Mr. Smith with BPH is going to surgery for a TURP. Discuss the pathophysiology of this disease process, assessment of the patient, lab work and diagnostic tests appropriate for this patient to diagnose BPH and prior to going to surgery, discuss the pharmacology especially the medical management of BPH, and the nurses role in caring for this patient before and after the surgery including the CBI.
The pathophysiology of Benign Prostatic Hyperplasia (BPH) involves the growth of prostatic tissue, leading to the enlargement of the prostate gland. BPH is a common condition in aging males, characterized by urinary symptoms such as frequency, urgency, nocturia, weak urinary stream, and incomplete bladder emptying. These symptoms result from the compression of the urethra by the enlarged prostate, leading to obstruction of urine flow.
BPH can be assessed through a variety of means. Firstly, a comprehensive medical history is crucial, including information about the duration and severity of urinary symptoms, any associated comorbidities, and the impact of these symptoms on the patient’s quality of life. Additionally, a physical examination should involve a digital rectal examination (DRE) to assess the size and consistency of the prostate gland. The International Prostate Symptom Score (IPSS) can also be used to determine the severity of urinary symptoms.
To diagnose BPH, various laboratory tests and diagnostic procedures may be employed. In terms of laboratory work, a complete blood count (CBC) and a prostate-specific antigen (PSA) blood test are commonly performed. The CBC can help identify any secondary complications of BPH, such as urinary tract infections or anemia. The PSA test measures a protein produced by the prostate gland and can be elevated in BPH, although it is not specific to the condition and can also be elevated in prostate cancer.
Imaging studies also play a role in diagnosing BPH. Transrectal ultrasound (TRUS) can provide detailed images of the prostate gland and help determine the size and shape of the prostate. Additionally, a cystoscopy may be performed, which involves the insertion of a thin tube with a camera through the urethra to visualize the prostate gland and other structures.
Prior to surgery, pharmacological management options are available to alleviate symptoms and improve urinary flow in patients with BPH. The main categories of medications used for BPH are alpha-1 adrenergic antagonists and 5-alpha-reductase inhibitors. Alpha-1 adrenergic antagonists work by relaxing the smooth muscle of the prostate, leading to a reduction in urinary obstruction. Drugs in this class include tamsulosin, terazosin, and doxazosin. 5-alpha-reductase inhibitors, such as finasteride and dutasteride, inhibit the conversion of testosterone into dihydrotestosterone, which helps reduce the size of the prostate gland.
Another pharmacological option for managing BPH is the use of combination therapy with both alpha-1 adrenergic antagonists and 5-alpha-reductase inhibitors. This combination therapy has been shown to provide more significant improvements in symptoms and a reduction in prostate volume compared to monotherapy.
The nurse plays a crucial role in caring for patients with BPH, both before and after surgery. Before the surgery, it is important for the nurse to educate the patient about the procedure, including potential risks and benefits, as well as the expected outcome. The nurse should also ensure that the patient has a clear understanding of the preoperative instructions, such as fasting requirements and medication management.
During the surgery, Continuous Bladder Irrigation (CBI) may be used to prevent blood clots from obstructing the urinary catheter. The nurse is responsible for monitoring the patient during CBI, assessing urine output, and ensuring proper functioning and positioning of the irrigation system. The nurse should also monitor the patient for potential complications, such as infection or bleeding, and provide appropriate interventions.
After surgery, the nurse should closely monitor the patient’s vital signs, assess for pain, and ensure proper wound care. The nurse should also assist the patient with mobilization and encourage adequate fluid intake to promote urinary flow and prevent urinary retention. Furthermore, the nurse should provide education and support regarding post-operative care, including the management of any urinary symptoms or complications that may arise.
In conclusion, BPH is a common condition in aging males, characterized by urinary symptoms resulting from the enlargement of the prostate gland. The diagnosis of BPH involves a thorough assessment of the patient’s medical history, physical examination, laboratory tests, and imaging studies. Pharmacological management options are available to alleviate symptoms and improve urinary flow. The nurse plays a crucial role in providing preoperative education, monitoring the patient during surgery, and providing post-operative care, including monitoring for complications and ensuring proper wound care. The use of Continuous Bladder Irrigation (CBI) may be necessary to prevent urinary catheter obstruction after surgery.