With BPH a CBC will show a _____ infection present if the WBCs are elevated. ______ could be decreased due to hematuria.
systemic
RBC
With BPH, BUN and creatinine will be _____, indicating kidney damage.
elevated
With BPH you want to do a _____ to rule out prostate cancer.
PSA
Culture and sensitivity of prostatic fluid can be performed if fluid is expressed during a _______.
DRE
When doing a DRE for a patient with BPH the prostate will be enlarged, but _____.
smooth
TRUS with needle aspiration biopsy is performed to rule out prostate cancer in the presence of a _______ prostate.
enlarged
Frequent ejaculation releases retained prostatic fluids, thereby decreasing the size of the _____.
prostate
Tell the client to avoid drinking large amounts of fluids at one time, and to urinate when the urge is ______ felt.
initially
Tell the client to avoid bladder stimulants, such as ______ and caffeine.
alcohol
Tell the client to avoid medications that cause decreased bladder tone, such as anticholinergics, decongestants, and _____
antihistamines
Medication is used for _____ treatment of BPH.
conservative
The goal of medication for BPH is to _______ uninhibited urine flow out of the bladder.
re-establish
Dihydrotestosterone (DHT)-lowering medications such as 5-alpha reductase inhibitor (5-ARI), such as finasteride decrease the production of ______ in the prostate gland.
testosterone
By decreasing the DHT often causes a decrease in the size of the ______.
prostate
When taking a ______ you can reinforce that it can take 6 months to 1 year before effects of the medication are evident.
DHT med
Inform the client that _____ and a decrease in libido are possible adverse effects of DHT meds.
impotence
Advise the client taking DHT meds to report _____ to the provider.
breast enlargement
_______ is a teratogenic to a male fetus. The medication is potentially absorbed through the skin. Women who are pregnant or who could become pregnant should avoid contact with tablets that are crushed or broken and with the semen of a client currently taking the medication.
Finasteride
Aphal-adrenergic receptor antagonists cause relaxation of the _______ to the prostate gland.
bladder outlet
Alpha blocking agents: tamsulosin decrease pressure on the urethra, thereby re-establishing a stronger ______.
urine flow.
With _______ the client could experience postural hypotension can occur, and to slowly make changes in position.
alpha blocking agents: tamsulosin
Warn the client that concurrent use of _______ with cimetidine can potentiate the hypotensive effect.
alpha blocking agents : tamsulosin
One therapeutic procedure to treat BPH is _________ that uses low-levels of radiation to shrink the prostate.
transurtethral needle ablation
One therapeutic procedure to treat BPH is _______ in which heat is applied to the prostate to decrease its size.
transurethral microwave therapy
One therapeutic procedure to treat BPH is a _________ in which a stent is placed to keep the urethra patent, especially if the client is a poor candidate for surgery.
prostatic stent
One therapeutic procedure to treat BPH is _______ also called contact laser prostatectomy. This is when laser energy is used to coagulate excess prostatic tissue.
interstitial laser coagulation
One therapeutic procedure to treat BPH is ______ in which high-frequency electrical current is used to cut and vaporize excess tissue.
electrovaporization of the prostate
One therapeutic procedure to treat BPH is _____ which is an option for clients who do not receive adequate relief from conservative measures.
surgical resection
One therapeutic procedure to treat BPH is _______ which involves incisions into the prostate to relieve constriction of the urethra.
transurethral incision of the prostate
The transurethral incision of the prostate is minimally invasive and typically performed in an _____ setting. Tissue is not removed with this procedure.
outpatient
One therapeutic procedure to treat BPH is _______ which uses a laser to remove excess prostatic tissue that is obstructing the client’s urethra. The extra tissue is then moved to the bladder where the client eliminates it in the _____.
Holmium laser enucleation of the prostate
urine
After having a Holmium laser enucleation of the prostate procedure the client often has an ____ urinary catheter that is left in place overnight.
indwelling
The most common surgical procedure for BPH is ______, which is performed using a resectoscope that is inserted through the urethra and trims away excess prostatic tissue, enlarging the passageway of the urethra through the prostate
TURP - Transurethral resection of the prostate
When transuretheral resection of the prostate (TURP) is done, typically, ______ and spinal anesthesia are used.
epidural
When transuretheral resection of the prostate (TURP) carefully assess cardio, respiratory, and _____ systems preoperative. Make sure the client fully understands the procedure and what to expect postoperative.
renal
Postoperative treatment for a TURP usually includes placement of an ______ catheter. This drains urine and allows fro instillation of a continuous bladder irrigation (CBI) or _________ (isotonic) or another prescribed irrigating solution to keep the catheter free from obstruction.
indwelling three way
normal saline
The rate of the CBI is adjusted to keep the irrigation return pink or _______. If bright-red or ketchup appearing (arterial) bleeding with clots is observed, the nurse should ____ the CBI rate.
lighter
increase
If the 3 way catheter becomes obstructed (bladder spasms, reduced irrigation outflow), turn off the CBI and irrigate with ____ irrigation solution using a large piston syringe or per facility or surgeon portocol. Contact the surgeon if unable to dislodge the clot.
50 mL
When using CBI, record the amount of irrigating solution instilled (generally very large volumes) and the amount of return. The difference equals _____.
urine output
Postoperatively with a TURP monitor vs and ______. You will need to administer/provide ____ fluids.
urinary output
increased
After a TURP monitor for ____ (persistent bright red bleeding unresponsive to increase in CBI and traction on the catheter or reduced Hgb levels) and report to the provider.
bleeding
Assist the client to ambulate as soon as possible to reduce the risk of ______ and other complications that occur due to immobility.
deep vein thrombosis
Administer the following meds after a TURP
Analgesics (surgical manipulation or incisional discomfort)
Antispasmodics (bladder spasms)
Antibiotics (prophylaxis)
Stool softeners (avoid straining)
Postoperatively with a TURP, the catheter is removed, monitor urinary output. The initial voiding following removal can be uncomfortable, red in color, and contain _____. The color of the urine should progress toward _____ in 2 to 3 days.
clots
amber
Instruct the client that expected output is ____ to ____ mL every 3 to 4 hours after a TURP procedure. The client should contact the provider if unable to void.
150 ml to 200 ml
After a TURP the client should avoid heavy lifting, strenuous exercise, straining and sexual intercourse for the prescribed length of time (usually ___ to ____ weeks)
2 to 6 weeks
After a TURP tell the client to drink ______ 8 oz glasses of water each day unless contraindicated.
12 or more
After a TURP tell the client to avoid _______ due to increased risk for bleeding.
NSAIDs
After a TURP tell the client to avoid bladder stimulants such as ______ and ______.
alcohol and caffeine
After a TURP tell the client to tell the client that if urine becomes bloody, to stop activity, rest and _____.
increase fluid intake
After a TURP tell the client to contact the surgeon for persistent bleeding or _____ (less than expected output or distention).
obstruction
Complications of procedures to treat BPH include regrowth of prostate tissue and _____ of bladder neck obstruction.
reoccurrence
TURP complications include
- ** Monitor the client and intervene for bleeding
- ** Provide antibiotic prophylaxis to the client
urethral trauma
urinary retention
bleeding
infection
_____ occurs in the presence of prostate cancer that has spread to other areas of the body.
Backache
In the presence of BPH, pressure on _______ leads to urinary stasis, which in turn promotes the occurrence of urinary tract infections.
urinary structures
Weight loss occurs in the presence of _______.
prostate cancer
Hematuria occurs in the presence of _____.
PBH
Overflow incontinence occurs in the presence of BPH due to an increased volume of ______.
residual urine
Oxybutynin is an anticholinergic med that is used to treat ________.
overactive bladder
Anticholinergic meds are contraindicated for a client who has _____.
BPH
Oxybutynin causes urinary ______.
retention
