Benign Prostate Hyperplasia (BPH)Matrix : 1524

LEARNING OBJECTIVE After end of case study I will able to; State the definition for benign prostate hyperplasia (BPH). Explain the anatomy and physiology of prostate gland. Explain the pathophysiology of BPH. State the etiology of BPH. State the clinical manifestation. State the complication on BPH. Describe the investigation done on patient with BPH. How do show your understanding the implication for medication and treatment used in care patient in BPH. Implement the nursing care plan. Appreciate the importance of giving health teaching to patient in BPH to prevent further complication.

PATIENT BIODATA Name: Mr. X Consultant: Dr. L MRN: xxxxxx Date of birth: 13 June 1945 Age: 60 years old Gender: Male Marital status: Married I/c no: 450613-xx-xxxx 450613-xxRace: Chinese

Religion: Buddha Occupation: Businessman Reason for admission: Complaint of difficulty passing urine for 1 weeks Diagnosis: Diagnosis: Benign prostate hyperplasia Medical history: Nil Surgical: Nil Family medical history: Mother had stroke Current medication: Nil Allergies: Norfloxacin and crab

ADMISSION

Mr. X was admitted to 4th floor in Puteri Specialist Hospital (PSH) on 02 December 2007 at 1330 pm with complaint of difficulty to passing urine for 1 week.

Vita sign Blood pressure: 140/80mmHg Temperature:36.5 Pulse: 80 beat per minutes consciousness Respiration:23 breath per minutes Skin condition: Normal and clean

Mode of admission Wheel chair Level of conscious

ACTIVITY DAILY LIVING BREATHING Mr. X no complaint of difficulty in breathing, shortness of breath (SOB) during admission. COUGH Mr. X no complaint of cough. SMOKE Mr. X is not active smoke only 3stick/day. EATING AND DRINKING Mr. X allergic to antibiotic (norfloxacin, and crab) ELIMINATION Mr. X did not complaint of constipation.

BLADDER Mr. X had difficulty in passing urine in 1week. SLEEPING Mr. X has sleeping disturbance at night because nocturia. MOBILITY Ambulant PERSONAL HYGIENE Mr. X can do himself. SAFE ENVIRONMENT Put the side rails up all the time.

SPIRITUAL Not applicable. COMMUNICATION Mr. X cans speech normally. VISION AND HEARING No complaint of blurred vision and hearing sound. INTEREST Like to reads news paper.

PHYSICAL EXAMINATION Physical examination was done on patient from head toe. Below is the information: HEAD Hair grey and black hair. Clean head scalp and no swelling seen. EYES No conjunctivitis and no discharge. Eyes appeared symmetrical. NOSE Nose shape is symmetrical. Patient able to smell slight. No discharge seen.

EAR No discharge seen. Ear shape is symmetrical. NECK No lymph node swelling or thyroid enlargement detected. No redness and scarring seen. UPPER LIMB ARM No bruises, flexible joint. WRIST Have a vasocan at right hand.

FINGERS Normal digitalis. Can move normally. NAIL No clubbing seen. SKIN Clean and warm.

BODY CHEST Symmetrical in shape. No scarring. ABDOMEN Having slight distended, wound not detected. LOWER LIMB No swelling and redness. Flexible joints. No itchiness so is detected.

vasocan

ANATOMY AND PHYSIOLOGYPROSTATE GLAND Lies on pelvic cavity in front of rectum and behind the symphysis pubis, surrounding the first part of the urethra. Consist of an outer fibrous covering , a layer of smooth muscle and glandular substances composed of columnar epithelial cells. The prostate makes a fluid that becomes part of semen. Semen is the white fluid that contains sperm.

DEFINITION OF BENIGN PROSTATE HYPERPLASIA (BPH)

An age related , non malignant enlargement of the prostate gland , is a common disorder of the ageing male , the prostate , very small at birth , grows at puberty , reaches adult size around age 20. (Medical surgical page 1537)

Definition 2 Benign prostatic hyperplasia is nonmalignant (non cancerous)enlargement of the prostate gland, a common occurrence in older men. It is also known as benign prostatic hypertrophy and abbreviated as BPH

DEFINITION 3 The prostate gland starts to enlarge after middle age.When the prostate becomes enlarged, the condition is called benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.

ETIOLOGY Unknown. The

aging process levels (DHT)

Testosterone

Dihydrotestosterone

PATHOPHYSIOLOGY Aging Androgen that mediates prostatic growth at all ages is Dihydrotestosterone (DHT) formed in prostate from testosterone Androgen reduce in aging men and more sensitive to DHT Estrogen produced in small amount in men, sensitive the prostate gland to effects of DHT

Increase estrogen level in aging related to testosterone level Its begins as small nodules in periurethral glands, inner layers prostate Prostate enlarge, formation and growth of nodules and enlargement of glandular cell Benign prostate hyperplasia (BPH)

CLINICAL MANIFESTATION More frequent urination Bladder irritability Nocturia Urge incontinence Dysuria Urinary retention

COMPLICATION OF BENIGN PROSTATE HYPERPLASIA (BPH) Vesicoureteric reflux Hydoureter Hydronephrosis

INVESTIGATION Chest x-ray xBlood test (pre operation) GP 78A or M19 Serology Prostate Specific Antigen (PSA)

Electrocardiogram (ECG) Uroflowmetry

PREPRE-OPERATIVE PROFILE (GP78A) @ M1 Date order: 3 January 2007 Date done: 3 January 2007 HAEMATOLOGY Haemoglobin Platelet count BIOCHEMISTRY Glucose

14.7g/d

13.0 - 18.0 450

207 10/uL 150 10

5.7mmol/L

3.9-6.1 3.9-

Reference range: Random blood sugar :