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NURS 3512 > Week 9 BPH > Flashcards

Week 9 BPH Flashcards

1
Q

What is BPH?

A

Enlargement of the prostate gland

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2
Q

What is PSA level?

A
  • Blood work that is taken from a patient

- PSA will increase if theres something going on with the prostate and it needs to be investigated further

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3
Q

What is BPH pathology?

A
  • there is an increase in number of epithelial cells in the inner part of the prostate and because of that it compressed the urethra
  • non- malignant and not cancerous
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4
Q

What are the treatments for BPH

A

removing part of the tissue that is compressing the urethra

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5
Q

what is the main problem with BPH?

A

Obstruction

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6
Q

what usually brings the patient to see the Doctor?

A

Patient having problem urinating. Patient will have problem with frequency, dribbling, and continents

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7
Q

What are the S&S of BPH?

A

Urinary elimination symptoms

  • frequency
  • dribling
  • decrease urinary stream force
  • UTI symptoms
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8
Q

How is BPH Diagnosed?(3)

A
  • PSA level blood work
  • Digital rectal exam
  • TRUS scan and biopsy
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9
Q

PSA level result

A

Higher = BPH

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10
Q

Who can do Digital rectal exam

A

Nurse Practitioner or Doctor

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11
Q

what is the result for rectal exam if patient have BPH?

A
  • Prostate feels abnormal

- If patient have BPH the prostate will feel symmetrically large, firm and smooth

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12
Q

How does TRUS scan used to DX?

A

Tissue is taken and sent off the see if its cancerous or just normal
BPH

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13
Q

how does TRUS scan work?

A

Ultrasound probe is inserted to the anus and with the probe, they can send a bot of needle biopsy through and take a tissue sample

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14
Q

What does is mean by watch-full waiting?

A

Can use lifestyle changing or medication treatments

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15
Q

what type of lifestyle changes does person with BPH should do (3)

A
  • Decrease/ avoid caffeine
  • Avoid decongestants and anticholinergics
  • restrict fluid in the evening to reduce peeing
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16
Q

What kind of meds are used for BPH treatments? (2)

A
  • 5a reductase inhibitor (Proscar)

- a- adenergic receptor blocker (Flomax)

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17
Q

what does 5-a reductase inhibitor ( Proscar ) do?

A

Decrease size of prostate gland.

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18
Q

How long does proscar work?

A

Takes 6 months

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19
Q

what does a - adenergic receptor blocker (Flomax) do?

A

Promotes smooth muscle relaxation and helps facilitate urine flow.

20
Q

what is the improvement time and rate of Flomax?

A
  • 50-60% improvement just after taking 2-3 weeks.
21
Q

What is minimally invasive therapy?

A

its an outpatient procedure - takes only a day

22
Q

What kind of minimally invasive procedures are done for BPH? (3)

A

1) Transurethral microwave thermotherapy
2) Transurethral needle ablation
3) laser prostectormy

23
Q

what is transurethral microwave thermotherapy

A
  • uses microwaves and putting them directly to the prostate trough a probe.
  • the heat of the microwave causes death of prostate tissue which relieves the obstruction
24
Q

Post - procedure of transurethral microwave thermotherapy

A
  • patient will go home with indwelling foley 2-7 days to make sure the flow of urine continues out and to facilitate the passing of small clots or necrotic tissue
  • patient is given antibiotics, pain medications and anti spasm
25
Q

transurethral needle ablation

A
  • uses low wave radio frequency through a needle at a high temperature
  • it uses a needle to go through the transurethra ( goes through urethra) and uses the needle to to locally burn off or cause necrosis to the prostate.
26
Q

post procedure of transurethral needle ablation

A
  • Patient will have foley for a short time.

- patient can also have hematuria for about a week due to burning

27
Q

laser prostatectomy

A
  • laser is used for cutting, coagulation, and vaporization of prostatic tissues.
28
Q

laser prostatectomy post op

A
  • takes several weeks for optimal effect

- patient will go home with foley for a few days

29
Q

What are the invasive therapy? (2)

A
  • Transurethral resection of the prostate (TURP)

- Prostectomy

30
Q

what is prostectomy?

A

Removal of the prostate

31
Q

what is Transurethral resection of the prostate (TURP)

A
  • Known to be the “goal standard’ of treatment
  • surgical procedure involving the removal of prostate tissue using a resectoscope inserted through the urethra. ( NO EXTERNAL INCISION)
  • it is done with general or spinal anaesthesia
  • They excise and cauterize obstructing prostate tissue
32
Q

Is TURP good for older adults?

A

No, because it is very invasive and risky

33
Q

TURP post op

A
  • patient will have 3- way foley catheter with 30mL ballon to provide hemostasis and to facilitate urinary drainage.
  • Bladder is irrigated for the first 24hrs, the bladder is either irrigated continuously or intermittently, to prevent obstruction from mucus and blood clots.
34
Q

what is the outcome of TURP?

A

the outcome for 80 - 90% is excellent, with marked improvement of symptoms and urinary flow rates.

35
Q

What is complication of TURP?

A

-Bleeding!!

36
Q

Continuous bladder irrigation

A
  • Constant flush of normal saline which is irrigating solution
  • whatever is in the bladder will drain out to the drainage bag
37
Q

Continuous bladder irrigation important things to do (4)

A
  • keep an eye on the solution on the top (3L)
  • There is a clamp to change rate of irrigating fluid going into the bladder
  • Watch closely of the drainage bag. we need to see that the bladder is constantly draining out both urine
  • Look at the contents of drainage bag. Note colour, blood and clots.
38
Q

TURP POST OP Care (5)

A
  • Manage pain
  • Mange continuous bladder irrigation
  • I&O
  • Control Bladder spasms
  • Follow-up care
39
Q

what is the normal urine colour after TURP?

A

Pinkish or pink is normal. if theres frank blood then we need to call the doctor because its bleeding

40
Q

Bladder irrigation clamps rate

A
  • A rapid infusion can cause bladder spasms

- Slow infusions will not prevent clot formations

41
Q

what do we do if 3 way folley is clotted?

A

1) stop irrigation with roller clamp

2) flush bladder through foley

42
Q

why do we tell patient not to void around catheter?

A

it can result in increase spasms which can increase pain

43
Q

why is monitoring I&O hard for 3 way foley?

A
  • because its not just urine coming out. theres also some irrigating fluid.
  • its not going to be accurate
44
Q

what else do we have to monitor when patient had TURP?

A

Monitor for BUN and Cr for kidney and do a bladder scan if worried about distention

45
Q

what is good to give for bladder spasms after TURP

A
  • Ditropan

- start patient with flomax to help urine flow better

46
Q

what do patient that had TURP have to avoid

A
  • avoid activity that increase intra abdominal pressure which increase chances of bleeding ( sitting or walking for prolonged time)
  • avoid heavy lifting over 4.5 kg
  • avoid straining - use stool softener
  • avoid sexual intercourse
  • avoid driving
  • avoid climbing the stairs
  • avoid travelling

Avoid all until doctor approves

47
Q

what does patient have to do if theyre having urinary continence or poor sphincter control? (Post foley removal)

A
  • kegel exercise
  • limit fluids 2-3h before bed
  • avoid bladder irritants such as coffee and tea, citrus juice and alcohol
  • void immediately when they have urgency to void

NURS 3512 (10 decks)

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