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Med Surg > Exam 4 - Benign Prostatic Hypertrophy > Flashcards

Exam 4 - Benign Prostatic Hypertrophy Flashcards

1
Q

Benign prostate hyperplasia

A

A benign enlargement of the prostate gland. Most common urologic problem in male adults. Occurs in 50% of men over 50 and 90% of men over 80.

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2
Q

Possible causes of BPH

A
  • Excessive accumulation of DHT in the prostate cells stimulates cell growth and overgrowth of prostate tissue. The older men get, testosterone levels decrease but DHT continues to increase in the prostate.
  • Increased amount of estrogen compared to testosterone. Increased estrogen levels will increase the amount of DHT in the prostate.
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3
Q

Difference in location of prostate cancer and BPH

A

BPH develops in the inner part of the prostate while prostate cancer most likely to develop in the outer part

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4
Q

Possible risk factors of BPH

A

Family history, obesity (increased waist circumference), physical activity level, alcohol consumption, smoking, diabetes

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5
Q

Clinical manifestations of BPH

A
  • Symptoms present in lower urinary tract, nocturia one of the first symptoms
  • gradual onset, prostate enlarged for some time
  • hyperplasia
  • enlargement occurs with age
  • enlarges beyond normal dimensions 4x5 cm
  • firmer consistency (DRE)
  • encroaches on the urethra and the urine stream changes
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6
Q

Complications of BPH

A
  • hydronephrosis
  • hydroureter
  • fishhooking of ureter
  • thickening diverticulation of bladder
  • impeding out flow of urine
  • enlarged prostate
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7
Q

Subjective assessment

A
  • increased frequency
  • nocturia
  • change in stream
  • difficulty starting stream
  • feeling of incomplete emptying
  • intermittency
  • urgency
  • urinary leakage
  • prostate symptom index
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8
Q

Objective assessment

A
  • enlarged prostate DRE

- Increased PSA (prostate specific antigen)

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9
Q

Diagnostic exams for BPH

A
  • urinalysis (RBC or infection)
  • urine C & S
  • DRE (firm prostate)
  • PSA (prostate specific antigen is increased/blood test can rule out prostate cancer)
  • TRUS (biopsy)
  • BUN, creatinine, creatinine clearance
  • ultrasound of kidney and ureters
  • residual urine: PVR or bladder scan
  • cystoscopy
  • IVP (intervenous pylogram where dye goes to kidneys and down to bladder)
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10
Q

5a reductase inhibitor

A
  • slow prostate growth & reduces size of prostate gland
  • meds block enzyme 5a-reductase which is key for testosterone to convert to DHT; inhibits DHT production
  • takes a while before it starts to work 3-6 months
  • Side effects: decreased libido, decreased volume of ejaculation, erectile dysfunction
  • OTC’s can impact these meds
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11
Q

Alpha-adrenergic blockers

A
  • relax the prostate muscle, bladder neck, urethra and smooth muscle
  • facilitates urinary flow
  • improvement in 2 to 3 weeks
  • Side effects: orthostatic hypotension And dizziness, retrograde ejaculation, nasal congestion
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12
Q

What is a medical treatment of BPH that will relieve retention?

A

Indwelling Foley catheter inserted for 2-4 weeks. It allows the bladder to be empty and regain muscle strength contraction.

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13
Q

Examples of 5A–reductase inhibitors:

A
  • finasteride (Proscar)

- dutasteride (Avodart)

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14
Q

Examples of a-adrenergic receptor blockers:

A
  • tamsulosin (Flomax)
  • doxazosin (Cardura)
  • silodosin (Rapaflo)
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15
Q

Other factors during medical treatment:

A
  • ask patient if there’s any bleeding
  • encourage fluids to help reduce irritation as it dilutes urine
  • decrease alcohol and caffeine intake
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16
Q

Invasive therapy indicated for BPH when:

A
  • decrease in urine flow is sufficient enough to cause discomfort
  • persistent residual urine
  • acute urinary retention
  • intermittent catheterization can reduce symptoms and bypass obstruction
17
Q

What is transurethral microwave thermotherapy?

A

Outpatient procedure that delivers microwaves directly to the prostate through a transurethral probe to raise the temp of the prostate. Causes death of tissue relieving obstruction.

18
Q

What is transurethral needle ablation (TUNA)?

A

Increases the temperature of prostate using low wave radio frequency causing tissue death. A needle is used and only the tissue that comes in direct contact with that needle is affected allowing for greater precision.

19
Q

What is laser prostatectomy?

A

A laser beam is used transurethrally and cuts, coagulates and vaporizes the prostatic tissue.

20
Q

Balloon dilation of the prostate/Intraprostatic urethral stent

A

A guided wire is inserted into the urethra and a balloon in inflated directly in the area of the enlarged prostate.

21
Q

Transurethral resection of the prostate (TURP)

A

An instrument is inserted through a resectoscope to remove part of the prostate gland that is enlarged

22
Q

TURP procedure:

A
  • spinal or general anesthesia (inpatient)
  • resectoscope through the urethra cauterizes obstructing prostate tissue
  • large 3-way indwelling catheter with 30 mL balloon inserted after procedure
23
Q

3-way continuous bladder irrigation post TURP:

A
  • urinary obstruction secondary to blood clots
  • isotonic fluid is used
  • monitor I’s & O’s
  • monitor color and character of urine
24
Q

Nursing implementations for PREOPERATIVE care:

A
  • aseptic technique for urinary catheter
  • antibiotics preoperatively
  • have patient express concerns about any alterations in sexual function
  • inform pt of possible complications of procedure
  • possible dribbling and incontinence
25
Q

Nursing implementations for POSTOPERATIVE care:

A
  • observe for signs of infection
  • dietary intervention
  • discharge instructions for catheter
  • managing incontinence
  • 2-3 L fluids daily
  • s/s of UTI, wound infection
  • stool softener to prevent straining
26
Q

Nursing implementations for POSTOPERATIVE care CON’T:

A
  • prevent constipation
  • avoid heavy lifting
  • refrain from driving & intercourse after surgery as directed
  • sexual counseling for possible ED
  • avoid bladder irritants (smoking, caffeine)
  • yearly DRE
27
Q

What nursing diagnosis would you anticipate for a pt with enlarged prostate?

A

Urinary retention, impaired coping, infection, need for enhanced education, etc.

28
Q

What outcomes would be appropriate to set for a patient with BPH?

A

demonstrate understanding of BPH, increased fluid intake, etc.

29
Q

What interventions would you expect for the client with BPH?

A

Teaching about: medications, fluids, medical or surgical options.

30
Q

List some nursing evaluations:

A
  • urinary elimination is restored and maintained
  • complications of BPH are avoided
  • post op complications are avoided
  • urinary control is restored post-op
  • follow up care is implemented

Med Surg (20 decks)

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