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OA Exam 2 > OA Elimination > Flashcards

OA Elimination Flashcards

1
Q

BPH

A

nonmalignant enlargement of the prostate gland commonly seen in aging men

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2
Q

What happens due to BPH?

A

decreases outflow of urine by obstructing the urethra, causing difficult urination

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3
Q

When does BPH usually begin?

A

40’s, but may have no symptoms until later

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4
Q

BPH and prostate cancer

A

BPH not considered precursor to prostate cancer

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5
Q

How does BPH begin?

A

as small nodules in the periurethral glands which are the inner layers of the prostate

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6
Q

Hyperplasia

A

increase in NUMBER of cells

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7
Q

Hypertrophy

A

increase in SIZE of individual cells

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8
Q

Hyperplasia and hypertrophy

A

used interchangeably even though the terms are different

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9
Q

Risk factors for BPH

A
  • **age
  • **presence of testes
  • AA, Hispanics
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10
Q

Clinical manifestations in terms of voiding

A
  • weak urinary stream
  • increase time to void
  • hesitancy
  • incomplete bladder empty
  • postvoid dribbing
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11
Q

Clinical manifestations in terms of storage

A
  • frequency
  • urgency
  • incontinence
  • nocturia
  • dysuria
  • bladder pain
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12
Q

Complications of BPH

A
  • urinary retention
  • incomplete bladder sensation
  • bladder distention
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13
Q

What can result from bladder distention?

A
  • diverticula
  • obstructed ureters
  • infection
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14
Q

Infection that ascends from bladder to kidneys cause…

A
  • hydroureter

- hydronephrosis

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15
Q

hydroureter

A

distention of the ureter with urine

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16
Q

hydronephrosis

A

accumulation of urine in the renal pelvis as a result of obstructed outflow

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17
Q

Types of urinary incontinence

A
  1. stress incontinence
  2. urge incontinence
  3. reflex incontinence
  4. overflow incontinence
  5. functional incontinence
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18
Q

stress incontinence

A

loss of small urine amts associated with increased intra-abdominal pressure during sneezing, coughing, lifting.

due to: multiple pregnancies, decreased estrogen levels, short urethra, weak abdominal wall, prostate surgery

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19
Q

urge incontinence

A

involuntary loss of urine associated with a strong urge to void

due to: neuro disorders, detrusor muscle overactivity associated with bladder outlet obstruction or aging

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20
Q

reflex incontinence

A

involuntary loss of urine at predictable intervals when a specific bladder volume is reached

due to: neuro impairment, tissue damage

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21
Q

overflow incontinence

A

inability to empty bladder, resulting in over distention and frequent loss of small amounts of urine

due to: spinal cord injuries below S2, diabetic neuropathy, prostatic hyperplasia, fecal impaction, drugs with anticholinergic effects

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22
Q

functional incontinence

A

incontinence resulting from physical, environmental, or psychosocial causes

due to: confusion/dementia, physical disability or immobility, therapy or sedation, depression, and regression.

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23
Q

Evidence-based research shows who needs to be treated for BPH?

A

Surgical referral if BPH-related complications develop, medical therapy fails, or the patient chooses it.

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24
Q

Mild or nonbothersome BPH symptoms…

A

do not require treatment

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25
Q

Bothersome symptoms are…

A

managed with lifestyle modifications, medications, and surgery

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26
Q

First-line medications for BPH

A

Alpha blockers

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27
Q

Evidence-based research shows dietary supplements…

A

are not recommended for the management of BPH

palmetto, pygeum, cernilton, beta sitosterols and acupuncture

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28
Q

BPH Nursing Assessment

A
  • > 40 yrs should be assessed
  • health hx
  • physical exam
  • dx tests
  • IPSS scale
29
Q

Health hx includes…

A
  • risk factors
  • pain
  • urinary elimination patterns
  • hematuria
30
Q

Physical exam includes…

A

DRE

31
Q

Dx tests

A
  • UA
  • Urine flow rate test
  • Postvoid residual
  • Pressure flow study
  • urine culture for blood or infection
  • cytoscopy
  • DRE
32
Q

IPSS

A

International Prostate Symptom Score

  • used to assess symptoms
  • collects data about several subjective factors
33
Q

Nursing Diagnosis’

A
  • impaired urinary elimination
  • risk for infection related to urinary retention

-overflow urinary incontinence related to sphincter
blockage secondary to enlarged prostate

  • acute pain related to bladder distention
  • deficient knowledge related to effect of prostate surgery on sexuality
34
Q

Nursing Care/Responsibilites

A
  • therapeutic communication
  • answering patient questions
  • providing emotional support
  • patient teaching
35
Q

Patient teaching for nursing intervention

A
  • self-care
  • proper admin of meds
  • med side effects to expect
  • symptoms to report to physician
  • nutrition
36
Q

3 types of medications for BPH therapy

A
  1. 5-alpha reductase inhibitors
  2. Alpha-adrenergic blockers
  3. Anticholinergic
37
Q

5-alpha reductase inhibitors

A

“ide”

  • dutasteride
  • finasteride
38
Q

Alpha-adrenergic blockers

A

“sin/soin/in”

  • doxazosin
  • prazosin
  • tamsulsoin
  • terazosin
39
Q

anticholinergic

A

tolterodine

40
Q

Treatment with medications is based on two considerations

A
  1. Hyperplastic tissue is androgen-dependent

2. Smooth muscle contraction within the prostate can exacerbate urinary obstruction

41
Q

What does 5-alpha reductase inhibitors do?

A

inhibit conversion of testosterone to DHT and cause enlarged prostate to shrink in size

42
Q

Side effects of 5-alpha reductase inhibitors

A
  • impotence
  • decreased libido
  • decreased volume of ejaculation
43
Q

What is used to treat mild prostate enlargement?

A

-finasteride or dutasteride

44
Q

What does Alpha-adrenergic antagonists do?

A

relax smooth muscle of prostate and bladder neck to relieve obstruction and increased the flow of urine

45
Q

Side effects of alpha-adrenergic antagonists

A

orthostatic hypotension

46
Q

Patient teaching for alpha-adrenergic antagonists

A
  • slow position changes
  • monitor BP
  • check with HCP before taking OTC cough, cold, allergies
47
Q

Why to avoid OTC cough, cold, and allergy meds while taking alpha-adrenergic antagonists ?

A

OTCs may contain adrenergic agents

48
Q

Research shows that using _______ and _______ together is more effective than using each alone to relieve manifestations and prevent BPH progression in clients with moderate or enlarged prostate

A

Finasteride and Doxazosin

49
Q

Medications that worsen BPH symptoms

A
  1. Alpha-adrenergic agents
  2. Drugs with anticholinergic side effects
  3. Testosterone and other anabolic steroids
50
Q

How does Alpha-adrenergic agents affect BPH condition?

A

-activate alpha1-adrenergic receptors in bladder neck, causing urine flow restriction

51
Q

How do drugs with anticholinergic side effects affect BPH condition?

A

adversely affects BPH

52
Q

How do testosterone and other anabolic steroids affect BPH condition?

A
  • increase prostate enlargement

- increases physical obstruction of the urethra

53
Q

Older men should avoid what meds?

A
  1. alpha-adrenergic agents
  2. drugs w/ anticholinergic side effects
  3. testosterone and other anabolic steroids
54
Q

Lifestyle changes needed for men with mild BPH

A
  • urinating at first urge
  • avoiding alcohol and caffeine
  • drinking small amounts of fluids throughout the day
  • avoiding drinking fluids within 2 hrs at bedtime
  • avoiding OTC cold and sinus meds that contain decongestants or antihistamines
  • exercising regularly including Kegel
  • reducing stress
55
Q

Mild BPH symptoms

A

“watchful waiting” and lifestyle change

-usually clear up with no treatment in one third men

56
Q

Nursing Interventions

A
  • absorbent pads
  • catheter
  • dietary supplements (not proven)
  • lifestyle modifications
57
Q

Surgical intervention for BPH

A

TURP

58
Q

TURP

A

Transurethral resection of the prostate

  • obstructing prostate tissue is removed with wire loop of a resectoscope and electrocautery inserted through the urethra
  • tissue is flushed into bladder with fluid and then flushed out at the end of the operation
59
Q

Risks with TURP

A
  • hemorrhage
  • clot retention
  • inability to void
  • UTI
  • incontinence
  • impotence
  • retrograde ejaculation
60
Q

postop nursing care

A
  • 3 way cath irrigation
  • maintain traction of foley
  • maintain irrigation (color)
  • monitor I & Os
  • monitor for TURP syndrome
61
Q

TURP syndrome

A

volume excess and hyponatermia

62
Q

Manifestations of TURP syndrome

A
  • hyponatermia
  • decreased hematocrit
  • HTN
  • bradycardia
  • nausea
  • confusion
  • crackles
  • infection
  • edema
  • impotence
63
Q

The manifestations of TURP syndrome results from?

A

systemic absorption of irrigating fluids during and after surgery

if goes untreated….dysrhythmias and/or seizures

64
Q

CBI

A

Continuous bladder irrigation

-prevents formation of blood clots which can obstruct urinary output

65
Q

What the nurse looks for while on CBI?

A
  • output urine light pink/rose or colorless

- assess q 1-2hrs for color, consistency of amt, and presence blood clots

66
Q

Frank blood after TURP

A

means hemorrhage/active bleeding

-assess pt and alert MD

67
Q

Complaints of bladder spasms after TURP

A

could be expected, will feel full, cath could be blocked

  • assess pt, cath patent with flowing fluid
  • meds to help with contraction
68
Q

No output after TURP

A

catheter blocked

  • increased fluids to try to flush clot
  • notify MD
69
Q

Reports discomfort or leaking around cath after TURP

A
  • may be expected

- go from there

OA Exam 2 (6 decks)

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