Benign Prostatic
Hyperplasia
BY: FATIMA LOVE V. ARIATE
I. Definition of the Disease
Benign prostatic hyperplasia (BPH) is an enlarged prostate gland. It
is one of the most common diseases in aging men. BPH typically
occurs in men older than 40 years of age. By the time they reach 60
years of age, 50% of men have BPH. It affects as many as 90% of
men by 85 years of age. BPH is the second most common cause of
surgical intervention in men older than 60 years of age.
II. PATIENT’S PROFILE
Patient’s Name: Patient X
Age: 75 years old
Gender: Male
Civil status: Married
Date of Admission: 3/21/16
Date of Discharge: 3/24/16
Admitting Diagnosis: Nephrolithiasis, Prostate Enlargement
Final Diagnosis: Benign Prostatic Hyperplasia, Obstructive Uropathy,
Acute Urinary Retention
II. PATIENT’S PROFILE
Initial Vital Signs:
BP: 140/80 CR: 106 RR: 29 TEMP: 36
Chief Complaint: Dysuria
History of present illness
5 days PTA (+) on and off urinary incontinence
3 days PTA (+) dysuria, no LBM, no vomiting, advised UTZ
III. ANATOMY AND
PATHOPHYSIOLOGY
Kidneys - produces urine.
Ureters - connects the kidney to the bladder
Bladder – urine is stored
Urethra – exit passage way
Testis - produces sperm
Epididymis – system of convoluted small tubes
leading from each testes and emptying into the vas
deferens
Prostate Gland
Wall nut sized gland situated just beneath
the bladder and encircles the upper part of the
urethra.
Secretes alkaline fluid rich in enzymes and
prostaglandin which is important for the sperms
performance and survival.
Modifiable: Non- modifiable:
Smoking > Old Age testosterone
Heavy alcohol
intake
Obesity
HPN, heart Increased production of
disease, DM Estrogen Dihydrotestosterone (DHT)
Increase sensitivity Increase stimulation
1. Increase intraglandular pressure
Voiding problems androgen receptors
Hesitating to start urinating
Feeling that the bladder is not completely empty
after urination’
Dribbling after urination Cell growth Absence of Apoptosis
Nocturia
2. Increase muscle tone
Post void urinary problems
Increase size of
Increase risk of infection
Bladder stone formation
prostate gland
Increase pressure
Cancer development in the urethra
IV. LABORATORY WORKS AND DIAGNOSTICS
URINALYSIS 3/21/16 3/23/16
Physical COMPLETE BLOOD 3/21/16 3/23/16 Normal
COUNT values
Color Light orange Dark yellow
Transparency Turbid Hazy Hemoglobin 129 115 130-170
Ph 5 5 Hematocrit 0.37 0.33 0.4-0.5
Specific gravity 1.025 1.030 Wbc 22.5 14.3 5-10
Microscopic Rbc 3.7 3.3 4-6
Pus cells Too numerous to 2-3 Differential count
count Segmenters 0.92 0.87 0.50-0.70
Rbc 18-20 10-12 Lymphocytes 0.04 0.08 0.20-0.40
Bacteria Many Few Monocytes 0.04 0.04 0.00-0.05
Mucus threads Few Eosinophil 0.00 0.01 0.00-0.04
Crystals Basophil 0.00 0.00 0.00-0.01
Amorphous Few Few MCV 98.4 98.8 79-92.2
urates MCH 34.7 34.5 25.7-32.2
Chemicals MCHC 35.2 35 32.3-36.5
Bilirubin Negative Negative Platelet count 208 200 150-450
Blood +2 +1 RDW-SD 43.3 42.7 37-54
Glucose Negative Negative RDW-CV 12.4 12.4 11-16
WBC esterase +3 Negative
Nitrite Positive Negative
Protein +2 Negative
Urobilinogen Negative Negative
Urine ketones Negative Negative
Potassium (3/21/16) 3.7 3.5-5.1 Fecalysis (3/23/16)
Creatinine (3/21/16) 1.2 0.8-1.3 Macroscopic
Color Brown
Chest x-ray result (3/21/16) Consistency Formed
Consider pneumonitis, right Microscopic
paracardiac area. WBC 0-1
Minimal bi-apical fibrotic residuals. RBC 0-1
Atheromatous aorta. Parasites None
Thoracic dextroscoliosis. Occult blood negative
UTZ (Kidney, prostate, urinary bladder –
3/21/16)
Renal cortical cyst right.
Subcentimeter nephrolithiasis, non-obstructive,
left.
Normal urinary bladder sonogram.
Complete urine retention (100%)
Markedly enlarge prostate gland, with intra-
prostatic protrusion, grade III.
V. MEDICAL MANAGEMENT
Foley Catheter
o It is a double-lumen retention catheter. The
larger lumen drains urine from the bladder,
and the second smaller lumen is used to
inflate the balloon near the tip of the
catheter to hold the catheter in place
within the bladder.
VI. PHARMACOLOGY REVIEW
GENERIC (BRAND) CLASSIFICATION AVAILABLE FORM INDICATION ADVRESE REACTION NURSING
RESPONSIBILITIES
Carisoprodol Carbamate 300/250 mg Skeletal muscle Dizziness, Assess patient for
(lagaflex) derivative tab relaxation headache, pain, muscle
syncope stiffness, and ROM
Tamsulosin Drugs for bladder 400mg cap Lower urinary Dizziness Can be taken with
(ocas) and prostate tract symptoms or without food.
disorder associated with Should be
BPH. swallowed whole,
not chewed.
Rowatinex Drugs for bladder Cap Urolithiasis, Should be taken
and prostate nephrolithiasis, without food.
disorder cystitis, renal
colic, UTI
Ceftriaxone Cephalosporin 1gm vial Lower respiratory GI disturbancesm Monitor patient for
(triax-1) tract infection, hematologic possible
bone and joint changes and skin hypersensitivity
infection, UTI reactions. reaction.
VI. PHARMACOLOGY REVIEW
GENERIC (BRAND) CLASSIFICATION AVAILABLE FORM INDICATION ADVRESE REACTION NURSING
RESPONSIBILITIES
Celecoxib NSAIDS 200mg/tab For mild to Anaphylactic Monitor patient for
moderate pain, reaction, acute evidence of
inflammation, renal failure, bleeding.
stiffnessm swelling abdominal pain,
or tenderness epigastric distress.
caused by
headache
Cefixime cephalosporins 400 mg/tab Acute bronchitis, Hypersensitive Monitor patient for
(Triocef) pyelonephritis, reactions, GI, possible
cystitis, renal effects. hypersensitivity
cholecystitis reaction
Ketorolac NSAIDS 30mg/amp Short-term Gi reactions, Monitor patient for
management of nausea, evidence of
moderate to dyspepsia, bleeding.
severe acute pain drowsiness,
that requires headache,
analgesia sweating edema
VII. NURSING CARE PLAN
Assessment Diagnosis Planning Implementation Evaluation
Subjective Urinary After series of Monitor patient’s I & To have baseline of After series of
“Feeling ko ay retention nursing O. the client’s output. nursing
may laman pa related to intervention, the intervention,
din ang pantog prostate patient will be Percuss and palpate To note if the goal was
ko, kahit naka ihi enlargement able to void in suprapubic area bladder is still partially met
na ako” as as evidenced sufficient amounts distended. as evidenced
verbalized by the by bladder with no palpable Facilitate regular May minimize by less
patient. distention. bladder draining of the urine urinary retention distention of
Objective distension. bag. and over distension the bladder.
Dysuria of the bladder.
Insert Catheter as It relieves and
Afebrile
per doctor’s order. prevents urinary
Distended
bladder retention and rules
Dribbling urine out presence of
ureteral stricture.
Assessment Diagnosis Planning Implementation Evaluation
Subjective Acute pain After series of Assess pain, noting Provides information After series of
“Ang sakit ng related to nursing location, intensity to aid in nursing
puson ko.” as increased intervention, the (scale of 0–10), determining choice intervention,
verbalized by the intraglandular patient’s pain will duration. or effectiveness of goal was
patient. pressure as be lessen. interventions. partially met
Objective evidenced by Provide comfort Promotes as evidenced
Facial grimace elevated measures such relaxation, by the
Pain scale of 7/10 blood as back rub, helping refocuses attention, patient’s pain
Restlessness pressure of patient assume and may enhance scale of 4/10.
Body malaise 140/90 position of comfort. coping abilities.
Suggest use of
relaxation and
deep-breathing
exercises, diversional
activities.
Provide warm To relieve pain
compress.
Administer To relieve pain.
medications as per
doctors order
[Link] PLAN
Home care considerations for clients with catheter.
Instruct the client to:
Never pull on the catheter.
Secure catheter tubing to your leg.
Ensure that there are no kinks or twists in the tubing.
Keep the urine drainage bag below the level of the bladder.
Empty the drainage bag regularly.
Monitor signs and symptoms of urinary tract infection including, burning, urgency,
abdominal pain, cloudy urine.
Ensure adequate oral intake of fluids.
Encourage to change catheter weekly.
Encourage client to maintain proper hygiene.
