UNIT 9 Benign Prostate Hypertrophy CHAPTER 67 Flashcards
What is Benign Prostatic Hypertrophy
enlargement of the prostate
Commonly known as BPH
* Most common condition in older men
* Enlarged prostate
Labs and diagnostic
-Elevated creatinine
* Elevated BUN
* Electrolyte imbalance
* UA
– Excessive protein, glucose, RBC, & WBC, decreased specific gravity & urine osmolality
* CBC
* 24 hrs. urine collection- determine GFR
* CT, US, X rays, MRI
* Renal Scan
Nursing Interventions for BPH
- Encourage fluids
- Avoid caffeine, alcohol and tea
- Medications – i.e. Finasteride
- Avoid “drying” medications – i.e. anticholinergic, antihistamine &
decongestants
Patient teaching for Drug Finasteride
*Monitor blood pressure, and teach to move slowly from sitting to standing; orthostatic hypotension can occur.
Teach about possible side effect of gynecomastia; men taking a 5-alpha-reductase inhibitor are three times more likely to develop this condition.
*Teach about the increased risk for development of prostate cancer; men taking a 5-alpha-reductase inhibitor are at higher risk for development of prostate cancer.
*Teach to keep medications stored away from pregnant women or women who may become pregnant; these drugs are teratogenic and can be absorbed through the skin; therefore, pregnant women should not touch dutasteride nor finasteride.
*Teach patients taking dutasteride to take the capsule with a full glass of water, and to refrain from opening the capsule to sprinkle on food; dutasteride irritates oropharyngeal mucosa.
*Do not put next to prenatal vitamin can cause tetratagenic
Assessment or S/S
of BPH
Prostatism
* Assess for dysuria/hematuria
* Digital rectal exam
* Generalized symptoms-fatigue, anorexia, n/v, epigastric
discomfort
* Hesitancy – difficulty starting and continuing urination, may
report straining to start urination
* Reduced force and stream
* Incomplete emptying
* Post void dribbling or leaking(Overflow incontinence)
- Difficulty in starting (hesitancy) and continuing urination
- Reduced force and size of the urinary stream (“weak” stream)
- Sensation of incomplete bladder emptying
- Straining to begin urination
- Postvoid (after voiding) dribbling or leaking
Risk Factors for BPH Modifiable and Nonmodifiable
Nonmodifiable
*Race—Black men younger than 65 need treatment earlier than white men; also, LUTS is more common in black men than white men.
* Genetic susceptibility—Variants in the GATA3 gene have been associated with development of BPH/LUTS.
* Family history of cancer—Men with a family history of bladder cancer (not prostate cancer) are at higher risk to develop BPH.
Modifiable risk factors include (McVary, 2019):
* Obesity and metabolic syndrome—Obesity, glucose intolerance, dyslipidemia, and hypertension are associated with higher risk for development of BPH.
* Beverage consumption—Coffee and caffeine intake have been associated with an increase in risk for progression of existing BPH.
Which selection of food should a patient with BPH avoid
A. Caffeinated tea
B. Grape Juice
C. Bananas
D. Ramon noodles
A. Caffeinated tea
- Beverage consumption—Coffee and caffeine intake have been associated with an increase in risk for progression of existing BPH.
What is Transurethral resection of the prostate (TURP)
and patient teaching POST OP
If a lesser invasive procedure is not indicated or desired, the historical gold standard surgery has been a transurethral resection of the prostate (TURP), in which the ENLARGED PART of the PROSTATE is REMOVED through an endoscopic instrument.
Preoperative care. When planning surgical interventions, the patient’s general physical condition, the size of the prostate gland, and the man’s preferences are considered.
The patient may have fears and misconceptions about prostate surgery, such as believing that automatic loss of sexual functioning or permanent incontinence will occur. Assess the patient’s anxiety, correct any misconceptions about the surgery, and provide accurate information to him and his family.
Remind patients taking anticoagulants that the drugs will be discontinued several days prior to the TURP or open prostate surgery to prevent postoperative bleeding. Other general preoperative care is described in Chapter 9.
Explain that it is normal for the urine to be blood-tinged after surgery. Small blood clots and tissue debris may pass while the catheter is in place and immediately after it is removed. Some patients also have continuous bladder irrigation (CBI), depending on the procedure performed.
Should men avoid coffee or caffeine to prevent the risk of BPH
A. No
B. Yes
B. Yes
Is Finasteride toxic to the liver? Should a pt have follow up lab pulled? When should the pt see improvement?
Remind patients taking a 5-ARI for BPH that they may need to take it for as long as 6 months before improvement is noticed. Remind them to keep all follow-up appointments for laboratory testing, because liver damage can occur. Teach about possible side effects including erectile dysfunction (ED), decreased libido, and dizziness due to orthostatic hypotension. Remind them to change positions carefully and slowly!
What is the estimated blood loss for TURPS
A. less than 500ml
B. more that 200ml
C.less than 1000ml
D. more than 600ml
A. less than 500ml
The estimated blood loss during TURP is less than 500 mL
What is Tranexamic acid used for in surgery?
A fibrinolytic inhibitor such as tranexamic acid may be used during surgery to prevent bleeding and excess clott ing. This does not prevent the need for blood transfusions, nor is it effective in increasing hemoglobin levels, after surgery. However, it does assist in preventing perioperative blood loss
POST OP CARE TURP
Postoperative care. During any surgical procedure for BPH, a urinary catheter is placed into the bladder. Traction is often applied on the catheter by pulling it taut and taping it to the patient’s abdomen or thigh.
If the catheter is taped to the patient’s thigh, instruct him to keep his leg straight. The patient who had a TURP may have a catheter and continuous bladder irrigation (CBI) in place for several days. For the CBI, a three-way urinary catheter is used to allow drainage of urine and inflow of a bladder irrigating solution (Fig. 67.3).
Be sure to maintain the flow of the irrigant to keep the urine clear. When measuring the fluid in the urinary drainage bag, subtract the amount of irrigating solution that was used, to determine actual urinary output.
After a TURP, all patients have an indwelling urethral catheter. Be sure that they know that they will feel the urge to void while the catheter is in place. Tell the patient that he will likely have traction on the catheter that may cause discomfort, and reassure him that analgesics will be prescribed to relieve pain.
if pt reports lower abdominal pain, it may be because the catheter is not patent increase flow of CBI to relieve the blockage and promote urinary flow
no pain meds if clot is present
Disadvantage of TURP
The disadvantage of a TURP is that only small pieces of the gland are removed. Remaining prostate tissue may continue to grow and cause urinary obstruction, requiring additional TURPs. Urethral trauma from the resectoscope with resulting urethral strictures is also possible.
Care of the Patient After Transurethral Resection of the Prostate
Care of the Patient After Transurethral Resection of the Prostate
* Monitor the patient closely for signs of infection. Older men undergoing prostate surgery often also have underlying chronic diseases (e.g., cardiovascular disease, chronic lung disease, diabetes).
* Help the patient out of the bed to the chair as soon as permi ed to prevent complications of immobility. Provide assistance, especially for patients with underlying changes in the musculoskeletal system (e.g., decreased range of motion, stiffness in joints). These patients are at high risk for falls.
* Assess the patient’s pain every 2 to 4 hours and intervene as needed to control pain.
* Provide a safe environment for the patient. Anticipate a temporary change in mental status for the older patient in the immediate postoperative period as a result of anesthetics and unfamiliar surroundings. Reorient the patient frequently. Keep catheter tubes secure.
* Maintain the rate of the continuous bladder irrigation to ensure clear urine without clots and bleeding.
* Use normal saline solution (which is isotonic) for the intermi ent bladder irrigant unless otherwise prescribed.
* Monitor and document the color, consistency, and amount of urine output.
* Check the drainage tubing frequently for external obstructions (e.g., kinks) and internal obstructions (e.g., blood clots, decreased output).
* Assess the patient for reports of severe bladder spasms with decreased urinary output, which may indicate obstruction.
* If the urinary catheter is obstructed, irrigate it per agency or surgeon protocol.
* Notify the surgeon immediately if the obstruction does not resolve by hand irrigation or if the urinary return looks like ketchup.
