Wednesday, January 19, 2011

NCP Nursing Care Plan For Benign Prostatic Hyperplasia (BPH)

Although almost men older than 50 have some prostatic enlargement, with benign prostatic hyperplasia (BPH), the prostate gland enlarges sufficiently to compress the urethra and cause some overt urinary obstruction. It is the most common cause of obstruction of urine flow in men. The degree of enlargement determines whether or not bladder outflow obstruction occurs. As the urethra becomes obstructed, the muscle inside the bladder hypertrophies in an attempt to assist the bladder to force out the urine. BPH may also cause the formation of a bladder diverticulum that remains full of urine when the patient empties the bladder. Depending on the size of the enlarged prostate, the age and health of the patient, and the extent of obstruction, BPH is treated symptomatically or surgically.

Causes for Benign prostatic hyperplasia (BPH)
A link between Benign prostatic hyperplasia (BPH) and hormonal activity suggests.  As males age, production of androgenic hormones decreases, causing an imbalance in androgen and estrogen levels and high levels of dihydrotestosterone, the main prostatic intracellular androgen.
Other causes of Benign prostatic hyperplasia (BPH) include:
·         Neoplasm
·         Arteriosclerosis
·         Inflammation
·         Metabolic Imbalance
·         Nutritional disturbances.

Complications for Benign prostatic hyperplasia (BPH)
  • Urinary stasis, urinary tract infection (UTI), or
  • Renal calculi
  • Bladder wall trabeculation
  • Detrusor muscle hypertrophy
  • Bladder diverticula and saccules
  • Urethral stenosis
  • Hydronephrosis
  • Paradoxical (overflow) incontinence
  • Acute or chronic renal failure
  • Acute postobstructive diuresis.
Nursing Diagnosis for Benign Prostatic Hyperplasia (BPH) determine by data that we collect in nursing assessment.
Nursing Assessment nursing care plans for Benign Prostatic Hyperplasia (BPH)
BPH Clinical features depend on the extent of prostatic enlargement and on the lobes affected. Patient history, generally, men with suspected BPH have a history of frequent urination, nocturia, straining to urinate, weak stream, and an incomplete emptying of the bladder
Patient usually complains of a group of symptoms known as prostatism: decreased urine stream caliber and force, an interrupted stream, urinary hesitancy, and difficulty starting urination, which results in straining and a feeling of incomplete voiding.
As the obstruction increases, the patient may report frequent urination with nocturia, dribbling, urine retention, incontinence and, possibly, hematuria.
Physical examination. Inspect and palpate the bladder for distension.
Physical examination reveals a visible midline mass above the symphysis pubis, which represents an incompletely emptied bladder. Palpation discloses a distended bladder, A digital rectal exam (DRE) reveals a rubbery enlargement of the prostate, but the degree of enlargement does not consistently correlate with the degree of urinary obstruction. Some men have enlarged prostates that extend out into soft tissue without compressing the urethra. Determine the amount of pain and discomfort that is associated with the DRE.

Diagnostic tests Benign Prostatic Hyperplasia (BPH)
Several tests help to confirm Benign Prostatic Hyperplasia (BPH) diagnosis:
·         Excretory urography may indicate urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying defects in the bladder.
·         Elevated blood urea nitrogen
·         Serum creatinine levels suggest impaired renal function.
·         Urinalysis and urine culture
·         Cystourethroscopy
·         Intravenous pyelography (IVP)
·         Transrectal prostatic ultrasound (TRUS)
·         A prostate-specific antigen test may be performed to rule out prostatic cancer.
Nursing diagnosis nursing care plans for  Benign Prostatic Hyperplasia (BPH)
Primary nursing diagnosis:
Urinary retention (acute or chronic) related to bladder obstruction
Common nursing diagnosis found in patient with Benign Prostatic Hyperplasia (BPH)
·         Acute pain
·         Fear/Anxiety [specify level]
·         Impaired urinary elimination
·         deficient Knowledge regarding condition,prognosis, treatment, self-care, and discharge needs
·         Risk for infection
·         Risk for injury
·         Sexual dysfunction
·         Urinary retention

Common nursing diagnosis found in patient with Benign Prostatic Hyperplasia (BPH);  Acute pain,  Fear, Anxiety, Impaired urinary elimination,  deficient Knowledge, Risk for infection, Risk for injury, Sexual dysfunction, Urinary retention

Nursing Priorities Nursing care plans for Benign Prostatic Hyperplasia (BPH)
·         Relieve acute urinary retention.                                                
·         Promote comfort.
·         Provide information about disease process, prognosis, and treatment needs.
·         Prevent complications.
·         Help client deal with psychosocial concerns.
Sample Nursing care plans for Benign Prostatic Hyperplasia (BPH) with nursing diagnosis Urinary retention (acute or chronic)

Nursing diagnosis
Nursing interventions
Urinary retention (acute or chronic) related to bladder obstruction, Decompensation of detrusor musculature
·       Review medical history for diagnoses such as prostatic hypertrophy, scarring, recurrent stone formation

·       Ask client about stress incontinence when moving, sneezing, coughing, laughing, or lifting objects.

·       Monitor vital signs

·       Observe urinary stream, size and force.

·       Prepare for and assist with urinary drainage, such as emergency cystostomy.

·       Prepare for procedures, such as the following: laser, transurethral microwave thermotherapy (TUMT), Cortherm, Prostatron, and transurethral needle ablation (TUNA), Urethral stent, Open prostate resection procedures, such as TURP
·      suggest detrusor muscle atrophy and/or chronic overdistention because of outlet obstruction

·      High urethral pressure inhibits bladder emptying or can inhibit voiding until abdominal pressure increases enough for urine to be involuntarily lost.

·      Evaluating degree of obstruction and choice of intervention.

·      May be indicated to drain bladder during acute episode

·      done to quickly create a wide open prostatic fossa, often resulting in immediate restoration of normal urine flow
·   Void in sufficient amounts with no palpable bladder distention.
·    Verbalize understanding of causative factors and appropriate interventions , Demonstrate techniques/behaviors to alleviate/prevent retention.
·   Voiding pattern normalized.

Benign Prostatic Hyperplasia (BPH), Patient Teaching Discharge And Home Healthcare Guidelines

Patient teaching discharge and home healthcare guidelines for patient with Benign Prostatic Hyperplasia (BPH). Patient usualy  need assistance with management of therapy and catheter. Provide instructions about all medications used. Provide instructions on the correct dosage, route, action, side effects, and potential drug interactions and when to notify these to the physician, Provide information about specific procedures and tests and what to expect afterward, such as catheter, bloody urine, and bladder irritation

·         Instruct patients about the need to maintain a high fluid intake, to ensure adequate urine output.
·         Teach the patient to monitor urinary output for 4 to 6 weeks after surgery to ensure adequacy in volume of elimination combined with a decrease in volume of retention. Teach the patient to recognize the signs of UTI. Urge him to immediately report these signs to the physician because infection can worsen the obstruction.
  • After the catheter is removed, the patient may experience urinary frequency, dribbling and, occasionally, hematuria. Reassure him and family members that he'll gradually regain urinary control
  • Instruct the patient to follow the prescribed oral antibiotic regimen, and tell him the indications for using gentle laxatives. 
Postoperative Patient teaching
·         Provide information about sexual anatomy and function as it relates to prostatic enlargement helps client understand the implications of proposed treatments because they might affect sexual performance.
·         Encourage the patient to discuss any sexual concerns he or his partner may have after surgery with the appropriate counselors.
·         Reassure the patient that a session can be set up by the nurse or physician whenever one is indicated. Usually, the physician recommends that the patient have no sexual intercourse or masturbation for several weeks after invasive procedures.
·         Reinforce prescribed limits on activity. Warn the patient against lifting, performing strenuous exercises, and taking long automobile rides for at least 1 month after surgery because these activities increase bleeding tendency. Also caution him not to have sexual intercourse for at least several weeks after discharge

Instruct the patient to report any difficulties with urination to the physician immediately. Explain that BPH can recur and that he should notify the physician if symptoms of urgency, frequency, difficulty initiating stream, retention, nocturia, or bladder distension recur.
  • Urge the patient to seek medical care immediately if he can't void at all, if he passes bloody urine, or if develops a fever.
  • Reinforce importance of medical follow-up for at least 6 months to 1 year, including rectal examination and urinalysis.


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