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

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 / 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 –  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 / 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

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 / 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

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

TURP Advantages 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