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