Benign Prostatic Hyperplasia, Diagnosis of Benign Prostatic Hyperplasia, Management of Benign Prostatic Hyperplasia, 3 Nursing Care Plans for Benign Prostatic Hyperplasia.

Benign Prostatic Hyperplasia, Diagnosis of Benign Prostatic Hyperplasia, Management of Benign Prostatic Hyperplasia, 3 Nursing Care Plans for Benign Prostatic Hyperplasia.

This study guide is about benign prostatic hyperplasia, diagnosis of benign prostatic hyperplasia, management of benign prostatic hyperplasia, 3 nursing care plans for benign prostatic hyperplasia. Use it to develop educational nursing care plans for benign prostatic hyperplasia.

Benign Prostatic Hyperplasia

What is Benign Prostatic Hyperplasia? 

Benign Prostatic Hyperplasia, Diagnosis of Benign Prostatic Hyperplasia, Management of Benign Prostatic Hyperplasia, 3 Nursing Care Plans for Benign Prostatic Hyperplasia.
Benign Prostatic Hyperplasia

Benign prostatic hyperplasia (BPH) is one of the most common diseases in aging men.

  • Benign prostatic hyperplasia (BPH) is the enlargement, or hypertrophy, of the prostate gland.
  • The prostate gland enlarges, extending upward into the bladder and obstructing the outflow of urine. Incomplete emptying of the bladder and urinary retention leading to urinary stasis may result in hydronephrosis, hydroureter, and urinary tract infections (UTIs).
  • The cause is not well understood, but evidence suggests hormonal involvement.
  • BPH is common in men older than 40 years.
  • It can cause bothersome lower urinary tract symptoms that affect quality of life by interfering with daily normal activities and sleep pattern.

What is the pathophysiology of benign prostatic hyperplasia?

The pathophysiology of BPH is as follows:

  • Resistance. BPH is a result of complex interactions involving resistance in the prostatic urethra to mechanical and spastic effects.
  • Obstruction. The hypertrophied lobes of the prostate may obstruct the bladder neck or urethra, causing incomplete emptying of the bladder and urinary retention.
  • Dilation. Gradual dilation of the ureters and kidneys can occur.
  • Schematic Diagram for Benign Prostatic Hyperplasia.

What is the incidence of benign prostatic hyperplasia?

Here are the current statistics for BPH:

  • BPH typically occurs in men older than 40 years of age.
  • By the time they reach 60 years of age, 50% of men have BPH.
  • BPH affects as many as 90% of men by 85 years of age.
  • BPH is the second most common cause of surgical intervention in men older than 60 years of age.

What are the causes of benign prostatic hyperplasia?

The cause of BPH is not well understood, but testicular androgens have been implicated.

  • Elevated estrogen levels. BPH generally occurs when men have elevated estrogen levels and when prostate tissue becomes more sensitive.
  • Smoking. Smoking increases the risk of acquiring BPH.
  • Reduced activity level. A sedentary lifestyle could also lead to the development of BPH.
  • Western diet. A diet high in animal fat and protein and refined carbohydrates while low in fiber predisposes a man to BPH.

What are the clinical manifestations of benign prostatic hyperplasia?

BPH may or may not lead to lower urinary tract symptoms; if symptoms occur, they may range from mild to severe.

  • Urinary frequency. Frequent trips to the bathroom to urinate may be an early sign of a developing BPH.
  • Urinary urgency. This is the sudden and immediate urge to urinate.
  • Nocturia. Urinating frequently at night is called nocturia.
  • Weak urinary stream. Decreased and intermittent force of stream is a sign of BPH.
  • Dribbling urine. Urine dribbles out after urination.
  • Straining. There is presence of abdominal straining upon urination.

Diagnosis of Benign Prostatic Hyperplasia

How do you diagnose benign prostatic hyperplasia?

There are several ways to diagnose benign prostatic hypertrophy.

  • Digital rectal examination (DRE). A DRE often reveals a large, rubbery, and nontender prostate gland.
  • Urinalysis. A urinalysis to screen for hematuria and UTI is recommended.
  • Prostate specific antigen levels. A PSA level is obtained if the patient has at least a 10-year life expectancy and for whom knowledge of the presence of prostate cancer would change management.
  • Urinalysis: Color: Yellow, dark brown, dark or bright red (bloody); appearance may be cloudy. pH 7 or greater (suggests infection); bacteria, WBCs, RBCs may be present microscopically.
  • Urine culture: May reveal Staphylococcus aureus, Proteus, Klebsiella, Pseudomonas, or Escherichia coli.
  • Urine cytology: To rule out bladder cancer.
  • BUN/Cr: Elevated if renal function is compromised.
  • Prostate-specific antigen (PSA): Glycoprotein contained in the cytoplasm of prostatic epithelial cells, detected in the blood of adult men. Level is greatly increased in prostatic cancer but can also be elevated in BPH. Note: Research suggests elevated PSA levels with a low percentage of free PSA are more likely associated with prostate cancer than with a benign prostate condition.
  • WBC: May be more than 11,000/mm3, indicating infection if patient is not immunosuppressed.
  • Uroflowmetry: Assesses degree of bladder obstruction.
  • IVP with post voiding film: Shows delayed emptying of bladder, varying degrees of urinary tract obstruction, and presence of prostatic enlargement, bladder diverticula, and abnormal thickening of bladder muscle.
  • Voiding cystourethrography: May be used instead of IVP to visualize bladder and urethra because it uses local dyes.
  • Cystometrogram: Measures pressure and volume in the bladder to identify bladder dysfunction unrelated to BPH.
  • Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum).
  • Cystometry: Evaluates detrusor muscle function and tone.
  • Transrectal prostatic ultrasound: Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH.

Management of Benign Prostatic Hyperplasia

How do you manage benign prostatic hyperplasia?

Benign Prostatic Hyperplasia, Diagnosis of Benign Prostatic Hyperplasia, Management of Benign Prostatic Hyperplasia, 3 Nursing Care Plans for Benign Prostatic Hyperplasia.
Management of Benign Prostatic Hyperplasia

Medical Management

The goals of medical management of BPH are to improve the quality of life and treatment depends on the severity of symptoms.

  • Catheterization. If a patient is admitted on an emergency basis because he is unable to void, he is immediately catheterized.
  • Cystostomy. An incision into the bladder may be needed to provide urinary drainage.

Pharmacologic Management

  • Alpha-adrenergic blockers (eg, alfuzosin, terazosin), which relax the smooth muscle of the bladder neck, and prostate, and 5alpha reductase inhibitors.
  • Hormonal manipulation with antiandrogen agents (finasteride [Proscar]) decreases the size of the prostate and prevents the conversion of testosterone to dihydrotestosterone (DHT).
  • Use of phytotherapeutic agents and other dietary supplements (Serenoa repens [saw palmetto berry] and Pygeum africanum [African plum]) are not recommended, although they are commonly used.
  • One herbal medication effective against BPH is Saw Palmetto.

Surgical Management

Other treatment options include minimally invasive procedures and resection of the prostate gland.

  • Transurethral microwave heat treatment. This therapy involves the application of heat to prostatic tissue.
  • Transurethral needle ablation (TUNA). TUNA uses low-level radio frequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues.
  • Transurethral resection of the prostate (TURP). TURP involves the surgical removal of the inner portion of the prostate through an endoscope inserted through the urethra.
  • Open prostatectomy. Open prostatectomy involves the surgical removal of the inner portion of the prostate via a suprapubic, retropubic, or perineal approach for large prostate glands.

Nursing Management

Nursing management of a patient with BPH includes the following:

Nursing Assessment

Nursing assessment focuses on the health history of the patient.

  • Health history. The health history focuses on the urinary tract, previous surgical procedures, general health issues, family history of prostate diseases, and fitness for possible surgery.
  • Physical assessment. Physical assessment includes digital rectal examination.

Nursing Diagnosis

Based on the assessment data, the appropriate nursing diagnoses for a patient with BPH are:

  • Urinary retention related to obstruction in the bladder neck or urethra.
  • Acute pain related to bladder distention.
  • Anxiety related to the surgical procedure.

Nursing Care Planning & Goals

The goals for a patient with BPH include:

  • Relieve acute urinary retention.
  • Promote comfort.
  • Prevent complications.
  • Help patient deal with psychosocial concerns.
  • Provide information about disease process/prognosis and treatment needs.

Nursing Interventions

Preoperative and postoperative nursing interventions for a patient with BPH are as follows:

  • Reduce anxiety. The nurse should familiarize the patient with the preoperative and postoperative routines and initiate measures to reduce anxiety.
  • Relieve discomfort. Bed rest and analgesics are prescribed if a patient experiences discomfort.
  • Provide instruction. Before the surgery, the nurse reviews with the patient the anatomy of the affected structures and their function in relation to the urinary and reproductive systems.
  • Maintain fluid balance. Fluid balance should be restored to normal.

Evaluation

  • Reduced anxiety.
  • Reduced level of pain.
  • Maintained fluid volume balance postoperatively.
  • Absence of complications.

Discharge and Home Care Guidelines

The patient and the family require instructions about how to promote recovery.

  • Instructions. The nurse provides written and oral instructions about the need to monitor urinary output and strategies to prevent complications.
  • Urinary control. The nurse should teach the patient exercises to regain urinary control.
  • Avoid Valsalva maneuver. The patient should avoid activities that produce Valsalva maneuver like straining and heavy lifting.
  • Avoid bladder discomfort. The patient should be taught to avoid spicy foods, alcohol, and coffee.
  • Increase fluids. The nurse should instruct the patient to drink enough fluids.

Documentation Guidelines

The focus of the documentation in a patient with BPH includes:

  • Degree of impairment.
  • Client’s description in response to pain.
  • Acceptable level of pain.
  • Prior medication use.
  • Level of anxiety and precipitating/aggravating factors.
  • Description of feelings.
  • Awareness and ability to recognize and express feelings.
  • Treatment plan.
  • Teaching plan.
  • Client’s response to interventions, teaching, and actions performed.
  • Attainment and progress toward desired outcomes.
  • Modifications to the plan of care.
  • Referrals made.

3 Nursing Care Plans for Benign Prostatic Hyperplasia

What are some of the available nursing care plans for benign prostatic hyperplasia?

Benign Prostatic Hyperplasia, Diagnosis of Benign Prostatic Hyperplasia, Management of Benign Prostatic Hyperplasia, 3 Nursing Care Plans for Benign Prostatic Hyperplasia.
3 Nursing Care Plans for Benign Prostatic Hyperplasia

Nursing Diagnosis

  • Urinary Retention

May be related to

  • Mechanical obstruction; enlarged prostate
  • Decompensation of detrusor musculature
  • Inability of bladder to contract adequately

Possibly evidenced by

  • Frequency, hesitancy, inability to empty bladder completely; incontinence/dribbling
  • Bladder distension, residual urine

Desired Outcomes

  • Void in sufficient amounts with no palpable bladder distension.
  • Demonstrate postvoid residuals of less than 50 mL, with absence of dribbling/overflow.
Nursing Interventions Rationale
Encourage patient to void every 2–4 hr and when urge is noted. May minimize urinary retention and overdistension of the bladder.
Ask patient about stress incontinence when moving, sneezing, coughing, laughing, lifting objects. High urethral pressure inhibits bladder emptying or can inhibit voiding until abdominal pressure increases enough for urine to be involuntarily lost.
Observe urinary stream, noting size and force. Useful in evaluating degree of obstruction and choice of intervention.
Have patient document time and amount of each voiding. Note diminished urinary output. Measure specific gravity as indicated Urinary retention increases pressure within the ureters and kidneys, which may cause renal insufficiency. Any deficit in blood flow to the kidney impairs its ability to filter and concentrate substances.
Percuss and palpate suprapubic area. A distended bladder can be felt in the suprapubic area.
Encourage oral fluids up to 3000 mL daily, within cardiac tolerance, if indicated. Increased circulating fluid maintains renal perfusion and flushes kidneys, bladder, and ureters of “sediment and bacteria.” Note: Initially, fluids may be restricted to prevent bladder distension until adequate urinary flow is reestablished.
Monitor vital signs closely. Observe for hypertension, peripheral and dependent edema, changes in mentation. Weigh daily. Maintain accurate I&O. Loss of kidney function results in decreased fluid elimination and accumulation of toxic wastes; may progress to complete renal shutdown.
Watch closely for signs of postobstructive diuresis (such as increased urine output and hypotension). May lead to serious dehydration, lower blood volume, shock, electrolyte loss, and anuria.
Provide and encourage meticulous catheter and perineal care. Reduces risk of ascending infection.
Recommend sitz bath as indicated. Promotes muscle relaxation, decreases edema, and may enhance voiding effort.
Administer medications as indicated:
  • Alpha-adrenergic antagonists: tamsulosin (Flomax), prazosin (Minipress), terazosin (Hytrin), doxazosin mesylate (Cardura);
Studies indicate that these drugs may be as effective as Proscar for outflow obstruction and may have fewer side effects in regard to sexual function.
  • Antispasmodics: oxybutynin (Ditropan)
Relieves bladder spasms related to irritation by the catheter.
  • Rectal suppositories (B & O)
Suppositories are absorbed easily through mucosa into bladder tissue to produce muscle relaxation and relieve spasms.
  • Antibiotics and antibacterials.
Given to combat infection. May be used prophylactically.
Catheterize for residual urine and leave indwelling catheter as indicated. Although this is usually difficult in a patient with BPH, it relieves and prevents urinary retention and rules out presence of ureteral stricture. Coudé catheter may be required because the curved tip eases passage of the tube through the prostatic urethra. Note: Bladder decompression should be done with caution to observe for sign of adverse reaction such as hematuria (rupture of blood vessels in the mucosa of the overdistended bladder) and syncope (excessive autonomic stimulation).
Check catheter often (every 15 minutes for the first 2 to 3 hours). For patency and urine color.
Often check dressings. For bleeding.
Keep the catheter open. To maintain returns that are clear and light pink.
Watch for septic shock, the most serious complication of prostatic surgery. May cause severe fever, tachycardia, hypotension and other sign of shock.

Nursing Diagnosis

  • Acute Pain

May be related to

  • Mucosal irritation: bladder distension, renal colic; urinary infection; radiation therapy
  • Possibly evidenced by
  • Reports of pain (bladder/rectal spasm)
  • Narrowed focus; altered muscle tone, grimacing; distraction behaviors, restlessness
  • Autonomic responses

Desired Outcomes

  • Report pain relieved/controlled.
  • Appear relaxed.
  • Be able to sleep/rest appropriately.
Nursing Interventions Rationale
Maintain patient comfort. To prevent postoperative  complications.
Assess pain, noting location, intensity (scale of 0–10), duration. Provides information to aid in determining choice or effectiveness of interventions.
Tape drainage tube to thigh and catheter to the abdomen (if traction not required). Prevents pull on the bladder and erosion of the penile-scrotal junction.
Recommend bedrest as indicated. Bedrest may be needed initially during acute retention phase; however, early ambulation can help restore normal voiding patterns and relieve colicky pain.
Provide comfort measures such as back rub, helping patient assume position of comfort. Suggest use of relaxation and deep-breathing exercises, diversional activities. Promotes relaxation, refocuses attention, and may enhance coping abilities.
Encourage use of sitz baths, warm soaks to perineum. Promotes muscle relaxation.
Insert catheter and attach to straight drainage as indicated. Draining bladder reduces bladder tension and irritability.
Instruct in prostatic massage. Aids in evacuation of ducts of gland to relieve congestion and inflammation. Contraindicated if infection is present.
Administer medications as indicated:
Narcotics: meperidine (Demerol); Given to relieve severe pain, provide physical and mental relaxation.
Antibacterials: methenamine hippurate (Hiprex); Reduces bacteria present in urinary tract and those introduced by drainage system.
Antispasmodics and bladder sedatives: flavoxate (Urispas), oxybutynin (Ditropan). Relieves bladder irritability.

Nursing Diagnosis

  • Risk for Deficient Fluid Volume

Risk factors may include

  • postobstructive diuresis from rapid drainage of a chronically overdistended bladder
  • Endocrine, electrolyte imbalances (renal dysfunction)

Desired Outcomes

  • Maintain adequate hydration as evidenced by stable vital signs, palpable peripheral pulses, good capillary refill, and moist mucous membranes.
Nursing Interventions Rationale
Monitor output carefully. Note outputs of 100–200 mL per hr. Rapid and sustained diuresis could cause patient’s total fluid volume to become depleted and limits sodium reabsorption in renal tubules.
Encourage increased oral intake based on individual needs. Patient may have restricted oral intake in an attempt to control urinary symptoms, reducing homeostatic reserves and increasing risk of dehydration and hypovolemia.
Monitor BP, pulse. Evaluate capillary refill and oral mucous membranes. Enables early detection of and intervention for systemic hypovolemia.
Promote bedrest with head elevated. Decreases cardiac workload, facilitating circulatory homeostasis.
Monitor electrolyte levels, especially sodium. As fluid is pulled from extracellular spaces, sodium may follow the shift, causing hyponatremia.
Administer IV fluids (hypertonic saline) as needed. Replaces fluid and sodium losses to prevent or correct hypovolemia following outpatient procedures.

 

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