conditions of prostate; refers to any condition that affects the prostate. the prostate is an...

CONDITIONS OF THE PROSTATE

PRESENTED

BY:

ONYEKWUO CHINONYE FESTA

RN, RM, BNSC, PGDE, MSC (IN-VIEW).

AT THE MANDATORY CONTINUING PROFESSIONALDEVELOPNMENT PROGRAMME

(MCPDP)ORGANIZED BY:(N&MCN) AND IMO STATE M. C.

P.D. P IMPLEMENTATION COMMITTEEVENUE: NEWTON HOTEL OWERRI

DATE: 7TH -11Th JULY, 2014

INTRODUCTION

Conditions of prostate; refers to any condition

that affects the prostate.

The prostate is an internal male organ,

Walnut –sized and located between the

bladder and the penis.

The prostate gland serves to usher urine

through the body in a tube called the Urethra.

INTRODUCTION CONTDS;

And also provides seminal

fluid, which helps sperm

develop.

Examples of prostate common

conditions includes; prostatitis,

prostate Cancer, and Benign

Prostate Hyperplasia (BPH).

OBJECTIVESThis paper seeks to;

Review the Anatomy and physiology of the prostate gland

Discuss the concept, causes, pathophysiology and management of patients with;

Prostatitis

Benign Prostatic

hyperplasia (BPH)

Prostate cancer.

Utilize the nursing process/ care plan in the management of these patients.

ANATOMY AND PHYSIOLOGY OF THE PROSTATE GLAND

The prostate gland is a

musculo- glanduar organ about the

size and shape of walnut.

It lies just below the neck of the

bladder and surrounds the urethra

posteriorly and laterally.

It is traversed by the ejaculatory

ducts and the continuation of the

vas deferens.

The gland consists of a capsule

and numerous partitions.

The cells lining the partitions

secrete prostatic fluid.

There are 10-20 short ducts that

carry secretion of the prostate

gland to the prostate part of the

urethra.

The prostatic fluid is chemically

and physiologically suitable to the

needs of the spermatozoa in their

passage from the genital glands.

The fluid is a thin milky fluid that

contains calcium, citrate ion,

phosphate ion, a clotting enzyme,

and a profibrinolysin.

During emission, the capsule of the prostate gland contracts simultaneously with the contractions of the vas deferns and the prostate fluid is added to the semen.

The slightly alkaline characteristic of the prostatic fluid helps neuturalize the citric acid from the vas deferns

And therefore is important for protecting the sperm till fertilization of the ovum.

PROSTATITIS

INFLAMMATION OF THE PROSTATE

There are four types of Prostatitis including;

Acute Bacterial Prostatitis

Chronic Bacterial Prostatitis

Chronic Pelvic pain Syndrome

(PPS), also called Asymptomatic

protatitis.

In most cases, the causes of

the inflammation are

unknown. However, Prostatitis

can be caused by bacteria.

Bacterial Prostatitis responds

well to anti bacterial drugs

that Concentrate in the

prostate.

Men of any age can be affected.

Condition is marked by pain in the

groin. Sometimes there may be

difficulty in urinating.

Acute Bacterial Prostatitis: This is

usually caused by E.coli, klebsiella or

Chlamydia organisms, symptoms are

similar to a urinary tract infection with

fever, fatigue and body aches.

There may be an increase in the

urgency and frequency of

urination.

Sometimes there is blood in the

urine.

Antibiotics, pain relievers and

bed rest are the usual treatment.

Chronic Bacterial Prostatitis

Is a much milder condition than the acute form

And involves episodes of infections that come

and go.

Treatment recommendation includes

antibiotics,

Pain relievers and soothing treatments such as

sitz bath.

PATHOPHYSIOLOGY

The prostate gland becomes

swellon and painful due to

bacterial infection or any other

inflammatory source.

The prostate surrounds the

urethra, but when inflamed,

It can compress the urethra

and results to urinary

obstruction.

In severe cases, prostate abscess

can occur.

Men with prostatitis mainly

complain of urination problem, such

as difficulty starting the stream

Or the need to strain on urination;

lower back pain, pelvic pain and

perineum pain are the common

symptoms

Also pain during or after

ejaculation may be felt.

The patient with bacterial

prostatitis often complains of

symptoms of urinary tract

infections.

Usually they complain of

urgency, frequency, painful

micturition and haematuria.

Bacteria infections results to

fever, chills and general

weakness.

Acute bacterial prostatitis

present with severe

symptoms while symptoms

of non bacterial are usually

mild.

SYMPTOMS OF PROSTATIS INCLUDES;

Difficult and painful urination

Low back pain

Fever

Pain in the genital and pelvic areas

Painful ejaculation

BENIGH PROSTATIC HYPERPLASIA.

INTRODUCTION;

Benign Prostatic Hyperplasia is a

progressive disease that is commonly

associated with lower urinary tract

symptoms (Nwoforame, 2013)

This is a benign enlargement of the

prostate gland.

In many patients above fifty

(50) years of age,

The prostate gland enlarges

extending upwards into the

Bladder and obstruct the

outflow of urine by

encroaching on the vesical

orifice.

It is estimated that 70% of men aged over

6o years and above should have some

prostate enlargement (Wale, 2013.)

Approximately half of these men will

experience symptoms ranging from mild to

severe.

These are due to the enlarging prostate

interfering with the free flow of urine from

the bladder into the urethra.

The prostate gland is usually

small during boyhood.

But between puberty and the

age of about (20) years,

increases roughly five fold in size.

Further enlargement is

increasingly common as the

gland becomes hyperplastic.

AETIOLOGY: Generally idiopathic but factors associated

are as follows;

AGEING: Increases estrogen and Androgens

receptor while testosterone decreases.

DHT: Specific mediator for prostate development

and

Increase in prostate specific androgen growth

i. e increase prostatic DHT and AR in ageing

males

Early castration in life prevents

development of prostate.

May be as a result of inflammatory

process and malignancy.

Decrease testosterone level as men

age

Failure in spermatic venous drainage

Infections like gonorrhea. (Bello,

2013.)

PATHOPHYSIOLOGY

Benign Prostate hypertropy is the

enlargment of the prostate gland

with hypertrophy and hyperplaxia of

the normal tissue in men over 50

years.

As men age, production of

androgenic hormones decreases

causing an imbalance in androgen

And oestrogen levels and high levels

of dihydrotestosterone (the main

prostatic intracellular androgen)

This results into inflammation and

enlargement of the prostate gland

(hyperplasia) and changes in

periurethral glandular tissue.

Gradually he experiences difficulty

in starting the flow of urine, reduced

urine stream, force and size,

straining.

And a feeling of incomplete

voiding, urgency and

frequent urination with

nocturia.

Incomplete voiding makes

the bladder to refill more

quickly.

In severe cases the bladder

becomes over distended,

Hypertrophy with small

diverticular musculature

that retains urine when the

bladder empties.

The back flow of urine

causes hydroureter or even

hydronephrosis thereby

impairing renal functions.

CLINICAL MANIFESTATIONObstructive and irritative symptom complex (prostatism) made up of:

Increased frequency of

urination.

Nocturia.

Urinary urgency

CLINICAL MANIFESTATION CONTD;

Hesitancy in starting

urination.

Abdominal straining.

A decrease in size or force of

urinary stream

Interruption of urinary stream

Terminal dribbling

A sensation of incomplete

emptying of the bladder

Acute urinary retention (post

voidal residual volume of more

than 60ml of urine).

Recurrent urinary tract

infections.

Generalized Symptoms.

Fatigue secondary to

nocturia.

Anorexia.

Nausea and vomiting

Epigastric discomfort.

DIAGNOStic PROCESS

History taking Physical examination

Rectal examination for

size and evidence of

tumor

DIAGNOSIS PROCESS CONTDS;

Palpation, percussion,

auscultation.

Cystoscopy

Biopsy of the prostate

gland.

DIAGNOSIS PROCESS continues;

Renal function test.

Serum creatinine analysis

Serum urea and

electrolyte.

Haematologic

investigation.

Urine analysis,

Culture and

sensitivity.

MANGEMENT OF ACUTE URINARY RETENTION

Urethral

Catheterization

Emergency (“blind’)

suprapubic cytostomy,

Open suprapubic

cytostomy

TREATMENT OPTIONS

Watchful waiting (Observation)

Medical Treatment

Transurethral resection of the

prostate (TURP)

Transurethral incision of the

prostate (TUIP)

Open prostatectomy.

WATCHFUL WAITING (OBSERVATION)

Patients with only mild

symptoms with little impact

on quality of life

And with no evidence of

complications can be

managed conservatively

Advice about reducing fluid

intake

And avoiding

caffeinated drinks and

alcohol.

Advice patients under

observation to ask for

further medical

consultation if their

condition deteriorate.

No optional time for follow

up/ intervention.

Regular sexual intercourse

(to relieve prostatic

congestion).

Sitz bath

Prostatic massages. (Bello,

2013.)

MEDICAL TREATMENT Alpha- Adrenegic Antagonists

Inhibiting these receptors relaxes the

muscle and decreases urinary outflow

resistance, thereby improving symptoms.

Phenoxybenzamina- A non selective

alpha blocker(blocks (a- 1 and a-2

receptors)

Prazosin- Relatively selective a- 1 blocker

Terazosin/ doxazosin- Relatively selective

a-1 blockers

Tamsulosin- Superselective blocker for

the a-1A subtype

5-a Reductase Inhibitor

Testosterone is converted to

dihydrotestosterone (DHT) by the

enzymes 5-alpha reductase within the

prostate cell. DHT induces BPH by acting

on the prostate tissue.

Finasteride

Dutestaride

Phytotheraphy

Refers to the use of plant

extracts(Saw Palmetto( Sabal

Serrulate)

Thought to act via alpha

receptor blockade, and 5ARI

inhibition & intra-prostatic

androgen blockade

COMMON ADVERSE EFFECTS

Cardiovascular System

•Postural hypotension

•Headache

•Central Nervous

System

•Dizziness

•Asthenia

•Somnolence

Genitourinary System

Abnormal

ejaculation

Anejaculation

TYPES OF PROSTATECTOMIES AND ITS INDICATIONS:

.

TYPES INDICATORS

1. Perineal Prostactectomy -Prostate Cancer-Benign Prostate hypertrophy -If the prostate is too large for transurethral resection-When the patient is no longer sexually active.

2. Supra-Public Prostatectomy -Benign Prostate hypertrophy - If the prostate is too large for transurethral resectionProstate cancer

3. Transurethral resection prostatectomy

-Benign prostate hypertrophy-- Moderately enlarged prostate--Prostate cancer, as a palliative measure to remove obstruction

TYPES OF PROSTATECTOMY AND ITS INDICATIONS contds:

TYPES INDICATIONS

4. Retro pubic prostatectomy

-Benign prostate hypertrophy -If the prostate is too-large for transurethral resection -Prostate cancer- Confirmed Prostate cancer

5. Radical perineal prostatectomy

-when the patient is no longer sexually active.

NURSING CARE PLAN OF A PATIENT UNDERGOING PROSTATECTOMY

PRE-OPERATIVE NURSING CARE PLAN.

NURSING

DIAGNOSI

S

OBJECTIVES NURSING ORDERS SCIENTIFIC PRINCIPLES/ RATIONALE EVALUATI

ON

Anxiety

related

to fear

of

unknow

n/outco

me of

the

surgery

as

evidenc

ed by

patient

asking

too

many

questio

ns

Patient

anxiety

will be

allayed

within

24hours

of

admissio

n

1.Maintain

rapport wilt

patient.

2.Ressure

patient and

explain

procedures to

him and

promptly attend

to his needs.

3. Permit his

visitors to see

him and allow

him to

participate in

some activitiess

4. Avoid noise

rush, confusion

and impatience

on the part of

members of

staff.

1. Rapport establishes a

therapeutic relationship, which

reduce anxiety.

2. Knowing that something is being

done or is going to be done provides

reassurance and reduces

apprehension.

3. Visitors and participant in activities

keep him interested and occupied.

4. Unfavourable stimulus aggravates

the patient and increases his anxiety.

5. Valium is a sedative, which receives

anxiety and apprehension.

Patient

s

anxiety

was

allayed

as

evidenc

e by his

cheerfu

lness

and

chats

with

the

nurses

and

relation

.

2.

Ineffective

airway

clearance

related

effects of

anaesthesia

evidenced

breath

sound and

shallow

respiration.

Patient will

Maintain

adequate

ventilation

post-

Operatively.

1Placed patient in

supine Position

with head tilt to

one side.

2.Monitor vital

signs closely

3.Encoursge

patient to

coughing deep

breathe and

change positions

as soon as

consciousness is

regained.

4. Sunction PRN

5. Give O2

1. Supine position prevents

obstructions of the airway and

promotes drainage of

secreations and vomitus

2. Helps to asses the progress

of his condition.

3. Coughing, deep breathing

execerise and frequent

position clears secreations,

prevent pulmonary

complication and prevent bed

sore, helps lungs expansion

and drainage of secreations.

Patient

Maintained

adequate

Ventilation as

evidence by

his Respiratory

rate of 20per

minute and

did not

develop

respiratory

Complications

2.

Ineffective

airway

clearance

related

effects of

anaesthesia

evidenced

breath

sound and

shallow

respiration.

Patient will

Maintain

adequate

ventilation

post-

Operatively.

1Placed patient in

supine Position

with head tilt to

one side.

2.Monitor vital

signs closely

3.Encoursge

patient to

coughing deep

breathe and

change positions

as soon as

consciousness is

regained.

4. Sunction PRN

5. Give Oxygen

PRN

1. Supine position prevents

obstructions of the airway and

promotes drainage of

secreations and vomitus

2. Helps to asses the progress

of his condition.

3. Coughing, deep breathing

execerise and frequent

position clears secreations,

prevent pulmonary

complication and prevent bed

sore, helps lungs expansion

and drainage of secreations.

4. Sunctioning clears airway

obstruction

5. Oxygen ensures organ

tissue perfusion.

Patient

Maintained

adequate

Ventilation as

evidence by

his Respiratory

rate of 20per

minute and

did not

develop

respiratory

Complications

Acute pain

related to surgical incision/ Bladder spasms.

Patient will

verbalize reduction

in pain within

48hours post-

operatively

1.keep patient

quiet and

comfortable

during

immediate

post-operative

period.

2.remind the

patient to

avoid trying

to void.

3.maintain

catheter

patency

4.administer

prescribed

antispasamodic

s & analgesic.

1.This prevents episodes

of spasms and

bleeding

2.Trying to void around

the catheter causes

the bladder muscles to

contract causing a

painful bladder spasms

3.Maintenance of

catheter patency

prevents clots.

4.Antipasmodics

decreases painful

bladder spasms by

acting on the smooth

muscles while

Analgesics relieved

incision pains by

blocking the pain

nervous part way

thereby blocking

interpretation of pain

Patient

verbalized

reduction in

pain after

48hous of

post-

operative

care.

Acute pain

related to surgical incision/ Bladder spasms.

Patient will

verbalize reduction

in pain within

48hours post-

operatively

1.keep patient

quiet and

comfortable

during

immediate

post-operative

period.

2.remind the

patient to

avoid trying

to void.

3.maintain

catheter

patency

4.administer

prescribed

antispasamodic

s & analgesic.

1.This prevents episodes

of spasms and

bleeding

2.Trying to void around

the catheter causes

the bladder muscles to

contract causing a

painful bladder spasms

3.Maintenance of

catheter patency

prevents clots.

4.Antipasmodics

decreases painful

bladder spasms by

acting on the smooth

muscles while

Analgesics relieved

incision pains by

blocking the pain

nervous part way

thereby blocking

interpretation of pain

Patient

verbalized

reduction in

pain after

48hous of

post-

operative

care.

COMPLICATIONS

Haemorrhage

Shock

Infection

Thrombosis

Catheter obstruction

Renal failure

PROSTATE CANCER

INTRODUCTION

Prostate cancer is the most common

cancer in men.

It is responsible for 10% of cancer

related deaths in men (ACS, 2003 in

Brunner and Suddarth).

Prostate cancer is a form of cancer that

develops in the prostate, a gland in the

male reproductive system.

Most prostatic cancers are

however slow growing, however,

there are cases of aggressive

prostate cancers.

The cancer cells may metastasize

from the prostate to other parts

of the body particularly the bones

and lymph nodes.

EPIDEMIOLOGY OF PROSTATE CANCER

PROSTATE CANCER DEVELOPS PRIMARILY IN

MEN OVER 50 YEARS. THE RATES OF PROSTATIC CANCER

VARY WIDELY ACROSS THE WORLD (GLOBAL CANCER STATISTICS, 2011).

THE RATES ALSO VARY WIDELY BETWEEN CONTINENTS, ACCORDING TO THE AMERICAN CANCER SOCIETY,

PROSTATE CANCER IS LEAST COMMON AMONG ASIAN MEN, MOST COMMON AMONG BLACK MEN, WITH FIGURES OF WHITE MEN IN BETWEEN.

IN NIGERIA, 2010 DATA

BASE COMPILED BY (FERLAY

ETAL FOR THE

INTERNATIONAL AGENCY

FOR RESEARCH ON CANCER)

PROVIDES THE

FOLLOWING DATA FOR

PROSTATE CANCER:

ESTIMATED NUMBER OF NEW

CASES PER YEAR: 6,236

ESTIMATED ONE YEAR

PREVALENCE:4,932

ESTIMATED 5 YEARS

PREVALENCE: 16,237

THE BOTTOM LINE IS THAT THE

INCIDENCE OF PROSTATE

CANCER

RISK FACTORS

AGE

FAMILY

HISTORY/GENETICS

DIETARY

FOLIC ACID SUPPLEMENTS

HIGH ALCOHOL INTAKE

MEDICATION

EXPOSURE

INFECTIONS

OBESITY AND

ELEVATED BLOOD

LEVELS OF

TESTOSTERONE

PATHOPHYSIOLOGY

Cancer of the prostate

usually starts as a nodule in

the perterior lobe of the

gland that is farthest from

the urethra.

If the tumour grows large

enough, it can obstruct

urinary flow and cause

frequency, nocturia and

dysuria.

The malignancy usually

spreads by the bloodstream

and lymphatics to the pelvic

lymph nodes and bones,

particularly the lumber

vertebrae, pelvis and hips.

The first symptoms the patient

usually notices is a back pain

Or a pain down the leg

due to metastasis to the

nerve sheaths.

A patient with these and

other symptoms is often

in the advanced stage of

the disease.

CLINICAL FEATURES THE SIGNS AND SYMPTOMS ARE:

FREQUENT URINATION

NOCTURIA

DIFFICULTY STARTING AND

MAINTAINING A STEADY

STREAM OF URINE

HAEMATURIA

DYSURIA

OBSTRUCTION OF URINARY FLOW

CAUSING STRAINING ON

VOIDING, REDUCED SIZE AND

FORCE OF URINARY STREAM.

ADVANCED PROSTATE CANCER

CAN SPREAD TO OTHER PARTS OF

THE BODY CAUSING ADDITIONAL

SYMPTOMS, SUCH AS:

BONE PAINS, IF THE VERTEBRAE

(BONES OF THE SPINE), PELVIS OR

RIBS ARE INVOLVED.

PERINEAL AND RECTAL

DISCOMFORTS.

ANAEMIA,WEIGHTLOSS,

WEAKNESS, NAUSEA.

OLIGURIA (FROM URAEMIA)

LOW EXTREMITY OEDEMA

oPROSTATE CANCER IN THE SPINE

CAN ALSO COMPRESS THE

SPINAL CORD CAUSING LEG

WEAKNESS, URINARY AND

FAECAL INCONTINENCE.

PROSTATE CANCER MAY ALSO

CAUSE PROBLEMS WITH SEXUAL

FUNCTIONS

AND PERFORMANCE, SUCH AS

DIFFICULTY ACHIEVING ERECTION

OR PAINFUL EJACULATION.

ASSESMENT AND DIAGNOSTIC FINDINGS

CANDIDATES FOR EARLY DETECTION:

MEN 50 YEARS AND OLDER

MEN 45 YEARS OLD OR OLDER

And WITH A FAMILY HISTORY

OF PROSTATE CANCER IN

AFRICAN AMERICAN

ETHNICITY.

DIAGNOSTIC MEASURES USED IN COMBINATION FOR EARLY DETECTION:

DIGITAL RECTAL EXAMINATION (DRE)

SERUM PROSTATE SPECIFIC ANTIGEN

(PSA) TEST

PROSTATIC ACID PHOSPHATASE (PAP)

LEVEL

TRANSRECTAL ULTRASOUND NEEDLE

BIOPSY

METASTATIC WORKUP WHICH MAY

INCLUDE:

BONE SCAN

SKELETAL X-RAY

COMPUTED TOMOGRAPHY (CT)

SCAN

MAGNETIC RESONANCE IMAGING

(MRI) ARE NECESSARY TO

DETECT LOCAL EXTENSION, BONE

AND LYMPH NODE INVOLVEMENT

OR TO RULE OUT METASTASIS.

CLASSIFICATION OF PROSTATE CANCER

An important part of evaluating

prostate cancer is determining the

stage or how far the cancer has spread.

Knowing the stage helps define

prognosis and useful when selecting

therapies.

The most common system is the four

stage TNM System (abbreviated

from tumour/nodes/metastases).

It components include the size of

the tumour,

The number of lymph nodes

involved and the presence of any

other metastases.

The most important distinction made by any staging system is whether or not the cancer is still confined to the prostate.

In the TNM system, clinical T1 and T2 cancers are found only in the prostate,

While T3 and T4 cancers have spread elsewhere.

MANAGEMENT OF PROSTATIC CANCER

Prostate cancer especially

the most common, low grade

forms found in the typically

elderly patient

Often grow so slowly that no

treatment is required at all.

Because of PSA screening,

almost ninety percent of

patients are diagnosed when

the cancer is localized to the

prostate gland

And its removal by surgery or

radiotherapy will in most cases

lead to a cure.

RADIATION THERAPY

HORMONAL THERAPY

CHEMOTHERAPY: High dose of

ketoconazole (HDK) lowers

testosterone through its ability

to decrease both testicular and

endocrine production of

androgen.

Oral chemotherapeutic drugs

like Temozolomide (TMZ).

CRYOSURGERY OF THE

PROSTATE: It is used to ablate

(remove or excise) prostate

cancer in patients who cannot

tolerate surgery and in those

with recurrent prostate cancer.

Chemotherapy agents such as

cyclophosphamide may also be

used.

SURGICAL MANAGEMENT OF PROSTATE CANCER

Surgical Approaches (procedures) are:

TRANSURETHRAL RESECTION OF

THE PROSTATE (TURP)

SUPRAPUBIC PROSTATECTOMY

LAPAROSCOPIC RADICAL

PROSTATECTOMY

COMPLICATIONS

AFTER TOTAL

PROSTATECTOMY (USUALLY

FOR CANCER) IMPOTENCE

ALMOST ALWAYS RESULTS.

FOR THE PATIENT TO WHOM

THIS IS UNACCEPTABLE,

OPTIONS ARE AVAILABLE TO

PRODUCE ERECTIONS

SUFFICIENT FOR SEXUAL

INTERCOURSE;

PROSTHETIC PENILE IMPLANTS

AND PHARMACOLOGICAL

INTERVENTIONS LIKE

SILDENAFIL (VIAGRA).

COMPLICATIONS MAY ALSO INCLUDE:

HAEMORRHAGECATHETER OBSTRUCTION

INFECTIONWOUND DEHISCENCE

NURSING MANAGEMENT USING NURSING PROCESS

NURSING DIAGNOSIS (1)

KNOWLEDGE DEFICIENT REGARDING

MANAGEMENT / TREATMENT OPTION

ABOUT THE DISEASE CONDITION.

NURSING OBJECTIVE

PATIENT WILL VERBALIZE

UNDERSTANDING AND IMPROVEMENT

IN HIS COPING ABILITY.

PLANNING AND IMPLEMENTATIONS

OBTAIN HEALTH HISTORY TO

DETERMINE THE LEVEL OF

UNDERSTANDING OF HIS HEALTH

PROBLEM,

Obtaining health history clarifies

information and facilitates

patient’s understanding and

coping Education about diagnosis

and treatment plan helps

decrease his anxiety and

promotes co-operation.

ASSESS HIS PSYCHOLOGICAL

REACTIONS TO HIS

DIAGNOSIS/PROGNOSIS AND HOW

HE HAS COPED WITH PAST

STRESSES,

Assessment of his psychological reaction provides clues in

determining appropriate measures to facilitate coping.

ENCOURAGE PATIENT TO ASK QUESTIONS AND

ANSWER THE QUESTIONS, Encouraging patient

to ask questions helps to correct

misconceptions and to allay patient’s fears.

EVALUATION

Patient becomes relaxed and verbalizes that

anxiety has been reduced. Demonstrates

understanding of illness. Engages in open

communication with others.

NURSING DIAGNOSIS (2)• Acute Urinary retention related to urethral obstruction secondary

to prostatic enlargement and loss of bladder tone.

NURSING OBJECTIVE

Patient’s pattern of urinary

elimination will improve within

forty eight hours of hospitalization.

PLANNING AND IMPLEMENTATION

Determine patient’s pattern of urinary

function, Determining patient’s usual

urinary pattern provides a base line

for comparison and goal to work

towards.

Assess for signs and symptoms of

urinary retention e.g. amount and

frequency of urination, supra pubic

distention, complaints of urgency and

discomfort.

Because Voiding 20 to 30 ml

frequently and output less than intake

suggest retention.

Catheterize patient to determine

amount of residual volume,

Catheterization determines amount of

urine remaining in bladder after

voiding.

Monitor catheter function and

maintain sterility of closed system,

Catheter function ensures the bladder

is emptied and also prevents Infection.

Prepare patient for

surgery if indicated,

Surgical removal of

obstruction is necessary

EVALUATION

Patient voids at normal

interval, maintains

balanced intake and

output.

NURSING DIAGNOSIS (3)

Imbalanced nutrition less than

body requirements related to

decreased oral intake because of

anorexia, nausea and vomiting

caused by cancer/ its treatment.

NURSING OBJECTIVE

Patient will maintain optimal

nutritional status.

PLANNING AND IMPLEMENTATION

Assess the amount of food eaten,

Assessment will help determine nutrient

intake.

Weigh patient routinely, Weighing the

patient on the same scale under similar

conditions can help to monitor changes in

weight.

Elicits patient’s explanation of why he is

unable to eat more, His explanations may

present easily corrected practices.

Cater to his individual food

preferences (e.g. avoiding foods

that are too spicy or too cold.) He

will be more likely to consume

larger servings if food is palatable

and appealing

Recognize effect of medication or

radiation therapy on appetite,

Many chemotherapeutic agents

and radiation therapy promotes

anorexia.

Inform patient that alteration in taste

can occur, Ageing and the process can

reduce taste sensitivity.

In addition smell and taste can be

altered as a result of the body’s

absorption of byproducts of cellular

destruction (brought on by malignancy

and its treatment).

Use measures to control nausea and

vomiting; Prevention of nausea and

vomiting can stimulate appetite.

Provide oral hygiene after vomiting episodes.

Provide rest periods after meals, Smaller portion of food are less overwhelming to the patient.

Administer anti- emetics if necessary.

Provide small meals and a comfortable and pleasant environment.

EVALUATION

Responds positively to his

favourite foods.

Reports absence of nausea

and vomiting.

Notes or notices increase

in weight after improved

appetite

CONCLUSION

This is detailed review of the

conditions of the prostate, with

emphasis on modern nursing plan of

care.

It is a fact that most men over the

age of 60 years are prone to have

prostate problem.

We have also establish that

the effective way to control the

increase in cases of prostate,

Is to put in place more check

up centres in urban and rural

health care facilities.

Also, it is necessary we create

awareness and encourage most

men of age, to go for check up

on regular basis.

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Mustapha R. O (2008): The easier approach To pharmacology of health professionals (2nd edition) Union Linpincolt, Williams and Wikins Publication

Nwoforame (2013): Benign prostate Hyperplasia, Recent Advances

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(2007) Alexander’s care of the patient in Surgery (13th edition) Philadelphia: Mosby Elsevier.

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FOR YOUR KIND ATTENTION,

MANY THANKS