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What is BPH?
- In BPH, the prostate gland enlarges sufficiently to compress or distort the urethra and cause some overt urinary obstruction
- – Begins with changes in periurethral glandular tissue
- – May extend into the bladder (and obstruct urinary outflow) or cause a pouch to form (that retains urine, which may lead to calculus
What are some causes of BPH?
- • Link between BPH and hormonal activity and aging.
- – Imbalance in androgen and estrogen levels
- – High levels of dihydrotestosterone (main prostatic intracellular androgen)
- • Others
- – Neoplasm, arteriosclerosis, inflammation, and metabolic or nutritional disturbances
What are some obstructive signs of BPH?
- – Frequent urination
- – Nocturia
- – Incontinence
- – Possible hematuria
Late signs of obstructive BPH?
- – Complete obstruction may follow infection or ingestion (decongestants, tranquilizers, ETOH, antidepressants, or anticholinergics)
- – Possible complications include infection, renal insufficiency, hemorrhage, and shock
How is BPH diagnosed?
Digital rectal exam. (Yay.)
T/F: you can go into renal failure due to BPH.
What Rx are used to treat BPH?
Alpha blockers (adrenergic blockers improve urine flow rates.
What surgical method is used to correct BPH?
- Trans urethra resection of the prostate, ie TURP.
- Only if prostate weighs < 2 oz (because that's a lot of jabbin'!)
What are some nursing interventions for BPH?
- Monitor and record VS, I&O, and daily wt
- – Monitor for post-obstructive diuresis (increased UO and hypotension)
- Administer antibiotics as ordered
- Do not force a transurethral catheter:
- assist with suprapubic cystostomy under local anesthetic
- According to your textbook, how much urine can be drained at one time? 1-1.5L. Do not drain more or you can change intraabdominal pressure and BP will drop.
Nursing care for pt during BPH surgery?
- Maintain patient comfort
- Observe for shock and hemorrhage from
- prostatic bleeding
- – Check catheter q 15 min for first 2-3 hours for patency and urine color
- – Check dressings for bleeding
- CBI (continuous bladder irrigation): Keep catheter open at a rate sufficient to maintain returns that are clear and light pink
Post-op pt teaching (BPH)
- Reassure patient that he will gradually regain urinary control
- After catheter removal, patient may have frequency, dribbling, and occasional hematuria
- • Reinforce limits on activity
- – Warn patient against lifting, strenuous exercise, and long car rides
- – Restrict sexual activity for several weeks
- Instruct patient to follow prescribed oral antibiotic regimen and tell indications for using gentle laxatives
- Tell patient to seek medical care immediately if he:
- – cannot void
- – passes bloody urine
- – develops a fever