PORTFOL

IO
Adult health
nursing-I
Submitted To Ma’am Nazia

Prepared By Aqsa Safdar

Roll Number 008669[UHS]

Class BSN 2nd Prof.

Rashid Latif Nursing College

SERIAL# TABLE OF CONTENTS

1 BPH

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 LEARNING OBJECTIVES
• By the end of the session learners will be able to:

• Discuss the causes, pathophysiology and manifestation of the following BPH

• Discuss Diagnostic Test, Medical and Surgical Management of BPH

• Apply nursing process including assessment, planning, implementation and

evaluation of care provided to the clients with BPH

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BENIGN PROSTATE HYPERTROPHY
• It is an enlarged prostate gland it squeezes or partly blocks the urethra
causing problems with urinating.

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 Benign Prostatic Hypertrophy
• Also known as benign prostatic hypertrophy characterized by proliferation
of the cellular elements of the prostate
• There is a chronic bladder outlet obstruction (BOO) secondary to BPH -
may lead to:
• Urinary retention
• Renal insufficiency
• Recurrent urinary tract infections
• Gross hematuria
• Bladder calculi

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 CAUSES

•  It is not well understood

• Common in older men

• It does not occur in men whose testicles are removed before puberty

• Factors are believed to be related to aging and the testicles may cause
BPH

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 RISK FACTORS

• Obesity

• Lack of physical activity

• Erectile dysfunction
• Increasing age

• Family history of BPH

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 PATHOPHYSIOLOGY

• There is the development of Multiple fibroadenomatous nodules in the

periurethral region of the prostate. - There is narrowing and lengthening of
the lumen of the prostatic urethra progressively obstructing urine flow
• There is a progression to hypertrophy of the bladder detrusor,
trabeculation, cellule formation, and diverticula
• Due to Increased pressure associated with micturition and bladder
distention
• Incomplete bladder emptying causes stasis
• Predisposes to calculus formation and infection
• Hydronephrosis may happen secondary to prolonged obstruction, even if
incomplet and it compromises renal function

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 CLINICAL MANISFESTATION

• Urinary frequency

• Urgency
• Nocturia
• Hesitancy
• Incomplete emptying of bladder
• Straining
• Dribbling

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  EXAMINATION
DIGITAL RECTAL EXAM
Evaluate prostate for size, consistency, shape and abnormalities suggestive of
prostate cancer (such as nodules or asymmetry)
• Assess suprapubic area to rule out bladder distention

• Evaluate overall motor and sensory function of the perineum and lower
limbs

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 ULTRASONOGRAPHY
• Help determine prostate and bladder size and degree of Hydronephrosis in
patients with urinary retention.
• Transrectal ultrasonography is recommended in selected patients to
determine the dimensions and volume of the prostrate.

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 NON-PHARMACOLOGICAL
MANAGEMENT
• Non-pharmacological Management
• Mild symptoms or limited discomfort?
• Watchful waiting and annual evaluation
•  Lifestyle Modifications
•  Avoid fluids prior to bedtime or going out
•  Reduce caffeine and alcohol
•  Scheduled urination at least once every 3 hours.
• Double voiding: after urinating, wait and try to urinate again.

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 TREATMENT
• Alpha-blockers are a first-line option for men with symptomatic bother who
desire treatment
• 5ARI’s are an effective option for symptomatic patients with demonstrable
prostatic enlargement
• Combination alpha-blocker and 5-ARI therapy improves symptom score and
peak urinary flow vs. monotherapy; appropriate for patients with LUTS
associated with prostatic enlargement
• A PDE5 inhibitor can be used once-daily in men with moderate to severe
symptoms and bother, to effectively reduce symptoms of BPH-LUTS while
maintaining sexual function

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 NURSING MANAGEMENT

• Nursing Assessment
• Nursing assessment focuses on the health history
of the patient.
• Health History. The health history focuses on the
urinary tract, previous surgical procedures,
general health issues, family history of prostate
diseases, and fitness for possible surgery.
• Physical Assessment. Physical assessment
includes digital rectal examination.
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 Nursing Diagnosis
• Based on the assessment data, the appropriate nursing diagnoses for a
patient with BPH are:
• Urinary retention related to obstruction in the bladder neck or urethra.
• Acute pain related to bladder distention.
• Anxiety related to the surgical procedure.

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 NURSING CARE PLANNING & GOALS

• The goals for a patient with BPH include:

• Relieve acute urinary retention.
• Promote comfort.
• Prevent complications.
• Help patient deal with psychosocial concerns.
• Provide information about disease
process/prognosis and treatment needs.

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 NURSING INTERVENTIONS
• Preoperative and postoperative nursing interventions for a patient with BPH
are as follows:
• Reduce anxiety. The nurse should familiarize the patient with the
preoperative and postoperative routines and initiate measures to
reduce anxiety.
• Relieve discomfort. Bed rest and analgesics are prescribed if a patient
experiences discomfort.
• Provide instruction. Before the surgery, the nurse reviews with the patient
the anatomy of the affected structures and their function in relation to the
urinary and reproductive systems.
• Maintain fluid balance. Fluid balance should be restored to normal.

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 REFERENCE

• McVary KT, Roehrborn CG, Avins AL, et al

(2011). Update on AUA guideline on the
management of benign prostatic hyperplasia. J
Urol.185(5):1793-803

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