Irritable Bowel Syndrome

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Irritable bowel syndrome (IBS) is a very common gastrointestinal condition that is diagnosed when a person has any of a variety of abdominal symptoms and/or a change in bowel habits in the absence of detectable organic pathology. It has been called a number of different names including “Spastic Colon.” Some individuals with IBS have abnormal sensations in their abdominal organs. It usually occurs in people who are between the ages of 20 and 50. It is seen in both sexes but is more common in women. It can be a chronic condition which tends to come and go over one's lifetime. Although it causes varying degrees of discomfort and inconvenient symptoms, it does not progress to any other diseases or cancer.

What Causes IBS?

IBS may be due to a variety of factors such as stress, diet, or hormones. Studies have shown that people with IBS may have changes in the way their intestinal muscles move food and liquid through the digestive tract.

What are Symptoms?

Individuals with IBS may have some of the following symptoms:

1. Change in the frequency of bowel movements from what is normal for the person ("normal" bowel movements are highly individual and range from 3 times a day to 3 times a week.)
2. Diarrhea, constipation, or alternating diarrhea and constipation.
3. Abdominal pain or discomfort which is often relieved by having a bowel movement.
4. Rectal pain or sensation of incomplete evacuation after having a bowel movement.
5. Increased abdominal bloating and/or gas.
6. Occasionally, painless diarrhea.

These symptoms may be associated with nausea, heartburn, headache, fatigue, anxiety, or depression. Factors such as stress may play an important role; some people can learn to recognize when their IBS is likely to "act up."

The following are not symptoms of IBS and should be reported immediately to your health care practitioner:

• Being awakened from your sleep by abdominal pain or diarrhea
• Fever, chills
• Blood in stool

How do I get tested for IBS?

The diagnosis of IBS is made after your health care practitioner reviews your medical history and does a physical examination. As indicated, additional blood and/or stool tests may be done.

Your medical history and description of symptoms is the most important part of the evaluation of IBS, since the physical exam and laboratory tests are usually entirely normal.

Your diet, especially regarding fiber, fat, lactose, gas-forming foods, caffeine, and alcohol intake, is important to consider. Also, drug use--including prescription and over-the-counter medications as well as recreational drugs--must be considered.

Symptoms similar to irritable bowel syndrome may be caused by lactose intolerance. This is the body's inability to digest lactose, a disaccharide found in milk products, which is frequently acquired as people get older. To test for this, you may be advised to eliminate milk products from your diet for 2 weeks to determine if your symptoms improve without lactose.

What is the Treatment for IBS?

Treatment may include counseling, dietary changes, and medications. There is no cure for IBS, but many things can be suggested to lessen the severity and frequency of symptoms.

Stress reduction

• Stress reduction techniques are often very useful for those individuals who note an association between their irritable bowel symptoms and stress.
• Exercise may reduce symptoms of IBS.

Diet

• Increase fiber content in your diet.
• Decrease fat intake.
• Avoid caffeine, alcohol, and sorbitol (a sweetener found in chewing gum).
• Avoiding gas-forming foods from the cruciferous vegetable family (cabbage, broccoli, brussel sprouts, cauliflower, radishes, turnips), beans, and legumes may help.
• Avoid large meals - smaller, more frequent meals may reduce symptoms.

Medications

• If diarrhea is a prominent symptoms of IBS, an antidiarrheal medication may be recommended by your health care practitioner.
• If pain, gas, or bloating are prominent symptoms, an antispasmodic medication may be prescribed.
• Antidepressants are sometimes used for chronic pain problems.

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Cerebral Palsy

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Cerebral palsy, a disorder that affects motor skills, muscle tone, and muscle movement, is a disorder which is most commonly due to damage during prenatal, perinatal, and postnatal periods during the pregnancy process.

Classifications

• Spastic Cerebral Palsy, Cerebral Palsy includes four classifications. Spastic cerebral palsy, the first subcategory of cerebral palsy, affects about seventy to eighty percent of individuals with the disorder. Spastic cerebral palsy is the most common classification of this particular disorder. This condition involves the stiffness of muscles in the body. Spastic cerebral palsy includes differentiating factors which set apart the levels of severity. The differentiating factors include the number of body extensions affected. The scissors affect refers to both legs muscles becoming tight and hard to control. Scissoring refers to the legs turning in and crossing at the knees.
• Athetoid Cerebral Palsy, Athetoid cerebral palsy affects about ten percent of children. "Athetoid cerebral palsy is caused by damage to the cerebellum or basal ganglia. These areas of the brain are responsible for processing the signals that enable smooth, coordinated movements as well as maintaining body posture (About Cerebral Palsy)." Children with athetoid cerebral palsy also have a difficult time maintaining posture.
• Mixed Cerebral Palsy, Mixed cerebral palsy affects about ten percent of children. This classification of cerebral palsy combines the affects of spastic cerebral palsy and athetoid cerebral palsy. This condition is due to the injuries to both the pyramidal and extra pyramidal areas of the brain (About Cerebral Palsy)."
• Ataxic Cerebral Palsy, "Ataxic cerebral palsy is classified by low muscle tone and poor coordination of movements (About Cerebral Palsy)." Ataxic cerebral palsy is the rarest form of this disorder, affecting about five to ten percent of children with cerebral palsy. It alters the child’s depth perception and balance.

Etiology

In about forty percent of all cases, the cause for cerebral palsy is unknown. The most prevalent cause of cerebral palsy is prenatal factors. Included in this category are radiation exposure, fetal anoxia, and brain growth deficiency. Perinatal factor include birth complications, cerebral hemorrhage, and trauma to brain during birth. Postnatal factors include prematurity, asphyxia, and head trauma.

Symptoms

Individuals with cerebral palsy will have neuromotor symptoms, such as persistence of primitive reflexes in infancy. A symptom that is connected with each disorder is spasticity and rigidity of muscles. Ataxia, which affects balance and coordination, also affects many individuals with cerebral palsy.

Those with cerebral palsy also have problems with motor development. A delay in motor development is expected in most cases. Also, in severe cases, some may develop permanent deficiency in motor control.

Individuals with cerebral palsy may also develop poor perceptual and attention problems, emotional disturbances, educational problems, and communication and speech disorders. Those with cerebral palsy can expect to have normal mental development in about fifty percent of all cases.

Treatment

Therapy is considered crucial in order for those with cerebral palsy to receive a good prognosis for their future. A large part of treatment involves physical therapy, which usually begins a few weeks after birth. In physical therapy programs, two sets of exercises work towards specific goals for the cerebral palsy patients. The first goal prevents the weakening or deterioration of muscles. The second prevents muscles from becoming fixed in an uncomfortable position.

Drug therapy is also used to control spasticity. The drugs help the child’s muscles to become less tense and more easily controlled. "The three medications that are used most often are diazepam, which acts as a general relaxant of the brain and body; baclofen, which blocks signals sent from the spinal cord to contract the muscles; and dantrolene, which interferes with the process of muscle contraction (Treatment of Cerebral Palsy)."

Surgery is another option for those suffering from cerebral palsy. This option is recommended when the tensing of muscles is severe enough to cause problems with movement. The main reason for surgery is to elongate muscles. Even so, surgery is usually accompanied by a long period of rest and recovery, which usually lasts about six months.

Prognosis

The prognosis of cerebral palsy depends upon each individual with the disorder. Depending on the severity of each case, prognosis for higher levels of functioning with rehabilitation is considered good for most children.

Overcoming Cerebral Palsy

Many young individuals with cerebral palsy try to overcome their disability. One young boy who was diagnosed at birth with spastic cerebral palsy was limited in the amount he could do, but not in the amount he wanted to achieve. He is now in his twenties, but throughout his life he has been able to accomplish many of his goals. Aside from attending school until his graduation in 2000, he has been able to work a part-time job. He was also able to attend all of his high school dances. He has maintained a stand that he wants to be independent, and for most of his daily activities he is able to be. Like many with cerebral palsy, he has a normal functioning brain, but is handicapped by his limited motor ability.

The motivation of those with cerebral palsy is also shown by a young girl, who made a huge impact on my life. Although this child is young, she has made a huge impact on my life. She is one of the happiest kids I have had the chance to meet. She always manages to have a smile on her face. She, like the young man above, has spastic cerebral palsy, but to a more severe condition. She is wheelchair bound, but there is hope that her physical therapy will help her to overcome the use of the wheelchair. She also has very strong feelings about being independent. It would be very easy for her to let others do things for her, because many try to. This little girl will not let that happen. For example, she wants to crawl from room to room, without being carried, and she wants to feed herself, and take her drinks without the help of others.

Looking at these two amazing people, makes me realize how much drive they must have to want to be independent. They strive to do anything that can be done without the help of others by themselves. Children with cerebral palsy have a hard time doing things normal kids can , but the rewards to see them accomplish what may seem impossible is unlimited.

Mechanical aids are also very useful for individuals with cerebral palsy. These devices range from computers to walkers or wheelchairs. These devices help individuals with cerebral palsy overcome the limitations their disorder has given them.

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NANDA NIC NOC Linkages

NANDA-I (North American Nursing Diagnoses Association International)

The NANDA International Classification is used for the identification of nursing diagnoses. The classification is recognized as a well established diagnosis terminology which is included in UMLS and recognized by ANA. The NANDA Nursing Diagnoses: Definition & Classification 2009-2011 includes 21 new diagnoses, 9 revised diagnoses, 6 retired diagnoses, and has a total of 202 nursing diagnoses for use in practice. Each diagnosis has a definition and the actual diagnoses include defining characteristics and related factors. Risk diagnoses include risk factors (NANDA-I, 2009). In this study, NANDA-I diagnoses are based on 155 nursing diagnoses including related factors and signs/symptoms (NANDA-I, 1999) used in the study hospital.

NOC (Nursing Outcomes Classification)

The current 4th edition Nursing Outcomes Classification has 385 outcomes with definitions, indicators, and measurement scales (1 to 5) for use at the individual, family, and community levels. It includes 58 new outcome labels and 67 revised outcomes (Moorhead et al., 2008). NOC allows nurses to follow changes in or maintenance of outcome states over time and across settings. Before providing an intervention, nurses use NOC to understand the patient’s current problems and nursing diagnoses and rate the chosen outcome to obtain a baseline rating. After providing an intervention, NOC is used to measure the outcome and determine a change score. In this study, NOC outcomes are defined as the second edition of NOC with 260 outcomes labels (Johnson, Maas, & Moorhead, 2000) as the available terminology in the study hospital

NIC (Nursing Interventions Classification)

The NIC taxonomy has 7 domains and 30 classes and 542 interventions in the fifth edition. It currently contains 34 new interventions and 77 revised interventions (Bulechek et al., 2008). Each intervention has a list of more specific activities for implementing the intervention that are selected based on the patients needs. In the study, NIC interventions from the third edition with 468 interventions were used in the study hospital as part of the nursing care planning (Dochterman & Bulechek, 2000)

NANDA NIC NOC NNN Linkages

NNN linkages provide associations between three standardized languages recognized by the American Nurses Organization: NANDA-I, NIC, and NOC. The first step in the process to link NNN is for nurses to determine a nursing diagnosis using NANDA-I diagnoses. The diagnoses that occur most frequently reflect their importance in representing an entire group of patients. After determining the nursing diagnosis, nurses consider which NOC outcomes are appropriate for the patient situation, and then choose NIC interventions that are most likely to achieve the desired outcome (Johnson, 2006).

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Understanding, Accepting, and Managing Anger in Disasters

Understanding, Accepting, and Managing Anger in Disasters. Disasters may evoke a broad spectrum of reactions in survivors, as well as responders. The cause and phase of the disaster, whether natural or human caused, may influence the intensity of emotions. Across the spectrum of reactions, anger is often one of the most understandable but most difficult to manage. Anger can be productive if channeled in the right way, but it can also become a significant obstacle to recovery, eroding physical and mental health, as well as family and community cohesion. In some instances, it can even represent a danger to mental health responders who want to assist survivors. It is important that responders and caregivers understand anger in the post-disaster environment and use effective anger management strategies.

Understanding Anger

Disasters of human intent that cause loss of innocent lives, such as terrorist attacks, may generate the most anger, while natural disasters are often considered beyond human control. However, some survivors may become intensely angry once they recognize human factors involved in a natural disaster (e.g., they may feel that the government neglected to mitigate the disaster through upgrades to the physical infrastructure or provided insufficient post-disaster resources). As a result, some survivors may project anger toward counselors, if they perceive the counselors to be representatives of government agencies. Of course, the intensity of anger can be highly variable, the targets of anger can shift or remain fixed, and targets are not mutually exclusive.

Anger can be projected toward several targets at once, and assisting survivors with anger can be tricky because it is a dynamic and ever-changing reaction. As such, we cannot suggest a universal approach to coping with anger. Some survivors feel entitled to their anger and are not quick to let it go, and some degree of anger must be allowed. Counselors should introduce anger management techniques slowly while emphasizing that anger management is actually a way of shifting control back to survivors, not just a ploy to quiet them.

Accepting Anger

Anger can be motivating in some instances and actually a powerful force in overcoming certain obstacles. But anger can be unpleasant and there is a natural tendency to see anger as a negative emotion that should be squelched. Before suggesting that anger is counterproductive in disaster recovery, responders should consider the following:

• Is the anger justified?
• Is the anger purposeful?
• Can the anger be channeled in a constructive manner?
• Does something about the target or intensity of the anger represent a danger?

Allowing ventilation, affirming the anger, and demonstrating that it can be tolerated and understood are effective first steps to de-escalating anger. But these steps must be taken safely and constructively if possible. Survivor anger, which increases or escalates over time, is common in long-term recovery projects during the “disillusionment” phase, when frustration runs high. In such instances, verbal de-escalation and relaxation techniques are useful. Anticipate escalating anger in recovery projects that survivors may perceive as delayed, “too little, too late,” or complicated by setbacks.

Managing Anger

Anger can be contagious, and even counselors can become angry, especially if they have been impacted by the disaster. This is not uncommon and should be both acknowledged in training and reinforced in team supervision. Survivors benefit most from counselors who can remain neutral and avoid being pulled into the “blame game,” yet sustain their compassion and commitment in the face of anger. Counselors who become consumed with anger are not helpful to survivors.

During the impact phase or later with populations that are hard to reach, counselors are often meeting survivors for the first time—and during one of the worst times of the survivors’ lives. Without much of a baseline knowledge of an individual, it can be difficult to assess when a survivor may cross that fine line between losing emotional control and losing physical control to the point of becoming a danger. Anger may also be an issue as people assess their losses during the disillusionment phase of disaster, especially if resources are not fully realized as expected. The following are three simple safety tips:

• Never sacrifice safety for rapport: As a disaster responder whose primary skill set is talking and listening, you know that building trust and creating an empathic connection is critical, but these should not be to one’s own detriment. You can rebuild rapport quicker than you will heal from a physical or psychological injury if a survivor becomes violent.
• Getting out or away too soon is always better than too late: Trust your instinct and intuition. If the situation or behavior feels threatening or dangerous, it probably is
• Don’t run from danger; run toward safety: Always have a plan B or exit strategy for any situation. In a home, know at least two ways out of the structure; in the community, identify safe places to go (e.g., lighted area, safe people) if the going gets rough.

In conclusion, counselors should be mindful to stay within the scope of their assigned program roles. After many years of work in the field of disaster response, one constant is true: the issues people have prior to the disaster are likely the same ones they have in the aftermath, especially those related to character and personality. Assisting a survivor in managing his or her anger is one way to help survivors cope with their response to the disaster, but if the survivor had long-standing issues with anger management prior to the disaster, these will likely continue and may even be exacerbated by the event. In some cases, these issues limit the effect of our assistance, so you may need to reconsider your definition of success. Full resolution is not always the goal

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Nursing Care Plan For Inguinal Hernia

Nursing Care Plan for Inguinal Hernia. Hernia is a protrusion or projection of an organ or organ part through an abnormal opening in the containing wall of its cavity, a hernia results. An inguinal hernia occurs when the omentum, the large or small intestine, or the bladder protrudes into the inguinal canal. In an indirect inguinal hernia, the sac protrudes through the internal inguinal ring into the inguinal canal and, in males, may descend into the scrotum. In a direct inguinal hernia, the hernial sac projects through a weakness in the abdominal wall in the area of the rectus abdominal muscle and inguinal ligament.

Hernia is classified into three types:

• Reducible, Hernias can be reducible if the hernia can be easily manipulated back into place
• Irreducible or incarcerated, this cannot usually be reduced manually because adhesions form in the hernia sac.
• Strangulated, if part of the herniated intestine becomes twisted or edematous and causing serious complications, possibly resulting in intestinal obstruction and necrosis.

Inguinal hernias can be direct which is herniation through an area of muscle weakness, in the inguinal canal, and inguinal hernias indirect herniation through the inguinal ring. Indirect hernias, the more common form, can develop at any age but are especially prevalent in infants younger than age 1. This form is three times more common in males.

Causes for Inguinal Hernia

An inguinal hernia is the result of either a congenital weakening of the abdominal wall, traumatic injury, aging, weakened abdominal muscles because of pregnancy, or from increased intra-abdominal pressure (due to heavy lifting, exertion, obesity, excessive coughing, or straining with defecation).

Inguinal hernia is a common congenital malformation that may occur in males during the seventh month of gestation. Normally, at this time, the testicle descends into the scrotum, preceded by the peritoneal sac. If the sac closes improperly, it leaves an opening through which the intestine can slip, causing a hernia.

Complications for Inguinal Hernia

Inguinal hernia may lead to incarceration or strangulation. That can interfere with normal blood flow and peristalsis, and leading to intestinal obstruction and necrosis.

Nursing Assessment Nursing care plan for Inguinal Hernia

Patient History, an infant or a child may be relatively free from symptom until she or he cries, coughs, or strains to defecate, at which time the parents note painless swelling in the inguinal area. On adult patient may occurs of pain or note bruising in the area after a period of exercise. More commonly, the patient complains of a slight bulge along the inguinal area, which is especially apparent when the patient coughs or strains. The swelling may subside on its own when the patient assumes a recumbent position or if slight manual pressure is applied externally to the area. Some patients describe a steady, aching pain, which worsens with tension and improves with hernia reduction

Physical Examination, If the patient has a large hernia, inspection may reveal an obvious swelling in the inguinal area. If he has a small hernia, the affected area may simply appear full. As part of your inspection, have the patient lie down. If the hernia disappears, it's reducible. Also ask him to perform Valsalva's maneuver; while he does so, inspect the inguinal area for characteristic bulging.

Auscultation should reveal bowel sounds. The absence of bowel sounds may indicate incarceration or strangulation. Palpation helps to determine the size of an obvious hernia. It also can disclose the presence of a hernia in a male patient.

Diagnostic tests

Commonly No specific laboratory tests are useful for the diagnosis of an inguinal hernia. Diagnosis is made on the basis of a physical examination. Although assessment findings are the cornerstone of diagnosis, suspected bowel obstruction requires X-rays and a white blood cell count, which may be elevated.

Treatment for Inguinal Hernia

The choice of therapy depends on the type of hernia. For a reducible hernia, temporary relief may result from moving the protruding organ back into place. Afterward, a truss may be applied to keep the abdominal contents from protruding through the hernial sac. Although a truss doesn't cure a hernia, the device is especially helpful for an elderly or a debilitated patient, for whom any surgery is potentially hazardous.

Herniorrhaphy is the preferred surgical treatment for infants, adults, and otherwise-healthy elderly patients. This procedure replaces hernial sac contents into the abdominal cavity and seals the opening. Another effective procedure is hernioplasty, which involves reinforcing the weakened area with steel mesh, fascia, or wire.

Strangulated or necrotic hernia requires bowel resection. Rarely, an extensive resection may require a temporary colostomy

Primary Nursing Diagnosis: Pain related to swelling and pressure

Primary nursing Outcomes: Pain, disruptive effects; pain level

Primary nursing Interventions: Analgesic administration; pain management

Nursing Outcome, Nursing Interventions, and Patient Teaching For Inguinal Hernia

Common Nursing diagnoses found on Nursing care plan for Inguinal Hernia

• Activity intolerance
• Acute pain
• Ineffective tissue perfusion: Gastro Intestinal
• Risk for infection
• Risk for injury

Nursing outcomes nursing care plans for Inguinal Hernia

• The patient will perform activities of daily living within the confines of the disease process.
• The patient will express feelings of comfort.
• The patient's bowel function will return to normal.
• The patient will remain free from signs or symptoms of infection.
• The patient will avoid complications.

Nursing interventions Nursing Care Plan For Inguinal Hernia

• Apply a truss only after a hernia has been reduced. For best results, apply it in the morning before the patient gets out of bed.
• Assess the skin daily and apply powder for protection because the truss may be irritating.
• Watch for and immediately report signs of incarceration and strangulation.
• Closely monitor vital signs and provide routine preoperative preparation. If necessary, When surgery is scheduled
• Administer I.V. fluids and analgesics for pain as ordered.
• Control fever with acetaminophen or tepid sponge baths as ordered.
• Place the patient in Trendelenburg's position to reduce pressure on the hernia site.

After surgery,

• Provide routine postoperative care.
• Don't allow the patient to cough, but do encourage deep breathing and frequent turning.
• Apply ice bags to the scrotum to reduce swelling and relieve pain; elevating the scrotum on rolled towels also reduces swelling.
• Administer analgesics as necessary.
• In males, a jock strap or suspensory bandage may be used to provide support.

Patient teaching home health guide Nursing Care Plan For Inguinal Hernia

• Explain what an inguinal hernia is and how it's usually treated.
• Explain that elective surgery is the treatment of choice and is safer than waiting until hernia complications develop, necessitating emergency surgery.
• Warn the patient that a strangulated hernia can require extensive bowel resection, involving a protracted hospital stay and, possibly, a colostomy.
• Tell the patient that immediate surgery is needed if complications occur.
• If the patient uses a truss, instruct him to bathe daily and apply liberal amounts of cornstarch or baby powder to prevent skin irritation.
• Warn against applying the truss over clothing, which reduces its effectiveness and may cause slippage. Point out that wearing a truss doesn't cure a hernia and may be uncomfortable.
• Tell the postoperative patient that he'll probably be able to return to work or school and resume all normal activities within 2 to 4 weeks.
• Explain that he or she can resume normal activities 2 to 4 weeks after surgery.
• Remind him to obtain his physician's permission before returning to work or completely resuming his normal activities.
• Before discharge, Instruct him to watch for signs of infection (oozing, tenderness, warmth, redness) at the incision site. Tell him to keep the incision clean and covered until the sutures are removed.
• Inform the postoperative patient that the risk of recurrence depends on the success of the surgery, his general health, and his lifestyle.
• Teach the patient signs and symptoms of infection: poor wound healing, wound drainage, continued incision pain, incision swelling and redness, cough, fever, and mucus production.
• Explain the importance of completion of all antibiotics. Explain the mechanism of action, side effects, and dosage recommendations of all analgesics.
• Caution the patient against lifting and straining.

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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 Benign Prostatic Hyperplasia (BPH)

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

Nursing care plans for Benign Prostatic Hyperplasia (BPH)

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	Rationale	Evaluations
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

Prevention

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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