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Nursing 172 > Week 13: Chp 66: Benign Prostatic Hyperplasia > Flashcards

Week 13: Chp 66: Benign Prostatic Hyperplasia Flashcards

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1
Q

What is Benign Prostatic Hyperplasia

A

an enlarged prostate

-not a form of cancer; can have BPH and prostate cancer simultaneously or independently of each other

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2
Q

Primary control of the prostate gland

A

assist in controlling urine flow

  • also mixes sperm with prostatic fluid and seminal fluid to be ejaculated during orgasm
  • around the age of 25, the prostate begins to grow
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3
Q

The clinical manifestations of BPH

A

related to lower urinary tract symptoms (LUTS)

  • difficulty starting the flow of urine even with straining
  • a weak stream of urine
  • multiple interruptions during urination
  • dribbling once urination is complete
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4
Q

Symptoms related to changes in the bladder include?

A

urgency, frequency, the feeling that the bladder has not completely emptied after urination, and frequent awakening at night to urinate

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5
Q

As the bladder becomes more sensitive to the retention of urine, what might result?

A

incontinence

-the patient may experience bet-wetting and the inability to respond quickly enough to the need to urinate

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6
Q

A urethral obstruction or enlarged prostate that is left untreated may result in?

A

bladder outlet obstruction (BOO)
-includes acute urinary retention (AUR), bladder infection, bladder stones, and increasing pressure in the kidney, possibly resulting in hydronephrosis or postrenal acute kidney injury (AKI) or pyelonephritis

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7
Q

Diagnostic Tests

A
  • digital rectal examination (DRE)
  • Urinalysis
  • prostate-specific antigen (PSA)
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8
Q

Digital rectal examination (DRE)

A

diagnosis of BPH is confirmed with DRE

-the enlarged prostate can be palpated on examination

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9
Q

Urinalysis: Why?

A

is done to rule out the presence of an infection causing symptoms

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10
Q

Prostate-specific antigen (PSA)

A

is a protein produced by the prostate gland and may be considered a tumor marker

  • elevated PSA may be indicative of prostate cancer
  • elevated PSA levels are also indicative of infection (PSA levels do not distinguish between cancer and BPH)
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11
Q

Complications of BPH

A
  • Acute urinary retention
  • UTI
  • Bladder stones
  • Bladder damage
  • Kidney damage
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12
Q

Complications: acute urinary retention

A

blockage of urethra by enlarged prostate, obstructing urine flow; causing AUR

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13
Q

Complications: UTI

A

secondary to urinary stasis

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14
Q

Complications: Bladder stones

A

crystallization of mineral deposits in concentrated urine due to obstructed urine flow

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15
Q

Complications: Bladder damage

A

stretching and weakening of the bladder wall muscles from incomplete emptying, resulting in the bladder no longer contracting properly

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16
Q

Complications: Kidney damage

A

increased pressure in the kidney secondary to urinary retention and backflow of urine, causing hydronephrosis (swelling of urine-collecting structures in the kidney) and postrenal AKI
-pyelonephritis- UTI migrating from the bladder to the kidney

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17
Q

Pharmacological management

A
  • 5-alpha reductase inhibitor
  • alpha-adrenergic blockers
  • if has an overactive bladder, an anticholinergic is added such as oxybutynin to relax bladder smooth muscle
18
Q

Medications: alpha-adrenergic blockers

A

alpha blockers act on the alpha receptors in the prostate, causing smooth muscles of the prostate to relax

  • relaxation of these muscles decreases the constriction of the urethra
  • takes 2 weeks to 4 months to notice symptom improvement
  • adverse effects: headache, nasal congestion, dizziness, drowsiness, postural hypotension, reflex tachycardia, and retrograde or delayed ejaculation
19
Q

Adverse effects of alpha-adrenergic blockers

A

headache, nasal congestion, dizziness, drowsiness, postural hypotension, reflex tachycardia, and retrograde or delayed ejaculation

20
Q

Medications: 5-alpha reductase inhibitors

A

act as antiandrogens

  • 5-alpha reductase converts testosterone into DHT; Dihydrotestosterone stimulates the growth factors that encourage prostate hyperplasia while concurrently reducing the rate of cell death in the prostate; this imbalance results in enlargement of the prostate
  • 5-alpha reductase inhibitors prevent testosterone from being converted to DHT, which causes enlarged tissues to shrink, thus reducing obstruction of the urethra
  • take 3 to 6 months to take effect
  • does not affect levels of circulating testosterone; reduces the chance of erectile dysfunction
  • adverse effects: rash, breast enlargement, breast tenderness, reduced volume of ejaculate, decreased libido, ED
  • reduction in male -pattern baldness
21
Q

Adverse effects in 5-alpha reductase inhibitors

A

rash, breast enlargement, breast tenderness, reduced volume of ejaculate, decreased libido, and erectile dysfunction (ED)

22
Q

What can be added to the medication regimen if the patient with BPH has an overactive bladder?

A

an anticholinergic to relax smooth muscle, such as oxybutynin, may be added

23
Q

Alternative Therapies if medication is not an effective treatment and is not a surgical candidate?

A
  • intermittent catheterization
  • indwelling urinary catheter
  • saw palmetto (Serenoa repens), African plum (Pygeum africanum), Cernilton, and South African star grass (Hypoxis rooperi and some species of Pinus and Picea)
24
Q

Alternative Therapies: Indwelling catheter: how long can it stay?

A

can stay in place and be changed monthly per protocol

25
Q

Surgical Management Treatment Options

A
  • Transurethral Resection of the Prostate (TURP)
  • Transurethral Incision of the Prostate (TUIP or TIP)
  • Open Prostatectomy
  • Laser Surgery
  • Transurethral Microwave Therapy (TUMT)
  • Transurethral Needle Ablation (TUNA)
  • Prostatic Stents
  • Water-induced thermotherapy and Transurethral Ethanol ablation
26
Q

Surgical Treatment Options: Transurethral Resection of the Prostate (TURP)

A

most common surgery for BPH

  • a lighted scope known as a resectoscope is passed into the urethra. A small cutting tool is used to remove the entire inner prostate, leaving the outer layer; symptoms are usually relieved quickly, resulting in a stronger flow of urine
  • a catheter may remain in place after surgery for 3 to 5 days to drain the bladder
  • recovery from a TURP may include a risk of bleeding and infection
  • permitted only light activity immediately postoperatively
27
Q

Treatment Options: Continuous Bladder Irrigation

A

Continuous bladder irrigation (CBI) is a procedure used to flush sterile fluid through a catheter and into the bladder. The irrigation helps remove and prevent blood clots from forming in the bladder. Catheter is to remain in place for 3-5 days

28
Q

Assessment and Analysis: Clinical manifestations of BPH are due to what?

A

caused by the obstruction of urine flow due to an enlarged prostate

  • difficulty starting flow of urine
  • a weak urine stream
  • multiple interruptions during urination
  • dribbling once urination is complete
  • urgency, frequency, the feeling that the bladder has not completely emptied after urination, and nocturia
29
Q

Nursing Diagnoses

A
  • disturbed sleep pattern r/t nocturia

- risk for infection r/t urinary stasis

30
Q

Nursing Interventions: Assessments

A
  • urinary symptoms
  • temperature
  • focused abdominal examination
  • bladder scan
  • urinalysis
31
Q

Assessments: Urinary symptoms

A

subjective data from the patient regarding the extent of urinary symptoms assist in diagnosis and aid in determining treatment options

  • mild symptoms that do not interfere with activities of daily living may require only watchful waiting
  • more severe symptoms that interfere with activities of daily living, such as nocturia and an ability to empty the bladder, may require more aggressive treatment
32
Q

Assessment: Temperature

A

an increase in temperature may indicate a UTI secondary to urinary stasis

33
Q

Assessment: Focused abdominal examination

A

a distended abdomen may signify bladder distention, thus indicating the patients inability to empty the bladder and risk for a UTI

34
Q

Assessment: Bladder scan

A

use of a bladder scanner to check postvoid residual (PVR) to determine the ability of the patient to empty his bladder and discovering any urinary stasis that may lead to infection

35
Q

Assessment: Urinalysis

A

the results will determine a possible infection from urinary stasis or related LUTS (lower urinary tract symptoms)

36
Q

Nursing Actions

A
  • catheterization

- administer medication therapy; 5-alpha reductase inhibitor and/ or alpha-adrenergic blockers are ordered

37
Q

Actions: Catherterization

A

to check for PVR and to relieve distended bladder, decreasing the risk for bladder damage

38
Q

Actions: administer medication therapy; 4-alpha reductase inhibitor and/or alpha-adrenergic blockers as ordered

A
  • 5-alpha reductase inhibitors limit the production of DHT, a substance that encourages prostate hyperplasia
  • alpha-adrenergic blockers relax the smooth muscle of the prostate
39
Q

Nursing Teachings

A
  • watchful waiting
  • decreased liquid intake in the evening
  • medication therapy education
  • follow-up
  • information regarding surgical options
  • care of surgical/ invasive treatment sites
40
Q

Teaching: “watchful waiting”

A

explanation of the term “watchful waiting”, including recognition of worsening symptoms, and when to seek further treatment help alleviate anxiety and ensure that the patient seeks treatment when necessary

41
Q

Teaching: Decrease liquid intake in the evening

A

decreased fluid intake in the evening may decrease nocturia

42
Q

A patient’s orders include the placement of a catheter as a temporary treatment of his BPH. The nurse understands that rationales for this intervention is which of the following? (select all that apply)
A. exact monitoring of intake and output
B. retrieving a sterile sample for urinalysis
C. to evaluate PVR volume
D. to facilitate complete emptying of the bladder
E. to avoid unnecessary surgical procedures

A

C. to evaluate PVR volume

D. to facilitate complete emptying of the bladder

Nursing 172 (120 decks)

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