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MS II > Chapter 66: Benign Prostatic Hyperplasia > Flashcards

Chapter 66: Benign Prostatic Hyperplasia Flashcards

1
Q

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).

A

urinary dysfunction

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2
Q

BPH is a very common condition of the ______ adult male.

A

older

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3
Q

BPH can significantly impair the outflow of urine from the bladder, making a client susceptible to infection and _______.

A

retention

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4
Q

Excessive amounts of urine retained can cause _____ of urine into the kidney, dilating the ureter and causing kidney infections.

A

reflux

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5
Q

Risk Factors for BPH

A 
Increased age
smoking, chronic alcohol use
sedentary lifestyle, obesity
western diet (high fat, protein, carb, low fiber)
diabetes mellitus, heart disease
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6
Q

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.

A

International Prostate Symptom Score

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7
Q

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.

A

0 to 5

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8
Q

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 _____.

A

incomplete

hematuria

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9
Q

Urinary _____ and persistent urinary retention leads to frequent UTIs.

A

stasis

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10
Q

If PBH persists, back flow of urine into the ureters and kidney can lead to _______.

A

kidney damage

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11
Q

With BPH you can use a urinalysis and culture to see if there is an elevated level of ______ and bacteria present with UTIs.

A

white blood cells

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12
Q

With BPH a CBC will show a _____ infection present if the WBCs are elevated. ______ could be decreased due to hematuria.

A

systemic

RBC

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13
Q

With BPH, BUN and creatinine will be _____, indicating kidney damage.

A

elevated

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14
Q

With BPH you want to do a _____ to rule out prostate cancer.

A

PSA

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15
Q

Culture and sensitivity of prostatic fluid can be performed if fluid is expressed during a _______.

A

DRE

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16
Q

When doing a DRE for a patient with BPH the prostate will be enlarged, but _____.

A

smooth

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17
Q

TRUS with needle aspiration biopsy is performed to rule out prostate cancer in the presence of a _______ prostate.

A

enlarged

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18
Q

Frequent ejaculation releases retained prostatic fluids, thereby decreasing the size of the _____.

A

prostate

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19
Q

Tell the client to avoid drinking large amounts of fluids at one time, and to urinate when the urge is ______ felt.

A

initially

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20
Q

Tell the client to avoid bladder stimulants, such as ______ and caffeine.

A

alcohol

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21
Q

Tell the client to avoid medications that cause decreased bladder tone, such as anticholinergics, decongestants, and _____

A

antihistamines

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22
Q

Medication is used for _____ treatment of BPH.

A

conservative

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23
Q

The goal of medication for BPH is to _______ uninhibited urine flow out of the bladder.

A

re-establish

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24
Q

Dihydrotestosterone (DHT)-lowering medications such as 5-alpha reductase inhibitor (5-ARI), such as finasteride decrease the production of ______ in the prostate gland.

A

testosterone

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25
Q

By decreasing the DHT often causes a decrease in the size of the ______.

A

prostate

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26
Q

When taking a ______ you can reinforce that it can take 6 months to 1 year before effects of the medication are evident.

A

DHT med

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27
Q

Inform the client that _____ and a decrease in libido are possible adverse effects of DHT meds.

A

impotence

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28
Q

Advise the client taking DHT meds to report _____ to the provider.

A

breast enlargement

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29
Q

_______ 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.

A

Finasteride

30
Q

Aphal-adrenergic receptor antagonists cause relaxation of the _______ to the prostate gland.

A

bladder outlet

31
Q

Alpha blocking agents: tamsulosin decrease pressure on the urethra, thereby re-establishing a stronger ______.

A

urine flow.

32
Q

With _______ the client could experience postural hypotension can occur, and to slowly make changes in position.

A

alpha blocking agents: tamsulosin

33
Q

Warn the client that concurrent use of _______ with cimetidine can potentiate the hypotensive effect.

A

alpha blocking agents : tamsulosin

34
Q

One therapeutic procedure to treat BPH is _________ that uses low-levels of radiation to shrink the prostate.

A

transurtethral needle ablation

35
Q

One therapeutic procedure to treat BPH is _______ in which heat is applied to the prostate to decrease its size.

A

transurethral microwave therapy

36
Q

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.

A

prostatic stent

37
Q

One therapeutic procedure to treat BPH is _______ also called contact laser prostatectomy. This is when laser energy is used to coagulate excess prostatic tissue.

A

interstitial laser coagulation

38
Q

One therapeutic procedure to treat BPH is ______ in which high-frequency electrical current is used to cut and vaporize excess tissue.

A

electrovaporization of the prostate

39
Q

One therapeutic procedure to treat BPH is _____ which is an option for clients who do not receive adequate relief from conservative measures.

A

surgical resection

40
Q

One therapeutic procedure to treat BPH is _______ which involves incisions into the prostate to relieve constriction of the urethra.

A

transurethral incision of the prostate

41
Q

The transurethral incision of the prostate is minimally invasive and typically performed in an _____ setting. Tissue is not removed with this procedure.

A

outpatient

42
Q

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 _____.

A

Holmium laser enucleation of the prostate

urine

43
Q

After having a Holmium laser enucleation of the prostate procedure the client often has an ____ urinary catheter that is left in place overnight.

A

indwelling

44
Q

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

A

TURP - Transurethral resection of the prostate

45
Q

When transuretheral resection of the prostate (TURP) is done, typically, ______ and spinal anesthesia are used.

A

epidural

46
Q

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.

A

renal

47
Q

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.

A

indwelling three way

normal saline

48
Q

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.

A

lighter

increase

49
Q

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.

A

50 mL

50
Q

When using CBI, record the amount of irrigating solution instilled (generally very large volumes) and the amount of return. The difference equals _____.

A

urine output

51
Q

Postoperatively with a TURP monitor vs and ______. You will need to administer/provide ____ fluids.

A

urinary output

increased

52
Q

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.

A

bleeding

53
Q

Assist the client to ambulate as soon as possible to reduce the risk of ______ and other complications that occur due to immobility.

A

deep vein thrombosis

54
Q

Administer the following meds after a TURP

A

Analgesics (surgical manipulation or incisional discomfort)
Antispasmodics (bladder spasms)
Antibiotics (prophylaxis)
Stool softeners (avoid straining)

55
Q

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.

A

clots

amber

56
Q

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.

A

150 ml to 200 ml

57
Q

After a TURP the client should avoid heavy lifting, strenuous exercise, straining and sexual intercourse for the prescribed length of time (usually ___ to ____ weeks)

A

2 to 6 weeks

58
Q

After a TURP tell the client to drink ______ 8 oz glasses of water each day unless contraindicated.

A

12 or more

59
Q

After a TURP tell the client to avoid _______ due to increased risk for bleeding.

A

NSAIDs

60
Q

After a TURP tell the client to avoid bladder stimulants such as ______ and ______.

A

alcohol and caffeine

61
Q

After a TURP tell the client to tell the client that if urine becomes bloody, to stop activity, rest and _____.

A

increase fluid intake

62
Q

After a TURP tell the client to contact the surgeon for persistent bleeding or _____ (less than expected output or distention).

A

obstruction

63
Q

Complications of procedures to treat BPH include regrowth of prostate tissue and _____ of bladder neck obstruction.

A

reoccurrence

64
Q

TURP complications include

  • ** Monitor the client and intervene for bleeding
  • ** Provide antibiotic prophylaxis to the client
A

urethral trauma
urinary retention
bleeding
infection

65
Q

_____ occurs in the presence of prostate cancer that has spread to other areas of the body.

A

Backache

66
Q

In the presence of BPH, pressure on _______ leads to urinary stasis, which in turn promotes the occurrence of urinary tract infections.

A

urinary structures

67
Q

Weight loss occurs in the presence of _______.

A

prostate cancer

68
Q

Hematuria occurs in the presence of _____.

A

PBH

69
Q

Overflow incontinence occurs in the presence of BPH due to an increased volume of ______.

A

residual urine

70
Q

Oxybutynin is an anticholinergic med that is used to treat ________.

A

overactive bladder

71
Q

Anticholinergic meds are contraindicated for a client who has _____.

A

BPH

72
Q

Oxybutynin causes urinary ______.

A

retention

MS II (10 decks)

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