How to Provide medical surgical nursing care for a client with benign prostatic hyperplasia BPH

enlarged prostate

The prostate is a gland in men that is about the size of a walnut. It lies below the bladder and in front of the rectum. The tube that takes urine out of the body (urethra) goes through the prostate gland. Benign Prostatic Hyperlasia (BPH) is an enlargement of the prostate gland cells which may block the urethral outlet causing urinary symptoms. BPH is non malignant, it is not cancer.

Instructions

1. 

   Assessment: signs and symptoms of BPH
   difficulty voiding (urinating),decreased force (hesitancy),incomplete bladder emptying causing cystitis, nocturia (urinating at night), frequent voiding in the day time, dribbling, increased urge to void, hematuria (blood in the urine).

2. 

   Assessment: Interview and history taking
   Ask questions about daytime voiding frequency, episodes of nocturia, urgency to void, urinary incontinence (inability to control voiding), force of the urine stream, hesitancy during voiding, need to strain while voiding,prior episodes of acute urinary retention and perception of bladder emptying( does it feel like they still need to void after just voiding?)

3. 

   Medical management
   Includes relaxing the prostate muscle by giving an alpha adrernergic blocker like Terazosin.
   Or slowing prostate growth by giving 5 alpha reducase inhibitors like proscar and avodart.

4. 

   Nursing Management of BPH
   Relieve retention by inserting an indwelling foley catherter ( need physicians order for catheterization) which is left in place for 2-4 weeks to let the bladder recover from injury due to over distention.

   Catheter should not be forced . If the nurse cannot insert it, the urologist should be notified.

   After insertion, observe the client for hourly output, hematuria and shock( which may be caused by the sudden increased flow of urine due to the inability of the kidneys to reabsorb water and electrolytes)

   Encourage fluids unless contraindicated to decrease the risk of urinary tract infections. Intake should be 30ml/kg/day.

   Discourage clients from taking medications that contain alpha adrenergic agonists e.g cold medications. They can cause a man with BPH to have urinary retention.

Tips & Warnings

• Read a nursing review book

• Read your med surg text books

Resources

• A website with powerpoint slides in med surg for student nurses