OA Elimination Flashcards
BPH
nonmalignant enlargement of the prostate gland commonly seen in aging men
What happens due to BPH?
decreases outflow of urine by obstructing the urethra, causing difficult urination
When does BPH usually begin?
40’s, but may have no symptoms until later
BPH and prostate cancer
BPH not considered precursor to prostate cancer
How does BPH begin?
as small nodules in the periurethral glands which are the inner layers of the prostate
Hyperplasia
increase in NUMBER of cells
Hypertrophy
increase in SIZE of individual cells
Hyperplasia and hypertrophy
used interchangeably even though the terms are different
Risk factors for BPH
- **age
- **presence of testes
- AA, Hispanics
Clinical manifestations in terms of voiding
- weak urinary stream
- increase time to void
- hesitancy
- incomplete bladder empty
- postvoid dribbing
Clinical manifestations in terms of storage
- frequency
- urgency
- incontinence
- nocturia
- dysuria
- bladder pain
Complications of BPH
- urinary retention
- incomplete bladder sensation
- bladder distention
What can result from bladder distention?
- diverticula
- obstructed ureters
- infection
Infection that ascends from bladder to kidneys cause…
- hydroureter
- hydronephrosis
hydroureter
distention of the ureter with urine
hydronephrosis
accumulation of urine in the renal pelvis as a result of obstructed outflow
Types of urinary incontinence
- stress incontinence
- urge incontinence
- reflex incontinence
- overflow incontinence
- functional incontinence
stress incontinence
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
urge incontinence
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
reflex incontinence
involuntary loss of urine at predictable intervals when a specific bladder volume is reached
due to: neuro impairment, tissue damage
overflow incontinence
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
functional incontinence
incontinence resulting from physical, environmental, or psychosocial causes
due to: confusion/dementia, physical disability or immobility, therapy or sedation, depression, and regression.
Evidence-based research shows who needs to be treated for BPH?
Surgical referral if BPH-related complications develop, medical therapy fails, or the patient chooses it.
Mild or nonbothersome BPH symptoms…
do not require treatment
Bothersome symptoms are…
managed with lifestyle modifications, medications, and surgery
First-line medications for BPH
Alpha blockers
Evidence-based research shows dietary supplements…
are not recommended for the management of BPH
palmetto, pygeum, cernilton, beta sitosterols and acupuncture
BPH Nursing Assessment
- > 40 yrs should be assessed
- health hx
- physical exam
- dx tests
- IPSS scale
Health hx includes…
- risk factors
- pain
- urinary elimination patterns
- hematuria
Physical exam includes…
DRE
Dx tests
- UA
- Urine flow rate test
- Postvoid residual
- Pressure flow study
- urine culture for blood or infection
- cytoscopy
- DRE
IPSS
International Prostate Symptom Score
- used to assess symptoms
- collects data about several subjective factors
Nursing Diagnosis’
- 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
Nursing Care/Responsibilites
- therapeutic communication
- answering patient questions
- providing emotional support
- patient teaching
Patient teaching for nursing intervention
- self-care
- proper admin of meds
- med side effects to expect
- symptoms to report to physician
- nutrition
3 types of medications for BPH therapy
- 5-alpha reductase inhibitors
- Alpha-adrenergic blockers
- Anticholinergic
5-alpha reductase inhibitors
“ide”
- dutasteride
- finasteride
Alpha-adrenergic blockers
“sin/soin/in”
- doxazosin
- prazosin
- tamsulsoin
- terazosin
anticholinergic
tolterodine
Treatment with medications is based on two considerations
- Hyperplastic tissue is androgen-dependent
2. Smooth muscle contraction within the prostate can exacerbate urinary obstruction
What does 5-alpha reductase inhibitors do?
inhibit conversion of testosterone to DHT and cause enlarged prostate to shrink in size
Side effects of 5-alpha reductase inhibitors
- impotence
- decreased libido
- decreased volume of ejaculation
What is used to treat mild prostate enlargement?
-finasteride or dutasteride
What does Alpha-adrenergic antagonists do?
relax smooth muscle of prostate and bladder neck to relieve obstruction and increased the flow of urine
Side effects of alpha-adrenergic antagonists
orthostatic hypotension
Patient teaching for alpha-adrenergic antagonists
- slow position changes
- monitor BP
- check with HCP before taking OTC cough, cold, allergies
Why to avoid OTC cough, cold, and allergy meds while taking alpha-adrenergic antagonists ?
OTCs may contain adrenergic agents
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
Finasteride and Doxazosin
Medications that worsen BPH symptoms
- Alpha-adrenergic agents
- Drugs with anticholinergic side effects
- Testosterone and other anabolic steroids
How does Alpha-adrenergic agents affect BPH condition?
-activate alpha1-adrenergic receptors in bladder neck, causing urine flow restriction
How do drugs with anticholinergic side effects affect BPH condition?
adversely affects BPH
How do testosterone and other anabolic steroids affect BPH condition?
- increase prostate enlargement
- increases physical obstruction of the urethra
Older men should avoid what meds?
- alpha-adrenergic agents
- drugs w/ anticholinergic side effects
- testosterone and other anabolic steroids
Lifestyle changes needed for men with mild BPH
- 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
Mild BPH symptoms
“watchful waiting” and lifestyle change
-usually clear up with no treatment in one third men
Nursing Interventions
- absorbent pads
- catheter
- dietary supplements (not proven)
- lifestyle modifications
Surgical intervention for BPH
TURP
TURP
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
Risks with TURP
- hemorrhage
- clot retention
- inability to void
- UTI
- incontinence
- impotence
- retrograde ejaculation
postop nursing care
- 3 way cath irrigation
- maintain traction of foley
- maintain irrigation (color)
- monitor I & Os
- monitor for TURP syndrome
TURP syndrome
volume excess and hyponatermia
Manifestations of TURP syndrome
- hyponatermia
- decreased hematocrit
- HTN
- bradycardia
- nausea
- confusion
- crackles
- infection
- edema
- impotence
The manifestations of TURP syndrome results from?
systemic absorption of irrigating fluids during and after surgery
if goes untreated….dysrhythmias and/or seizures
CBI
Continuous bladder irrigation
-prevents formation of blood clots which can obstruct urinary output
What the nurse looks for while on CBI?
- output urine light pink/rose or colorless
- assess q 1-2hrs for color, consistency of amt, and presence blood clots
Frank blood after TURP
means hemorrhage/active bleeding
-assess pt and alert MD
Complaints of bladder spasms after TURP
could be expected, will feel full, cath could be blocked
- assess pt, cath patent with flowing fluid
- meds to help with contraction
No output after TURP
catheter blocked
- increased fluids to try to flush clot
- notify MD
Reports discomfort or leaking around cath after TURP
- may be expected
- go from there
