Benign Prostatic Hyperplasia (BPH) is like a common disease for men. So, Benign Prostatic Hyperplasia Nursing Care Plan influence nurse in operative nursing care.

Benign Prostatic Hyperplasia Definition

50 years old people commonly has prostate enlargement as a normal condition, but if there is Benign prostatic hyperplasia (BPH), the prostate gland becomes bigger and press the bladder and urethra , this condition makes severe urinary tract obstruction. BPH is handled symptomatically or operation, it is depend on prostate size enlargement, ages and patient’s health status, and obstruction grade.

Benign Prostatic Hyperplasia (BPH)

Benign Prostatic Hyperplasia (BPH)
Pic: wikipedia

Whatever the Benign prostatic hyperplasia etiology, BPH begins with periurethral gland tissue changes. While it becomes bigger, the prostate press the bladder and obstructs urine flow in the ureter. BPH contributes a balloon formation inside the bladder; it can block the urine flow. The blocked urine inside bladder will become calculus or cyst.

Causes

  • Atherosclerosis
  • Androgen and estrogen imbalance, and high level of dihydrotestosterone
  • Inflammation
  • Metabolic or nutrition disturbances
  • Neoplasm

Sign and Symptoms

Rectal Assessment for BPH

Rectal Assessment for BPH
Pic: Wikipedia

  • Symptoms cluster called prostatism; the urine flow during urinating is decrease, difficult to start micturition, incomplete urinating feeling, and sometime urine retention
  • Prostate enlargement during rectal touch assessment
  • High frequency of urinating with nocturia, incontinence, and hematuria; infection and total urine flow blockage at last
  • Bladder distention, it indicates incomplete urine discharging
  • Complications are like infection, renal insufficiency, hemorrhage, anemia, and shock.

Diagnosis Examination

First Benign Prostatic Hyperplasia Nursing Care plan are to make sure that this is right BPH diagnosis. Some of diagnosis examination for patients are as follow;

  1. Excretory urography indicates urinary tract occlusion, hydro nephrosis, calculus or tumor, and urine admission disturbances
  2. Blood urea nitrogen and creatinine in high level indicates renal function disturbances
  3. Urinalysis and urine culture shows hematuria, pyuria, and urinary tract infection if the bacteria in urine is more than 100.000/µl
  4. If the symptoms of Benign prostatic hyperplasia is severe, cystourethroscopy is able to ensure the disease, but this diagnosis examination should be done before the surgery to determine the best diagnosis result and therapy. This diagnosis examination can show prostate enlargement, bladder wall changes, and upward bladder.

Treatment

In benign prostatic hyperplasia nursing care, you should colaborate with doctors about right treatment. So the treatments play important part of the nursing care, they should be performed side by side.

Conservative treatment like prostate massage, sitz showers, short-term fluid limitation for bladder distension, antimicrobial for infection. Routine ejaculation can help prostatic congestion

Increase the urine flow with alfa-adrenergic like doxazosin, terazosin, tamsulosin, and prazosin. Those medication reduce urinary tract obstruction by preventing prostate and ureter contraction . Finastride can reduce prostate enlargement in some patients

Operation is the only effective therapy to reduce acute urine retention, hydro nephrosis, severe hematuria, recurrent UTI, and other severe sign and symptoms.

How to handle septic shock after prostate operation:

  • If patient had operated and tremor caused by low temperature, tachycardia, hypotension, and other shock sign and symptoms;
    • Inform other nurses team
    • Take antibiotic infusion if needed
    • Pay attention to pulmonary embolism, heart failure, and kidney failure
    • Monitor vital signs, central venous pressure, and artery pressure continuously.
    • Patient needs supportive care in ICU ward
    • Transurethral resection can be done if prostate weight about 56,7 gram. In this procedure, resectoscope erodes the prostate tissues with electric wire. For high risk patient, continuous drainage through catheter can reduce urine retention.
  • Other alternatives like:
    • Suprapubic resection (trans vesical); this is the most common procedure if prostate enlargement still in bladder.
    • Perineal resection; for larger gland in elder patient, sometime it can cause impotence and incontinence.
    • Retropubic resection (extra vesical); give direct vision, potential and continence are usually maintained.
    • Transurethral microwave (heat therapy); nowadays this therapy is used for some patients. The effectivity lies on alfa-adrenergic blocker and operation.

Benign Prostatic Hyperplasia Nursing Care

Here are some Benign Prostatic Hyperplasia Nursing Care that could guide you to perform nursing care plan and implementation for patient with BPH;

  • Monitor and documented vital signs, intake and output, and body weight of patient every days. Aware of post-obstructive diuresis like high fluid output and hypotension, that can be a severe dehydration, hypotension, low blood volume, shock, electrolyte loss, and anuria.
  • Give antibiotic for UTI as needed, urethral instrumentation, and cystoscope as needed.
  • If patient has urine retention, use catheter to help urination (it is difficult for BPH patient sometime). If the urine cannot flow through catheter, do suprapubic cystectomy with local anesthesia.
  • Post Operative Benign Prostatic Hyperplasia Nursing Care guides are as follow;
    • Maintain patient in comfortable, aware of post-operative complication
    • Look at prostatic bleeding (shock and hemorrhage). Check the catheter every 15 minutes for first 2-3 hours to know urine color and patency, check the bandage for bleeding sign and symptoms.
    • Many urologists insert 3 ways catheter and make continuous bladder irrigation. Keep the opening catheter open to maintain clear or redness color.
    • Look at excessive fluid that is caused by fluid irrigation in systemic circulation. If patient uses common catheter, look at it carefully. If the drainage stopped which is caused by blood clots, do catheter irrigation, normally with normal saline about 80-100 ml while maintaining aseptic technique.
    • Aware of shock septic as a severe complication after prostate surgery
    • Give belladonna extract and suppository as needed, or anticholinergics to reduce painful bladder spasm after transurethral resection.
    • After opening procedure, give patient a suppository (except for perineal prostatectomy), analgesic to control incisional pain, and replace the bandage.
    • Keep in giving fluid infusion intravenously till the patient can drink independently 2-3 liters / days to maintain balance hydration.
    • Give a suppository and laxative as doctor’s order so that the patient does not use extra energy during defecation. Do not assess fecal impaction, this assessment can increase prostate bleeding.
    • After the catheter is taken off, patient often urinates, incontinence, and sometime hematuria. Make sure the patient can control his urination step by step. Explain this condition to patient’s family so that the family can control it too.
    • Limit the activities of patient like lifting something weight, over exercising, and driving for long time. Those activities can increase the bleeding. In addition, remind the patient should limit sexual activity for weeks after hospitalization.
    • Ask patient to take antibiotic routinely, and inform the patient how to use laxative gently. Ask him/her to see medical workers immediately if he/she cannot urinate, bleeding urinating, or fever.