Nursing A ConceptBased Approach to Learning VOLUME ONE

Nursing: A Concept-Based Approach to Learning VOLUME ONE EDITION VOLUME ONE|| SECOND EDITION MODULE 5 Elimination Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Exemplar 5. 1 Benign Prostatic Hyperplasia Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Exemplar Learning Outcomes After reading about this exemplar, you will be able to: 1. Describe the pathophysiology, etiology, clinical manifestations, and direct and indirect causes of benign prostatic hyperplasia. 2. Identify risk factors and prevention methods associated with benign prostatic hyperplasia. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 3. Illustrate the nursing process in providing culturally competent care across the life span for individuals with benign prostatic hyperplasia. 4. Formulate priority nursing diagnoses appropriate for an individual with benign prostatic hyperplasia. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 5. Summarize therapies used by interdisciplinary teams in the collaborative care of an individual with benign prostatic hyperplasia. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Exemplar Learning Outcomes, continued After reading about this exemplar, you will be able to: 6. Plan evidence-based care for an individual with benign prostatic hyperplasia and his family in collaboration with other members of the healthcare team. 7. Evaluate expected outcomes for an individual with benign prostatic hyperplasia. Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Overview • Prostatitis § Inflammatory disorders of the prostate gland • Prostatodynia § Client experiences symptoms of prostatitis but shows no evidence of inflammation or infection Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Overview, continued • Benign prostatic hyperplasia § Nonmalignant enlargement of prostate § Common in aging men § Most common benign neoplasm in men Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Pathophysiology and Etiology • Benign prostatic hyperplasia § Nodules formed from hyperplasia (increase in number of cells) § Not formed from hypertrophy (increase in size of individual cells) § Occurs over long period of time Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Etiology • Benign prostatic hyperplasia § Influenced by androgens § Aging prostate more sensitive to available DHT § Increase in estrogen levels may contribute Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Risk Factors • Age § Rare before age 40 § >50% of men in 60 s have symptoms § 90% of men in 70 s, 80 s have symptoms Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Risk Factors, continued • Presence of testes § Men whose testes were removed before puberty not susceptible to BPH § Removal of testes after puberty results in shrinkage of prostate Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Risk Factors, continued • Racial background § Black, Hispanic men develop symptoms earlier than White men § Asian men develop symptoms later than White men Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Clinical Manifestations • Urethral compression § § Partial or complete obstruction Increased resistance to urinary flow Decreased bladder compliance Bladder instability Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Clinical Manifestations, continued • Voiding symptoms § § § Weak urinary stream Increased time to void Incomplete bladder emptying Postvoid dribbling Urinary retention Bladder distention Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Clinical Manifestations, continued • Storage symptoms § § § Frequency Urgency Incontinence Nocturia Dysuria Bladder pain Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Clinical Manifestations, continued Complications if mass is not reduced Bladder distention Diverticula Infection more common in retained urine and diverticula • May ascend from bladder to kidneys • Hydroureter • Hydronephrosis • • Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Collaboration • Focus on: § Diagnosing disorder § Minimizing urinary obstruction § Preventing or treating complications • BHP is irreversible. • Mild cases are monitored. § May remain stable § Improve over time Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Diagnostic Tests • • Digital rectal exam (DRE) Urine flow rate test Postvoid residual urine test Pressure flow study Urinalysis, urine culture PSA test Cystoscopy Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Surgery • Minimally invasive surgery § Transurethral microwave thermotherapy § Transurethral needle ablation (TUNA) • Transurethral surgery § TURP § TUIP • Open surgery • Laser surgery Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Surgery, continued • New treatments § Minimally invasive § Balloon urethroplasty § Intraurethral stents Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Pharmacologic Therapy • Two considerations § Hyperplastic tissue is androgen-dependent. • Antiandrogen agents • Side effects • Impotence, decreased libido, decreased ejaculate volume Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Pharmacologic Therapy, continued • Two considerations § Excessive smooth muscle contraction • Alpha-adrenergic antagonists block contraction • Relieve obstruction → increase urine flow • May cause orthostatic hypotension • Combination of meds more effective • Medications can worsen symptoms of BPH Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Pharmacologic Therapy, continued • Some medications can worsen symptoms of BPH, should be avoided by older men • Alpha-adrenergic agents (e. g. , pseudoephedrine) • Drugs with anticholinergic side effects (e. g. , antihistamines) • Testosterone, other anabolic steroids Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nonpharmacologic Therapy • Lifestyle changes § Urinate at first urge § Avoid alcohol and caffeine § Drink small amounts of fluids spread throughout the day Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nonpharmacologic Therapy, continued • Lifestyle changes § Avoid drinking fluids within 2 hours of bedtime § Avoid over-the-counter cold and sinus medications § Exercise regularly § Reduce stress Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Nursing Process • Must be sensitive to concerns and fears • Provide education and support Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Assessment • Health history • Risk factors § Urinary elimination patterns, manifestations § Hematuria § Pain • Physical assessment § Includes DRE Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Assessment, continued • Symptoms assessed with International Prostate Symptom Score • Laboratory tests • Urinalysis § § Measure of residual urine Ultrasonography Postvoiding catheterization Uroflowmetry Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Diagnosis • • • Impaired Urinary Elimination Risk for Infection Overflow Urinary Incontinence Acute Pain Deficient Knowledge Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Planning • Client will regain urinary continence after catheter removal • Client will verbalize rationale for performing postoperative exercise • Client will verbalize need for continued follow-up care Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Planning, continued • Client will verbalize warning signs of UTI • Client will verbalize proper administration of meds, adverse effects • Client will report pain level of ≤ 3 on 0– 10 scale Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Implementation: Preoperative Care • • • Education Support Address concerns, anxiety Informed consent Explain preoperative activities Explain postoperative conditions Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Implementation: Postoperative Care • Monitor vital signs closely for 24 hours, then regularly • Maintain I&O records • Assess patency of catheters, drains • Monitor color, character of urine Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Implementation: Postoperative Care, continued • Assess, manage client's pain • Maintain antiembolic stockings, pneumatic compression devices • Assist with ambulation, leg exercises • Encourage fluid intake Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Implementation: Postoperative Care, continued • • Instruct regarding indwelling catheter Continuous bladder irrigation TURP syndrome Catheter care Postremoval instructions Retropubic prostatectomy Suprapubic prostatectomy Perineal prostatectomy Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved

Evaluation • Client is continent • Client maintains adequate pain control • Client is asymptomatic or symptoms less severe • Client describes symptoms to report • Client lists OTC medications to avoid Nursing: A Concept-Based Approach to Learning Volume One, Second Edition Copyright © 2015, 2011 by Pearson Education, Inc. All Rights Reserved