Prostatic neoplasms / cancer

1. Prostatic neoplasms / cancer • Behavioral Objectives • Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for Prostatic neoplasms / cancer • Brunner and Suddarth’s Medical Surgical Nursing pg 1752-61

2. Prostatic neoplasms / cancer Pathophysiology • Most common cancer in men • Risk Factors • Increased age • African American Men • A familial predisposition

3. Prostatic neoplasms / cancer Clinical manifestations • Early stages • asymptomatic • Late stage • Urinary obstruction Dysuria, hesitancy, dribbling • Blood in the urine • Painful ejaculation • Metastasis to bone, lymph,

4. Prostatic neoplasms / cancer Assessment and diagnostic procedures • DRE > 40 • PSA

5. Prostatic neoplasms / cancer Nursing process / Diagnosis / Interventions • Anxiety related to concern and lack of knowledge about the diagnosis, treatment plan and prognosis Uncertain outcomes, sexual dysfunction • Assess • Provide • Teach

6. Prostatic neoplasms / cancer Urinary retention related to urethral obstruction secondary to Prostatic enlargement or tumor and loss of bladder tone due to prolonged distention/retention • Baseline • S&S of retention • i urine output • h frequency • Supra-pubic distention • C/O urgency

7. Urinary retention cont. Catheterize to check residual • Sterile • Irrigate • Monitor • Position for urination: normal • Administer meds • Monitor effects

8. Prostatic neoplasms / cancer Deficient knowledge related to the diagnosis of cancer, urinary difficulties and treatment modalities • Enc. communication • Teach • Terminology (anatomy) • Catheter care

9. Prostatic neoplasms / cancer Imbalanced nutrition: less than body requirements related to decreased oral intake because of anorexia, nausea and vomiting caused by cancer or its treatment • Assess % food • Weights • Food preferences • Recognize effect of medications and treatment on appetite • N/V • Antiemetics & Oral care • Frequent small meals

10. Prostatic neoplasms / cancer Sexual dysfunction related to effects of therapy: chemotherapy, hormonal therapy, radiation therapy surgery • Assess sexual function • Inform of treatments effects on sexuality • Include the partner

11. Prostatic neoplasms / cancer Pain related to progression of disease and treatment modalities • Evaluate pain • Avoid activities that h pain • Administer analgesics/Opiates

12. Prostatic neoplasms / cancer Impaired physical mobility and activity intolerance related to tissue hypoxia, malnutrition and exhaustion and to spinal cord or nerve compression from metastases • Assess factors causing limited mobility • Administer pain relief • Encourage use of assistive devices • ROM • Positioning • Walking • Assess nutritional status

13. Prostatectomy Transurethral resection of the prostate: TURP • Most common • Endoscopy • Surgical & optic scope  urethra  prostate • Gland removed in small chips

14. TURP Advantages • No abd. incisions • i Risks • Shorter hospital • i morbidity rate • i pain Disadvantages • Recurrent obstruction • stricture • Delayed bleeding • Erectile dysfunction

15. TURP Specific nursing implications • Monitor for hemorrhaging • Observe for urethral stricture • Dysuria • Straining • Weak urinary stream

16. Nursing Process - TURP Assessment • How affected pts life • Urinary problems? • Pain? • Erectile dysfunction?

17. Nursing Dx - TURP • Preoperatively • Anxiety about surgery and its outcome • Acute pain related to bladder distention • Deficient knowledge about factors related to the disorder and the treatment protocol

18. Nursing Dx - TURP • Postoperative • Acute pain related to the surgical incision, catheter placement and bladder spasms • Deficient knowledge about postoperative care and management

19. Nursing Interventions • Reducing anxiety • Assess support & coping • Est. & enc communication • Assess knowledge - educate • Inform routines • Privacy

20. Nursing Interventions • Relieving discomfort • Bed rest • Analgesic • Assess bladder distention

21. Nursing Interventions • Preparing the patient • Elastic compression stocking • Enema • No aspirin

22. Nursing Interventions • Maintaining fluid balance d/t irrigation of surgical site • I&O • irrigation • Check BP • Confusion • Respiratory distress  crackles • = fluid overload

23. Nursing Interventions • Relieving pain d/t bladder spasms • Day 1 dangle legs • Day 2 ambulate • Meds to relax bladders • Warm compresses to pubis • Sitz baths • Analgesics • Do not sit for a long time • Stool softeners

24. Nursing Interventions • Monitoring and managing potential complication of hemorrhaging • Drainage red  pink  It pinks with in 24 hours • Monitor V/S • IV • Blood component treatment /transfusion • I&O

25. Nursing Interventions • Monitoring and managing potential complication of infection • Monitor Temp & Vital signs • Heat lamp • Sitz bath • Antibiotics (Prophylactic) • Dysuria, urinary frequency, urgency • Aseptic technique with catheter • I&O

26. Nursing Interventions • Monitoring and managing potential complication of Deep vein Thrombosis • Prophylactic low dose heparin • Elastic compression socks • Monitor for DVT • Homan Sign • Check pedal pulses • Early ambulation

27. Nursing Interventions • Monitoring and managing potential complication of Obstructed Catheter • Lasix (Furosemide) • Increase fluids • Assess pain – • Check catheter for kinks, loops, placement • Decreased BP / increased pulse

28. Nursing Interventions • Monitoring and managing potential complication of sexual dysfunction • Meds • Privacy • Sex therapy • Determine history of level of functioning • Include partner