N 326 Test 4 Study Guide Part 2Benign Prostate Hyperplasia- Enlargement of prostate gland resulting from increase in number of epithelial cells and stromal tissue- Most common urologic problem in males- Occurs in 50% of men over 50 and 90% of men over 80- Approximately 25% will require treatment by age 80- Does not predispose to development of prostate cancerEtiology and Pathophysiology- Not completely understood- Thought to result from endocrine changes from aging process- Typically develops in inner part of prostate- Enlargement gradually compresses urethra - Partial or complete obstruction- Compression leads to clinical symptoms- No direct relationship between prostate size and obstruction - Location of enlargement determines obstructive symptoms- Risk factors: Family history, Environment, Obesity (Increased waist circumference), Diet (Polyunsaturated fatty acids)Clinical Manifestations- Symptoms categorized into two groups: Obstructive symptoms & Irritative symptoms- Obstructive symptoms - Symptoms due to urinary retentiono Decrease in caliber of force of urinary streamo Difficulty in initiating urinationo Intermittencyo Dribbling at end of voiding- Irritative symptoms - Symptoms associated with inflammation or infectiono These include: Urinary frequency and urgency, Dysuria, Bladder pain, Nocturia, IncontinenceComplications- Related to urinary obstruction- Acute urinary retention: Common complication is indication for surgical intervention- UTI and sepsis - Incomplete bladder emptying with residual urine provides medium for bacterial growth- Calculi may develop in bladder because of alkalinization of residual urine - Renal failure: caused by hydronephrosis- Pyelonephritis- Bladder damageDiagnostic Studies- History and Physical Exam- Digital Rectal Examination [DRE]- Urinalysis with culture & sensitivity- PSA level [Prostate Specific Antigen]- Serum creatinine- TRUS scan [Trans Rectal Ultrasound]- Uroflometry - CystourethroscopyCollaborative Care- Goals: Restore bladder drainage, Relieve symptoms, Prevent/treat complications- Watchful waiting- Dietary changes- Timed voiding schedule- Drug therapy: Offers symptomatic relief of BPHo ↓ Size of prostate glando Promotes smooth muscle relaxation in prostate; facilitates urinary flowo Side effects: Decreased libido, decreased volume of ejaculation, erectile dysfunction, orthostatic hypotension and dizziness, retrograde ejaculation, nasal congestion- Herbal therapyo Saw palmetto-May alleviate nocturia, improve urinary flow, reduce residual bladder volume -Side effects: Mainly GI, may increase BP, increase risk of bleeding-Long-term effectiveness and ability to prevent complications unknown- Invasive therapy indicated wheno Decrease in urine flow sufficient to cause discomforto Persistent residual urineo Acute urinary retentiono Intermittent catheterization can reduce symptoms and bypass obstruction- Long-term catheter use contraindicated because of risk for infection- Choice of treatment depends on size and location of prostatic enlargement as well as age and surgical risk- Transurethral Resection of Prostate (TURP)o Removal of obstructing prostate tissue using resectoscope inserted through urethrao Outcome for 80% to 90% is excellento Relatively low risko Performed under spinal or general anesthesia and requires hospital stayo Bladder irrigated for first 24 hours to prevent mucus and blood clotso Complications include bleeding, clot retention, dilutional hyponatremia, retrograde ejaculationo Patients must stop anticoagulants before surgery- Other options: Transurethral microwave therapy (TUMT), Transurethral needle ablation, & Laser ProstatectomyNursing Assessment- Medications - Estrogen or testosterone supplementation- Surgery or previous treatment for BPH- Knowledge of condition- Voluntary fluid restriction- Nocturia- Urinary urgency- Diminution in caliber and force of urinary stream - Hesitancy in initiating voiding- Postvoid dribbling- Incontinence - Dysuria- Sensation of incomplete voiding - Anxiety of sexual dysfunction- Older adult male- Distended bladder on palpation; smooth, firm, elastic enlargement of prostate on rectal examination- U/A findings, enlargement on ultrasound, residual urine, creatinine levelsNursing Diagnoses: Acute pain, Risk for infection, Fear, Ineffective therapeutic regimen management, Urge urinary incontinence, HemorrhagePlanning- Goals of patient having invasive procedures: Restoration of urinary damage, Treatment of UTI, Understanding of procedure and complications- Goals for postoperative care: No complications, Restoration of urinary control, Complete bladder emptying, Satisfactory sexual expressionNursing Implementation- Focus: Early detection and treatment- Yearly DRE for men over 50- Educate patients that alcohol, caffeine, cold and cough meds can increase symptoms- Instruct patient with obstructive symptoms to urinate q2–3h and when first feeling urge (Minimizes urinary stasis) - Teach patient need for adequate fluid intake- Use aseptic technique when using urinary catheter- Administer antibiotics pre-operation- Provide patient opportunity to express concerns over alterations in sexual function - Inform patient of possible complications of procedures- Postop bladder irrigation to remove blood clots and ensure drainage or urine - Administer antispasmodics- Teach Kegel exercises - Observe patient for signs of infection- Dietary intervention- Stool softeners to prevent straining- Discharge instructions on indwelling catheter - Managing incontinence - 2 to 3 L fluids per day- Signs and symptoms of UTI, wound infection- Preventing constipation- Avoid heavy lifting- Refraining from driving, intercourse after surgery as directed- Sexual counseling if erectile dysfunction becomes a problem- Avoid bladder irritants- Yearly digital rectal examination (DRE)Evaluation- No complaints of pain- No evidence of UTI or other infection- Decreased fear of effect of surgery on sexuality- Carry out appropriate interventions- Absence of or satisfactory control of dribbling Urinary Tract Infections (UTIs) & Renal Calculi UTIs - The urinary system is structured in a way that helps ward off infection. The ureters and bladder normally prevent urine from backing up toward the kidneys, and the flow of urine from the bladder helps