DSM: Benign Prostatic Hyperplasia

The nurse is providing teaching to an older patient and his wife about nonpharmacologic therapies they can implement for his mild benign prostatic hyperplasia (BPH). Which is an appropriate lifestyle change for the nurse to include?

"Avoid drinking fluids within 2 hours of bedtime." Patients with mild BPH may have symptom improvements by avoiding drinking fluids within 2 hours of bedtime, urinating at the first urge, avoiding alcohol and caffeine, exercising regularly, reducing stress, and other measures.

The nurse is completing the International Prostate Symptom Score (IPSS) scale on a patient to assess for symptoms of benign prostatic hyperplasia (BPH). Which question would the nurse ask as part of this evaluation?

"Do you need to urinate within 2 hours after previously urinating?" The health hx to assess for possible BPH should include: Risk factors. Urinary elimination patterns and manifestations. Hematuria. Pain. *IPSS scale can also be used to assess for symptoms. This scale collects data about several subjective factors related to BPH, including: Feeling as though bladder did not empty after urination. Starting & stopping stream several times while urinating. Needing to urinate 2 hours after urinating. Straining to urinate. Nocturia. How the person feels about having BPH.

A patient diagnosed with mild benign prostatic hyperplasia (BPH) asks, "What can I do to relieve symptoms of BPH?" Which response by the nurse provides appropriate self-care interventions?

"Exercise regularly, including pelvic floor exercises." Exercising regularly, including pelvic floor exercises, can be a helpful lifestyle change for men diagnosed c mild BPH. Fluid intake does not need to be restricted. OTC decongestants & antihistamines should be avoided because they can precipitate urinary retention. Use of alcohol should be avoided because it can cause urinary incontinence.

The nurse has provided discharge teaching to a patient on urinary catheter care following surgery for benign prostatic hyperplasia (BPH). Which statement by the patient indicates correct understanding?

"If I see a change in the color or consistency of my urine and if I note an odor, I should let my HCP know." pt stating need to contact the healthcare provider regarding any changes in urine color and consistency or an odor indicates correct understanding of catheter care upon discharge. pt should not expect to see large blood clots upon discharge; these should be reported to the healthcare provider. At night, a larger bag suspended from the bed frame, not the leg bag, should be used to prevent urine reflux. The leg bag should not be secured very tightly to the leg, because this can decrease venous return and increase the risk from thrombophlebitis or embolic complications. Instructions for catheter care upon discharge should also include: Emptying the bag every 3-4 hours during waking hours to prevent overfilling. Placing a soft cloth between the leg bag and thigh to decrease friction and absorb perspiration to reduce the risk of skin irritation. Promptly reporting hematuria, frank bleeding, and a lack of or significant decrease in urine output.

The nurse evaluates teaching to a patient about an alpha-adrenergic blocker, doxazosin, prescribed for benign prostatic hyperplasia (BPH). Which statement by the patient indicates the need for further teaching?

"It's ok to continue to take my allergy medicine as long as I limit its use." Doxazosin is an alpha-adrenergic blocker and many meds for coughs, colds, or allergies may contain an adrenergic agent. Therefore, the patient should first check with the healthcare provider before taking any of these meds, and limiting use would not be appropriate. Doxazosin relaxes the smooth muscle of the prostate and bladder neck, helping to relieve obstruction and increase the flow of urine, so this is a correct statement.

A 40-year-old patient states he is hoping to prevent the development of benign prostatic hyperplasia (BPH). Which statment by the nurse is accurate based on recent evidence?

"Living an overall healthy lifestyle can help prevent metabolic syndrome that has recently been connected to BPH." Recent evidence has suggested a connection between metabolic syndrome and BPH, thus encouraging men to live an overall healthy lifestyle to prevent metabolic syndrome. This may, in turn, help to prevent BPH. Other than this recent suggested connection, there is no known prevention for BPH. To possibly prevent/delay BPH: maintain healthy lifestyle, control body weight; exercise daily, maintain blood glucose levels c proper management of diet

Which statement by the nurse supports self-care behavior to help prevent benign prostatic hyperplasia (BPH)?

"Maintain a healthy lifestyle that includes exercise and maintenance of a healthy weight."

The nurse is preparing teaching for a patient-posttransurethral resection for benign prostatic hyperplasia (BPH). Which intervention should the nurse encourage the patient to implement in order to decrease the risk for urinary tract infections?

"Maintain a liberal fluid intake of 2-3 L per day."

A 50-year-old man asks the nurse during a routine visit about risk factors for development of benign prostatic hyperplasia (BPH), because several relatives have been diagnosed with BPH. Which response by the nurse provides accurate information?

"There are two main risk factors for BPH; age and presence of testosterone." The two main risk factors for developing BPH are age & presence of testosterone; thus, this would be the most accurate response. Neither genetics nor history of hydrocele are implicated as risk factors for development of BPH.

A patient diagnosed with benign prostatic hyperplasia (BPH) asks the nurse, "What does hyperplasia mean?" Which response by the nurse is accurate?

"There has been a increase in the number of cells in your prostate that have formed nodules." BPH begins as small nodules in the periurethral glands (inner layers of the prostate) due to hyperplasia, an increase in the number of cells. Hypertrophy refers to an increase in the size of individual cells, which also contribute to the problem of BPH, but for a different reason than hyperplasia.

A patient recently diagnosed with benign prostatic hyperplasia (BPH) is told he can no longer take the decongestant medication he has routinely used for the sniffles. He asks the nurse why he should avoid this medication.

"This medication causes urinary retention." Several classes of medications can precipitate urinary retention in men with BPH, including anticholinergics and over-the-counter medications for the common cold, such as decongestants.

An older adult patient with benign prostatic hyperplasia (BPH) tells the nurse that he has been prescribed a tricyclic antidepressant by his counselor. How should the nurse respond?

"Tricyclic antidepressants can worsen the symptoms of BPH; thus, a different antidepressant may need to be considered." Tricyclic antidepressants should be avoided because they have anticholinergic side effects & therefore can increase urinary frequency, worsening symptoms of BPH. Older men c more inconvenient lower urinary tract symptoms should avoid drugs such as alpha-adrenergic agents, drugs c anticholinergic side effects & testosterone and anabolic steroids, all of which are known to worsen BPH symptoms.

During discharge teaching post-prostate surgery, the patient asks when he can resume sexual intercourse. Which response by the nurse is appropriate?

"You can resume sexual activity 6 weeks after surgery." In order to prevent bleeding, sexual activity should not be resumed until 6 weeks after surgery. Another teaching point for the patient and/or partner is that after resuming sex, the ejaculate will flow back into the bladder, so the patient will express little or no semen.

The community health nurse discusses preventive care guidelines for benign prostatic hyperplasia (BPH) with a community group. At which age should the nurse recommend assessment for benign prostatic hyperplasia (BPH) to begin?

40. Men over the age of 40 should be assessed for possible BPH and screened for prostate cancer if risk factors are present. Assessment includes a health history, physical assessment, and diagnostic tests.

The nurse is assessing a patient for symptoms of benign prostatic hyperplasia (BPH). Which factor in the patient's health history should the nurse consider?

Age. Age is most common risk factor for BPH. Almost all men will develop BPH if they live long enough. Race may play a role, because African American and Latino men develop BPH earlier than Caucasian Americans, but Asian American men develop it later.

Nursing care for patients with CBI include:

Assess catheter & drainage tubing at regular intervals. Maintain rate of flow to keep output light pink or colorless. Assessing urinary output every 2 hours for color, consistency of amount, and presence of blood clots. Assessing the patient for bladder spasms.

Important facts to note about BPH include:

BPH begins as small nodules in periurethral glands; nodules are formed from hyperplasia (increase in the number of cells) of stromal and epithelial cells in te prostate gland rather than hypertrophy (increase in the size of individual cells). *Hyperplasia occurs over a long period of time, making BPH more common in older men. Hypertrophy (increase in the size of individual cells) also contributes to the problem.

If the enlarging mass is not reduced, complications may occur that include:

Bladder distention. Development of diverticula (saclike outward projections of mucosa protruding through the muscular layer of the bladder wall, developing from the pressure of urinary retention). Obstruction of the ureters. Infection (may ascend from the bladder to the kidneys). Hydroureter (distention of the ureter with urine). Hydronephrosis (accumulation of urine in the renal pelvis as a result of obstructed outflow). Renal insufficiency.

A patient presents with complaints of increasing symptoms related to previously diagnosed benign prostatic hyperplasia (BPH). Which diagnostic test should the nurse anticipate being ordered to assess urinary function?

Bladder ultrasound to measure residual urine. An ultrasound to assess residual urine can be used to determine urinary function. A UA can be used to determine issues secondary to BPH such as infection. *Diagnostic tests to assess for BPH include: Digital rectal exam: in BPH the prostate is assymetrical and enlarged. Exam of the urine for WBCs, RBCs, and bacteria. Assessment of urinary function by measuring residual urine through ultrasonography or postvoid. catheterization (more than 100 mL is considered high) and through uroflowmetry (normal urine flow rate is greater than 14 mL/sec). Creatinine levels to assess for kidney damage. PSA levels to rule out prostate cancer: serum level corresponds with the volume of both benign and malignant tissue.

Upon completion of a health history for a patient reporting urinary frequency and urgency, the patient asks, "Which diagnostic tests will be needed to determine if I have an enlarged prostate?" Which is the first test that the nurse should discuss with the patient?

Digital rectal examination (DRE). The digital rectal examination is the most common diagnostic test for BPH.

A patient diagnosed with benign proalstatic hyperplasia (BPH) states to the nurse, "I don't understand why I have this condition. What has caused it?" In the nurse's explanation, which hormone should be presented as the primary mediator of prostatic growth?

Dihydrotestosterone. The androgen that mediates prostatic growth at all ages is dihydrotestosterone (DHT), which is formed in the prostate from testosteron

A patient with benign prostatic hyperplasia (BPH) is scheduled for minimally invasive surgery for his condition. He asks the nurse, "What's the worst that can happen if I don't have the procedure?" The nurse should consider which complication in response to the patient?

Diverticula. Several complications may occur if the mass is not reduced in size. One significant complication relates to pressure resulting from urinary retention. This causes development of diverticula, which are saclike outward projections of mucosa protruding through the muscular layer of the bladder wall. Infection resulting from the retained urine and in the diverticula can ascend from the bladder to the kidney.

The nurse caring for a patient with continuous bladder irrigation (CBI) post-transurethral resection of the prostate notes that the amount of large blood clots has increased. Which action should the nurse undertake first to address this issue?

Increase the flow rate of the irrigation solution.

The nurse completes a health history for a patient diagnosed with mild benign prostatic hyperplasia (BPH). Which behavior noted during the assessment should the nurse discourage the patient from continuing?

Drinking one to two beers daily. Pts with mild BPH should avoid the use of alcohol; thus, the nurse should encourage the pt to avoid drinking beer. Alcohol is a bladder stimulant that can cause urinary incontinence. *Lifestyle interventions for patients diagnosed with mild BPH include: Urinating at first urge. Avoiding alcohol & caffeine.Drinking small amounts of fluids spread throughout day. Avoiding drinking fluids within 2 hrs of bedtime. Avoiding over-the-counter decongestants and antihistamines. Exercising regularly, including pelvic floor exercises. Reducing stress.

The ultrasound of a patient with benign prostratic hyperplasia (BPH) reveals an accumulation of urine in the renal pelvis. Which complication of untreated BPH should the nurse suspect this patient is experiencing?

Hydronephrosis. An accumulation of urine in the renal pelvis reflects development of hydronephrosis, which can occur if the enlarging mass of BPH is not reduced.

The nurse is performing a history and physical for a patient with benign prostatic hyperplasia (BPH). Which questionnaire should the nurse use to best collect several subjective factors identifying symptoms of BPH?

International Prostate Symptom Score (IPSS)

A patient has been scheduled for a transurethral needle ablation (TUNA) to address his benign prostatic hyperplasia (BPH). Which statement describes this surgical approach?

Low-level radio frequency is used through twin needles to burn away a region of the enlarged prostate. Transurethral needle ablation (TUNA) utilizes low-level radio frequency through twin needles to burn away a region of the enlarged prostate. Transurethral resection of the prostate (TURP) is performed with the use of a wire loop resectoscope to remove prostate tissue and perform electrocautery through the urethra

While performing a health history, the patient tells the nurse that he has benign prostatic hyperplasia (BPH). Which assessment finding in the health history supports this diagnosis?

Nocturia. Clinical manifestations of BPH include a weak urinary stream, increased time to void, hesitancy, incomplete bladder emptying, postvoid dribbling, frequency, urgency, incontinence, nocturia, dysuria, and bladder pain.

A patient post-transurethral resection of the prostate (TURP) is receiving a continuous bladder irrigation (CBI). How should the nurse titrate the flow rate for the patient?

Rate of flow should be maintained to keep the output light pink or colorless. CBI prevents formation of blood clots postsurgery. Flow rate should be maintained to keep output light pink or colorless. While flow rate may be adjusted if pt is having bladder spasms, typically, flow rate is determined by volume, color, & consistency of output in tubing and collection bag, not overall pt comfort.

A patient 6 hours postsurgery for a transurethral resection of the prostate (TURP) complains of symptoms indicating to the nurse that he may be experiencing bladder spasms. Which medication should the nurse anticipate administering?

Rectal belladonna and opium suppositories. Belladonna and opium suppositories are used to relieve bladder spasms.

Which surgical option for treating benign prostatic hyperplasia (BPH) utilizes low-level radio frequency through twin needles to burn away a region of the enlarged prostate?

Transurethral needle ablation (TUNA)

The nurse is completing an assessment for a patient and suspects benign prostatic hyperplasia (BPH). Which complaint by the patient supports this diagnosis?

Urinary hesitancy and a weak urinary stream. Clinical manifestations of BPH include: Weak or intermittent urinary stream.Hesitancy. Incomplete emptying.Dribbling at the end of urination. Straining during urination.Frequency. urgency. Incontinence.Nocturia.Dysuria.Bladder pain. Bladder distention.Diverticula.Ureter obstruction. Bladder or kidney infection.Hydroureter. hydronephrosis.Renal insufficiency.

The nurse is providing teaching to a 59-year-old patient diagnosed with benign prostatic hyperplasia (BPH). Which common signs and symptoms of BPH should the nurse include?

Urinary retention, obstruction of urinary flow, and hesitancy

Lifestyle interventions for patients diagnosed with mild BPH include:

Urinating at the first urge. Avoiding alcohol and caffeine. Drinking small amounts of fluids spread throughout the day. Avoiding drinking fluids within 2 hours of bedtime. Avoiding over-the-counter decongestants and antihistamines. Exercising regularly, including pelvic floor exercises. Reducing stress.