NUS111 Test #4 Flashcards
What are the risk factors for Benign Prostatic Hyperplasia
Increased age in Caucasian Men
African American men at a younger age
Smoking
Chronic Alcohol Use
Sedentary Lifestyle
Obesity
Poor Diet (western diet)
Diabetes Mellitus
Heart disease
Hypertension
What is the pathophysiology of BPH
Hypertrophied lobes of the prostate may obstruct the vesical neck or prostatic urethra causing incomplete emptying of the bladder and urinary retention.
What further complications can occur as a result of BPH
A gradual dilation of the ureters (hydroureter) and kidneys (hydronephrosis) can occur causing kidney infections. UTIs may result from urinary stasis
what is the International Prostate Symptom Score? (IPSS)
An assessment tool used to determine the severity of manifestations (of prostate symptoms) and their effect on the client’s quality of life
What does the IPSS ask the client to rate?
On a scale of 1-5 the severity of lower urinary tracy manifestations and how their quality of life is affected
What are the clinical manifestations of BPH
Urinary retention
Persistent UTI’s
Urinary frequency
Urinary urgency
Urinary incontinence
Kidney infections
Nocturia
Hesitancy in starting urination
Incomplete urination
Decrease in volume and force of urinary stream
Abdominal straining when urinating
Interruption of urinary stream
Dribbling
What are the Laboratory tests for BPH?
Urinalysis and culture: WBC’s elevated, hematuria and bateria present with UTI
BUN & creatinine: Elevated, indicating kidney damage
Urodynamic studies
CBC: WBC elevated if systemic infection present, RBC possibly decreased due to hematuria
culture and sensitivity of prostatic fluid: if fluid is expressed during D.R.E
what are the diagnostic procedures for BPH?
- Digital Rectal Examination (DRE)
- Transrectal Ultrasound with needle aspiration biopsy
- Early prostate cancer antigen
What will a DRE reveal in a patient with BHP?
an enlarged smooth prostate
What does the Transrectal Ultrasound with needle aspiration biopsy rule out in a patient with BHP?
prostate cancer in the presence of an enlarged prostate
What does an early prostate cancer antigen blood test rule out in patients with BHP?
presence of prostate cancer
What client education do we provide regarding BPH?
- Frequent wanks keep your prostate small
- Avoid drinking large amounts of fluid at the same time and void when you feel the urge
- Avoid bladder stimulants such as alcohol and caffeine
- avoid medications that reduce bladder tone (anticholinergenics, decongestants, antihistamines)
What is the goal of medication in a patient with BHP?
To re-establish uninhibited urine flow ou of the bladder
What are the medications we use for patients with BHP?
Finasteride (5-Alpha reductase inhibitor)
Tamsulosin (Alpha adrenergic agent)
What is the effect of finasteride on patients with BHP?
DHT medications decreases the production of testosterone in the prostate gland which often causes a decrease in the size of the prostate
what client education would we provide in relation to finasteride?
- MEdication can take up to 6 months to take effect
- impotence and decrease in libido are possible adverse effects
- Report breast enlargement to the provider
- Finasteride is teratogenic to a male fetus as potentially absorbed through the skin.
- Pregnant women should avoid contact with crushed medication or semen of a client taking the medication
What is the effect of Tamsulosin on patients with BHP?
- Causes relaxation of the bladder outlet and prostate gland
- Decreases pressure on the urethra thereby re-establishing a stronger urne flow
what client education would we provide in relation to Tamsulosin?
- Tachycardia, syncope, and postural hypotension can occur. Change positions slowly
- Drug-Drug interaction with cimetidine can potentiate hypotensive effect
What are the potential procedures for BPH?
Transurethral needle ablation
Transurethral microwave therapy
Prostatic stent
Interstitial laser coagulation
Electrovaporization of the prostate
Transurethral resection of the Prostate (TURP) **
What is a TURP procedure?
A surgical procedure to trim excess prostatic tissue emlarging the passageway of the urethra through the prostatic gland. Typically epidural and spinal anasthesia are used
What are the Pre-Op nursing interventions for TURP procedure?
Asses CV respiratory and renal systems
Education. ensure client fully understands procedure and expected outcomes (physical/social/sexual)
Insert Coude catheter
Lab values: clotting factors
Give prophylactic antibiotic
What are the post operative nursing interventions after a TURP procedure?
Continuous Bladder Irrigation (CBI)
Placement of a three way catherter for CBI
Monitoring of the CBI
Monitor I & O
Monitor CBI for excessive bleeding
Drinking 2-3L fluid per day
Administering medications for pain and bladder spasms, stool softeners to avoid straining
Helping client to ambulate as soon as possible to avoid DVT
If the CBI appears not to be draining what should we do?
Check for kinks
If still not draining, stop flow of catheter and irrigate with 50ml saline to remove blockage
How large is the balloon on a CBI catheter?
30-45ml