Sunday, July 29, 2007

"Prostate Hypertrophy"

1. Definition
The prostate is a gland in a man's reproductive system. It makes and stores seminal fluid, a milky fluid that nourishes sperm. This fluid is released to form part of semen. The prostate is about the size of a walnut. It is located below the bladder and in front of the rectum. It surrounds the upper part of the urethra, the tube that empties urine from the bladder. If the prostate grows too large, the flow of urine can be slowed or stopped.To work properly, the prostate needs male hormones (androgens). Male hormones are responsible for male sex characteristics. The main male hormone is testosterone, which is made mainly by the testicles. Some male hormones are produced in small amounts by the adrenal glands.

Prostatic Hypertrophy is malfunction of the urinary tract resulting from a lesion (benign or malignant) of the prostat gland.
Cancer is a group of many related diseases. These diseases begin in cells, the body's basic unit of life. Cells have many important functions throughout the body.

Normally, cells grow and divide to form new cells in an orderly way. They perform their functions for a while, and then they die. This process helps keep the body healthy.

Sometimes, however, cells do not die. Instead, they keep dividing and creating new cells that the body does not need. They form a mass of tissue, called a growth or tumor.

Tumors can be benign or malignant:

Benign tumors are not cancer. They can usually be removed, and in most cases, they do not come back. Cells from benign tumors do not spread to other parts of the body. Most important, benign tumors of the prostate are not a threat to life.Benign prostatic hyperplasia (BPH) is the abnormal growth of benign prostate cells. In BPH, the prostate grows larger and presses against the urethra and bladder, interfering with the normal flow of urine. More than half of the men in the United States between the ages of 60 and 70 and as many as 90 percent between the ages of 70 and 90 have symptoms of BPH. For some men, the symptoms may be severe enough to require treatment.

Malignant tumors are cancer. Cells in these tumors are abnormal. They divide without control or order, and they do not die. They can invade and damage nearby tissues and organs. Also, cancer cells can break away from a malignant tumor and enter the bloodstream and lymphatic system. This is how cancer spreads from the original (primary) cancer site to form new (secondary) tumors in other organs. The spread of cancer is called metastasis.

When prostate cancer spreads (metastasizes) outside the prostate, cancer cells are often found in nearby lymph nodes. If the cancer has reached these nodes, it means that cancer cells may have spread to other parts of the body -- other lymph nodes and other organs, such as the bones, bladder, or rectum. When cancer spreads from its original location to another part of the body, the new tumor has the same kind of abnormal cells and the same name as the primary tumor. For example, if prostate cancer spreads to the bones, the cancer cells in the new tumor are prostate cancer cells. The disease is metastatic prostate cancer; it is not bone cancer.

2. Pathophysiology

Prostate enlarges, bulges upward, block flow of urine from bladder into urethra-------------->obstruction------->hydroureter, hydronephrosis.

3. Risk Factors :

a. Benign
  • Changes in estrogen and endrogen levels.

  • Men > 50 Years Old

b. Malignant
  • Genetic tendency

  • Hormonal Factors (e.g., Late puberty, higher fertility)

  • Diet (high Fat)

  • Chemical carcinogens (fertilizer, rubber, cadmium batteries).

4. Assessment

a. Subjective Data

  • Difficulty starting stream

  • Smaller, less forceful

  • Dribbling

  • Frequency

  • Urgency

  • Nocturia

  • Tetention

  • Inability to void after ingestion of alcohol or exposure to cold

b. Objective Data

5. Alalysis/ Nursing Diagnosis
a. Urinary retention related to incomplete emptying
b. Altered urinary elimination related to obstruction
c. Urinary incontinence related to urgency, pressure
d. Anxiety related to potential surgery
e. Body image disturbance related to threat to male identity.

6. Nursing Care Plan
a. Goal : Relieve urinary retention
  • Catheterization : release maximum of 1000 mL initially; avoid bladder decompression, wich results in hypotension, bladder spasms, ruptured blood vessels in bladder; empty 200mL every 5 min.

  • Patency : Irrigate intermittently or continually, as ordered.

  • Fluids : minimum 2000 mL/24 hours.

b. Goal : Health Teaching.
  • Preparation for surgery (cystostomy, prostatectomy) :

  • Expectations (indwelling catheter------->will feel urge to void)

  • Avoid pulling on catheter (this increases bleeding and clots)

  • Bladder spasms commons 24-48 hours after surgery, particularly with TUR ans suprapubic approaches.

  • Threatening nature of procedure.

#References :
  • Sally L. Lagerquist, NCLEX-RN Examination Review, 1998

  • Dolores F. Saxton, Comprehensive Review Of Nursing For NCLEK-RN, Sixteenth Edition, Mosby, St. louis, Missouri, 1999.

  • The lippincott Manual of Nursing Practice, 7th Edition, 2005.

  • Nursing Procedures, Springhouse Publishing Co, 3rd, ed, Mosby, 2000

  • Pediatric Nursing Procedures, Vicky R.Bowden and Cindy Smith Greenbers, Lippincott Williams and Wolkins Publisher, 2003.


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