بسم الله الرحمن الرحيم

Nursing management for patient with prostate

cancer

prepared by;Shamsadeen A. Mohammad

2010-2011

What is the Prostate?

1. A male sex gland

2. The size of a walnut below

the bladder and infront of

the rectum

3. Produces the fluid that is part of semen

What is Prostate Cancer?

• To understand prostate cancer, we need to understand cancer because prostate cancer is cancer that starts in the prostate gland. They have three main characteristics:

• A cancerous cell's natural process of growth and death is uncontrolled

• A cancerous cell has lost its normal structure and, consequently, its ability to function as it should

• A cancerous cell can escape the area in which it first grew and invade other parts of the body

Risk factors for prostate cancer

.Age – Found mainly in men over age 55. Average age of diagnosis is 70

.Family History – Men’s risk is higher if father or brother is diagnosed before the age of 60

Risk Factors continuedRisk Factors continued

• Race – Prostate cancer is found more often in African American men then White men. It is less common in Asian and American Indian men

• Dietary factors – Evidence suggests that a diet high in fat may increase the risk of prostate cancer and diets high in fruits and vegetables decrease the risk

Sign and Symptoms

1. need to urinate often, especially at night. 2. intense need to urinate (urgency). 3. difficulty in starting or stopping the urine flow. 4. inability to urinate .5. weak, decreased or interrupted urine stream .6. a sense of incompletely emptying the bladder. 7. burning or pain during urination. 8. blood in the urine or semen. 9. painful ejaculation.

pathophysiologyThe pathophysiology of prostate cancer is poorly

understood,Although prostate cancer typically manifests in men older

than 65 years, Prostatic intraepithelial neoplasia (PIN) is the histologic

entity widely considered to be the most likely precursor of invasive

prostate cancer. genetic abnormalities that affect the androgen

receptor(AR)and other molecules that are involved in cell survival and

apoptosis(programmed cell death)

Nodular prostate

There are a four stage of prostate cancer

Tests for Prostate Cancer:

1. The Digital Rectal Exam (DRE). 2. Ct scan3. PSA - Prostate Specific Antigen.normal

range(<4ng/ml).4. Beckman Coulter's Hybritech free PSA (fPSA)

test.5. PSA density test.6. Telomerase.7. Ultra sound

Prostate exam

Prostate Cancer

1. Asymmetric shape .

2. Hard consistency.

3. Discrete nodule may be palpable.

4. Median sulcus often obscured.

Note: Hard areas of prostate are not always cancerous but may indicate conditions such as prostatic stones or chronic inflammation.

Treatment .Laparoscopic Prostatectomy –

Removal of entire prostate gland and nerves using a minimally invasive surgery

.Radical Prostatectomy – Removal of entire prostate gland and nerves

.Radiation Therapy – High-energy rays to kill or shrink cancer cells

.Expectant Therapy – Regularly scheduled screenings

Treatment continue

.Cryosurgery – freezes abnormal cells of the prostate with a metal probe

.Hormone Therapy – Decreases the androgen (testosterone) levels in the body

.Chemotherapy – Anticancer drugs injected into a vein or taken by mouth

.TUPR-transe urethral prostate resection

Complication and side effect of prostectomy;

1. Bleeding2. Infection3. Infertility4. Incontinence5. Erectile dysfunction6. death

ASSESSMENT

Subjective data Objective dataMedications: Testosterone supplements; use of any medications affecting urinary tract such as morphine, anticholinerqics, and tricyclic antidepressants.

General: Older adult male; pelvic lymphadenopathy (late sign). Urinary: Distended bladder on palpation; unilaterally hard, enlarged, fixed prostate on rectal examination. Musculoskeletal: Pathologic fractures (metastasis).

1-NURSING DIAGNOSIS: Urinary retention related to urethral obstruction secondary to prostatic

enlargement or tumor and loss of bladder tone due to prolonged distention.

PLANNING: Improved pattern of urinary elimination. IMPLEMENTATION: 1-Determine patients usual pattern of urinary function.2-Assess for signs and symptoms of urinary retention.3-Catheterize the patient to determine amount of residual urine.4- Monitor catheter function. 5-Prepare patient for surgery if indicated. 6- Consult with physician regarding intermittent or indwelling. EVALUATION: Voids at normal intervals.

2.NURSING DIAGNOSIS: Pain related to progression of disease and treatment modalities. PLANNING: Relief of pain.IMPLEMENTATION:1. Evaluate nature of patient’s pain, its location and intensity using pain

rating scale. 2. Avoid activities that aggravate or worsen pain. 3. Provide support for affected extremities.4. Administer analgesics or opioids at regularly scheduled intervals as

prescribed. EVALUATION:1. Reports relief of pain. 2. Expects exacerbations, reports their quality and intensity, and obtain

relief.3. Uses pain relief strategies appropriately and effectively. 4. Identifies strategies to avoid complications of analgesic use (e.g.

constipation).

3-NURSING DIAGNOSIS: Impaired nutrition, less than body requirement related to decreased oral

intake because of anorexia. PLANNING: Maintain optimal nutritional status. IMPLEMENTATION: 1. Assess the amount of food eaten.2. Routinely weigh patient. 3. Elicit patient’s explanation of why he is unable to eat more. 4. Recognize effect of medication or radiation therapy on appetite.

EVALUATION: 1- Responds positively to his favorite foods. 2- Assumes responsibility for his oral hygiene.3- Reports his absence of nausea and vomiting.4- Notes increase in weight after improved appetite.

4-NURSING DIAGNOSIS: Anxiety related to concern and lack of knowledge about the

diagnosis. PLANNING: Reduced stress and improved ability to cope IMPLEMENTATION: 1-Obtain health history. 2-Provide education about diagnosis and treatment plan.3-Assess his psychological reaction to his diagnosis. EVALUATION: 1-Appears relaxed. 2- States that anxiety has been reduced and relieved. 3-Engages in open communication with others.

5-NURSING DIAGNOSIS: Sexual dysfunction related to effects of therapy. PLANNING: Ability to resume\enjoy modified sexual

functioning. IMPLEMENTATION: 1. Determine from nursing history what effect patients

medical condition is having on his sexual functioning. 2. Inform patient of the effects of prostate surgery,

orchiectomy, chemotherapy, irradiation, and hormonal therapy on sexual function.

EVALUATION: 1. Describes the reasons for changes in sexual functioning. 2. Discusses with appropriate health care personal

alternative approaches and methods of sexual expression.

References;

1. TEXT BOOK OF MEDICAL SURGICAL NURSING,BRUNNER&SUDADARTH,ELEVEN EDITION{PAGE1740-1769}

2. WWW.CANADACA PROSTATE.COM;17-10-20103. LAPROSCOPIC UROLOGIC SURGURY IN

MALIGNANCIES,JEAN DE LAROSSETI,{133-176}.4. CURRENT MEDICAL DIAGNOSIS AND

TREATMENT,2008,STEFEN.J.MACFEE

5. National Prostate Cancer Coalitionwww.npcc.org