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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
- -Dribbling at the end of voiding
- Irritative Symptoms: (associated with inflammation and infection)-Urinary frequency
- -Bladder pain
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.