NCD IV 2016-2017 Semester 1 Male Rerodacte Stem 1e12016 Clare chow Outline Prostate disorder + Prostati's + Benign prostatic hyperplasia * Cancerof Prostate Learning Outcomes 44. Understand the anatomy and physiology ofmale Feproductivesyster 42 dent the clinical manifestations af common pros fiscrder and malignant disorder make reprocuctivesytem #3 Understand the medical and surgical treatment of common, prostate ciserder and malignant disotder male reprecuctve 4 4. Desctibe mesial and ursing management common prostate disorcer andmalignandisrs lem withratinales ‘alerepreductive +5: Discuss nursing interventions for pavent ater operation such as prostatectomy ard TURP. Prostate ‘smallgland at the base of thebladder *sieofa ‘surrounds the first part of the tube (uretira} * produces protein called prostate specific antigen i)Prostatitis + fection in theprostate * Common disorder in youngermen less than $0 + Infectious agent: * bacteria, fungi, mycoplasma *Eg. Escherichia coli klebsiella Clinical Manifestations + Pelvicpain, perineum pain + Dysuria * Urgency and frequency in urination * bifficultyurinating + Tiredness + Chills + Fever Prostatitis Atypes of posattis Aeute bacteria prostatitls dléen onset of fever, dysuria, UTIs onic bacteria pastas Chron presattis + nobacteia presence in urinary tract + hemos common form + urinaryand genial pain fr atleast threw ofthe past six rronts Asymptematicinammatory prostatitis + identify incidentally Medical Treatment ‘antiinflammatory drugs * Antibiotics for infectious prostatitis, + Analgesic ‘eMuscle relaxants + Surgical removal of the infected portions ‘Supportive therapiesNursing Management + educatedrug compliance + symotomsmanagement + increase fuidintake + increase fber intake +localheat such assitz hath for pain relieve Risk factors —— Bi Rr] ses oe ns © ee Benign prostatic hyperplasia (BPH) ‘= Common diseases middle agemen + Proliferative process of celular elements of prostate ‘* Depends on androgen dihydrotestosterone (DHT) Clinical Manifestations Urinary frequency Unnary urgency H staringurination DriAssessment and Diagnosis historytaking prysieal exami tal examination (ORE) + -Prostatespeciicantigen (PSA, ceatnine level Urinary funetion| ‘ -urcelaric st 4+ urethroeystoscepy alrasound Surgical Treatment esfbladderpressure tush) Transutethal resection ef the prestate {TURP} + remavalof the inner partion af the pros endoscope through an Treatment + Goal impreve the urinary le, elev obstruction sistem, + Medication ¢ -terazosn (Hytrin oxazosn{Cardura} 1 1 Special preparations: + Antiembolismstockings -pievent deep vein thrombosis (0VT) operative stainingPotential Complication + Flysdvolumeimbs on during and “asa and tain *Pain Bader soasm “Infection Managing the irrigation system + -goreralcondiion and tal sens. eai detection + sense proper tanetioning,3aayndtellng caster th 1822, 4 -poency af the ngaten, no obsteucton correct ate and type of eration fad + -brewarm irgatio hid +S compicatons such as urnay retention urethral or Short pain + led sei drainage stem + prevention onthe bladder, drape tubes taped the inne hgh + -educaton patentnot to pullthecathter Nursing care for preventing hemorrhage Inholdanticaagulant medication before surgeryto ent excessive bleeding +2) Closely menting the crainagecolous from redlishpink anther clears ta ihe pink Casely monitoring vital sith, early detection #4) Monitor hemoglabin ve, ransfusion needed? erve fr s/s ofhypovolemic eg # 6)htokeancioutput, nte there is 4 7)Patenoyofdrainagessstem, ensureadequate urine lox Aid ilance 4 8]Avoidstainng, enema befee operation +} norm Cancer of Prostate ‘+ mosteommon cancer in men ‘ occursin men at their 50s ‘develops slowly, may be no signsRisk factors + Age + Hereditary factor * Genetic changes * Dietary factors + Obesity Diagnosis + Meal history + DREdaalrecatewm + Aloo test + serumPsa tosatespecicnntizen) + -aprotein peotuced ty the prosategland s+ snceeses with age + uirasound guided wansrectal biopsy RUS) 1 abe negatve rest Clinical Manifestations Urinary frequency ‘Urinary urgeney * Nocturia * Difficultypassing urine + Hematuria lf metastasis Back pain ‘Rectal discomfort + Weight loss Ultrasound guided transrectal biopsy (TRUS) * an ultrasound probeis inserted into rectum * needlethrough the rectal wall into the prostate gland to take small amples *localanaesthesia * complications: bleedingand infectionTreatment + Nonsurgical and surgical + Nonsurgical= + sctively monitoring Suitable for + patient with life expectancy < 5 years, lowrisk of cancers + -esymptomic “Tumor + growsiowly + small tumor + sinsitu Hormonal strategies + Androgen deprivation therapy (ADT) ar enéteger suppression therapy oe + Loner level of androgens + Radiation External and internal ( brachytherapy) Side effect * inflammation and mucosal loss at the bladder neck, prostate, urethra * urinary dysfunction + rectal urgency + erectile dysfunction + rectal fistula *rectalbleeding Palliative role Hormonal strategies + orchiectomy o castation + surgical procedure to remove one or both testicles + Luteinizinghormonereleasing hormone [LAR agenists [RH analogs) += eastationar castration +E, Louprolde (Lupron Elgar, Goserelin Zolades), Tiptorelin(Tresta)Chemotherapy + cytotoxicdrugs + 8im + shrink tumor + selieve symptoms + control cancer + improvequality oflife Retropubic prostatectomy + Incision in lower abdomen + dleta remove moh nese + catheter inserted intapenistor drains Surgical treatment + Racial mostaectomy + emovalof arostate, seminal vesicles, pation af heck, surteundingnerve, cod vessels, and fa tissue + Transurethral esection of prostate + Retropubic prostatectomy * Peringalprestatectemy Perineal prostatectomy + Incsionin the ski betwen the anus and seratur + DsedvantaPotential complication related to radical prostatectomy + urinary incontinence + erectile dysfunction Patient Education on discharge Det ‘+ Resume normal det, increase fluidintake, avoid alcohol Sexualintercourse + Avoid for weeks Urin + My experiencing burning, stinging forseveral weeks Reportfor abnormality * Unable to urinate + Excessive and uncontrolled dleeding ‘Fever, chills + swollen scrotum ‘Pain on one calf, chest pain Patient Education on discharge Activity Avoid activity *Donot take long walks Take avoid while catheter in place Bleeding + heavy bleeding seek medical advise and withhold aspirin and NSAID for 2 weeks Bowel movement ‘* Keep BM regular, avoid constipation and on prostate