02 ATI Ch 66 Benign Prostatic Hyperplasia, Erectile Dysfunction, and Prostatitis

dihydrotestosterone (DTH)-lowering medications

-5-alpha reductase inhibitor (5-ARI), such as finasteride

Vacuum constriction device (VCD)

-A cylinder is placed around the penis while a vacuum is created to draw blood into the penis. -A rubber ring is then placed at the base of the penis to maintain an erection and the cylinder is removed.

penile suppository client education

-A urethral suppository (alprostadil) is inserted 10 min before intercourse. -Erections can last up to 1 hr and can be used twice a day -Adverse effects include urethral and genital pain, risk of hypertension, and syncope. -This medication is not recommended with pregnant partners.

Alpha-blocking agents (Tamsulosin) actions

-Alpha-adrenergic receptor antagonists cause relaxation of the bladder outlet and prostate gland. -These agents decrease pressure on the urethra, thereby re-establishing a stronger urine flow.

International Prostate Symptom Score (1-PSS)

-An assessment tool used to determine the severity of manifestation and their effect on the client's quality of life. -The client rates the severity of lower urinary tract manifestations using a 0 to 5 scale and also rates their quality of life as affected by urinary tract manifestations.

TURP post-op medications

-Analgesics (surgical manipulation or at incisional discomfort) -Antispasmodics (bladder spasms) -Antibiotics (prophylaxis) -Stool softeners (avoid straining

prostatitis client education

-Avoid alcohol, tea, coffee, and spicy foods that increase findings. -Avoid OTC cold preparations that contain decongestants or antihistamines that can cause urinary retention. -Sitz baths, NSAIDS, and muscle relaxants prescribed for promotion of comfort -Take medications as directed and complete the entire course of therapy. -Sexual intercourse and masturbation helps to manage chronic prostatitis. -Prostatitis is not infectious or contagious.

TURP client education

-Avoid heavy lifting, strenuous exercise, straining, and sexual intercourse for the prescribed length of time (usually 2 to 6 weeks). -Drink 12 or more 8-oz glasses of water each day unless contraindicated -Avoid nonsteroidal anti-inflammatory medications due to increased risk for bleeding. -Avoid bladder stimulants (caffeine, alcohol). -If urine becomes bloody, then stop activity, rest, and increase fluid intake -Contact the surgeon for persistent bleeding or obstruction (less than expected output or distention).

TURP preoperative nursing actions

-Carefully assess cardiovascular, respiratory, and renal systems. -Ensure that the client fully understands the procedure and what to expect postoperatively.

Age related changes of the male reproductive system

-Changes in gonadal function include a decline in plasma testosterone levels and reduced production of progesterone. -Decrease in sperm production. -Decrease in volume and viscosity of seminal fluid. -The testes become smaller and more firm. -A loss of muscular tone causes the scrotum to become more pendulous.

Prostatitis: Urinalysis

-Collection of an early morning specimen provides a more concentrated sample. -If infection is suspected, possibly in prostatitis, a midstream, clean-catch sample should be obtained. -Urine for culture and sensitivity identifies the causative organism (bacteria) and determines the type of antibiotic to treat the infection.

BPH diagnostic procedures

-DRE: reveals an enlarged, smooth prostate -TRUS w/ needle aspiration biopsy: rules out\prostate cancer in the presence of an enlarged prostate -EPCA-2: blood test can be prescribe instead of a biopsy to rule out prostate cancer

dihydrotestosterone (DTH)-lowering medications action

-Decreases the production of testosterone in the prostate gland -Decreasing DHT often causes a decrease in the size of the prostate

TURP complication nursing actions

-Monitor the client and intervene for bleeding. -Provide antibiotic prophylaxis to the client.

TURP indwelling three-way catheter considerations

-Drains urine and allows for instillation of a continuous bladder irrigation (CBI) of normal saline (isotonic) or another prescribed irrigating solution to keep the catheter free from obstruction. -Rate of the CBI is adjusted to keep the irrigation return pink or lighter. For example, if bright-red or ketchup-appearing (arterial) bleeding with clots is observed, increase the CBI rate. -If the catheter becomes obstructed (bladder spasms, reduced irrigation outflow), turn off the CBI and irrigate with 50 mL irrigation solution using a large piston syringe or per facility or surgeon protocol. Contact the surgeon if unable to dislodge the clot. -Record the amount of irrigating solution instilled (generally very large volumes) and the amount of return. The difference equals urine output. -The catheter has a large balloon (30 to 45 mL). The leg, creating traction pressure to the catheter is taped tightly to the so that the balloon will apply firm prostatic fossa to prevent bleeding. This makes the client feel a continuous need to urinate. Instruct the client to not void around the catheter as this causes bladder spasms. Avoid kinks in the tubing.

prostatitis complications

-Epididymitis (inflammation of the epididymis) -Cystitis (inflammation of the bladder) -Urinary tract infections -Difficulty with sexual function

acute prostatitiss/sx

-Fever, chills -Dysuria -Urethral discharge -Boggy, tender prostate -Palpation of the prostate that can result in urethral discharge containing white blood cells

BPH client education

-Frequent ejaculation releases retained prostatic fluids, thereby decreasing the size of the prostate. -Avoid drinking large amounts of fluids at one time, and urinate when the urge is initially felt. -Avoid bladder stimulants (caffeine, alcohol). -Avoid medications that cause decreased bladder tone (anticholinergics, decongestants, antihistamines). -Medication is used for conservative treatment of BPH.

erectile dysfunction risk factors

-Inflammation of seminal vesicles, urethra, and prostate -Prostatectomy -Pelvic fractures -Lumbosacral injuries -Vascular disease, such as hypertension -Chronic neurologic conditions (multiple sclerosis, Parkinson's) -Endocrine disorders (diabetes, thyroid disorders) -Medications such as antihypertensives -Smoking and alcohol consumption -Poor overall health that prevents sexual intercourse

Transurethral incision of the prostate

-Involves incisions into the prostate to relieve constriction of the urethra -Tissue is not removed with this procedure. - -It is minimally invasive and typically performed in an outpatient setting.

Dihydrotestosterone (DHT)-lowering medications client education

-It can take 6 months before effects of the medication are evident. -Impotence and a decrease in libido are possible adverse effects. -Report breast enlargement to the provider. -Finasteride is teratogenic to a male fetus. -The medication is potentially absorbed through the skin. -Clients who are pregnant or who could become pregnant should avoid contact with tablets that are crushed or broken and with the semen of a client currently taking this medication.

Interstitial laser coagulation

-Laser energy is used to coagulate excess prostatic tissue. (aka contact laser prostatectomy)

Prostatitis: Prostate specific antigen

-PSA value greater than 4 ng/mL requires further evaluation. -An elevated PSA is an indication of a number of conditions, including prostate cancer, BPH, and acute prostatitis.

TURP Postoperative Nursing Actions

-Postoperative treatment for a TURP usually includes placement of an indwelling three-way catheter. -Monitor vital signs and urinary output. -Administer/provide increased fluids. -Monitor for bleeding (persistent bright-red bleeding unresponsive to increase in CBI and traction on the catheter or reduced Hgb levels) and report to the provider. -Assist the client to ambulate as soon as possible to reduce the risk of deep-vein thrombosis and other complications that occur due to immobility. -When the catheter is removed, monitor urinary output. The initial voiding following removal can be uncomfortable, red in color, and contain clots. The color of the urine should progress toward amber 2 to 3 days. Instruct the client that expected output is 150 to 200mL every 3 to 4 hr. The client should contact the provider if unable to void.

Alpha-blocking agents (Tamsulosin) client education

-Postural hypotension can occur. Change positions slowly. -Concurrent use with cimetidine can potentiate the hypotensive effect.

Prostatitis

-Prostatitis is an inflammation of the prostate gland often associated with lower urinary tract findings and findings including sexual dysfunction. -Organisms reach the prostate through the urethra or bloodstream.

penile implants client education

-Squeeze the pump located in the scrotum to fill the penis with fluid to achieve erection of the penis. -Depress the release button to deflate the prosthesis following sexual activity. -Observe the surgical site for bleeding and infection following insertion.

PPDE-5 inhibitors client education

-Take the medication 1 hour before sexual intercourse. -With sildenafil and vardenafil, sexual stimulation is needed within 1/2-1 hour to promote the erection. -With tadalafil, sexual stimulation can occur over a longer period of time. -Avoid alcohol when taking PDE-5 inhibitors. -If taking nitrates, avoid PDE-5 inhibitors due to vasodilation effects that can cause profound hypotension and reduction of blood flow to vital organs.

Transurethral resection of the prostate (TURP)

-The most common surgical procedure for BPH -TURP is performed using a resectoscope (similar to cystoscope) that is inserted through the urethra and trims always excess prostatic tissue, enlarging the passageway of the urethra through the prostate gland. -Typically, epidural and spinal anesthesia the prostate gland. are used.

penile implants

-This modality is used when other interventions fail. -A three-piece inflatable device is implanted in the penis with the reservoir planted in the scrotum.

chronic prostatitis s/sx

-Urinary hesitancy and frequency -Dysuria -Difficulty initiating -Decreased strength and volume and stopping the flow of urine of urine -Pain in back and perineal area -Irregularly enlarged prostate

Holmium laser enucleation of the prostate

-Uses a laser to remove excess prostatic tissue that is obstructing the client's urethra -The tissue is then moved to the bladder where the client eliminates it in the urine. -The client often has an indwelling urinary catheter that is left in place overnight.

BPH urinalysis and culture

-WBCs elevated -hematuria -bacteria present with urinary tract infection

BPH CBC

-WBCs elevated if systemic infection present -RBCs possibly decreased due to hematuria

Risk factors for prostate cancer

-age over 40 -African American man

prostatitis medications

-antimicrobials -alpha-blocking agents (Tamsulosin) -stool softeners

risk factors for testicular cancer

-chryptochidism

BPH medications

-dihydrotestosterone (DTH)-lowering medications -alpha-blocking agents: tamsulosin -the goal of medication for BPH is to re-establish uninhibited urine flow out of the bladder

potential adverse effects of PDE-5 inhibitors

-dyspepsia -headaches -facial flushing -stuffy nose -Taking more than one dose in a day can cause leg and back cramps, nausea, and vomiting.

BPH s/sx

-frequency -urgency -hesitancy -incontinence -incomplete emptying of the bladder -dribbling post-voiding -nocturia -diminished force of urinary stream -straining -hematuria

BPH risk factors

-increased age -smoking, chronic alcohol use -sedentary lifestyle, obesity -wester diet (high-fat, -protein, -carbohydrate; low-fiber) -diabetes mellitus -heart disease

The impaired flow of urine from BPH can make the client susceptible to what?

-infection -retention -reflux of urine into the kidneys (which can dilatate the ureter and cause kidney infections)

erectile dysfunction medications

-phosphodiesterace-5 (PDE-5) inhibitors -vasodialators

Prostatitis diagnostic procedures

-prostate specific antigen -urinalysis -white blood cell count

Alpha-blocking agents (Tamsulosin) adverse effects

-tachycardia -syncope -postural hypotension

BPH therapeutic procedures

-transurethral needle ablation -transurethral microwave therapy -prostatic stent -interstitial laser coagulation -electro vaporization of the prostate -surgical resection -transurethral incision of the prostate -holmium laser enucleation of the prostate -transurethral resection of the prostate (TURP)

TURP complications

-urethral trauma -urinary retention -bleeding -infection

BPH lab tests

-urinalysis/culture -CBC -BUN and creatinine -prostate-specific antigen\ -culture and sensitivity of prostatic fluid

erectile dysfunction therapeutic procedures

-vacuum constriction device (VCD) -penile implants -penile suppository

How long does a catheter remain in place after a TURP

2 to 4 days after surgery and is only removed wit a physician's order.

The nurse is reviewing the medical record of a client who has been diagnosed with prostate cancer. The nurse notes that the Gleason score was used to grade the cancer. Which total score would the nurse interpret as indicating a highly aggressive cancer?

9 The Gleason score is the most commonly used tumor grading system which assigns two scores with a combined value ranging from 2 to 10. With each increase in Gleason score, there is an increase in tumor aggressiveness. High Gleason scores indicate more aggressive cancer. A total score of 8 to 10 indicate a high-grade cancer.

Which client would the nurse identify as having the greatest risk for testicular cancer?

A 36-year-old Caucasian American who is HIV positive The client who is 36 years old, Caucasian American, and HIV-positive would have the greatest risk. Testicular cancer is the most common cancer diagnosed in men 15 to 35 years old and the second most common malignancy in those 35 to 39 years old. Caucasian Americans have a five times greater risk than African Americans and more than two to three times greater risk than Asian, Native American, and Hispanic men. The risk of developing testicular cancer is higher in HIV-positive men. Occupational hazards such as exposure to chemicals in mining, oil, and gas production, and leather processing have been suggested as possible risk factors. No evidence has linked testicular cancer to prenatal exposure to diethylstilbestrol. The client who is 20 years old is in the appropriate age group, but his ethnicity poses a lower risk than that of the 36-year-old Caucasian American. Both the 50 year-old Hispanic American and 45-year-old Asian American are at lower risk based on their ethnic group. Additionally, both these clients are not in the typical age group affected. Working in a textile factory and having an enlarged prostate are not risk factors associated with testicular cancer.

Hydrocele

A collection of fluid, generally in the tunica vaginalis of the testes.

Phimosis

A condition in which the foreskin is constricted so that it cannot be retracted over the glans.

Varicocele

An abnormal dilation of the veins of the pampiniform venous plexus in the scrotum.

Surgical resection

An option for clients who do not receive adequate relief from conservative measures

prostatitis: antimicrobials client education

Antimicrobial treatment can last weeks or months and can require hospitalization inpatient IV antibiotics.

Which treatment involves implantation of interstitial radioactive seeds under anesthesia to treat prostate cancer?

Brachytherapy

How often should a TSE be done?

Monthly beginning in adolescence

BPH culture and sensitivity of prostatic fluid

Can be performed if fluid is expressed during digital rectal examination

During a routine office visit, a client mentions difficulty maintaining an erection. While reviewing the client's medical history, the nurse notes the client's medication history. Which medication would the nurse interpret as a potential cause of erectile dysfunction? Select all that apply.

Clonidine (antihypertensive) Lorazepam (anxiolytic) Nadolol (beta blocker) Fluoxetine (selective serotonin reuptake inhibitor)

complications of tx procedures for BPH

Complications of procedures to treat BPH include regrowth of prostate tissue and recurrence of bladder neck obstruction.

A client who comes to the clinic complaining of perineal pain, dysuria and fever is diagnosed with prostatitis. The nurse understands that which of the following organisms would be the most likely cause?

Escherichia coli

In a client with benign prostatic hyperplasia (BPH), which assessment finding provides the best indication of urinary retention?

Frequency As residual urine accumulates, the client has an urge to void more often. Urgency, hesitancy, and dribbling are all urinary symptoms associated with BPH but not specific to urinary retention.

Transurethral microwave therapy

Heat is applied to the prostate to decease its size.

Which of the following may result if prostate cancer invades the urethra or bladder?

Hematuria

Electrovaporization of the prostate

High-frequency electrical current is used to cut and vaporize excess tissue.

Cryptorchidism

The failure of one or both of the testes to descend into the scrotum.

The nurse is obtaining a medication history from a client who is reporting erectile dysfunction. Which medication would the nurse identify as being least likely to contribute to the client's condition?

Ibuprofen Certain medications, such as antihypertensive agents (e.g. methyldopa and spironolactone), antidepressants, narcotics, and cimetidine cause sexual dysfunction in men. Ibuprofen is not associated with causing erectile dysfunction.

All prostatectomies include the risk of damage to the pudendal nerve. Therefore, postoperatively, the nurse assesses for:

Impotence. The pudendal nerve innervates the penis and the perineum. It can be damaged during prostate surgery, leading to the complication of impotence.

erectile dysfunction expected findings

Inability to achieve or maintain an erection for sexual intercourse

Transurethral needle ablation

Low-level radiation is used to shrink the prostate.

In BPH, urinary stasis and persistent urinary retention can lead to what?

frequent UTIs

The nurse is preparing a discharge teaching plan for a client who has had a prostatectomy. Which of the following would be appropriate to include?

Performing perineal exercises frequently throughout the day. Avoid bearing down (straining) to urinate because of the increased risk for hematuria. Avoid strenuous exercise, which increases the tendency to rebleed. Urinate as soon as you feel the first urge to do so.

Prostatic stent

Placed to keep the urethra patent, especially if client is a poor candidate for surgery

prostatitis: antimicrobials

Prescribed based on the results of the culture and sensitivity testing of urine

erectile dysfunction medication considerations

Prior to medication therapy, a cardiovascular workup is recommended.

A patient is suspected to have prostate cancer related to observed clinical symptoms. What definitive test can the nurse assist with to confirm a diagnosis of prostate cancer?

Prostate biopsy

Phosphodiesterace-5 (PDE-5) inhibitors

Relax the smooth muscles in the corpora cavernosa to increase penile blood flow while compressing the veins to prevent loss of blood.

Penile suppository

Relaxes smooth muscle, increasing blood flow into the penis

A client expresses concerns about future reproduction after a surgery to correct the cancer of the testes. For this client, treatment proceeded without first collecting and storing sperm. Which alternative should the nurse suggest to the client?

Suggest donor insemination or adoption

BPH prostate-specific antigen

To rule out prostate cancer

The nurse is providing care to a client who has had a transurethral resection of the prostate. The client has a three-way catheter drainage system in place for continuous bladder irrigation. The nurse anticipates that the catheter may be removed when the urine appears as which of the following?

Typically a three-way catheter drainage system is removed when the urine appears clear and amber (light yellow). (Reddish-pink urine with clots usually occurs in the immediate postoperative period. Eventually the urine becomes light pink within 24 hours after surgery.)

Which assessment finding would create the greatest risk to a client ordered a phosphodiesterase inhibitor such as sildenafil?

Use of nitrates PDE5 inhibitors facilitate penile erection by producing smooth muscle relaxation in the corpora cavernosa via vasodilation of the blood vessels. If a client is using nitrates (which also exhibit vasodilation) hypotension is likely to occur.

Stool softeners indication for prostatitis

Used for prevention of straining and rectal irritation of the prostate during bowel movements.

Vasodilators

Vasodilators are injected into the penis to cause engorgement resulting in an erection. -alprostadil -papaverine -phentolamine -a combination of these

Functional ED

a result of a psychological cause such as high stress.

How often should a DRE be done?

annually for men older than 50

When the prostate enlarges enough to cause urinary dysfunction, what is it called?

benign prostate hypertrophy (BPH)

BPH BUN and creatinine

elevated, indicating kidney damage

Should a client increase or restrict fluids after a TURP?

increase It helps to dilute the urine and maintain urine output.

Prostatitis: White blood cell count

increased due to infection and inflammation seen in prostatitis

Organic ED

involves a gradual reduction in function resulting from other sources (diabetes, medications, vascular disease).

If BPH persists, back flow of urine into the ureters and kidney lead to what?

kidney damage

two types of erectile dysfunction

organic and functional

Following morning hygiene of an elderly client, the nurse is unable to replace the retracted foreskin of the penis. Which is the most likely outcome?

painful swelling Paraphimosis results in strangulation of the glans penis from inability to replace the retracted foreskin. The strangulation results in painful swelling of the glans.

erectile dysfunction diagnostic procedure

penile Doppler ultrasonography

A client underwent a transurethral resection of the prostate gland 24 hours ago and is on continuous bladder irrigation. Should clean or sterile technique be used when irrigating the catheter?

sterile If the catheter is blocked by blood clots, it may be irrigated according to physician's orders or facility protocol. The nurse should use sterile technique to reduce the risk of infection.