Prostatic neoplasms / cancer Behavioral Objectives – Describe etiology, pathophysiology, clinical...
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Transcript of Prostatic neoplasms / cancer Behavioral Objectives – Describe etiology, pathophysiology, clinical...
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
Prostatic neoplasms / cancer
Pathophysiology– Most common cancer in men – Risk Factors• Increased age• African American Men• A familial predisposition
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,
Prostatic neoplasms / cancer
Assessment and diagnostic procedures
• DRE > 40• PSA
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
Prostatic neoplasms / cancerUrinary 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 – urine output– frequency– Supra-pubic distention– C/O urgency
Urinary retention cont.
Catheterize to check residual– Sterile – Irrigate– Monitor
• Position for urination: normal• Administer meds • Monitor effects
Prostatic neoplasms / cancer
Deficient knowledge related to the diagnosis of cancer, urinary difficulties and treatment modalities
• Enc. communication• Teach– Terminology (anatomy)– Catheter care
Prostatic neoplasms / cancerImbalanced 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
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
Prostatic neoplasms / cancer
Pain related to progression of disease and treatment modalities
• Evaluate pain• Avoid activities that pain• Administer analgesics/Opiates
Prostatic neoplasms / cancerImpaired 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
Prostatectomy
Transurethral resection of the prostate: TURP• Most common • Endoscopy
– Surgical & optic scope urethra prostate
• Gland removed in small chips
TURPAdvantages• No abd. incisions• Risks • Shorter hospital• morbidity rate• pain
Disadvantages• Recurrent obstruction– stricture
• Delayed bleeding • Erectile dysfunction
TURP
Specific nursing implications• Monitor for hemorrhaging• Observe for urethral stricture– Dysuria– Straining– Weak urinary stream
Nursing Process - TURP
Assessment• How affected pts life• Urinary problems?• Pain?• Erectile dysfunction?
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
Nursing Dx - TURP
• Postoperative– Acute pain related to the surgical incision,
catheter placement and bladder spasms– Deficient knowledge about postoperative care
and management
Nursing Interventions
• Reducing anxiety– Assess support & coping– Est. & enc communication– Assess knowledge - educate– Inform routines– Privacy
Nursing Interventions
• Relieving discomfort– Bed rest– Analgesic – Assess bladder distention
Nursing Interventions
• Preparing the patient– Elastic compression stocking – Enema– No aspirin
Nursing Interventions
• Maintaining fluid balance d/t irrigation of surgical site– I&O• irrigation
– Check BP – Confusion– Respiratory distress crackles • = fluid overload
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
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
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
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
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
Nursing Interventions
• Monitoring and managing potential complication of sexual dysfunction– Meds– Privacy– Sex therapy– Determine history of level of functioning– Include partner