Download Male GU 1c - Porterville College

Prostatic neoplasms / cancer
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Behavioral Objectives
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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
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Most common cancer in men
Risk Factors
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Increased age
African American Men
A familial predisposition
Prostatic neoplasms / cancer
Clinical manifestations
• Early stages
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Late stage
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asymptomatic
Urinary obstruction  Dysuria, hesitancy,
dribbling
Blood in the urine
Painful ejaculation
Metastasis to bone, lymph,
Prostatic neoplasms / cancer
Assessment and
diagnostic
procedures
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DRE > 40
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PSA
Prostatic neoplasms / cancer
Nursing process / Diagnosis / Interventions
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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
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Baseline
S&S of retention
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i urine output
h frequency
Supra-pubic distention
C/O urgency
Urinary retention cont.
Catheterize to check residual
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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
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Assess % food
Weights
Food preferences
Recognize effect of medications and treatment on
appetite
N/V
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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
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Assess factors causing limited mobility
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Administer pain relief
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Encourage use of assistive devices
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ROM
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Positioning
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Walking
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Assess nutritional status
Prostatectomy
Transurethral resection
of the prostate:
TURP
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Most common
Endoscopy
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Surgical & optic
scope  urethra
 prostate
Gland removed in
small chips
TURP
Advantages
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No abd. incisions
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i Risks
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Shorter hospital
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i morbidity rate
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i pain
Disadvantages
• Recurrent obstruction
– stricture
• Delayed bleeding
• Erectile dysfunction
TURP
Specific nursing implications
• Monitor for hemorrhaging
• Observe for urethral stricture
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Dysuria
Straining
Weak urinary stream
Nursing Process - TURP
Assessment
• How affected pts life
• Urinary problems?
• Pain?
• Erectile dysfunction?
Nursing Dx - TURP
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Preoperatively
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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
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Postoperative
– Acute pain related to the surgical incision,
catheter placement and bladder spasms
– Deficient knowledge about postoperative care
and management
Nursing Interventions
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Reducing anxiety
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Assess support & coping
Est. & enc communication
Assess knowledge - educate
Inform routines
Privacy
Nursing Interventions
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Relieving discomfort
– Bed rest
– Analgesic
– Assess bladder distention
Nursing Interventions
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Preparing the patient
– Elastic compression stocking
– Enema
– No aspirin
Nursing Interventions
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Maintaining fluid balance d/t irrigation of
surgical site
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I&O
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irrigation
– Check BP
– Confusion
– Respiratory distress  crackles
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= fluid overload
Nursing Interventions
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Relieving pain d/t bladder spasms
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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
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Monitoring and managing potential
complication of hemorrhaging
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Drainage red  pink  It pinks with in 24 hours
Monitor V/S
IV
Blood component treatment /transfusion
I&O
Nursing Interventions
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Monitoring and managing potential
complication of infection
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Monitor Temp & Vital signs
Heat lamp
Sitz bath
Antibiotics (Prophylactic)
Dysuria, urinary frequency, urgency
Aseptic technique with catheter
I&O
Nursing Interventions
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Monitoring and managing potential
complication of Deep vein Thrombosis
– Prophylactic low dose heparin
– Elastic compression socks
– Monitor for DVT
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Homan Sign
Check pedal pulses
– Early ambulation
Nursing Interventions
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Monitoring and managing potential
complication of Obstructed Catheter
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Lasix (Furosemide)
Increase fluids
Assess pain –
Check catheter for kinks, loops, placement
Decreased BP / increased pulse
Nursing Interventions
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Monitoring and managing potential
complication of sexual dysfunction
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Meds
Privacy
Sex therapy
Determine history of level of functioning
Include partner