Transcript Male GU 1c - Porterville College

Prostatic neoplasms / cancer
•
Behavioral Objectives
–
•
Describe etiology, pathophysiology, clinical
manifestations, nursing management and
patient education for Prostatic neoplasms /
cancer
Brunner and Suddarth’s Medical Surgical
Nursing pg 1752-61
Prostatic neoplasms / cancer
Pathophysiology
–
–
Most common cancer in men
Risk Factors
•
•
•
Increased age
African American Men
A familial predisposition
Prostatic neoplasms / cancer
Clinical manifestations
• Early stages
–
•
Late stage
–
–
–
•
asymptomatic
Urinary obstruction  Dysuria, hesitancy,
dribbling
Blood in the urine
Painful ejaculation
Metastasis to bone, lymph,
Prostatic neoplasms / cancer
Assessment and
diagnostic
procedures
•
DRE > 40
•
PSA
Prostatic neoplasms / cancer
Nursing process / Diagnosis / Interventions
•
Anxiety related to concern and lack of knowledge
about the diagnosis, treatment plan and prognosis
Uncertain outcomes, sexual dysfunction
– Assess
– Provide
– Teach
Prostatic neoplasms / cancer
Urinary retention related to urethral obstruction secondary to Prostatic
enlargement or tumor and loss of bladder tone due to prolonged
distention/retention
•
•
Baseline
S&S of retention
–
–
–
–
i urine output
h frequency
Supra-pubic distention
C/O urgency
Urinary retention cont.
Catheterize to check residual
–
–
–
•
•
•
Sterile
Irrigate
Monitor
Position for urination: normal
Administer meds
Monitor effects
Prostatic neoplasms / cancer
Deficient knowledge related to the diagnosis of
cancer, urinary difficulties and treatment
modalities
• Enc. communication
• Teach
– Terminology (anatomy)
– Catheter care
Prostatic neoplasms / cancer
Imbalanced nutrition: less than body requirements related to
decreased oral intake because of anorexia, nausea and
vomiting caused by cancer or its treatment
•
•
•
•
Assess % food
Weights
Food preferences
Recognize effect of medications and treatment on
appetite
N/V
•
–
•
Antiemetics & Oral care
Frequent small meals
Prostatic neoplasms / cancer
Sexual dysfunction related to effects of
therapy: chemotherapy, hormonal therapy,
radiation therapy surgery
– Assess sexual function
– Inform of treatments effects on sexuality
– Include the partner
Prostatic neoplasms / cancer
Pain related to progression of disease and
treatment modalities
• Evaluate pain
• Avoid activities that h pain
• Administer analgesics/Opiates
Prostatic neoplasms / cancer
Impaired physical mobility and activity intolerance related to
tissue hypoxia, malnutrition and exhaustion and to spinal
cord or nerve compression from metastases
•
Assess factors causing limited mobility
•
Administer pain relief
•
Encourage use of assistive devices
•
ROM
•
Positioning
•
Walking
•
Assess nutritional status
Prostatectomy
Transurethral resection
of the prostate:
TURP
•
•
Most common
Endoscopy
–
•
Surgical & optic
scope  urethra
 prostate
Gland removed in
small chips
TURP
Advantages
•
No abd. incisions
•
i Risks
•
Shorter hospital
•
i morbidity rate
•
i pain
Disadvantages
• Recurrent obstruction
– stricture
• Delayed bleeding
• Erectile dysfunction
TURP
Specific nursing implications
• Monitor for hemorrhaging
• Observe for urethral stricture
–
–
–
Dysuria
Straining
Weak urinary stream
Nursing Process - TURP
Assessment
• How affected pts life
• Urinary problems?
• Pain?
• Erectile dysfunction?
Nursing Dx - TURP
•
Preoperatively
–
–
–
Anxiety about surgery and its outcome
Acute pain related to bladder distention
Deficient knowledge about factors related to the
disorder and the treatment protocol
Nursing Dx - TURP
•
Postoperative
– Acute pain related to the surgical incision,
catheter placement and bladder spasms
– Deficient knowledge about postoperative care
and management
Nursing Interventions
•
Reducing anxiety
–
–
–
–
–
Assess support & coping
Est. & enc communication
Assess knowledge - educate
Inform routines
Privacy
Nursing Interventions
•
Relieving discomfort
– Bed rest
– Analgesic
– Assess bladder distention
Nursing Interventions
•
Preparing the patient
– Elastic compression stocking
– Enema
– No aspirin
Nursing Interventions
•
Maintaining fluid balance d/t irrigation of
surgical site
–
I&O
•
irrigation
– Check BP
– Confusion
– Respiratory distress  crackles
•
= fluid overload
Nursing Interventions
•
Relieving pain d/t bladder spasms
–
–
–
–
–
–
–
–
Day 1 dangle legs
Day 2 ambulate
Meds to relax bladders
Warm compresses to pubis
Sitz baths
Analgesics
Do not sit for a long time
Stool softeners
Nursing Interventions
•
Monitoring and managing potential
complication of hemorrhaging
–
–
–
–
–
Drainage red  pink  It pinks with in 24 hours
Monitor V/S
IV
Blood component treatment /transfusion
I&O
Nursing Interventions
•
Monitoring and managing potential
complication of infection
–
–
–
–
–
–
–
Monitor Temp & Vital signs
Heat lamp
Sitz bath
Antibiotics (Prophylactic)
Dysuria, urinary frequency, urgency
Aseptic technique with catheter
I&O
Nursing Interventions
•
Monitoring and managing potential
complication of Deep vein Thrombosis
– Prophylactic low dose heparin
– Elastic compression socks
– Monitor for DVT
•
•
Homan Sign
Check pedal pulses
– Early ambulation
Nursing Interventions
•
Monitoring and managing potential
complication of Obstructed Catheter
–
–
–
–
–
Lasix (Furosemide)
Increase fluids
Assess pain –
Check catheter for kinks, loops, placement
Decreased BP / increased pulse
Nursing Interventions
•
Monitoring and managing potential
complication of sexual dysfunction
–
–
–
–
–
Meds
Privacy
Sex therapy
Determine history of level of functioning
Include partner