Prostatic neoplasms cancer

1
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
• SS of retention
• i urine output
• h frequency
• Supra-pubic distention
• C/O urgency

2
Urinary retention cont.

• Catheterize to check residual
• Sterile
• Irrigate
• Monitor
• Position for urination normal
• Administer meds
• Monitor effects

3
Prostatic neoplasms / cancer

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

4
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

5
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

6
Prostatic neoplasms / cancer

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

7
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

8
Prostatectomy

• Transurethral resection of the prostate TURP
• Most common
• Endoscopy
• Surgical optic scope ? urethra ? prostate
• Gland removed in small chips

9
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10
TURP

• Advantages
• No abd. incisions
• i Risks
• Shorter hospital
• i morbidity rate
• i pain

• Disadvantages
• Recurrent obstruction
• stricture
• Delayed bleeding
• Erectile dysfunction

11
TURP

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

12
Nursing Process - TURP

• Assessment
• How affected pts life
• Urinary problems?
• Pain?
• Erectile dysfunction?

13
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

14
Nursing Dx - TURP

• Postoperative
• Acute pain related to the surgical incision,
  catheter placement and bladder spasms
• Deficient knowledge about postoperative care and
  management

15
Nursing Interventions

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

16
Nursing Interventions

• Relieving discomfort
• Bed rest
• Analgesic
• Assess bladder distention

17
Nursing Interventions

• Preparing the patient
• Elastic compression stocking
• Enema
• No aspirin

18
Nursing Interventions

• Maintaining fluid balance d/t irrigation of
  surgical site
• IO
• irrigation
• Check BP
• Confusion
• Respiratory distress ? crackles
• fluid overload

19
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

20
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
• IO

21
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
• IO

22
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

23
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

24
Nursing Interventions

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