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Benign Prostate Benign Prostate Hyperplasia (BPH)Hyperplasia (BPH)
Matrix : 1524Matrix : 1524
LEARNING OBJECTIVELEARNING OBJECTIVE After end of case study I will able to;After end of case study I will able to; State the definition for benign prostate hyperplasia State the definition for benign prostate hyperplasia
(BPH).(BPH). Explain the anatomy and physiology of prostate gland. Explain the anatomy and physiology of prostate gland. Explain the pathophysiology of BPH.Explain the pathophysiology of BPH. State the etiology of BPH. State the etiology of BPH. State the clinical manifestation.State the clinical manifestation. State the complication on BPH.State the complication on BPH. Describe the investigation done on patient with BPH.Describe the investigation done on patient with BPH. How do show your understanding the implication for How do show your understanding the implication for
medication and treatment used in care patient in BPH.medication and treatment used in care patient in BPH. Implement the nursing care plan.Implement the nursing care plan. Appreciate the importance of giving health teaching to Appreciate the importance of giving health teaching to
patient in BPH to prevent further complication.patient in BPH to prevent further complication.
PATIENT BIODATAPATIENT BIODATAName: Name: Mr. XMr. X
Consultant:Consultant: Dr. L Dr. L
MRN:MRN: xxxxxx xxxxxx
Date of birth:Date of birth: 13 June 1945 13 June 1945
Age:Age: 60 years old 60 years old
Gender:Gender: Male Male
Marital status:Marital status: Married Married
I/c no:I/c no: 450613-xx-xxxx 450613-xx-xxxx
Race:Race: Chinese Chinese
Religion:Religion: Buddha Buddha
Religion:Religion: Buddha BuddhaOccupation:Occupation: Businessman Businessman
Reason for admission:Reason for admission: Complaint of difficulty Complaint of difficulty passing urine for 1 weeks passing urine for 1 weeks
DiagnosisDiagnosis: Benign prostate hyperplasia: Benign prostate hyperplasia
Medical history:Medical history: Nil Nil
Surgical:Surgical: Nil Nil
Family medical history:Family medical history: Mother had stroke Mother had stroke
Current medication:Current medication: Nil NilAllergies:Allergies: Norfloxacin and crab Norfloxacin and crab
ADMISSIONADMISSION
Mr. X was admitted to 4th floor in Puteri Specialist Hospital Mr. X was admitted to 4th floor in Puteri Specialist Hospital (PSH) on 02 December 2007 at 1330 pm with complaint of (PSH) on 02 December 2007 at 1330 pm with complaint of difficulty to passing urine for 1 week.difficulty to passing urine for 1 week.
Vita sign Vita sign Mode of admissionMode of admissionBlood pressure: 140/80mmHgBlood pressure: 140/80mmHg Wheel chairWheel chairTemperature:36.5ºTemperature:36.5ºPulse: 80 beat per minutesPulse: 80 beat per minutes Level of Level of
consciousnessconsciousnessRespiration:23 breath per minutesRespiration:23 breath per minutes consciousconscious
Skin condition:Skin condition:Normal and cleanNormal and clean
ACTIVITY DAILY LIVINGACTIVITY DAILY LIVING
BREATHINGBREATHINGMr. X no complaint of difficulty in breathing, shortness Mr. X no complaint of difficulty in breathing, shortness
of breath (SOB) during admission.of breath (SOB) during admission.
COUGHCOUGHMr. X no complaint of cough.Mr. X no complaint of cough.
SMOKESMOKEMr. X is not active smoke only 3stick/day.Mr. X is not active smoke only 3stick/day.
EATING AND DRINKINGEATING AND DRINKINGMr. X allergic to antibiotic (norfloxacin, and Mr. X allergic to antibiotic (norfloxacin, and
crab) crab)
ELIMINATIONELIMINATIONMr. X did not complaint of constipation.Mr. X did not complaint of constipation.
BLADDERBLADDERMr. X had difficulty in passing urine in 1week.Mr. X had difficulty in passing urine in 1week.
SLEEPINGSLEEPINGMr. X has sleeping disturbance at night because Mr. X has sleeping disturbance at night because
nocturia.nocturia.
MOBILITYMOBILITYAmbulantAmbulant
PERSONAL HYGIENEPERSONAL HYGIENEMr. X can do himself.Mr. X can do himself.
SAFE ENVIRONMENTSAFE ENVIRONMENTPut the side rails up all the time.Put the side rails up all the time.
SPIRITUALSPIRITUALNot applicable.Not applicable.
COMMUNICATIONCOMMUNICATIONMr. X cans speech normally.Mr. X cans speech normally.
VISION AND HEARINGVISION AND HEARINGNo complaint of blurred vision and hearing sound.No complaint of blurred vision and hearing sound.
INTERESTINTERESTLike to reads news paper. Like to reads news paper.
PHYSICAL EXAMINATIONPHYSICAL EXAMINATIONPhysical examination was done on patient from Physical examination was done on patient from
head toe. Below is the information:head toe. Below is the information:
HEADHEADHair grey and black hair.Hair grey and black hair.Clean head scalp and no swelling seen.Clean head scalp and no swelling seen.
EYESEYESNo conjunctivitis and no discharge.No conjunctivitis and no discharge.Eyes appeared symmetrical.Eyes appeared symmetrical.
NOSENOSENose shape is symmetrical.Nose shape is symmetrical.Patient able to smell slight.Patient able to smell slight.No discharge seen.No discharge seen.
EAREAR
No discharge seen.No discharge seen.
Ear shape is symmetricalEar shape is symmetrical..
NECKNECKNo lymph node swelling or thyroid No lymph node swelling or thyroid enlargement detected.enlargement detected.No redness and scarring seen.No redness and scarring seen.
UPPER LIMBUPPER LIMBARMARMNo bruises, flexible joint.No bruises, flexible joint.
WRISTWRISTHave a vasocan at right hand.Have a vasocan at right hand.
FINGERSFINGERS
Normal digitalis. Can move normally.Normal digitalis. Can move normally.
NAILNAIL
No clubbing seen.No clubbing seen.
SKINSKIN
Clean and warm.Clean and warm.
BODYBODY
CHESTCHESTSymmetrical in shape.Symmetrical in shape.No scarring.No scarring.
ABDOMENABDOMENHaving slight distended, wound not detected.Having slight distended, wound not detected.
LOWER LIMBLOWER LIMBNo swelling and redness.No swelling and redness.Flexible joints.Flexible joints.No itchiness so is detected.No itchiness so is detected.
vasocan
ANATOMY AND PHYSIOLOGYANATOMY AND PHYSIOLOGY
PROSTATE GLANDPROSTATE GLANDLies on pelvic cavity in front of rectum and Lies on pelvic cavity in front of rectum and
behind the symphysis pubis, surrounding behind the symphysis pubis, surrounding the first part of the urethra.the first part of the urethra.
Consist of an outer fibrous covering , a layer Consist of an outer fibrous covering , a layer of smooth muscle and glandular substances of smooth muscle and glandular substances composed of columnar epithelial cells.composed of columnar epithelial cells.
The prostate makes a fluid that becomes The prostate makes a fluid that becomes part of semen. Semen is the white fluid that part of semen. Semen is the white fluid that contains sperm.contains sperm.
DEFINITION OF BENIGN PROSTATE DEFINITION OF BENIGN PROSTATE HYPERPLASIA (BPH)HYPERPLASIA (BPH)
An age related , non malignant enlargement of the An age related , non malignant enlargement of the prostate gland , is a common disorder of the ageing prostate gland , is a common disorder of the ageing male , the prostate , very small at birth , grows at male , the prostate , very small at birth , grows at puberty , reaches adult size around age 20.puberty , reaches adult size around age 20.
(Medical surgical (Medical surgical page 1537)page 1537)
Definition 2Definition 2Benign prostatic hyperplasia is nonmalignant (non Benign prostatic hyperplasia is nonmalignant (non
cancerous)enlargement of the prostate gland, a cancerous)enlargement of the prostate gland, a common occurrence in older men. It is also known common occurrence in older men. It is also known as benign prostatic hypertrophy and abbreviated as as benign prostatic hypertrophy and abbreviated as BPHBPH
DEFINITION 3DEFINITION 3
The prostate gland starts to enlarge after middle The prostate gland starts to enlarge after middle age.When the prostate becomes enlarged, the age.When the prostate becomes enlarged, the condition is called benign prostatic hyperplasia condition is called benign prostatic hyperplasia
(BPH), or benign prostatic hypertrophy.(BPH), or benign prostatic hypertrophy.
ETIOLOGYETIOLOGY
Unknown.Unknown.
The aging process The aging process
Testosterone levelsTestosterone levels
Dihydrotestosterone (DHT) Dihydrotestosterone (DHT)
PATHOPHYSIOLOGYPATHOPHYSIOLOGY
AgingAging↓↓
Androgen that mediates prostatic growth at Androgen that mediates prostatic growth at all ages is Dihydrotestosterone (DHT) all ages is Dihydrotestosterone (DHT) formed in prostate from testosteroneformed in prostate from testosterone
↓↓Androgen reduce in aging men and more Androgen reduce in aging men and more
sensitive to DHTsensitive to DHT↓↓
Estrogen produced in small amount in men, Estrogen produced in small amount in men, sensitive the prostate gland to effects of sensitive the prostate gland to effects of
DHTDHT↓↓
Increase estrogen level in aging related to Increase estrogen level in aging related to testosterone leveltestosterone level
↓↓Its begins as small nodules in periurethral Its begins as small nodules in periurethral
glands, inner layers prostateglands, inner layers prostate↓↓
Prostate enlarge, formation and growth of Prostate enlarge, formation and growth of nodules and enlargement of glandular nodules and enlargement of glandular
cellcell↓↓
Benign prostate hyperplasia (BPH)Benign prostate hyperplasia (BPH)
CLINICAL MANIFESTATIONCLINICAL MANIFESTATION
More frequent urinationMore frequent urination
Bladder irritability Bladder irritability
NocturiaNocturia
Urge incontinenceUrge incontinence
DysuriaDysuria
Urinary retentionUrinary retention
COMPLICATION OF BENIGN PROSTATE COMPLICATION OF BENIGN PROSTATE HYPERPLASIA (BPH)HYPERPLASIA (BPH)
Vesicoureteric reflux Vesicoureteric reflux
Hydoureter Hydoureter
Hydronephrosis Hydronephrosis
INVESTIGATIONINVESTIGATION Chest x-rayChest x-ray
Blood test (pre operation) GP 78A or Blood test (pre operation) GP 78A or M19M19
Serology – Prostate Specific Antigen Serology – Prostate Specific Antigen (PSA) (PSA)
Electrocardiogram (ECG)Electrocardiogram (ECG)
UroflowmetryUroflowmetry
PRE-OPERATIVE PROFILE (GP78A) @ M1PRE-OPERATIVE PROFILE (GP78A) @ M1
Date order: 3 January 2007Date order: 3 January 2007
Date done: 3 January 2007Date done: 3 January 2007
HAEMATOLOGYHAEMATOLOGY
HaemoglobinHaemoglobin 14.7g/d 13.0 - 14.7g/d 13.0 - 18.018.0
Platelet countPlatelet count 207 10207 10/uL 150 – /uL 150 – 450450
BIOCHEMISTRYBIOCHEMISTRY
GlucoseGlucose 5.7mmol/L5.7mmol/L 3.9-6.13.9-6.1
Reference range: Random blood sugar : <7.8 Reference range: Random blood sugar : <7.8 mmol/L (<140mg / dL)mmol/L (<140mg / dL)
Creatinine Creatinine 63 umol/L63 umol/L 51 – 13351 – 133UreaUrea 5.8 mmol/L5.8 mmol/L 2.0 – 6.82.0 – 6.8SodiumSodium 141 mmol/L141 mmol/L 135 – 155135 – 155ChlorideChloride 103 mmol/L 103 mmol/L 95 – 11195 – 111
SEROLOGYSEROLOGYProstate specific antigen (PSA)Prostate specific antigen (PSA) 4.97ng/mL4.97ng/mL <4.0<4.0
BLOOD GROUPBLOOD GROUP
ABO groupABO group O ORhesus group (D)Rhesus group (D) positive positiveVDRL (RPR)VDRL (RPR) non reactive non reactive non reactive non reactive
HIV I/II antigen /antibodies non reactive HIV I/II antigen /antibodies non reactive non reactive non reactiveHBs antigenHBs antigen
CHEST X RAY RESULTSCHEST X RAY RESULTS
Date order: 3 January 2007Date order: 3 January 2007Date done: 3 January 2007Date done: 3 January 2007
No focal lung lesionNo focal lung lesionHeart size is normalHeart size is normalNo hilar or pleural abnormalitiesNo hilar or pleural abnormalitiesThe mediastinum is not widened.The mediastinum is not widened.No body abnormalitiesNo body abnormalities
ECGECG
Date order: 3 January 2007Date order: 3 January 2007Date done: 3 January 2007Date done: 3 January 2007
Vent. Vent. RateRate 72 bpm72 bpmPRPR intint 196 ms196 msQRSQRS durdur 118 ms118 msQT / QTcQT / QTc intrintr 388 / 412 ms388 / 412 msP QRS / TP QRS / T axisaxis 60 / 3 / 46º60 / 3 / 46ºRVS SV 1RVS SV 1 ampamp 1.630 / 1.070 mv1.630 / 1.070 mvRVS + SV 1RVS + SV 1 ampamp 2.700 mv2.700 mv1100 sinus rhythm1100 sinus rhythm1102 sinus arrhythmia1102 sinus arrhythmia2320 non specific intraventricular conduction delay2320 non specific intraventricular conduction delay9130 ** borderline ECG** 9130 ** borderline ECG**
UroflowmetryUroflowmetry
0
100
200
300
400
500
600
700
0 20 40 1:00 1:20
Flow ml/s
vol.mL
Dev (male)Dev (male)
Max flow:Max flow: 8.6 ml/s8.6 ml/s -42%-42%
Averange flow:Averange flow: 3.5ml/s3.5ml/s -67%-67%
Voiding time: Voiding time: 1: 09. 2 sec1: 09. 2 sec -219%-219%
Flow time:Flow time: 58.6 sec 58.6 sec
Time to peak flow:Time to peak flow: 6.0sec6.0sec42%42%
Voided vol:Voided vol: 207.8ml207.8ml
Flow at 2 seconds:Flow at 2 seconds: 7.1 ml/s7.1 ml/s
Acceleration:Acceleration: 1.2ml/s1.2ml/s
Statistic of BPH in Puteri Specialist Hospital Statistic of BPH in Puteri Specialist Hospital (PSH)(PSH)
0
10
20
30
40
50
60
70
YEAR 2003 YEAR 2004 YEAR 2005 YEAR 2006
31- 40YRS
41-50YRS
51- 60YRS
>=61YRS
Medication in wardMedication in ward
Name of drug:Name of drug: Date on: Date on: Date off:Date off:
Tab tramal 50mg TDS Tab tramal 50mg TDS 3/1/20073/1/2007 5/1/20075/1/2007IV maxolon 10mg TDS/PRNIV maxolon 10mg TDS/PRN 3/1/20073/1/2007 3/1/20073/1/2007Tab zinnat 250mg BD Tab zinnat 250mg BD 3/1/20073/1/2007 continue continue
at at homehomeIV pethidine 50mg STATIV pethidine 50mg STAT 3/1/20073/1/2007 3/1/20073/1/2007IV phenergan 25mg STATIV phenergan 25mg STAT 3/1/20073/1/2007 3/1/20073/1/2007Proscar 5mg OMProscar 5mg OM 3/1/2007 3/1/2007 continue at continue at homehome
Medication when dischargeMedication when dischargeTab maxolon I/I TDS/PRN 3/7Tab maxolon I/I TDS/PRN 3/7Zinnat 250mg BD 3/7Zinnat 250mg BD 3/7
NamNamee
DosDosee
FreqFreq IndctIndct s/effcts/effct D/D/onon
D/offD/off
IM IM pethipethidinedine
50 50 mgmg
STATSTAT Reduce Reduce painpain
DizzinessDizziness,sweatin,sweating,nause g,nause and and vomiting,vomiting,dry dry mouthmouth
3/13/1 3/13/1
IM IM phenephenerganrgan
25 25 mgmg
STATSTAT control control nausea nausea and and vomitingvomiting
TachycarTachycardia,dizzindia,dizziness,constess,constipationipation
3/13/1 3/13/1
Tab Tab tramatramall
50 50 mgmg
TDS/TDS/PRNPRN
Release Release painpain
SweatingSweating,dizzines,dizziness,s,
vomiting vomiting dry dry mouthmouth
3/13/1 5/15/1
NameName DoseDose FreFreqq
Indct.Indct. s/effcts/effct D/onD/on D/offD/off
ZinnatZinnat 250 250 mgmg
BDBD Prevent Prevent infectioinfectionn
HeadacHeadache, he, eosinopieosinopilliallia
3/13/1 cntn. at cntn. at homehome
ProscaProscarr
5mg 5mg OMOM Control Control and and vomitinvomitingg
ImpotenImpotence,decrce,decrease ease libidolibido
3/13/1 Cntn.at Cntn.at homehome
TREATMENTTREATMENT
CONSERVATIVE (usually for mild cases)CONSERVATIVE (usually for mild cases) Antibiotic therapyAntibiotic therapy Hormone therapyHormone therapy Health educationHealth education
SURGERYSURGERY
TURP (Transurethral Resection of Prostate)TURP (Transurethral Resection of Prostate)
This is an instrument that’s used in TURP procedures.
This is the way TURP was done to patient This is the way TURP was done to patient and the end of the resectoscope have the and the end of the resectoscope have the electrode cutting wire to cut the electrode cutting wire to cut the enlargement of prostate. enlargement of prostate.
Doctors inserts the resectoscope through the penis
This photos shows that doctors cutting the prostate by using the electrode wire loop
ZINNATZINNAT
Group:Group: Macrolides Macrolides
Name of drugName of drug: Cefuroxime axetil: Cefuroxime axetil
Indication:Indication: Broncholitis , pneumonia , upper respiratory Broncholitis , pneumonia , upper respiratory tract , GUT , skin and soft tissue infection , pyelonephritis .tract , GUT , skin and soft tissue infection , pyelonephritis .
Dosage: Dosage: 250mg BD 250mg BD
Contra indication:Contra indication: Hypersensitivity and cephalosporin’s. Hypersensitivity and cephalosporin’s. Special precaution:Special precaution: Anaphylactic reaction to penicillin’s Anaphylactic reaction to penicillin’s
Side effectSide effect:. I disturbances occasionally pseunomembranous :. I disturbances occasionally pseunomembranous colitis , hypersensitivity reactions . Eosinophillia .headache . colitis , hypersensitivity reactions . Eosinophillia .headache . super infection.super infection.
PROSCARPROSCAR
Group:Group: Genito urinary system Genito urinary system
Name of drug: Name of drug: FinasterideFinasteride
Indication:Indication: treatments and control benign treatments and control benign prostate hyperplasia to cause regression prostate hyperplasia to cause regression of enlarged prostate, improve urinary flow of enlarged prostate, improve urinary flow and symptom associated with benign and symptom associated with benign prostate hyperplasia.prostate hyperplasia.
Dosage:Dosage: 5mg OM 5mg OM
Contra indication:Contra indication: women and peads patients women and peads patients
Special precautionSpecial precaution: Large residual urine : Large residual urine volume and or severely diminished urinary volume and or severely diminished urinary flow (monitor for obstructive uropathy ) flow (monitor for obstructive uropathy ) exclude prostate cancer . Generally baseline exclude prostate cancer . Generally baseline PSA further evaluation and consideration of PSA further evaluation and consideration of biopsy. Decrease in serum PSA concentration biopsy. Decrease in serum PSA concentration even in the presence of prostate cancer. BPH even in the presence of prostate cancer. BPH patient treated with proscar with reduction of patient treated with proscar with reduction of serum PSA level does not rules out serum PSA level does not rules out concomitant prostate cancer.concomitant prostate cancer.
Side effect:Side effect: Impotence, decrease libido and Impotence, decrease libido and
volume of ejaculate.volume of ejaculate.
TRAMALTRAMAL
GroupGroup: Analgesic and antipyretic : Analgesic and antipyretic
Name of drug: Name of drug: Tramdol HCLTramdol HCL
Indication: Indication: Moderate to severe acute chronic pain, Moderate to severe acute chronic pain, painful diagnostic measures and surgical pain. painful diagnostic measures and surgical pain.
Dosage: Dosage: 50mg TDS50mg TDS
Contraindication: Contraindication: Analgesic or psychotropic. Analgesic or psychotropic. Narcotic withdrawal treatments. HypersensitivityNarcotic withdrawal treatments. Hypersensitivity
Special precaution: Special precaution: Reduce level of consciousness of Reduce level of consciousness of unclear origin, respiration disorder, increase intracranial unclear origin, respiration disorder, increase intracranial pressure. Patient knows to suffer from convulsion. pressure. Patient knows to suffer from convulsion. Pregnancy and lactation. On long term use, possibility of Pregnancy and lactation. On long term use, possibility of tolerance, psychic and physical dependence .Capacity to tolerance, psychic and physical dependence .Capacity to drive or operate machines may be impaired, especially if drive or operate machines may be impaired, especially if taken with alcohol. taken with alcohol.
Side effect:Side effect: Sweating , dizziness , drowsiness , vomiting , dry Sweating , dizziness , drowsiness , vomiting , dry
mouth. In rare cases , influence on CVS regulation , mouth. In rare cases , influence on CVS regulation , especially after IV administration , headache , vomiting, especially after IV administration , headache , vomiting, constipation , GI irritation , skin reaction. In very cases, constipation , GI irritation , skin reaction. In very cases, motorial weakness, appetite changes, micturation disorder . motorial weakness, appetite changes, micturation disorder . Psychic side effect e.g. mood. Perception and activity Psychic side effect e.g. mood. Perception and activity changes. In isolated cases, cerebral convulsion especially changes. In isolated cases, cerebral convulsion especially on co –medication with neuroleptics . Allergies reaction and on co –medication with neuroleptics . Allergies reaction and shocks cannot definity be ruled out. shocks cannot definity be ruled out.
Drug interactionDrug interaction: Avoid concurrent administration of MOAIs. : Avoid concurrent administration of MOAIs. Co medication with other centrally acting depressants Co medication with other centrally acting depressants include alcohol may potentiate CNS effects. include alcohol may potentiate CNS effects.
PETHIDINEPETHIDINE
Group: Group: Analgesic and antipyreticsAnalgesic and antipyretics
Indication: Indication: Pain relief of moderate to severe pains. As Pain relief of moderate to severe pains. As anaesthetic adjust and for obstetric analgesia.anaesthetic adjust and for obstetric analgesia.
Dosage:Dosage:50mg STAT50mg STAT
Contra Indication: Contra Indication: Respiratory distress head injury increases Respiratory distress head injury increases ICP brain tumor cardiac arrthymia eclampsiaICP brain tumor cardiac arrthymia eclampsia
Special Precautions: Special Precautions: May impair ability to drive or operate May impair ability to drive or operate machinery. Elderly. Reduced renal and liver function.machinery. Elderly. Reduced renal and liver function.
Side Effect: Side Effect: Respiration depression dizziness, sedation, Respiration depression dizziness, sedation, sweating, nausea and vomiting,Tachycardian bradycardia, sweating, nausea and vomiting,Tachycardian bradycardia, gangrene.gangrene.
Drug Interaction: Drug Interaction: Barbituration CNS depresses increase the Barbituration CNS depresses increase the CNS effects.CNS effects.
MAXOLONMAXOLON
Group:Group: Antacids. Antacids.
Name of drug:Name of drug: Metoclopramide. Metoclopramide.
Indication:Indication: Dyspepsia, flatulence, digestive disorders Dyspepsia, flatulence, digestive disorders associated with hiatus hernia, peptic ulcer ulceration, reflux associated with hiatus hernia, peptic ulcer ulceration, reflux oesophagitis, gastritis, duodenitis.oesophagitis, gastritis, duodenitis.
DosageDosage: IV 10mg TDS.: IV 10mg TDS.
Special precautionSpecial precaution: Neuroleptics, anticholinergics, : Neuroleptics, anticholinergics, phyroplasty pregnancy.phyroplasty pregnancy.
Side effect:Side effect: rarely, extra pyramidal reaction, tacdive dry rarely, extra pyramidal reaction, tacdive dry skinesia.skinesia.
Drug interaction:Drug interaction: Phenothiazines, anti cholinergic, narcotic Phenothiazines, anti cholinergic, narcotic analgesics.analgesics.
Special careSpecial care
Catheter bladder drainage (CBD)Catheter bladder drainage (CBD)
Continues bladder irrigation (CBI)Continues bladder irrigation (CBI)
CBDCBD
Wash hand before and after handling the Wash hand before and after handling the CBD.CBD.
Ensure the urine is low with gravity.Ensure the urine is low with gravity. Maintain urine free flow all the time.Maintain urine free flow all the time. Urine bag not touching the floorUrine bag not touching the floor Ensure the catheter not kinking or blocked.Ensure the catheter not kinking or blocked. Empty the urine bag 8hourly or PRN.Empty the urine bag 8hourly or PRN. Avoid patient to touch the urine catheter.Avoid patient to touch the urine catheter. Do not take the urine specimen from urine Do not take the urine specimen from urine
bag.bag. Do the perineal care and ensure it is clean Do the perineal care and ensure it is clean
and dry.and dry. Do not pull out the catheter Do not pull out the catheter Urine bag must be attach to the frame and Urine bag must be attach to the frame and
must be hanging at the bed.must be hanging at the bed.
CBICBI
Solution as prescribed is normal salineSolution as prescribed is normal saline Run the solution at rate prescribed fast in 1st Run the solution at rate prescribed fast in 1st
5hours.5hours. Check and record pulse and blood pressure.Check and record pulse and blood pressure. Reduce the rate when blood stained is reduce.Reduce the rate when blood stained is reduce. Change the normal saline when empty Change the normal saline when empty
immediately to prevent air embolism.immediately to prevent air embolism. Ensure it is not blocked or kinking.Ensure it is not blocked or kinking. Frequently observe the urine bag and empty if Frequently observe the urine bag and empty if
fullfull Urine bag must be lower from bladder and not Urine bag must be lower from bladder and not
touch the floor.touch the floor. Inform doctor if bleeding still persists. Inform doctor if bleeding still persists.
NURSING CARE PLAN (NCP)NURSING CARE PLAN (NCP)
PRE OPERATIONPRE OPERATION1)Alteration in emotional status: anxiety related to 1)Alteration in emotional status: anxiety related to
pre operation.pre operation.
2) Alteration in emotional status: pain(dysuria) 2) Alteration in emotional status: pain(dysuria) related to constriction of urethre.related to constriction of urethre.
POST OPERATIONPOST OPERATION
3)Alteration in comfort: pain related to post 3)Alteration in comfort: pain related to post operation.operation.
4)Potential hypovolemic shock related to excessive 4)Potential hypovolemic shock related to excessive bleeding.bleeding.
5)Potential infection related to poor care of CBD.5)Potential infection related to poor care of CBD.
NCP 1NCP 1Date:3 January 2007Date:3 January 2007Time:0730Time:0730
Alteration in emotional status: anxiety related to pre Alteration in emotional status: anxiety related to pre operation.operation.
Supporting data: Supporting data: 1)Patient facial expression look anxious.1)Patient facial expression look anxious.2) Patient keep in asking question about the 2) Patient keep in asking question about the
operation.operation.
Goal: Patient will be reduce anxiety 1-2 hours after nursing Goal: Patient will be reduce anxiety 1-2 hours after nursing intervention given and during hospitalization.intervention given and during hospitalization.
Nursing intervention:Nursing intervention:1) Assess patient general condition such as facial 1) Assess patient general condition such as facial
expression.expression.® Act as baseline data and plan appropriate nursing care.® Act as baseline data and plan appropriate nursing care.I- I assess patient general condition during admission and I- I assess patient general condition during admission and
patient look anxious.patient look anxious.
2) Monitor patient vital sign such as blood pressure, 2) Monitor patient vital sign such as blood pressure, pulse , temperature and respiration. pulse , temperature and respiration.
® Patient anxious may indicated in high blood ® Patient anxious may indicated in high blood pressure.pressure.
I- I check patient vital sign and my patient blood I- I check patient vital sign and my patient blood pressure is 160/90 mmHg.pressure is 160/90 mmHg.
3) Re inforce doctors explaination about the 3) Re inforce doctors explaination about the procedure will done to him.procedure will done to him.
® To reducing the anxiety level.® To reducing the anxiety level.I- I re inforce doctors explaination to patient to him I- I re inforce doctors explaination to patient to him
get a picture about the operation.get a picture about the operation.
4) Encourage patient to asking the question regarding 4) Encourage patient to asking the question regarding the operation.the operation.
® To ensure patient understand about the operation ® To ensure patient understand about the operation and reducing anxiety.and reducing anxiety.
I- I encourage him to asking question and give answer I- I encourage him to asking question and give answer in simple language.in simple language.
5) Teach patient to do deep breathing exercise 5) Teach patient to do deep breathing exercise (DBE)(DBE)
® For relaxation and divert patient mind.® For relaxation and divert patient mind.I- I teach him to do DBE , inhaled and hold in 10 I- I teach him to do DBE , inhaled and hold in 10
seconds then exhale do in 5 to 10 minutes.seconds then exhale do in 5 to 10 minutes.
6) Encourage patient to rest in bed (RIB)6) Encourage patient to rest in bed (RIB) ® To reduce anxiety and relaxation.® To reduce anxiety and relaxation.I- I advice him to rest and relax it is also can divert I- I advice him to rest and relax it is also can divert
patient mind.patient mind.
7) Encourage family member to be with patient. 7) Encourage family member to be with patient. ® To give moral support to him.® To give moral support to him.I- I encourage his wife to spend time with him.I- I encourage his wife to spend time with him.
8) Inform doctors if patient still anxious.8) Inform doctors if patient still anxious.
® To further treatment and intervention.® To further treatment and intervention.
I- I not inform doctor because the anxiety is reducing and I- I not inform doctor because the anxiety is reducing and blood pressure back to normal level.blood pressure back to normal level.
Evaluation:Evaluation:
Patient reduce the anxiety level in 1hours after nursing Patient reduce the anxiety level in 1hours after nursing intervention given and during hospitalization.intervention given and during hospitalization.
Supporting data: Supporting data:
Patient look more calm and relax.Patient look more calm and relax.
Patient blood pressure back to normal range 140-80 Patient blood pressure back to normal range 140-80 mmHg.mmHg.
Date:3 January 2007Date:3 January 2007
Time:0830Time:0830
NCP 2NCP 2Date: 3 January 2007Date: 3 January 2007Time:0930Time:0930
Alteration in comfort: pain dysuria related to constriction of Alteration in comfort: pain dysuria related to constriction of the urether.the urether.
Supporting data:Supporting data:1.1. Patient verbalize pain during passing urine.Patient verbalize pain during passing urine.2.2. Patient facial expression look pale.Patient facial expression look pale.
Goal: Patient will be reduce the pain within 3-4 hours after Goal: Patient will be reduce the pain within 3-4 hours after nursing intervention given during hospitalization.nursing intervention given during hospitalization.
Nursing intervention:Nursing intervention:1) Assess patient general condition such as severity of pain 1) Assess patient general condition such as severity of pain
by using pain scale.by using pain scale. Act as baseline data and plan appropriate nursing care.Act as baseline data and plan appropriate nursing care.I- I assess severity of pain by asking him how the pain it is. I- I assess severity of pain by asking him how the pain it is.
2) Monitor patient vital sign such as blood pressure, 2) Monitor patient vital sign such as blood pressure, pulse, temperature and respiration.pulse, temperature and respiration.
To detect any changes in vital sign especially in To detect any changes in vital sign especially in blood pressure reading.blood pressure reading.
I- I do observation 4 hourly and blood pressure is I- I do observation 4 hourly and blood pressure is 150/80 mmHg.150/80 mmHg.
3) Encourage patient to do deep breathing exercise 3) Encourage patient to do deep breathing exercise (DBE).(DBE).
To reduce the pain and relaxation.To reduce the pain and relaxation.I-I demonstrate to him how to do the DBE and ask I-I demonstrate to him how to do the DBE and ask
patient to demonstrate back to me.patient to demonstrate back to me.
4) Ensure patient in rest in bed (RIB)4) Ensure patient in rest in bed (RIB) To reduce pain and minimize movement.To reduce pain and minimize movement.I- I ensure him to rest in bed for reduce pain it is I- I ensure him to rest in bed for reduce pain it is
also can divert patient mind.also can divert patient mind.
5)5) Serve medication as prescribed by doctors such as Serve medication as prescribed by doctors such as antipyretic tramal 250 mg.antipyretic tramal 250 mg.
To decreasing and stop the pain.To decreasing and stop the pain.
I- I serve tramal 250mg to him with supervise of staff I- I serve tramal 250mg to him with supervise of staff nurse.nurse.
6) provide divertional therapy6) provide divertional therapy
TO divert patient mind and not thing of the pain.TO divert patient mind and not thing of the pain.
I- I provide new strait time and switch on the televison.I- I provide new strait time and switch on the televison.
7) inform dortors if the pain is not reduce.7) inform dortors if the pain is not reduce.
For futher treatment and investigation.For futher treatment and investigation.
I- I did not inform to doctors because the pain is I- I did not inform to doctors because the pain is reduce.reduce.
Evaluation : Patient reduce the pain after 3 hours Evaluation : Patient reduce the pain after 3 hours after nursing intervention given and during after nursing intervention given and during hospitalization.hospitalization.
Supporting data:Supporting data:
Patient verbalize the pain is reducing.Patient verbalize the pain is reducing.
Patient blood pressure is normal range Patient blood pressure is normal range 140/70mmHg.140/70mmHg.
Date: 3 January 2007Date: 3 January 2007
Time:1230Time:1230
NCP 3NCP 3
Date:3 January 2007Date:3 January 2007Time:1715Time:1715
Alteration in comfort: pain related to post operation.Alteration in comfort: pain related to post operation.
Supporting data:Supporting data:Patient verbalize pain at the operation site.Patient verbalize pain at the operation site.Patient look pale. Patient look pale.
Goal: Pain will reduce pain in 3-4hours after intervention Goal: Pain will reduce pain in 3-4hours after intervention given and during given and during
hospitalization.hospitalization. Nursing intervention:Nursing intervention:1) Asses patient pain by using pain scale 1-10, 10 consider 1) Asses patient pain by using pain scale 1-10, 10 consider
is severe pain.is severe pain.® Act as baseline data and plan appropriate nursing care.® Act as baseline data and plan appropriate nursing care.I- I asking patient how severe the pain for further I- I asking patient how severe the pain for further
treatment.treatment.
2) Monitor patient vital sign especially blood pressure.2) Monitor patient vital sign especially blood pressure. ® Increase blood pressure indicated patient in pain. ® Increase blood pressure indicated patient in pain. I- I do observation 4hourly and blood pressure is I- I do observation 4hourly and blood pressure is
150/80mmHg.150/80mmHg.
3) Position patient in patient desired (recumbent)3) Position patient in patient desired (recumbent) ® To reduce pain and relaxation.® To reduce pain and relaxation.I- I position him in recumbent position as him desired.I- I position him in recumbent position as him desired. 4)Encourage patient to rest in bed (RIB) 4)Encourage patient to rest in bed (RIB) ® To minimize patient movement and relaxation.® To minimize patient movement and relaxation.I- I encourage him to RIB and explain to him it is also can I- I encourage him to RIB and explain to him it is also can
reducing the pain.reducing the pain.
5) Encourage patient to do double breathing exercise 5) Encourage patient to do double breathing exercise (DBE) (DBE)
® For release the pain and muscle relaxation.® For release the pain and muscle relaxation.I-I teach patient to do DBE , inhale and hold in 10second I-I teach patient to do DBE , inhale and hold in 10second
than release.than release.
6) Serve antipyretic drugs such as tramal 50mg TDS.6) Serve antipyretic drugs such as tramal 50mg TDS. ® To reduce and stop pain ® To reduce and stop pain I- I serve antipyretic drug tramal to patient with I- I serve antipyretic drug tramal to patient with
supervise of staff nurse.supervise of staff nurse.
Evaluation: Patient reduce the pain in 3hours after Evaluation: Patient reduce the pain in 3hours after nursing intervention given during hospitalization.nursing intervention given during hospitalization.
Supporting data: Supporting data: Patient verbalize the pain is reducingPatient verbalize the pain is reducingPatient look more relax compare than before Patient look more relax compare than before
interventioninterventiongiven. given.
Date: 3 January 2007Date: 3 January 2007Time: 2015Time: 2015
NCP 4NCP 4Date: 3 January 2007Date: 3 January 2007Time: 2030Time: 2030
Potential hypovolemic shock related to excessive Potential hypovolemic shock related to excessive bleeding.bleeding.
Supporting data:Supporting data:1.1. Patient post surgery ( TURP )Patient post surgery ( TURP )2.2. Patient back to ward with CBI.Patient back to ward with CBI.
Goal: Patient will be free from bleeding 2-3 hours Goal: Patient will be free from bleeding 2-3 hours after nursing intervention given and during after nursing intervention given and during hospitalization. hospitalization.
Nursing intervention:Nursing intervention:1) Assess patient site and severity of bleeding such as 1) Assess patient site and severity of bleeding such as
amount and color of blood.amount and color of blood. Act as baseline data and plan appropriate nursing Act as baseline data and plan appropriate nursing
care.care.I- I assess the site of surgery and check the amount I- I assess the site of surgery and check the amount
blood in the urine bag and how the color dark red or blood in the urine bag and how the color dark red or no.no.
2) Monitor patient vital sign such as blood pressure, 2) Monitor patient vital sign such as blood pressure, pulse, respiration and temperature.pulse, respiration and temperature.
If patient is severe bleeding blood pressure will If patient is severe bleeding blood pressure will decrease can lead to hypovolemic shock.decrease can lead to hypovolemic shock.
I- I do observation to patient 4 hourly and check the I- I do observation to patient 4 hourly and check the blood pressure, pulse, temperature.blood pressure, pulse, temperature.
3) Observe sign and symptom of bleeding such as blood 3) Observe sign and symptom of bleeding such as blood pressure decrease, and rapid pulse.pressure decrease, and rapid pulse.
To prevent severe bleeding occurs.To prevent severe bleeding occurs.I- I do observation especially blood pressure and pulse I- I do observation especially blood pressure and pulse
to know any changes in patient vital sign.to know any changes in patient vital sign.
4) Set up intravenous drip such as Hartman’s 4) Set up intravenous drip such as Hartman’s solutionsolution
Hartman can increasing the blood pressure and Hartman can increasing the blood pressure and reduce the bleeding.reduce the bleeding.
I- I assist the staff nurse to set up the intravenous I- I assist the staff nurse to set up the intravenous line.line.
5) Position patient in the recumbent position.5) Position patient in the recumbent position. To reducing the bleeding. To reducing the bleeding. I- I position him in recumbent position and I- I position him in recumbent position and
encourage him to relax.encourage him to relax.
6) Avoid to do hot compress6) Avoid to do hot compress Hot compress can dilate the blood vessel and can Hot compress can dilate the blood vessel and can
cause severe bleeding.cause severe bleeding.I- I did not give hot compress to patient.I- I did not give hot compress to patient.
7)Avoid to serve anticoagulant drug such as wafarin, heparin.
If can cause more bleeding. I- I did not serve the anticoagulant drug to patient.
Evaluation: Patient free from excessive bleeding after Evaluation: Patient free from excessive bleeding after nursing intervention given and during nursing intervention given and during hospitalization.hospitalization.
Supporting data:Supporting data:1.1. Patient blood pressure in normal range 140/70 Patient blood pressure in normal range 140/70
mmHgmmHg2.2. Patient facial expressions not pale. Patient facial expressions not pale.
Date: 3 January 2007Date: 3 January 2007Time: 2210Time: 2210
NCP 5NCP 5Date: 4 January 2007Date: 4 January 2007Time: 0830Time: 0830
Potential infection due to poor care of CBD.Potential infection due to poor care of CBD.
Goal: Patient will free from infection after nursing Goal: Patient will free from infection after nursing intervention given and during hospitalization.intervention given and during hospitalization.
Nursing intervention:Nursing intervention:
1) Assess patient general condition such as site of CBD.1) Assess patient general condition such as site of CBD. ® Act as baseline data and plan appropriate nursing ® Act as baseline data and plan appropriate nursing
care to patient.care to patient.I- I check patient catheter and ensure it is clean and I- I check patient catheter and ensure it is clean and
intact.intact.
3) Maintain personal hygiene.3) Maintain personal hygiene. ® To prevent getting infection.® To prevent getting infection.I-I do perineal care to him for first hours after operation I-I do perineal care to him for first hours after operation
because patient in RIB.because patient in RIB.
4) Ensure wash hand before and after handling patient 4) Ensure wash hand before and after handling patient with CBD.with CBD.
® To prevent transmission of microorganism.® To prevent transmission of microorganism.
I-I wash hand before and after attend to patient.I-I wash hand before and after attend to patient.5) Empty the CBD 8 hourly or PRN.5) Empty the CBD 8 hourly or PRN.
® To prevent retention of urine in the bladder.® To prevent retention of urine in the bladder.I- I empting the urine bag when it is full and chart in I- I empting the urine bag when it is full and chart in
intake and output chart.intake and output chart.
6) Avoid patient to touch the catheter.6) Avoid patient to touch the catheter. ® To prevent cross infection happened.® To prevent cross infection happened.I- I advice to him do not necessary touch the catheter I- I advice to him do not necessary touch the catheter
2)Monitor patient vital sign such as blood pressure, 2)Monitor patient vital sign such as blood pressure, temperature, pulse and respiration.temperature, pulse and respiration.
® High temperature may indicate patient in ® High temperature may indicate patient in infection.infection.
I-I do observation to him and his not develop fever I-I do observation to him and his not develop fever and the temperature is 36.3º.and the temperature is 36.3º.
3) Maintain personal hygiene.3) Maintain personal hygiene. ® To prevent getting infection.® To prevent getting infection.I-I do perineal care to him for first hours after I-I do perineal care to him for first hours after
operation because patient in RIB.operation because patient in RIB.
4) Ensure wash hand before and after handling 4) Ensure wash hand before and after handling patient with CBD.patient with CBD.
® To prevent transmission of microorganism.® To prevent transmission of microorganism.I-I wash hand before and after attend to patient.I-I wash hand before and after attend to patient.
5) Empty the CBD 8 hourly or PRN.5) Empty the CBD 8 hourly or PRN. ® To prevent retention of urine in the bladder.® To prevent retention of urine in the bladder.I- I empting the urine bag when it is full and chart in I- I empting the urine bag when it is full and chart in
intake and output chart.intake and output chart.
6) Avoid patient to touch the catheter.6) Avoid patient to touch the catheter. ® To prevent cross infection happened.® To prevent cross infection happened.I- I advice to him do not necessary touch the I- I advice to him do not necessary touch the
catheter.catheter.
7) Observe the sign and symptom of infection such 7) Observe the sign and symptom of infection such as itchiness and redness.as itchiness and redness.
® To detect infection early.® To detect infection early.I-I check the site if have redness and I asking him I-I check the site if have redness and I asking him
that he feel itchy or no.that he feel itchy or no.
Evaluation: Patient free from infection after nursing Evaluation: Patient free from infection after nursing intervention given and during hospitalization.intervention given and during hospitalization.
Supporting data: Supporting data:
No redness and patient no complaint feel itchiness.No redness and patient no complaint feel itchiness.
The area is clean and dry.The area is clean and dry.
Date: 5 January 2007Date: 5 January 2007
Time: 1330Time: 1330
Health educationHealth education
DietDiet ExerciseExercise LifestyleLifestyle HygieneHygiene MedicationMedication Follow upFollow up
DISCHARGEDISCHARGE
My patient discharge on 5 January 2007 at My patient discharge on 5 January 2007 at 1330. I told to him that the bill is ready 1330. I told to him that the bill is ready and can settle down at counter 38 on and can settle down at counter 38 on ground floor. I also told him to take the ground floor. I also told him to take the medication at the nurses counter in the medication at the nurses counter in the ward. Staff nurse give explanation to him ward. Staff nurse give explanation to him regarding the medicine and lastly I off the regarding the medicine and lastly I off the vasocan. The doctors was order the tab vasocan. The doctors was order the tab maxolon I/I TDS/PRN x 3/7 , zinnat 250 mg maxolon I/I TDS/PRN x 3/7 , zinnat 250 mg BD x 3/7, proscar 5 mg OM TDS/PRN x BD x 3/7, proscar 5 mg OM TDS/PRN x 3/7 .3/7 .
I also remind him about the follow up on 18 I also remind him about the follow up on 18 January 2007.January 2007.
Follow upFollow up
My patient appointment on 18 January 2007 My patient appointment on 18 January 2007 for follows up and Dr.L order to do for follows up and Dr.L order to do ultrasound abdomen and do the ultrasound abdomen and do the ureflowmetry to check still got the ureflowmetry to check still got the obstruction or no.obstruction or no.
And the result show the patient not having And the result show the patient not having the obstruction.the obstruction.
SUMMARYSUMMARY
Mr. X was admitted on 3rd January 2007 at Mr. X was admitted on 3rd January 2007 at O710am. He was complaint of difficulty in passing O710am. He was complaint of difficulty in passing urine for 1 week, Dr. L diagnose him a Benign urine for 1 week, Dr. L diagnose him a Benign prostate hyperplasia (BPH) and transurethral prostate hyperplasia (BPH) and transurethral resection of prostate (TURP) was done to patient resection of prostate (TURP) was done to patient on 3rd January 2007 at 1330pm. He was on 3rd January 2007 at 1330pm. He was hospitalized for 2 days and discharge on 5 hospitalized for 2 days and discharge on 5 January 2007. There was no complaint of difficulty January 2007. There was no complaint of difficulty in passing urine anymore. Health educations were in passing urine anymore. Health educations were given on regarding the CBD and follow up given on regarding the CBD and follow up appointment on 19 January 2007. Dr. L was appointment on 19 January 2007. Dr. L was ordered maxolon and zinnat 250mg to him.ordered maxolon and zinnat 250mg to him.
CONCLUSIONCONCLUSION
Thank you, to all staff in Puteri Specialist Thank you, to all staff in Puteri Specialist Hospital (PSH) especially to Sister Marina Hospital (PSH) especially to Sister Marina who that guide me to do and finish my case who that guide me to do and finish my case study. Not forgotten to my collogue in study. Not forgotten to my collogue in guided me also thank you so much. Not guided me also thank you so much. Not forgetting to my parents support in do my forgetting to my parents support in do my case study. I choose this case because it is case study. I choose this case because it is interesting case and of course common interesting case and of course common happen in male population in the world.But happen in male population in the world.But not so worry because now we have the not so worry because now we have the treatment to treat it become enlarge the treatment to treat it become enlarge the treatment called transurethral resection of treatment called transurethral resection of prostate. Thank you so much once again to prostate. Thank you so much once again to my collogue and staff PSH may Allah bless my collogue and staff PSH may Allah bless u.u.
REFERENCEREFERENCE
Medical surgical nursing book 10th edition editor by Medical surgical nursing book 10th edition editor by Mark Johnson page 1192,1195,1196,1958.Mark Johnson page 1192,1195,1196,1958.
A Complete Hospital Manual of INSTRUMENT AND A Complete Hospital Manual of INSTRUMENT AND PROCEDURES editor by MM Kapur New Delhi page PROCEDURES editor by MM Kapur New Delhi page 288, 289.288, 289.
Operating room technique editor by Berry and Kohns Operating room technique editor by Berry and Kohns page 709,710,711,712,713,714.page 709,710,711,712,713,714.
Benign prostate hyperplasia editor by Axeanders and Benign prostate hyperplasia editor by Axeanders and Jane C. Rothrock page 1020,1021,1022.Jane C. Rothrock page 1020,1021,1022.
Watson’s clinical nursing and related sciences editor Watson’s clinical nursing and related sciences editor by Mike Walsh page 980,981,985.by Mike Walsh page 980,981,985.
MIMS 99TH Edition 2004 page 13,73,128,177.MIMS 99TH Edition 2004 page 13,73,128,177.http://www.benignprostatehyperplasia.com/http://www.benignprostatehyperplasia.com/
GUT /urinaryGUT /urinarysystemsystemhttp://http://www.TURPprocedures.com.mywww.TURPprocedures.com.my/treatment/treatmenthttp://www.anatomy&physiologyofprostateglandhttp://www.anatomy&physiologyofprostateglandhttp://www.uroflowmetryprocedures.com.myhttp://www.uroflowmetryprocedures.com.my
Any question ?Any question ?
Thank you for your attenttionThank you for your attenttion
