Care of Patient With Alterations of the Prostate

8/6/2019 Care of Patient With Alterations of the Prostate

1/12


2/12


3/12


4/12


5/12

2. Laboratory exams

1. Prostate-specific antigen (PSA) is a specific antigen produced by the

cells of the prostate capsule (membrane covering the prostate) and

periurethral glands. Patients with benign prostatic hyperplasia (BPH) or

prostatitis produce larger amounts of PSA. The PSA level also isdetermined in part by the size and weight of the prostate.The test

measures the amount of PSA in the blood in nanograms per milliliter

(ng/mL). A PSA of 4 ng/mL or lower is normal; 410 ng/mL is slightly

elevated; 1020 is moderately elevated; and 2035 is highly elevated.

Most men with slightly elevated PSA levels do not have prostate cancer,

and many men with prostate cancer have normal PSA levels. A highly

elevated level may indicate the presence of cancer.However, the PSA

test can produce false results. A false positive result occurs when thePSA level is elevated and there is no cancer. A false negative result

occurs when the PSA level is normal and prostate cancer is present.

Because of this, a biopsy usually is performed to confirm or rule out

cancer when the PSA level is high. Total PSA (also known as PSA II) is

the sum of the levels of both forms and free PSA measures the level of

unbound PSA only. Studies suggest that malignant prostate cells

produce more bound PSA; therefore, a low level of free PSA in relation

to total PSA might indicate prostate cancer, and a high level of free PSAcompared to total PSA might indicate a normal prostate, BPH, or

prostatitis.

2. Urinalysis is a laboratory test of your urine performed to rule out the

presence of an infection or condition that may produce similar

symptoms or to check for bleeding. The urine is spun in a centrifuge so

that sediments, bacteria, blood cells. Urinary tract infections most often

occur in older men with BPH.

3. Creatinine. In men with symptoms, blood tests can measure a

substance called serum creatinine, which is a marker for kidney trouble.

Kidney problems exist in an average of 13.6% of BPH patients. Studies

have reported rates as high as 30% and as low as 0.3%.

3.Cystourethroscopy:Cystoscopy (Also called cystourethroscopy.) - an examination in which ascope, a flexible tube and viewing device, is inserted through the urethra

to examine the bladder and urinary tract for structural abnormalities or

15

mins.


6/12


7/12

5. Analyze the

pathophysologic

processes of the

compilations of

prostatectomies

Possible complications would be bladder spasms, urinary leakage into the

abdominal wall around the suprapubic catheter, prolonged and

uncomfortable convalescene. Incontinence and erectile dysfunction may

occur after this procedure.

d.

Retropubic Prostatectomy. In this type of surgery, the surgeonapproaches the prostate through a low abdominal incision without entry

into the bladder. This is the best type of operation when the prostate is

very large and severe urethral stricture is evident . Advantages: direct

visualization of the prostate and direct hemostasis in the prostatic fossa.

Disadvantages: bladder problems may occur which cannot be treated

and osteitis pubis.

V.

Prostatectomy Complicationsa.TURP syndrome: also known as TUR syndrome. During transurethral

resection of the prostate surgery, a sterile irrigation solution is used to

keep the surgical area clean and to prevent distribution of cancer cells if

they are present. This solution is low in sodium. When this solution enters

the bloodstream, it can lower the sodium level in the body.

Hyponatremia, or low blood sodium, can cause disorientation, nausea,

vomiting, fatigue, and in severe cases, brain edema and seizures.

Treatment may be as simple as restricting fluid intake, or may involve IVmedication, or the administration of salt.

b.Incontinence. After the procedure, a strong sense of urgency may

develop i.e. an urgent desire to pass urine sometimes associate with

urinary leakage ('urge incontinence'). This occurs because the bladder

muscle is intrinsically overactive in about 1 in 3 men who have the

procedure, and the prostate prevented leakage by its sheer bulk before

surgery. Drugs such as tolterodine, oxybutynin or solifenacin can improvethese symptoms. This usually resolves by 6 months.

c.Retrograde Ejaculation. Most men (over 70%) find that they have either a

much reduced volume of semen or no semen when they have an orgasm

and ejaculate. This is called 'retrograde ejaculation. verumontanum is

destroyed during most surgery, forward ejaculation cannot accour.

Instead, the semen goes into the bladder during ejaculation. The semen

is passed in the urine. This is not dangerous, but obviously some men mayfind that unacceptable.

Lecture discussion

with powerpoint

presentation.


8/12

6. Formulate priority

diagnosis based on

hypothetical case

scenarios.

d.Erectile dysfunction. Occurs 5% to 10% of client and this only happens

when nerves are damaged during surgery for prostate resection.

e. Thromboplebitis. Thromboplebitis occurs because patients

undergoing prostatectomy have a high incidence of deep vein

thrombosis (DVT) and pulmonary embolism,the physician mayprescribe prophylactic (preventive) low-dose heparin therapy.

The nurse assesses the patient frequently after surgery for

manifestations of DVT and applies elastic compression stockings

to reduce the risk for DVT and pulmonary embolism.

f. Excessive Bleeding. The immediate dangers after a prostatectomy

are bleeding and hemorrhagic shock. This risk is increased with

BPH because hyperplastic prostate gland is very vascular.Bleeding may occur from the prostatic bed. Bleeding may also

result in the formation of clots, which then obstruct urine flow.

The drainage normally begins as reddish-pink and then clears to a

light pink within 24 hours after surgery. Bright-red bleeding with

increased viscosity and numerous clots usually indicates arterial

bleeding. Venous blood appears darker and less viscous. Arterial

hemorrhage usually requires surgical intervention (e.g., suturing

ofbleeders or transurethral coagulation of bleeding vessels),where as venous bleeding may be controlled by applying

prescribed traction to the catheter so that the balloon holding

the catheter in place applies pressure to the prostatic fossa. The

surgeon applies traction by securely taping the catheter to the

patients thigh.

g. Infection. Urinary tract infections and epididymis are possible

complications after prostatectomy. It is mostly due to poorirrigation or introduction of bacteria by p oor aseptic technique

during installation of irrigating system and urinary catheters.

Intravenous or oral antibiotics are administered in the first few

days after surgery. The patient is encouraged to increase fluid

intake to promote flushing of the system, help pr event urinary

stasis and decrease the chance of infection. The nurse reviews

the symptoms of UTI (fever higher than 37.6oC, chills, painful

urination, back or flank pain and general malaise) which thepatient should report to the physician.

Group work oncase scenarios


9/12

VI . Nursing Management

a. Preoperative phase

y Reducing anxiety. Establish communication with the pa tient to

assess his understanding of the diagnosis and of the planned

procedure. Preoperative teaching - Include attention to

expectations about the pr ocedure, such as anticipated changes invoiding and sexual function.

y Preparing the patient. Properly assess the patients health history,

contraindications and other preoperative assessment. Client taking

any drug or supplement with anticoagulant effects should be

discontinued before the surgery. Urinary drainage should be done.

Obtain informed consent.

y The nurse should provide opportunity for patient and partner to

express concerns about the surgery.

y Providing Instructions before surgery.

b. Intraopertaive phase

y Maintain safety and prevent injury. Position client properly.

y Maintain surgical asepsis

y Assist in wound closure.

y Monitoring: vital signs, malignant hyperthermia, cardiac respiratory arrest,

allergic reactions

c. Postoperative phase

y Relieve pain. Ensure patency of catheter and prevent catheter

dislodgement. Offer warm compress to pubis or hot sitz bath to relieve

spasms. Encourage to ambulate. Administer prescribed medications.

Medications for bladder spasms would be: belladonna and opium

suppositories, propantheline bromide (Po- Banthine) or immediate release

oxybutynin (Dirtropan IR) . These medications should be given with stools

softeners such as docusate sodium (Colace).

y Maintain fluid and electrolyte balance. Monitor for electrolyte imbalance

and for retention.

y Monitor for bleeding. Monitor vital signs and laboratory results.

Implement strategies to stop bleeding and to prevent or reverse

hemorrhagic shock. If blood loss is extensive, fluids and blood

component therapy may be given.

y Prevent infection. Careful aseptic technique should be used when

irrigating the bladder. Proper care of the catheter is important.


10/12


11/12

Resources:

Books:

Black, J. & Hawks, J. (2004). Medicalsurgicalnursing:clinicalmanagementforpositiveoutcomes.7th

ed. Singapore: Elsevier Science.

Lewis, S.M. et al. (2004).Medicalsurgicalnursing:assessmentandmanagementofclinicalproblem. Mosby: Missouri

Marieb, E. & Hoehn, K. (2007).Humananatomy&physiology.7th ed.Pearson Education,Inc.

Smeltzer, S. & Bare, B. (2004).Brunner& suddarthstextbookofmedicalsurgicalnursing.11th

ed. USA: Lippincott Williams and Wilkins

Internet:

Monica Rhodes (2008). Retrieved November 15, 2010, from http://www.webmd.com/colorectal-cancer/digital-rectal-examination-dre?page=1

Bupa's health information team (2009) Retrieved November 15, 2010, from http://hcd2.bupa.co.uk/fact_sheets/html/turp.html


12/12

SillimanUniversity

College ofNursing

Resource Unit on

Submitted to:

Ms. Joanna Marie Apao

Clincal instructor A1

Submitted by:

Kristin Joy Tan Mah A1

Documents

Care of Patient With Alterations of the Prostate