benign prostatic hyperplasia.ppt2

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BENIGN

PROSTATICHYPERPLASIA



THE PROSTATE



ENLARGED PROSTATE



Benign prostatic hyperplasia (BPH) also knownas benign prostatic hypertrophy (technically amisnomer), benign enlargement of the prostate

(BEP), and adenofibromyomatous hyperplasia,refers to the increase in size of the prostate inelderly men.

To be accurate, the process is one of hyperplasia rather than hypertrophy, but the

nomenclature is often interchangeable, evenamongst urologists.[1] It is characterized byhyperplasia of prostatic stromal and epithelialcells, resulting in the formation of large, fairlydiscrete nodules in the periurethral region of the prostate. When sufficiently large, the

nodules compress the urethral canal to causepartial, or sometimes virtually complete,obstruction of the urethra, which interferes the normal flow of urine. It leads to symptomsof urinary hesitancy, frequent urination, dysuria(painful urination), increased risk of urinary tract infections, and urinary retention.



Predisposing/ Risk Factors:

>AGE: 50y/o and above

>FAMILY HISTORY>HORMONAL FACTORS:

TESTOSTERONE &

ESTROGEN; LATEACTIVATION OF CELL

GROWTH

>DIABETESMELLITUS>DIET-OBESITY

>SMOKING & ALCOHOL USE



.

Incidence and Prevalence of

BPH

It is difficult to determine the

exact incidence and

prevalence of BPH because

research groups often use

different criteria to define the

condition. According to the

National Institutes of Health

(NIH), benign prostatic

hyperplasia affects more than50% of men over age 60 and

as many as 90% of men over

the age of 70.



.

Sign and Symptoms

Obstructive voiding Symptoms

Weak urinary stream

Prolonged emptying of the

bladder

Abdominal straining Hesitancy

Irregular need to urinate

Incomplete bladder emptying

Post-urination dribble



.

Irritative Symptoms

Frequent urination

Nocturia (need to urinate

during the night)

Urgency

Incontinence (involuntary

leakage of urine)

Bladder pain

Dysuria (painful urination)

Problems in ejaculation



. Urinary retention

Renal impairment

Urinary tract infection

Gross hematuria

Bladder stones

Bladder damage

(trabeculations, cellules,

diverticula)

Overflow incontinence

COMPLICATIONS



.

Management:

Treatment

Avoidance of anticholinergics,sympathomimetics, and

opioids

Use of -adrenergic blockers

(eg, terazosin , doxazosin ,tamsulosin , alfuzosin ) or 5-

reductase inhibitors (

finasteride , dutasteride )

Transurethral resection of theprostate or a less invasive

procedure



.

Less invasive procedures include

microwave thermotherapy, laser ablation,

electrovaporization, high-intensity focused

ultrasound, transurethral needle ablation,radiofrequency vaporization, and

intraurethral stents. The circumstances

under which these procedures should be

used have not been firmly established, but

those done in the physician's office

(microwave thermotherapy and

radiofrequency procedures) are being

more commonly used and do not require

use of general or regional anesthesia.

Their long-term ability to alter the natural

history of BPH is under study.



DEMOGRAPHIC

D ATA



General Profile Name: Patient X Address: P-5, Estrella, San

Mateo, Isabela Age: 56 y/o Gender: Male Nationality: Filipino Birthday: 11/25/1954 Birthplace: San Mateo,

Isabela Civil Status: Married Educational Attainment:

College Undergraduate Occupation: Farming Religious Affiliation: Born

Again Christian Date and Time Admitted:

12/06/10; 8:00 PM



Chief Complaints

>Difficulty of Urination

Final Diagnosis:

Benign Prostatic

Hyperplasia S/P Trans Urethral

Resection of the

Prostate Hypertension II



NURSING HISTORY



History of Present Illness

The patient is a hardworking farmer, he usually

spend 6-7 hours a day in

the farm. His father wasdiagnosed with Benign

Prostatic Hyperplasia

(BPH). Three years ago he

was also diagnosed to

have BPH.



One week prior to consultationthe patient was admitted at

BPCSS due to difficulty of

urination. It was diagnosed as

Urinary Tract Infection (UTI). Hewas treated in the said hospital

accordingly. After a day he was

discharged with a Foley catheter

in placed, and was advised tocome back after one week for

the removal of the catheter.



Two days prior to confinement patient was again

brough

t,Foley cat

heter was removed and serum PSAand ultrasound was requested for him to undergo but

not done.

The night of December 05, 2010, the patientexperienced chills and fever. His wife provided tepid

sponge bath to relieve the fever and put additionalblanket to keep the patient warm. The patient also tookparacetamol 500mg. In the morning, he and his wifeplanned to go to the market to buy their commoditiesfor the week but the patient felt sudden pain at the

hypogastric area and had body weakness and so heopted to seek consultation on December 06,2010 toCagayan Valley Adventist Hospital under the service of Dr.Mamuric for further care and management.



PastMedical/Surgical History

The patient verbalized that he is unfortunate toreceive any childhood immunizations. But he was

able to acquire natural, active immunity throughhis exposure to the illnesses targeted by theimmunization such as measles, mumps, and

chicken pox. No further childhood illnessesrecalled.

According to the patient he was hospitalizedbefore due to common illnesses like cough andcolds, fever and diarrhea. He was also hospitalizeddue to hypertension and was advised to takeNorvasc 5 mg daily as his maintenance medicationbut not religiously taken.



In the year 2007, he seek consultation to Dr.M

amuric due to dysuria and was considered asBPH. The doctor advised him to undergo series

of test regarding his illness for confirmation but

it was not done because of financial constraint.

Af ter a few months, he seek second opinion atChinese General Hospital and was prescribed totake Hytrin 1 tab once a day. He took themedication for 1 year and was advised to take it

as needed. He stopped taking the saidmedication because he thought he was fine, nopain felt and difficulty urinating.



Socio-cultural Background

The patient is from Isabela. He speaks three different dialects:

Tagalong, Ilocano and English. He verbalized that he and hisfamily tends on farming as a means to provide their daily

resources.

The patient verbalized that he is an occasional alcoholic

beverage drinker, consumes approximately one bottle (500 ml)per session. He does not claim of being a smoker.

With regards to his personal medical beliefs, he professed on

the curative capability of herbal preparations. He utilizes a wide

array of herbal plants whether approved by the Department of Health is basis or not. These includes, Garlic, Guava, Lagundi,

etc. His basis lies on the traditional beliefs of the efficacy and

the effectiveness of such herbal preparation.



13 Areas of Assessment

VIII.I Psychosocial

Mr. X, a 56 year old male, is a resident of P-5, Estrella,

San Mateo, Isabela. He is a farmer, and makes a living through

farming. His wife Mrs. X. works as a social worker at DSWD SanMateo chapter. She aids in the provision of financial resources for

the family. The patient is the head of the family and is the major

decision maker with regard to financial and health matters. He is

a father of three children.

The patient did not verbalized any specific earnings butassured that it is fairly adequate to meet the familys daily needs.

At present, his developmental task is reflected on the crisis of

Integrity versus despair, in which as per assessment , he is able

to equate.

The patient is baptized as a Roman Catholic but was then

converted as a member of Born Again Christian during his youngadult days. He is a mildly anxious with regard to the change or threat to his health status. The patient has a good relationship

with his family members and to his significant others as

claimed. During the course of his confinement , his immediate

family visits him.



The patient appears to be coherent,

responds appropriately to several stimuli such

as verbal, noise and light, touch and pain

stimuli. The patient is oriented to time and

place, and does not experience confusion in

any form.

The patient is a college

undergraduate. He is able to read and write,

able to articulate himself in English, Filipino and

Ilokano. He is able to comprehend and follow

simple to complex directions. He also exhibitspositive affirmations regarding his present

health condition though at times feel anxious

about the change to or threat to his health

condition. The patient is not irritable and shows

appropriate mood and emotional response. At

present, he claims to have a good relationship

with his family members and SO. He also

interacts with the health care providers

appropriately. He is able to communicate and

verbalize his feelings, needs and concerns

regarding his condition.



The patient is confined in the

VIP room under the service of

medical adult. The objects and

furnitures around him are well

arranged. There are no sources of

possible accident, fire, or chemical

hazards found in the room. The room

has good lighting condition, has

adequate ventilation and minimalnoise is observed.

With regard o infection

control, there are no present or

ongoing infections in the family. Onthe other hand, as a preventive

measure, they practice hand washing

and the use of pathogens that may

cause infection. Moreover, they also

practice proper pulmonary toileting



VIII.IV Sensory Status

Visual Status

The patient has a fair visual acuity, no blurring of visionnoted. He verbalized that he is farsighted thats why he

uses reading glasses. Pupils are equally round and

reactive to light (intact CN3). Patient has good corneal

reflex. No known deficits such as color blindness as

well as any unusual sensations noted. He has pale to

pinkish palpebral conjunctiva. No lacrimal discharges or

tender mass were noted.



Auditory

Patient is able to distinguish the loudness of voice at a certain distance. Has

good bilateral hearing. Ears are symmetrical, smooth in texture and are the

same color with the skin. No known deficits and discharges noted.

Olfactory Status

The patient can discriminate odors and could differentiate them accurately.

Patient has bilaterally patent nostrils. No obstruction and discharges noted.Gustatory Status

The patient is able to discriminate sweet, sour and salty foods (CN 10), he

does not verbalize a decrease in sense of taste. There is no difficulty in

swallowing as verbalized. He can protrude and move his tongue (CN 9). He

does not use any prosthetic device such as dentures. There are no lesions or

ulcerations noted on the gums and he is negative of halitosis.



Tactile Status

The patient is able to discriminate sharp from dull

sensations on his upper extremities as assessed whenIV cannula was reinserted at his left metacarpal vein..

He is also able to discriminate light to firm touch. He is

able to perceive heat and cold sensations.

Language, Perceptions and FormationHis teeth are in good condition. No use of dentures

noted. He can protrude his tongue and no tongue

fasciculation was noted. He is able to understand andinitiate speech without difficulty. He is able to read and

write. He is able to articulate words properly and there

is absence of slurred speech.



VIII.V Motor Status

The patient is in complete bed rest. The patient receives minimal assistance

from health care providers and significant others. He was uncomfortable to move

because of the catheter attached to him. The patient has a muscle strength of 5/5

on the upper extremities and 3/5 on the lower extremities. He is also observed to

have difficulty from his lying position to sitting position. No evidence of muscle

wasting or dystrophy or foot drop noted. It requires full assistance for him to

ambulate.

VIII.VI Nutritional Status

Patient is on DAT. He manifests a good appetite and consumes the foods

served. Moreover the patient prefers three main meals instead of small frequent

feedings. His meals is comprised of complex carbohydrates, vegetables, and

meat. He usually drinks coffee in the morning before breakfast.His height is 56 and weighs 64 kg (according to him before hospitalization).

Assessment revealed no changes as to weight loss/gain. Patient has medium built

body figure and there is absence of muscle wasting. Patient perceives food as a

life-giving force, he also verbalized that he has no religious restrictions to food

and has no food or drug allergy. He has an incomplete set of teeth and has

normoactive bowel sounds with a range of 6-15/minute.



. m na on a us

Before the occurrence of BPH, he

normally urinates 6-8 times a day. And

defecates at least once a day. However, due

to BPH, it resulted to changes in his boweland bladder habits. During his confinement,

he has indwelling foley catheter. At first

hours post TURP, it drains dark red colored

fluid but in the latter days of confinement, itbecomes clear and light yellow colored.

With regard to bowel movement prior to

hospitalization, he normally defecates

everyday with irregularity in time (morning

or afternoon), but, due to BPH and postTURP, he claims that he had not yet

defecated since his admission on December

06, 2010. He was given Laxoberal but claims

to only have a small amount of stool upon

elimination.



VIII.VIII Fluid and Electrolyte Balance

He normally consumes 1-2 liters of

fluids daily. After the operation intake and outputwas closely monitored. At present, he has no fluid

restrictions ordered.

The patient verbalized no episodes of vomiting prior to admission. The patients skin is

slightly dry with good skin turgor. Mucous

membranes are moist and there is no evidence of dehydration or edema noted.



PHYSICALASSESSMENT



PHYSICAL ASSESSMENT

(DECEMBER 09, 2010 8:00 PM)

Received pt awake, lying on bed with on going IVF of PNSS iLx KVO patent and infusing well.

General Appearance: Alert, conscious and coherent.

V/S

BP: 160/100

T: 36.5 CCR:110bpm

RR:24cpm

BODY PARTS METHOD ACTUAL FINDINGS INTERPRETATION

I.SKIN >INSPECTION >fair >NORMAL

II.HEAD >INSPECTION

>PALPATION

>Normocephalic

>No nodules

>Normal

>Normal

HAIR >INSPECTION >Thin hair >Normal

III.FACE >INSPECTION (+) facial grimace >d/t pain after the procedure

EYES

EYE BROWS >INSPECTION >symmetrical >Normal

CONJUNCTIVA >INSPECTION >Pink >Normal

SCLERA >INSPECTION >White >Normal

PUPILS >INSPECTION >PERRLA=3MM >Normal

EYE MOVEMENT >INSPECTION > move eyes upward and

downward

>Normal



IV. EARS

AURICLE >INSPECTION >symmetrical >Normal

>PALPATION >Auricle aligned

with inner canthus

>Normal

V. NOSE >INSPECTION >intact nasal

septum>no discharge

>Normal

>Normal

VI. MOUTH

LIPS >INSPECTION >Pink >Normal

Tongue >INSPECTION >Pink >Normal

Teeth >INSPECTION >clean, complete >Normal



VII. NECK

Lymph Nodes >INSPECTION >Not palpable >Normal

VIII. THORAX AND

LUNGS

>INSPECTION >Symmetrical chest

movement

>Normal

>AUSCULTATION >(-)abnormal breath

sounds

>Normal

IX. ABDOMEN >INSPECTION

>AUSCULTATION

>(-) distention

>(+) Bowel sounds

>non tender

>Normal

>Normal

>Normal

X. GENITALIA

PENIS

URETHRAL OPENING

>INSPECTION

>INSPECTION >(+)3 way Foley

catheter inserted

> For continuous bladder

irrigation and draining of

urine from the bladder

XI. NAILS >INSPECTION >capillary refill 3 sec >Normal

>pink nail bed >Normal



LAB RESULTS



PARAMETERS RESULT RANGE INTERPRETATIONCholesterol 3.28 0.00-5.20 NORMAL

Triglycerides 0.93mol/L 0.00-1.69 NORMAL

Direct HDLC 0.94 1.03-1.55 HDL cholesterol is lower

in pts with increased

risk for coronary heart

disease

LDL 1.92 1.55- 4.65 Optimal level

VLDL 0.43 0.00-0.77 NORMAL

Chol/dHDL 3.49 <5.20 NORMAL

LABORATORY RESULT

December 11, 2010

,



PARAMETERS RESULT RANGE INTERPRETATION

HGB 129 110-180 NORMAL

HCT 0.38 27.0-54 NORMAL


GLUCOSE 8.51 3.9-9.5 NORMAL

,

December 08, 2010

December 08, 2010

Immunochemistry



PARAMETERS RESULT

ABO GROUP O

Rh Type Positive

PARAMETERS RESULT INTERPRETATION

sPS HI >20.00mg/ml elevated d/t enlargement of the

prostate

Immunochemistry

December 08, 2010 (09:44 am)



December 08, 2010

Chest X-Ray

>Lung fields are clear

>Heart is not enlarged

>the costophrenic sulci

and diaphragm are intact

>the bony thorax are

unremarkable

Remarks:

Normal Chest Findings




Sp. Gravity 1.020 1.003-1.030 NORMAL

pH 5.5 4.60-8.00 NORMAL

Protein +2 +1,+2 NORMALGlucose N NEGATIVE

Ketone N NEGATIVE

Erythrocyte +3 - Indicates bacteria may be present in urine

Nitrite +3 - Indicates bacteria may be present in urine

urobilinogen N NEGATIVE

Bilirubin +1 NEGATIVE May indicate presence of liver diseaseLeukocyte +3 Indicates presence of Ifection

WBC/hpf Innumerable 0-4 Indicates presence of infection or

Rbc/hpf 5-6 0-3 Indicates presence of hematuria

Epithelial cell squamous occasional Normal

Epithelial cells round Occasional Normal

Amorphous sediments +3 Normal

Crystals N NEGATIVE

Mucus +2 Normal

December 07, 2010

Bacteria +4 indicates the presence of infection




CREATININE 108.6

umol/L

58-110 NORMAL

SODIUM 137.2mmol/

L

137-145 NORMAL

POTASSIUM 3.57 3.50-5.10 NORMAL


WBC 29.5 5.00-10.00 elevated d/t presence of inflammation or

infection

RBC 4.6 4.00-5.00 NORMAL

HCT 0.40 0.40-0.54 NORMAL

HGB 132 130-180 NORMAL

December 06, 2010



December 06, 2010

Ultrasound result: KUB, ProstateProstate is enlarged. It measures 6.65 x 5.80 x 5.35

cms or about 106 grams in weight. The contour is irregular.

Parenchymal echotexture is coarsened.

Conclusion:

Normal sonographic findings in the kidneys and

urinary bladder. Enlarged Prostate, correlation with trans

urethral ultrasound is suggested for further evaluation.



PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY

D5NSSiL x 8 hrs. 470

L=400 400 450D5 NaCl iL x 8 hrs 460 400

started 300

30

80

20

TOTAL 860 1850

FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY

P.O #1 D5NSSiL x 8 hrs. PNSS 1000 40 Pnss irrigation 1000

L=540 540 1000 50 1000

P.O # 2 D5 NaCl iL x 8

hrs

300 1000 250 1000

started 1000 50 1000

1000 30 1000

1000 25 1000

1000 50 1000

1000 50 1000

840 8,0000 545 8,000

TOTAL 8,840 8,545

December 09, 2010

AM

PM

NOC,




P.O #2 D5NSSiL x 8 hrs. H20 210 PNSS 1000 175 Pnss irrigation 1000

L=700 700 1000 280 1000

P.O # 3 D5 NaCl iL x 8 hrs 500 1000 300 1000

started

1,200 210 755 3000TOTAL 1,410 3,755

NOC

NOC


P.O #3 D5NSSiL x 8 hrs. H20 60 PNSS 1000 100 Pnss irrigation 1000

L=500 500 1000 275 1000P.O # 4 D5 NaCl iL x 8 hrs 150 1000 400 1000

started 1000 225 1000

1000 320 1000

1000

650 60 6,000 1,320 7000TOTAL 6700 7320

AM

DEC.10,2010 AM




P.O #4 D5NSSiL x 8 hrs. H20 150 PNSS 1000 300 PNSS Irrigation 1000

L=850 650 60 1000 375 1000

P.O # 5 D5 NaCl iL x 8 hrs 1000 80 1000

R-250 250 1000 105 1000

1000 375 1000

1000 275 1000

900 210 6,000 1510 6000

TOTAL 7110 7510


P.O #5 D5NSSiL x 8 hrs. PNSS 1000 225 Pnss irrigation 1000

L=200 200 1000 215 1000

P.O # 6 D5 NaCl iL x 8 hrs 450 1000 100 1000

started

650 3,000 540 3000

TOTAL 3650 3540

PM

NOC




PNSS iL x KVO H20 240 PNSS 1000 180 Pnss irrigation 1000

L=580 200 430 1000 150 10001000 180 1000

1000 575 1000

200 670 4,000 905 4000

TOTAL 4870 4905


D5NSSiL x 8 hrs. H20 350 PNSS 1000 250 Pnss irrigation 1000

L=350 65 1000 495 1000

65 350 2,000 745 2000

TOTAL 2415 2745

DECEMBER 11, 2010

AM

PM



T H

EENd

Thankyou!

benign prostatic hyperplasia.ppt2

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