NUR 114 #1 BPH

What is bph?

Enlarged prostate, most common in aging men, affects half of men older than 40 & 50% of men older than 60, develops over time, slow & insidious, by 85, 90% of men are affected

pathophysiology?

Not well understood, testicular androgens have been implicated, DHT plays a role in development of BPH. The prostate tissues become sensitive to estrogen & less responsive to DHT

What is DHT?

A metabolite of testosterone, a critical mediator of prostatic growth

What are some risk factors?

Smoking, heavy alcohol consumption, obesity, HTN, heart disease, diabetes, diet high in animal fat & low in fiber (western diet), sedentary lifestyle

Clinical manifestations?

Depend on severity, dysuria, nocturia, dribbling, hesitancy in starting urination, decreased & intermittent force of stream, sensation of incomplete bladder emptying

How to diagnose?

Health history, voiding diary, urinalysis, prostate-specific antigen test (PSA) - annually for men >50 & >45 for AA men, high risk, & men with family hx

What is TURP?

Removal of prostatic tissue by optical instrument introduced through urethra

Nursing implications for TURP?

Monitor for hemorrhage, observe symptoms of urethral stricture (dysuria, straining, weak urinary stream)

What meds are used?

Alpha adrenergic blockers, 5 alpha predicate inhibitors, and herbal therapy

Post care of TURP with 3 way cath?

Blood tinged urine is expected first few days after surgery, bladder irrigation to keep flow rate continuous & keep urine diluted, strict asepsis, traction by PCP, cath patency, prophylactic antibiotics, pain management w/ PCA & oral narcotics, B&O suppositories for bladder spasms, I&Os, always know CBI infusion rate (hourly)

What is bladder irrigation and continuous flow rate important?

It keeps urine diluted and to reduce clot formation

Interventions?

Catheter for acute condition, TUMT, TUNA, TURP

What is TUMT?

Transurethral microwave thermotherapy: involves the application of heat to prostatic tissue

What is TUNA?

Transurethral needle ablation: uses radiofreqency energy & the uroLume stent. Uses low level radiofrequencies delivered by thin needles placed in the prostate gland to produce localized heat that destroys prostate tissue while sparing other tissues

What are some complications of BPH?

UTIs, hydroureter, hydronephrosis, azotemia (high nitrogenous waste), renal failure, stones

What is the 1st line medication for symptom relief?

Alpha blockers

What is transurethral resection syndrome?

Serious complication of TURP. Caused by neurological, CV, and electrolyte imbalances associated with absorption of the sodium (hyponatremia) used to irrigate the surgical site during the surgical procedure → headache, collapse, hypotension, lethargy, confusion, muscle spasms, N/V, seizures, tachycardia

Prevention education?

Avoid heavy lifting, straining & sex, regular voiding, avoid irritants (caffeine, alcohol), weight management, exercise, hydration (limit at night), avoid antihistamines & decongestants

What are 5 alpha reductase inhibitors?

Finasteride, dutasteride

5 alpha reductase inhibitors indication?

Steriods that shrink prostate by blocking conversion of testosterone to DHT. Takes 3-6 months to work

5 alpha reductase inhibitors side effects?

Low libido, ED, gynecomastia

What are alpha adrenergic blockers?

Terazosin, tamsulosin

Alpha adrenergic blockers indication?

Relax that bladder smooth muscles & lower BPH/ size of prostate

Alpha adrenergic blocker side effects?

Hypotension, orthostatic hypotension, dizziness

What are PDE5 inhibitors?

Tadalafil, sildenafil, vardenafil

PDE5 inhibitors indication?

Improve urine flow and reduces bladder outlet resistance

PDE5 inhibitors side effects?

Headache, flushing, back pain, hypotension (if taken with NITRATES), dyspepsia

Beta 3 agonists indication?

An alternative to an anticholinergic. Used for overactive bladder symptoms