BENIGN PROSTATIC HYPERPLASIA (BPH)
Benign prostatic hyperplasia is characterized by progressive enlargement of the prostate gland (commonly seen in men older than age 50), causing varying degrees of urethral obstruction and restriction of urinary flow.
CARE SETTING
Community level, with more acute care provided during outpatient procedures.
RELATED CONCERNS
Prostatectomy
Psychosocial aspects of care
Renal failure: acute
Patient Assessment Database
CIRCULATION
May exhibit: Elevated BP (renal effects of advanced enlargement)
ELIMINATION
May report: Decreased force/caliber of urinary stream; dribbling
Hesitancy in initiating voiding
Inability to empty bladder completely; urgency and frequency of urination
Nocturia, dysuria, hematuria
Sitting to void
Recurrent UTIs, history of calculi (urinary stasis)
Chronic constipation (protrusion of prostate into rectum)
May exhibit: Firm mass in lower abdomen (distended bladder), bladder tenderness
Inguinal hernia; hemorrhoids (result of increased abdominal pressure required to empty bladder against resistance)
FOOD/FLUID
May report: Anorexia; nausea, vomiting
Recent weight loss
PAIN/DISCOMFORT
May report: Suprapubic, flank, or back pain; sharp, intense (in acute prostatitis)
Low back pain
SAFETY
May report: Fever
SEXUALITY
May report: Concerns about effects of condition/therapy on sexual abilities
Fear of incontinence/dribbling during intimacy
Decrease in force of ejaculatory contractions
May exhibit: Enlarged, tender prostate
TEACHING/LEARNING
May report: Family history of cancer, hypertension, kidney disease
Use of antihypertensive or antidepressant medications, OTC cold/allergy medications containing sympathomimetics, urinary antibiotics or antibacterial agents
Self-treatment with saw palmetto or soy products
Discharge plan
DRG projected mean length of stay: 3.7 days
May need assistance with management of therapy, e.g., catheter
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Urinalysis: Color: Yellow, dark brown, dark or bright red (bloody); appearance may be cloudy. pH 7 or greater (suggests infection); bacteria, WBCs, RBCs may be present microscopically.
Urine culture: May reveal Staphylococcus aureus, Proteus, Klebsiella, Pseudomonas, or Escherichia coli.
Urine cytology: To rule out bladder cancer.
BUN/Cr: Elevated if renal function is compromised.
Prostate-specific antigen (PSA): Glycoprotein contained in the cytoplasm of prostatic epithelial cells, detected in the blood of adult men. Level is greatly increased in prostatic cancer but can also be elevated in BPH. Note: Research suggests elevated PSA levels with a low percentage of free PSA are more likely associated with prostate cancer than with a benign prostate condition.
WBC: May be more than 11,000/mm3, indicating infection if patient is not immunosuppressed.
Uroflowmetry: Assesses degree of bladder obstruction.
IVP with postvoiding film: Shows delayed emptying of bladder, varying degrees of urinary tract obstruction, and presence of prostatic enlargement, bladder diverticuli, and abnormal thickening of bladder muscle.
Voiding cystourethrography: May be used instead of IVP to visualize bladder and urethra because it uses local dyes.
Cystometrogram: Measures pressure and volume in the bladder to identify bladder dysfunction unrelated to BPH.
Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum).
Cystometry: Evaluates detrusor muscle function and tone.
Transrectal prostatic ultrasound: Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH.
NURSING PRIORITIES
1. Relieve acute urinary retention.
2. Promote comfort.
3. Prevent complications.
4. Help patient deal with psychosocial concerns.
5. Provide information about disease process/prognosis and treatment needs.
DISCHARGE GOALS
1. Voiding pattern normalized.
2. Pain/discomfort relieved.
3. Complications prevented/minimized.
4. Dealing with situation realistically.
5. Disease process/prognosis and therapeutic regimen understood.
6. Plan in place to meet needs after discharge.
Benign prostatic hyperplasia is characterized by progressive enlargement of the prostate gland (commonly seen in men older than age 50), causing varying degrees of urethral obstruction and restriction of urinary flow.
CARE SETTING
Community level, with more acute care provided during outpatient procedures.
RELATED CONCERNS
Prostatectomy
Psychosocial aspects of care
Renal failure: acute
Patient Assessment Database
CIRCULATION
May exhibit: Elevated BP (renal effects of advanced enlargement)
ELIMINATION
May report: Decreased force/caliber of urinary stream; dribbling
Hesitancy in initiating voiding
Inability to empty bladder completely; urgency and frequency of urination
Nocturia, dysuria, hematuria
Sitting to void
Recurrent UTIs, history of calculi (urinary stasis)
Chronic constipation (protrusion of prostate into rectum)
May exhibit: Firm mass in lower abdomen (distended bladder), bladder tenderness
Inguinal hernia; hemorrhoids (result of increased abdominal pressure required to empty bladder against resistance)
FOOD/FLUID
May report: Anorexia; nausea, vomiting
Recent weight loss
PAIN/DISCOMFORT
May report: Suprapubic, flank, or back pain; sharp, intense (in acute prostatitis)
Low back pain
SAFETY
May report: Fever
SEXUALITY
May report: Concerns about effects of condition/therapy on sexual abilities
Fear of incontinence/dribbling during intimacy
Decrease in force of ejaculatory contractions
May exhibit: Enlarged, tender prostate
TEACHING/LEARNING
May report: Family history of cancer, hypertension, kidney disease
Use of antihypertensive or antidepressant medications, OTC cold/allergy medications containing sympathomimetics, urinary antibiotics or antibacterial agents
Self-treatment with saw palmetto or soy products
Discharge plan
DRG projected mean length of stay: 3.7 days
May need assistance with management of therapy, e.g., catheter
Refer to section at end of plan for postdischarge considerations.
DIAGNOSTIC STUDIES
Urinalysis: Color: Yellow, dark brown, dark or bright red (bloody); appearance may be cloudy. pH 7 or greater (suggests infection); bacteria, WBCs, RBCs may be present microscopically.
Urine culture: May reveal Staphylococcus aureus, Proteus, Klebsiella, Pseudomonas, or Escherichia coli.
Urine cytology: To rule out bladder cancer.
BUN/Cr: Elevated if renal function is compromised.
Prostate-specific antigen (PSA): Glycoprotein contained in the cytoplasm of prostatic epithelial cells, detected in the blood of adult men. Level is greatly increased in prostatic cancer but can also be elevated in BPH. Note: Research suggests elevated PSA levels with a low percentage of free PSA are more likely associated with prostate cancer than with a benign prostate condition.
WBC: May be more than 11,000/mm3, indicating infection if patient is not immunosuppressed.
Uroflowmetry: Assesses degree of bladder obstruction.
IVP with postvoiding film: Shows delayed emptying of bladder, varying degrees of urinary tract obstruction, and presence of prostatic enlargement, bladder diverticuli, and abnormal thickening of bladder muscle.
Voiding cystourethrography: May be used instead of IVP to visualize bladder and urethra because it uses local dyes.
Cystometrogram: Measures pressure and volume in the bladder to identify bladder dysfunction unrelated to BPH.
Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum).
Cystometry: Evaluates detrusor muscle function and tone.
Transrectal prostatic ultrasound: Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH.
NURSING PRIORITIES
1. Relieve acute urinary retention.
2. Promote comfort.
3. Prevent complications.
4. Help patient deal with psychosocial concerns.
5. Provide information about disease process/prognosis and treatment needs.
DISCHARGE GOALS
1. Voiding pattern normalized.
2. Pain/discomfort relieved.
3. Complications prevented/minimized.
4. Dealing with situation realistically.
5. Disease process/prognosis and therapeutic regimen understood.
6. Plan in place to meet needs after discharge.
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