Question

Abstract: Charles Watts, age 68, was diagnosed with benign prostatic hypertrophy (BPH). He is admitted to the medical–surgical unit and scheduled for a transurethral resection of the prostate (TURP).  

Objective: Explain the pathophysiology, manifestations, complications, interprofessional care and nursing care of disorders of the male reproductive system, including disorders of sexual function, the penis, the testes and scrotum, the prostate gland, and the breast.  Discuss the purposes, nursing implications, and health education for medications and treatments used to treat disorders of sexual function, the penis, the testes and scrotum, the prostate gland, and the breast.  

Charles Watts, age 68, sought treatment from his healthcare provider for urinary symptoms. He complained of urgency, frequency, difficulty starting his urinary stream, nocturia, and post-void dribbling. After the digital rectal examination and a prostatespecific antigen (PSA) level that was slightly elevated, the diagnosis of prostatic hypertrophy was made. Mr. Watts was referred to the urologist, who, upon further testing, ruled out prostatic cancer and made the diagnosis of benign prostatic hypertrophy. Mr. Watts is now admitted to the medical–surgical unit for a transurethral resection of the prostate (TURP). He is 5 feet, 10 inches tall, and weighs 188 pounds. His admission vital signs are T 97.7°F, P 88, R 24, and BP 132/78. He has a past history of hypertension and a myocardial infarction 4 years ago that was treated by a surgical stenting procedure. He currently takes aspirin 81 mg p.o. daily and enalapril (Vasotec) 10 mg p.o. daily.  

This activity contains 6 questions.  

1. Explain the pathophysiology of BPH and the reasons Mr. Watts experienced the urinary symptoms.  

2. The nurse assesses Mr. Watts regarding his knowledge of the scheduled surgical procedure, and he tells the nurse that other than his operation for placement of the stent in his heart, he has never had any other surgery. The nurse establishes that he has a nursing diagnosis of Knowledge Deficit related to pre- and postoperative measures important for prostate surgery as evidenced by patient statement. What preoperative teaching should the nurse include for Mr. Watts?  

3. What are the important nursing interventions related to the management of continuous bladder irrigation (CBI) by use of the three-way catheter?  

4. Why does the nurse assign the priority diagnosis Risk for Imbalanced Fluid Volume related to blood loss from the operative site and the possibility of absorbing excess fluid from the bladder irrigation solution?  

5. Mr. Watts questions the nurse regarding any special things he should do when he leaves the hospital. The nursing diagnosis of Readiness for Enhanced Therapeutic Regimen Management secondary to home care after prostate surgery as evidenced by patient questions is made. What discharge instructions does the nurse provide for Mr. Watts?  

6. Describe the pharmacological options available for the patient diagnosed with BPH.

Answer 1

1. They is lot of theory that was related to the development benign prostatic hypertrophy (BPH). Prostate has androgen receptor on his surface.Hih level of Dihydroxytestosterone was found in geriatric patients by activation of these receptor results in prostatic enlargement and smooth muscle hyperplasia. These hyperplasia cause urinary bladder outflow obstruction and develop symptoms such as urinary urgency and increased frequency.

2. Peroperative instructions to patients are:

• Provide detailed information about the operative procedure to patient and to their family members.
• Take informed consent that was signed by patient or patient representatives.
• Advise patient emptying the bladder before operation.
• Advise patients not to take any drugs before operation such as aspirin.
• Advise patients not to take any drinks or solid food before operation.

3.Nursing interventions:

• Use or take precautions before procedure according to standard guidelines.
• Check the catheter is their is any obstruction or leaking tube.
• Do not clean peri urethral area vigorously with antiseptic.
• Check patency of all 3 parts regularly.
• Observe or always look for signs of urinary tract infections.

4. In transurethral resection of the prostate(TURP) operation for cancer of post transurethral resection of the prostate syndrome which is dilation of hyponatremia due to large amount of saline irrigation during operating procedure.So always looks for hyponatremia and can managed by using sodium chloride 0.9% intravenous solution.

5.Discharge instruction:

• Do not bath until the catheter was removed
• Drink plenty of fluids.
• Include fiber containing food in diet.
• Consult doctor if patient was in serious condition

6. Pharmacological therapy:

• Tamsulosin:Alpha blocker used to relax muscle in the prostate and urinary bladders to flow urine easily. Dose:0.4mg
• Finasteride: 5 alpha reductase inhibitor used to prevent the enlargement of prostate.Dose: 1mg, 5mg