Ch 54 BPH Lewis Study Guide

A patient is seeking medical intervention for erectile dysfunction. Why should he be thoroughly evaluated? a. Treatment of erectile dysfunction is based on the cause of the problem. b. Psychologic counseling can reverse the problem in 80% to 90% of the cases. c. New invasive and experimental techniques currently used have unknown risks. d. Most treatments for erectile dysfunction are contraindicated in patients with systemic diseases.

a. Before treatment for erectile dysfunction is initiated, the cause must be determined so that appropriate treatment can be planned. Only a small percentage of erectile dysfunction is caused by psychologic factors. In the case of the 80% to 90% of erectile dysfunction that is of physiologic causes, interventions are directed at correcting or eliminating the cause or restoring function by medical means. New invasive or experimental treatments are not widely used and should be limited to research centers and patients with systemic diseases can be treated medically if the cause cannot be eliminated.

What is the effect of finasteride (Proscar) in the treatment of BPH? a. A reduction in the size of the prostate gland b. Relaxation of the smooth muscle of the urethra c. Increased bladder tone that promotes bladder emptying d. Relaxation of the bladder detrusor muscle promoting urine flow

a. Finasteride results in suppression of androgen formation by inhibiting the formation of the testosterone metabolite dihydroxytestosterone, the principal prostatic androgen, and results in a decrease in the size of the prostate gland. α-Adrenergic blockers are used to cause smooth muscle relaxation in the prostate that improves urine flow. Drugs affecting bladder tone are not indicated.

Which therapies for BPH are done on an outpatient basis (select all that apply)? a. Intraprostatic urethral stents b. Transurethral needle ablation (TUNA) c. Transurethral incision of prostate (TUIP) d. Transurethral microwave therapy (TUMT) e. Visual laser ablation of the prostate (VLAP)

b, c, d. TUNA, TUIP, and TUMT are currently done on an outpatient basis or in a health care provider's office.

The nurse provides discharge teaching to a patient following a TURP and determines that the patient understands the instructions when he makes which statement? a. "I should use daily enemas to avoid straining until healing is complete." b. "I should avoid heavy lifting, climbing, and driving until my follow-up visit." c. "At least I don't have to worry about developing cancer of the prostate now." d. "Every day I should drink 10 to 12 glasses of liquids such as coffee, tea, or soft drinks."

b. Activities that increase intraabdominal pressure should be avoided until the surgeon approves these activities at a follow-up visit. Stool softeners and high-fiber diets may be used to promote bowel elimination but enemas should not be used because they increase intraabdominal pressure and may initiate bleeding. Because TURP does not remove the entire prostate gland, the patient needs annual prostatic examinations to screen for cancer of the prostate. Fluid intake should be high but caffeine and alcohol should not be used because they have a diuretic effect and increase bladder distention.

Before undergoing a TURP, what should the patient be taught? a. Some degree of urinary incontinence is likely to occur. b. This surgery results in some degree of retrograde ejaculation. c. Erectile dysfunction is a common complication of this prostate surgery. d. An indwelling catheter will be used to maintain urinary output until healing is complete.

b. Because of injury to the internal urinary sphincter, there is usually some degree of retrograde ejaculation following most transurethral surgeries, especially following TURP. The semen is ejaculated into the bladder and is eliminated with the next voiding. Urinary incontinence, erectile dysfunction, and continued catheterization are uncommon following TURP.

Priority Decision: A patient with continuous bladder irrigation following a prostatectomy tells the nurse that he has bladder spasms and leaking of urine around the catheter. What should the nurse do first? a. Slow the rate of the irrigation. b. Assess the patency of the catheter. c. Encourage the patient to try to urinate around the catheter. d. Administer a belladonna and opium (B&O) suppository as prescribed.

b. The nurse should first check for the presence of clots obstructing the catheter or tubing and then may administer a belladonna and opium (B&O) suppository if one is ordered. The patient should not try to void around the catheter because this will increase the spasms. The flow rate of the irrigation fluid may be decreased if orders permit because fast-flowing, cold fluid may also contribute to spasms.

Which treatment for BPH uses a low-wave radiofrequency to precisely destroy prostate tissue? a. Laser prostatectomy b. Transurethral needle ablation (TUNA) c. Transurethral microwave thermotherapy (TUMT) d. Transurethral electrovaporization of prostate (TUVP)

b. The transurethral needle ablation (TUNA) uses lowwave radiofrequency to heat the prostate, causing necrosis. Laser prostatectomy uses a laser beam. Transurethral microwave thermotherapy (TUMT) uses microwave radiating heat to produce coagulative necrosis of the prostate and is not used for men with rectal problems. Transurethral electrovaporization of prostate (TUVP) uses electrosurgical vaporization and desiccation to destroy prostate tissue.

Priority Decision: When caring for a patient following a radical prostatectomy with a perineal approach, what is the priority nursing intervention the nurse should use to prevent complications? a. Use chemotherapeutic agents to prevent metastasis. b. Administer sildenafil (Viagra) as needed for erectile dysfunction. c. Provide wound care after each bowel movement to prevent infection. d. Insert a smaller indwelling urinary catheter to prevent urinary retention.

c. A prostatectomy performed with a perineal approach has a high risk for infection because of the proximity of the wound to the anus, so wound care is the priority. Chemotherapy is usually not the first choice of drug therapy following surgery, nor is sildenafil. The catheter size would not be changed but the catheter would be removed. Urinary incontinence is a bigger problem than retention.

On admission to the ambulatory surgical center, a patient with BPH informs the nurse that he is going to have a laser treatment of his enlarged prostate. The nurse plans patient teaching with the knowledge that the patient will need to know what? a. The effects of general anesthesia b. The possibility of short-term incontinence c. Home management of an indwelling catheter d. Monitoring for postoperative urinary retention

c. Because of edema, urinary retention, and delayed sloughing of tissue that occurs with a laser prostatectomy, the patient will have postprocedure catheterization for up to 7 days. The procedure is done under local anesthetic, and incontinence or urinary retention is not usually a problem with laser prostatectomy.

Following a TURP, a patient has continuous bladder irrigation. Four hours after surgery, the catheter is draining thick, bright red clots and tissue. What should the nurse do? a. Release the traction on the catheter. b. Manually irrigate the catheter until the drainage is clear. c. Increase the rate of the irrigation and take the patient's vital signs. d. Clamp the drainage tube and notify the patient's health care provider.

c. Bleeding and blood clots from the bladder are expected after prostatectomy and continuous irrigation is used to keep clots from obstructing the urinary tract. The rate of the irrigation may be titrated to keep the clots from forming, if ordered, but the nurse should also check the vital signs because hemorrhage is the most common complication of prostatectomy. The traction on the catheter applies pressure to the operative site to control bleeding and should be relieved only if specific orders are given. The catheter does not need to be manually irrigated unless there are signs that the catheter is obstructed and clamping the drainage tube is contraindicated because it would cause distention of the bladder.

When taking a nursing history from a patient with BPH, the nurse would expect the patient to report a. nocturia, dysuria, and bladder spasms. b. urinary frequency, hematuria, and perineal pain. c. urinary hesitancy, postvoid dribbling, and weak urinary stream. d. urinary urgency with a forceful urinary stream and cloudy urine.

c. Classic symptoms of uncomplicated BPH are those associated with irritative symptoms, including nocturia, frequency, urgency, dysuria, bladder pain, and incontinence associated with inflammation or infection. Urinary obstruction symptoms include diminished caliber and force of the urinary stream, hesitancy, difficulty initiating voiding, intermittent urination, dribbling at the end of urination, and a feeling of incomplete bladder emptying because of urinary retention.

The extent of urinary obstruction caused by BPH can be determined by which diagnostic study? a. A cystometrogram b. Transrectal ultrasound c. Urodynamic flow studies d. Postvoiding catheterization

c. Urinary flow meters are used to measure the urinary flow rate, which is slowed with increased obstruction. Cystourethroscopy may also evaluate the degree of obstruction but a cystometrogram measures bladder tone. A transrectal ultrasound may determine the size and configuration of the prostate gland. Post voiding catheterization measures residual urine.

A patient asks the nurse what the difference is between benign prostatic hyperplasia (BPH) and prostate cancer. The best response by the nurse includes what information about BPH? a. BPH is a benign tumor that does not spread beyond the prostate gland. b. BPH is a precursor to prostate cancer but does not yet show any malignant changes. c. BPH is an enlargement of the gland caused by an increase in the size of existing cells. d. BPH is a benign enlargement of the gland caused by an increase in the number of normal cells.

d. Hyperplasia is an increase in the number of cells and in benign prostatic hyperplasia (BPH), it is thought that the enlargement caused by the increase in new cells results from hormonal changes associated with aging. Hypertrophy refers to an increase in the size of existing cells. The hyperplasia is not considered a tumor, nor has BPH been proven to predispose to cancer of the prostate.

What is the most common screening intervention for detecting BPH in men over age 50? a. PSA level b. Urinalysis c. Cystoscopy d. Digital rectal examination

d. The prostate gland can be easily palpated by rectal examination and enlargement of the gland is detected early if yearly examinations are performed. If symptoms of prostatic hyperplasia are present, further diagnostic testing, including a urinalysis, prostate-specific antigen (PSA), and cystoscopy, may be indicated.

What occurs with chronic bacterial prostatitis but not with acute prostatitis? a. Postejaculatory pain b. Frequency, urgency, and dysuria c. Symptoms of a urinary tract infection d. Enlarged, boggy prostate on palpation

d. The prostate with chronic bacterial prostatitis feels enlarged and firm, often described as boggy, and is tender. The other options are true of both chronic and acute prostatitis.

Which characteristics describe transurethral resection of the prostate (TURP) (select all that apply)? a. Best used for a very large prostate gland b. Inappropriate for men with rectal problems c. Involves an external incision prostatectomy d. Uses transurethral incisions into the prostate e. Most common surgical procedure to treat BPH f. Resectoscopic excision and cauterization of prostate tissue

e, f. The transurethral resection of the prostate (TURP) is the most common surgical procedure to treat BPH and uses a resectoscopic excision and cauterization of prostate tissue. A simple open prostatectomy is used for a large prostate and has an external incision. Transurethral incision into the prostate to expand the urethra for a small to moderate-sized prostate is done with a transurethral incision of the prostate (TUIP).