Week 13: Chp 66: Benign Prostatic Hyperplasia Flashcards
What is Benign Prostatic Hyperplasia
an enlarged prostate
-not a form of cancer; can have BPH and prostate cancer simultaneously or independently of each other
Primary control of the prostate gland
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
The clinical manifestations of BPH
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
Symptoms related to changes in the bladder include?
urgency, frequency, the feeling that the bladder has not completely emptied after urination, and frequent awakening at night to urinate
As the bladder becomes more sensitive to the retention of urine, what might result?
incontinence
-the patient may experience bet-wetting and the inability to respond quickly enough to the need to urinate
A urethral obstruction or enlarged prostate that is left untreated may result in?
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
Diagnostic Tests
- digital rectal examination (DRE)
- Urinalysis
- prostate-specific antigen (PSA)
Digital rectal examination (DRE)
diagnosis of BPH is confirmed with DRE
-the enlarged prostate can be palpated on examination
Urinalysis: Why?
is done to rule out the presence of an infection causing symptoms
Prostate-specific antigen (PSA)
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)
Complications of BPH
- Acute urinary retention
- UTI
- Bladder stones
- Bladder damage
- Kidney damage
Complications: acute urinary retention
blockage of urethra by enlarged prostate, obstructing urine flow; causing AUR
Complications: UTI
secondary to urinary stasis
Complications: Bladder stones
crystallization of mineral deposits in concentrated urine due to obstructed urine flow
Complications: Bladder damage
stretching and weakening of the bladder wall muscles from incomplete emptying, resulting in the bladder no longer contracting properly
Complications: Kidney damage
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
Pharmacological management
- 5-alpha reductase inhibitor
- alpha-adrenergic blockers
- if has an overactive bladder, an anticholinergic is added such as oxybutynin to relax bladder smooth muscle
Medications: alpha-adrenergic blockers
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
Adverse effects of alpha-adrenergic blockers
headache, nasal congestion, dizziness, drowsiness, postural hypotension, reflex tachycardia, and retrograde or delayed ejaculation
Medications: 5-alpha reductase inhibitors
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
Adverse effects in 5-alpha reductase inhibitors
rash, breast enlargement, breast tenderness, reduced volume of ejaculate, decreased libido, and erectile dysfunction (ED)
What can be added to the medication regimen if the patient with BPH has an overactive bladder?
an anticholinergic to relax smooth muscle, such as oxybutynin, may be added
Alternative Therapies if medication is not an effective treatment and is not a surgical candidate?
- 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)
Alternative Therapies: Indwelling catheter: how long can it stay?
can stay in place and be changed monthly per protocol
Surgical Management Treatment Options
- 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
Surgical Treatment Options: Transurethral Resection of the Prostate (TURP)
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
Treatment Options: Continuous Bladder Irrigation
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
Assessment and Analysis: Clinical manifestations of BPH are due to what?
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
Nursing Diagnoses
- disturbed sleep pattern r/t nocturia
- risk for infection r/t urinary stasis
Nursing Interventions: Assessments
- urinary symptoms
- temperature
- focused abdominal examination
- bladder scan
- urinalysis
Assessments: Urinary symptoms
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
Assessment: Temperature
an increase in temperature may indicate a UTI secondary to urinary stasis
Assessment: Focused abdominal examination
a distended abdomen may signify bladder distention, thus indicating the patients inability to empty the bladder and risk for a UTI
Assessment: Bladder scan
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
Assessment: Urinalysis
the results will determine a possible infection from urinary stasis or related LUTS (lower urinary tract symptoms)
Nursing Actions
- catheterization
- administer medication therapy; 5-alpha reductase inhibitor and/ or alpha-adrenergic blockers are ordered
Actions: Catherterization
to check for PVR and to relieve distended bladder, decreasing the risk for bladder damage
Actions: administer medication therapy; 4-alpha reductase inhibitor and/or alpha-adrenergic blockers as ordered
- 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
Nursing Teachings
- watchful waiting
- decreased liquid intake in the evening
- medication therapy education
- follow-up
- information regarding surgical options
- care of surgical/ invasive treatment sites
Teaching: “watchful waiting”
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
Teaching: Decrease liquid intake in the evening
decreased fluid intake in the evening may decrease nocturia
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
C. to evaluate PVR volume
D. to facilitate complete emptying of the bladder
