Question

Charles Watts, age 68, was diagnosed with benign prostatic hypertrophy (BPH). He is admitted to the medical–surgical unit and scheduled for a transurethral resection of the prostate (TURP).  

Charles Watts, age 68, sought treatment from his healthcare provider for urinary symptoms. He complained of urgency, frequency, difficulty starting his urinary stream, nocturia, and post-void dribbling. After the digital rectal examination and a prostatespecific antigen (PSA) level that was slightly elevated, the diagnosis of prostatic hypertrophy was made. Mr. Watts was referred to the urologist, who, upon further testing, ruled out prostatic cancer and made the diagnosis of benign prostatic hypertrophy. Mr. Watts is now admitted to the medical–surgical unit for a transurethral resection of the prostate (TURP). He is 5 feet, 10 inches tall, and weighs 188 pounds. His admission vital signs are T 97.7°F, P 88, R 24, and BP 132/78. He has a past history of hypertension and a myocardial infarction 4 years ago that was treated by a surgical stenting procedure. He currently takes aspirin 81 mg p.o. daily and enalapril (Vasotec) 10 mg p.o. daily.  

1. Explain the pathophysiology of BPH and the reasons Mr. Watts experienced the urinary symptoms.  

2. The nurse assesses Mr. Watts regarding his knowledge of the scheduled surgical procedure, and he tells the nurse that other than his operation for placement of the stent in his heart, he has never had any other surgery. The nurse establishes that he has a nursing diagnosis of Knowledge Deficit related to pre- and postoperative measures important for prostate surgery as evidenced by patient statement. What preoperative teaching should the nurse include for Mr. Watts?  

3. What are the important nursing interventions related to the management of continuous bladder irrigation (CBI) by use of the three-way catheter?  

4. Why does the nurse assign the priority diagnosis Risk for Imbalanced Fluid Volume related to blood loss from the operative site and the possibility of absorbing excess fluid from the bladder irrigation solution?  

5. Mr. Watts questions the nurse regarding any special things he should do when he leaves the hospital. The nursing diagnosis of Readiness for Enhanced Therapeutic Regimen Management secondary to home care after prostate surgery as evidenced by patient questions is made. What discharge instructions does the nurse provide for Mr. Watts?  

6. Describe the pharmacological options available for the patient diagnosed with BPH.

Answer 1

Ans 1 :- there are lots of theory related to development of bph but most acceptable is androgen related.

Prostate has androgen receptor of his surface

High level of Dihydroxyteststerone seen in old age patients activated these receptor and causes prostatic enlargement and smooth muscles hyperplasia.

These hyperplasia causes bladder outflow obstruction and features like urinary urgency and frequency seen.

Ans 2 :- preoperative teaching for patients are:-

1.give patients whole information about procedure and also includes family member

2.information about what to wear on operation

3.ask patient to void (emptying the bladder) before operation

4.ask patient to do not take specific drugs like aspirin

5.ask patients to nil per oral (npo) before operation

Ans 3

1.use standerd precautions before procedure

2.prevent tube or cathater from kinking or obstruction

3.no dot clean peri urethral area vigorously with anti septic

4.check patency of all 3 ports regularly

5.always looks for sign of urinary tract infection

Ans 4

In TRUP procedure there is cancer of POST TRUP SYNDROME Which is dilation hyponatremia due to large amount of saline irrigation during TRUP.

So one should always look for hyponatremia and treat with 0.9% N.S. solution iv

Ans 5

1.do not take bath until catheter not removed

2.drinks lots of water

3.take fiber rich diet

Ans 6

Pharmacological options :-

1.Tamsulosin:- alpha antagonist

2.Finasteride:- 5-alpha reductase inhibitors