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Using your text (Lewis, Ch. 57, Male Reproductive Problems), complete the following:
a. Write brief definitions of each of the following terms in your own words:
Term Definition
Benign prostatic hyperplasia
Prostate specific antigen (PSA)
Prostatitis
Transurethral resection of the prostate
a. BPH is a very common urological problem in males (although note that this is included in Male Reproductive chapter); it is so common that by the age of 50, about 50% of males have some symptoms of BPH. In your readings, answer the following:
o BPH is a precursor to the development of prostate cancer. True/False
o When the prostate is enlarged, it compresses the ____.
o It is not clear what causes BPH, but many males will experience BPH. True/False
o A client’s father had BPH; is the client at higher risk? Yes/No
o There seems to be some evidence that consuming high amounts of fruits and vegetables increases the risk of BPH. True/False
o In general, the signs and symptoms experienced by a client are mostly related to what type of obstruction? ___________
o What would the nurse anticipate as being the worst case scenario in a client with BPH? ¬¬¬-_______________________
o A physician suspecting BPH in a client will first perform a ¬¬ examination. What findings would suggest BPH? _____________.
o Consider this: why are symptoms exhibiting early in the course of BPH usually very mild and tolerable? ________________________
b. Complete the following chart comparing symptoms of obstructive vs irritative. Consider what might cause ‘obstructive’ symptoms, and what might lead to ‘irritative’ symptoms.
Obstructive Irritative
a. Why would a physician order a urinalysis and culture for a newly diagnosed client with BPH?
b. Take a look at the AUASIDSP scoring system in Table 57-1; Does a higher or lower number indicate the presence of BPH?
c. A physician determines a client likely has BPH based on the above scoring system, a positive DRE, and the client’s subjective description of symptoms.
d. What do you anticipate the physician will order next? And why?
Diagnostic/Lab Testing Rationale
To r/o infection
PSA
TRUS (how is this done?)
Measures volume of urine passed per second (why do we want to know this)
Post void residual
To assess kidney function
a. Write three priority goals for a client diagnosed with BPH.
i. Note that treatment for BPH is usually dependant on the symptoms of the client. Remember we usually treat with the least invasive, moving towards more invasive if the goal is not achieved. Given that the prostate is enlarged, it would make sense to decrease the enlargement, or relax the muscles of the prostate. We can do this in three main ways:
Treatment
Drug: 5 reductase inhibitors: drugs such as Finasteride (Proscar) -- This drug reduces the size of the prostate gland (this would help!!)
Takes 3 – 6 months to be effective
Must be taken continuously, ongoing
Drug: adrenergic receptor blocker (also used for hypertension, alpha blockers)
Promote smooth muscle relaxation in the prostate Minipres (Prazosin) Improvement with 2 to 3 weeks
Watch for postural hypotension, dizziness
Note that this drug provides symptom relief, where Finasteride does decrease the hyperplasic tissue.
If we put Finasteride and Prazosin together ~ would we have even more benefit?
If urinary flow is fairly restricted, or the client c/o discomfort due to not being able to void adequately, more assertive treatment is required. Now, it is likely that some prostate tissue will need to be removed. Refer to Table 57-3 in your text; in general, review each test, and be aware of the options available. It is fairly common to have a client post TURP in hospital.
a. Nursing Care:
Pre – operatively: what factors will the nurse monitor? Think pain, intake/output, potential for infection. If this is your patient, what will need to be a priority? If a catheter needs to be inserted, use a ‘coude’ catheter, with a tilted end that passes the prostate gland easier. Do not force a catheter in. Use lots of lubricant.
Post – operatively: as with many surgeries, bleeding is always a concern; in particular to a TURP, bleeding is a high priority, along with bladder spasms, incontinence, and infection.
Bleeding: refer to ‘triple lumen catheters’; and review how a CBI is used. This is VERY IMPORTANT when caring for a patient post TURP surgery:
o Run the CBI to keep the outflow light pink without clots; in other words, if the drainage is red, dark, +/- clots, increase the rate; slow it down when the drainage is light pink. Clots can occur up to 36 hours after surgery. Large amounts of bright red bleeding are not normal; consider hemorrhage.
o Calculating the intake and output of the BLADDER is essential – hang a 3L CBI bag (NS), ensure the foley bag is empty. You will need to empty the foley frequently – and keep track. Once the CBI bag is empty, you will know that 3L has gone into the bladder; add up what you have emptied from the foley, you will know this amount is what comes out. The difference is the true urine output.
o Example: 3000 cc NS infuses into the bladder. Total output of the foley bag is 3600 cc. The true urine output is 3600 – 3000 = 600 cc. In your output for charting, 600 cc is the urine output.
o Note that this is not IV input – it is an irrigation that ONLY goes into the bladder, so it is NOT counted as output. If you have questions, please ask me!!
o It is acceptable to manually flush the foley catheter if it does not appear to be draining. There could be clots in the way; under aseptic technique, instil 50 cc NS into the catheter, withdraw to remove clots
Bladder Spasms: can be caused by irritation of the mucosa, the catheter, or blood clots, and can be very painful.
o First intervention if bladder spasms occur is to check the catheter for clots; irrigate if required. Antispasmodics can be administered – such as opium and belladonna suppositories (O and B supps).
Sphincter: let the client know that the sphincter may have decreased tone when the catheter is removed; some dribbling or incontinence is not unusual (the client may be quite upset about this). Kegel’s exercise are helpful. Improved control can occur for up to 12 months.
Stool softeners: are helpful post operatively; they prevent straining, and therefore increasing the intra abdominal pressure that can lead to bleeding.
Health Teach: fluids fluids fluids! Avoid bladder irritants such as coffee; some erectile dysfunction may occur although can continue to improve for up to 12 months.
Prostatitis
o What is the difference between BPH and prostatitis (note the ‘itis’ ending)?
o Symptoms will include urinary type symptoms, but also include what?
o If you determined the key difference between BPH and prostatitis, you will understand that ________ are always ordered. Note the length of time……
o Clients may also be ordered ________ for the inflammation.
o Would Proscar or Prazosin be helpful?
o The client should be encouraged to drink fluids.
o The worst case scenario for this client would be: _________.
All done – if there is ANYTHING on this online learning session that does not make sense, or you are confused about, or don’t understand, please first go to your text. If that doesn’t assist you, please ask me
Answer to h: restore bladder functioning, relieve the symptoms, prevent complications
Sample Solution