-
Describe the defining characteristics of urinary obstructions caused by an enlarged prostate.
- Obstructive Symptoms: (due to urinary retention)-Difficulty initiating urination
- -Decrease in force and caliber of urination
- -Intermittancy
- -Dribbling at the end of voiding
- Irritative Symptoms: (associated with inflammation and infection)-Urinary frequency
- -Urgency
- -Dysuria
- -Bladder pain
- -Nocturia
- -Incontinence
-
Describe how an enlarged prostate gland can impede the flow of urine from the bladder from a scientific basis.
-
Explain how how the enlarged prostate may cause anatomical changes in the bladder, ureters and kidneys from a scientific basis.
-
Explain why an enlarged prostate may cause a UTI from a scientific basis.
Compression of the urethra may cause incomplete bladder emptying which results in high residual urine in the bladder, increased residual urine is a prime area for increased bacterial growth that can lead to UTI's.
-
Develop a NCP and describe the nursing interventions for the pt with BPH, include nursing dx, goals and expected outcomes.
-
Describe medical and surgical interventions for BPH.
- Drug Therapy:
- 1. 5-a-reductase inhibitors- Proscar- works by reducing the size of the prostate
- 2. a-Adrenergic receptor blockers- Cadura, Flomax- works by promoting smooth muscle relaxation in the prostate
- 3. Saw Palmetto- alleviation of symptoms associated with BPH
- Invasive Therapy:
- 1. Transurethral resection of the prostate (TURP): Surgical procedure inolving the removal of prostate tissue using a resectoscope inserted thru the urethra, gold standard, req hospital stay, no external insision, CBI
- 2. Transurethral incision of the prostate (TUIP): Involves making transurethral slits into prostatic tissue to relieve obstruction
- 3. Open Prostatectomy: Surgery of choice for men with large prostates, involves an external incision with 3 possible approaches: retopubic, perineal, suprapubic.
- Minimally Invasive Therapy:1. Transurethral microwave thermotherapy (TUMT): Use of microwave radiating heat to produce coagulative necrosis of the prostate
- 2. Transurethral needle alabation (TUNA): Low-wave radiofrequency used to heat the prostate, causing necrosis
- 3. Laser Prostatectomy: Procedure ised a laser beam to cut or destroy part of the prostate
- 4. Transurethral electrovaporization of the prostate (TUVP): Electro surgical vaporization and desicastion are used together to destroy prastatic tissue
- 5. Intraprostatic urethral stents: insertion of self expandable metallic stent into the urethra where enlarged area of the prostate occurs
-
Differentiate the nursing care associated with TURP and other sx procedures which may be preformed for prostate abn, including microwave therapy and laser therapy.
-
\\Identify the purpose for and nursing intervention associated with continuous bladder irrigation. Be able to calculate I&O for a pt undergoing continuous bladder irrigation.
- Purpose of CBI is to remove clotted blood from the bladder and ensure drainage of urine PO.
- The NI include constant monitoring of the I&O, if output is less than the input then the catheter patency should be assessed for kinks and clots.
-
Identify the learning needs and pertinent data to be documented when implementing a NCP and formulating a teaching plan for a pt with BPH.
-
Define pain and state of importance of using pan as the "5th vital sign."
-
Differentiate between transduction, transmission, perception and modulation.
-
Describe sources of pain.
-
Identify factors that influence the pain experience.
-
Differentiate bt acute and non-malignant chronic pain as to definition, clinical manifestations, commonly used drug therapy, and non-pharmacologic interventions.
-
Identify the components of a pain assessment.
-
Identify the physiological data associated with pain.
-
Describe the nurses responsibilities reguarding pain medication administration.
-
Differentiate b/t drug addiction, drug tolerance, physical dependency and pseudo-addiction.
-
Describe the value of pain clinics for pt's with chronic pain.
-
Identify tasks that can be delegated to assistive personnel.
|
|
