Nursing in patients with benign prostate hypertrophy (BPH)

Nursing in patients with benign prostate hypertrophy (BPH)

A. Definition

Hypertrophy of prostate is a gland hyperplasia of the periurethral prostate tissue which is then urged the original to the periphery and into the hoop surgery. (Jong, Wim de, 1998).

Hiperplasi benign prostate (BPH) is a benign enlargement of prostate gland, caused by the hiperplasi some or all components, including a prostate gland / tissue that causes obstruction fibromuskuler pars prostatic urethra (Lab / UPF Surgery dr. Sutomo, 1994: 193).

B. Etiology

The cause of benign prostate hypertrophy is not known with certainty. But only 2 factors that influence the occurrence of prostate Benigne Hypertropi the testis and the elderly.

There are several theories put forward why the periurethral gland can undergo hyperplasia, namely:

Stem cell theory (Isaacs 1984)
Based on this theory of prostate tissue in adults is in the balance between cell growth and cell death, a condition called steady state. In prostate tissue contained stem cells that can proliferate faster, resulting in periurethral gland hyperplasia.

Theory MC Neal (1978)
According to the MC. Neal, benign prostate enlargement starts from the transition zone that is located next to the proximal of the external spincter veromontatum on both sides of the periurethral zone.

C. Anatomy Physiology

Proatat gland is a fibromuscular and glandular tissue encircling the urethra grandular proximal part consisting of kelnjar compound, channels and smooth muscle located below the bladder and attached to the bladder wall with a length: 3-4 cm and width: 4, 4 cm, thickness: 2.6 cm and of a hazel nut, enlargement of the prostate will stem the urethra and can cause urinary retention, prostate gland consists of the posterior lateral lobes, anterior and medial lobes, the prostate gland is useful to protect the spermatozoa against the existing pressure urethra and vagina. And increase the alkaline liquid in the seminal fluid.

D. Pathophysiology

According to Arif in 2000 Mansjoer prostate enlargement occurred gradually in the urinary tract. In the early stages of prostate enlargement occurred, causing physiological changes that result in resistance to the urethra the prostate, neck and detrusor vesika cope with stronger contractions.

As a result of fiber will become thicker detrusor and detrusor fibers protruding into the bladder mucosa will be seen as blocks that tampai (trabekulasi). When viewed from within vesika with sitoskopi, mucosal vesika to bust out among the detrusor fibers that are formed when small mucosal protrusion called sakula and to the extent called diverkel. Detrusor thickening phase is the phase which, if continued detrusor compensation will be tired and eventually will experience decompensation and no longer able to contraction, resulting in total urinary retention which can lead to hydronephrosis and upper urinary tract dysfunction.

E. Signs and Symptoms

The loss of beam strength when miksi (tub not lampias)
Difficulty in emptying the bladder.
Pain during start miksi /
The presence of urine mixed with blood (hematuri).


F. Complication

Aterosclerosis
Myocardial infarction
Impotent
Haemoragik postoperative
Fistula
Postoperative stricture & inconentia urine


G. Examination Diagnosis

Laboratories

Include urea (BUN), creatinine, elekrolit, urine culture and sensitivity tests.

Radiological

Intravenous pylografi, BNO, sistogram, retrograde, ultrasound, CT scanning, cystoscopy, abdominal plain photos. Indications sistogram retrogras made where poor kidney function, ultrasound can be done by trans-abdominal or trans-rectal (TRUS = Trans Rectal Ultra Sonography), other than to find ultra-sonography of prostate enlargement can also determine the bladder volume, residual urine mengukut and other pathological conditions such as difertikel, tumors and stones (Syamsuhidayat and Wim De Jong, 1997).
Retro pubic prostatectomy

Making an incision in the lower abdomen, but the bladder is not opened, just pull and adematous prostate tissue removed through an incision in the anterior prostate capsule.
Prostatectomy Parineal

Namely with the prostate gland removed surgically through the perineum.


H. Management

Non-Operative
Enlargement of the hormones estrogen and progesterone
Massase prostate, frequent masturbation is recommended
Suggest do not drink much in a short time
Prevent taking anticholinergic drugs, antihistamines & dengostan
Catheter placement.

Operative
Indications: dilation of the bladder and residual urine 750 ml
TOURS (Trans urethral resection)
STP (Suprobic Transersal prostatectomy)
Extravesical Retropubic Prostatectomy)
Perineal prostatectomy

A. Assessment

Subjective Data:
The patient complained of pain in the wound incision.
Patients said they could not have sex.
Patients always ask for the action taken.
Patients say urination does not feel.

Objective Data:
There incision wound
Tachycardia
Nervous
Increase in blood pressure
Expressions w ajah fears
Catheter inserted


B. Appears Possible Nursing Diagnosis

Impaired sense of comfort: pain associated with muscle spasm spincter

Lack of knowledge: of TUR-P related to the lack of information

Sleep disorders associated with pain / effects of surgery


C. Intervention

Nursing Diagnosis 1. :
Impaired sense of comfort: pain associated with muscle spasm spincter

Objectives:
After treatment for 3-5 days the patient was able to maintain adequately the degree of comfort.

Criteria results:
Patient verbally express pain decreases or disappears.
Patients can rest easy.

Intervention:
Assess pain, note the location, intensity (scale 0 - 10)
Monitor and record the presence of pain, location, duration and trigger factors and pain relief.
Observation of non-verbal signs of pain (anxiety, forehead wrinkle, increased blood pressure and pulse)
Give ompres warm in the abdomen, especially the lower abdomen.
Instruct patient to avoid stimulants (coffee, tea, smoking, abdominal strain)
Adjust the position of the patient as comfortable as possible, teach relaxation techniques
Perform aseptic therapeutic treatment
Report your doctor if pain increases.


Nursing Diagnosis 2. :
Lack of knowledge: of TUR-P related to the lack of information

Objectives:
Clients can describe the prohibition of activities and the need for continued treatment.

Criteria results:
Clients will make a change in behavior.
Clients participate in treatment programs.
Clients will say understanding the prohibition of activities and needs continued treatment.

Intervention:
Give an explanation to prevent heavy activity for 3-4 weeks.
Give an explanation to prevent straining CHAPTER time for 4-6 weeks, and feces for laxative use lubricant as needed.
Fluid intake of at least 2500-3000 ml / day.
Suggest to treatment continued on a doctor.
Empty your bladder when the bladder is full.


Nursing Diagnosis 3. :
Sleep disorders associated with pain / effects of surgery

Objectives:
Sleep and rest needs are met

Criteria results:
Clients are able to rest / sleep in a reasonable time.
Clients express was able to sleep.
Clients are able to explain the factors inhibiting sleep.

Intervention:
Explain to the client and family causes of sleep disorders and possible ways to avoid.
Create a supportive atmosphere, the atmosphere is quiet by reducing noise.
Give the client the opportunity to reveal the causes of sleep disorders.
Collaboration with physician for medication that can reduce pain (analgesic).

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