BPH NSG 130
after having turp done postop patient had continuous bladder irrigation in place c/o bladder spasm what can be done to relieve discomfort?what appropriate nursing action can relieve the discomfort of the patient
irrigate the foley with 30-50 cc ns as ordered
post op manual bladder irrigation
leave CBI hooked up not sterile in real life etoh wipe tray between legs 30 cc nss slight force to dislodge the clot pull and push quickly change tray q 24 hours. saline in =saline out
patient has turp and has continuous bladder irrigation.now 24 hours post op what color will the urine be in the drainage bag
light pink
what would the nurse include in a teaching plan for a client that is not yet a candidate for surgery?
maintain optimal bladder emptying
post op care bladder spasms
painful BO suppository beledona and opiate
increased psa test can be from?
prostititis
irritative symptoms
s/s like uti frequency urgency dysuria bladder pain nocturia incontinent at time surgery
what herb do you avoid when on proscar
saw palmetto
proscar(finistride)
shrinks the prostate takes 3=6 months to work make affect sexual function ***crush tablets should not be handled by pregnant women always glove*****
post of foley
3 way foley-red rubber foley 30 cc balloon 3 ports
potency can return when?
6-8 weeks
WHAT IS BPH
BENIGN PROSTATIC HYPERPLASIA
DRE
Digital Rectal Exam at age 40 palpate surface *soft= enlarges prostate ca= hard firm irregular nodule
a client comes to the clinic reporting urinary symptoms.what statement would you suspect bph?
Ive had trouble getting started when i urinate often straining to do so
post op complication TURP SYNDROME
Rare pt absorbs irrigation fluid decreases na level
gold surgical management
TURP- transurethral resection prostate scope int o the bladder to the narrowing then scrape done inpatient
you would do a rectal exam on?
a 52 year old man in good health done annually on men over 50
what to ask H&P
age void pattern symptoms
patient complains that he has to urinate and has a continuous irrigation cath what would the nurse do?
assess the system for patency
after turp patient cool clammy pulse 110 -24-90/40 what would you do?
assess urine,lower hob,elevate the foot of bed,contact the surgeon
what is the initial s/s reported by the patient with bph?
at first they notice that it takes more effort to void
where do you place the irrigation bag?
at the end of the bed facing the door to monitor
turp outcome patient improving
bladder spasm relieved by medication
terozin(hytrin) doxazosin(cardura) tamsulosin flomax
can cause ***orthostatic hypotension***,decrease smooth musle contraction relieving the obstruction and increasing the urine flow ***caution with otc cough cold and sinus med
discharge panning
cath care no long car ride force fluids void every 2-3 hours manage incontinence- kegal constipation- colace increase fiber and fluids avoid lifting s/s of infection sex in 6 weeks diet fiber fruits vegetables
pylonepherosis
complication UTI infected urine to the kidney infected kidney
renal failure
complication rare
Hyronephrosis
complication urine in the bladder,distention of the kidney
post op bladder irrigation CBI
continuous bladder irrigation done due to clots will have run keep urine clear done due to clot formation dont want back flow run to keep urine clear
dietary changes
decrease caffeine,spicy foods part of wait and see approach
restrict evening fluids why?
don't have to get up all night usually after 7 part of wait and see approach
post op traction
done to decrease the bleeding
PSA
done to screen for prostate ca Prostate specific antigen normal 0-4 increases at age 70-79 0-6.3 can be elevated related to uti should be done prior to DRE
a client is prescribed avodart as part of tx for bph.when teaching about the drug what is the drugs action?
drug interferes with testosterone and causes the prostate to shrink
avoid decongestants and anticolinergics why?
due to vasoconstriction part of wait and see approach
post op diet
encourage fluid and fiber
voiding schedule
every 2 hours part of wait and see approach
post op patient teaching
foley care valslva maneuver-never bear down *no vomit *no cough-*no lifting *bm kegal exercises-in the middle pass urine stop flow for 10 seconds 10 times a day once foley removed may have dribble or inc.
pre op preparation
foley-coude 12-14 fr iv abt-uti signed consent patient teaching:done spinal anesthetic,hob flat, increase fluids
onset for BPH
gradual onset
dx studies
h&p dre ua c/s psa serum creatnine post void residual
nursing dx post op
hemorrhage
Complications post op
hemorrhage urine will be cherry red
post op spinal precaution
hob flat 6 hours
serum creatnine
indicative of kidney damage
what is inconsistent with a dre
that it can reveal a hydrocele
what would indicate that the cath is occluded post op
the client reports bladder spasms and the urge to void
red urine and several large clots in tube of nss continuous irrigation cath.patient is day 1 post op turp intervention
titrate the nss to run faster for cherry red. day 1 should be pink
a patient is to undergo a turp for bph which is accurate in regards to turp?
urethral strictures are more frequent for turp than with non transuethal procedures,rarely causes erectile dysfunction
complications
urinary retention leads to a UTI
urinalysis
urine c&s to identify uti
obstructive symptoms
urine retention decrease flow of urine difficulty initiating urine dribble end of void incomplete bladder empty
Post void residual
void then cath want less then 100 in the bladder
which factor should be checked when evaluating the effectiveness of an alpha andronergic blocker given to a client?
voiding pattern-these drugs relax the smooth muscle of bladder neck and prostate
after turp client has 3 way bladder system in place for irrigation.when will the catheter be removed when the urine appears as?
when the urine appears yellow and clear
post op cath removal when will it be removed
when the urine is clear yellow urine after and first void in the am blood
post op teaching effective if the patient verbalizes
will call md if difficulty urinating
nursing dx undergoing turp
potential for hemmhorage
obstructive and irritative symptom complex caused by bph hypertrophy is called
prostatism
alpha andronergic blocker for a client.the nurse understands that this drug achieves what?
relieve urinary sx.due to relaxation of the smooth muscle.
Etiology of BPH
results from endocrine changes develops in the inner portion of the prostate->compression of the urethra
herb used for prostate shrinkage
saw palmetto don't take with other meds
risk factors for BPH
starts 40,surgery 60-70 FAMILY HX. African American environment diet
post op constipation will cause?
strain will cause more bleeding take colace
