Theories about the cause of benign prostatic hypertrophy

Theories about the cause of benign prostatic hypertrophy

There are 3 theories put forward about the causes of benign prostatic hypertrophy, are:
1. Stem cell theory
In normal circumstances periuretral gland balanced between growth and the dead (SteadyState). New cells are usually grown from stem cells, because of some reason like the factor of age, hormonal disorders or other factors then trigger the stem cells proliferate faster so happens hiperplasi periuretral gland.

2. Theory Reawakening
Re-grow tissues such as stem cell growth during embriologik level, so that periuretral network can grow faster than the surrounding tissue.

3. The theory de Hidrotestoteron
This theory says that hiperplasi caused by the change in the balance between testosterone and estrogen. Testosterone produced by Leydig cells located in the two testes by 90% while 10% in the adrenal gland. However, there were 20% in a state of free testosterone that can cause prostate enlargement. Testosterone that is free to enter into the prostate to penetrate the cell membrane into the cytoplasm of prostate cells to form DHT heseplar acid complex which will affect the RNA that resulted in the synthesis of proteins that can cause cell proliferation.

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Nursing care in patients with benign prostatic hyperplasia

Nursing care in patients with benign prostatic hyperplasia

DEFINITIONS
Benign prostatic hyperplasia is an urgent periuretral gland hyperplasia prostate tissue native to the peripheral and the surgical capsule.

ETIOLOGY
The cause of benign prostatic hypertrophy is less clear but there are 3 indications that the hormone causes tissue hyperplasia and stromal buffer glandural elements of the prostate. As we get older there will be changes in the balance of testosterone and estrogen, decreased testosterone production and testosterone is converted to estrogen in peripheral adipose tissue. Lobes that have an enlarged neck can clog vesika or prostatic urethra. Thing that happens is that delays the emptying of urine (urinary retention). The result is dilatation of the ureter (hidroureter) and kidneys (hydronephrosis) in stages. Urinary tract infections can occur due to stasis of urine, because most of urine inside the bladder is settled will be where the growth of the organism.

There are several theories about the balance of hormones that cause benign prostate hiperplasi.
1. stem cell theory (Isaacs)
2. Reawekening Theory (Mc Neal)
3. theory de hydro testosterone (DHT)
 
Predisposing factors :

• Age
• Hormonal
• Precipitation factor
• Too much sitting
• Too much sex
• Many masturbate
• Stress

PATOFISIOLOGY
Areas often affected are the lateral lobe regions of central and medial lobes. Prostate weight is about 60 -100 grams. Enlarged prostate cause narrowing of the lumen of the prostatic urethra pars and will inhibit the flow of urine, causing pressure intervasikal this situation. To remove the urine, bladder must contract more strongly for resistance against it. The contractions which continue to cause anatomic changes of bladder muscle hypertrophy destrusor form, trabekulasi, trbentuknya selula, sakula and divertikel vesika urinaria. At this stage destrusor muscle thickening called phase compensation.
With the increase in urinary retention, detrusor muscle into the phase of decompensation and eventually no longer mapu to contract. Resulting in urinary retention. The pressure of the higher intra vesikal, will be forwarded to all parts of vesika urinaria up in the two estuaries ureter. The pressure on these two estuaries ureter can cause backflow of urine from the bladder into the ureter or bladder occurs fesiko-ureteric reflux. if this situation continues to cause hidroureter, hydronephrosis can occur even kidney failure.

CLINICAL MANIFESTATIONS
Obstructive and irritating symptoms of the syndrome is also called prostatismus the mark with:

• Increased urinary frequency
• Nocturia
• The urge to urinate constantly
• Abdomen tense
• Decreased urine volume and must be straining during micturition
• Urine flow is not smooth
• Feeling like the bladder does not empty properly.
• Dribbling (urine continues to drip after urination)
• Acute urinary retention
• Recurrence of urinary tract infection

Clinically the degree of symptoms prostatismus divided into:
1. Grade I: symptoms prostatismus + residual urine <50 ml
2. Grade II: symptoms prostatismus + residual urine> 50ml
3. Grade III: urinary retention with upper urinary tract disorders + residual urine> 150 ml

In benign prostatic hypertrophy symptoms of symptoms known as the lower urinity symtoms tract (LUTS), which are divided into obstructive and irritating symptoms.
1. Irritating symptoms

• Frequent urination
• Waking at night to urinate
• Urgency
• Dysuria

2. Obstructive symptoms

• Flow / poor stream when urinating
• Not satisfied in micturition
• Long wait (hesitancy)
• Must straining
• Piss off break
• long time urinating and urinary incontinence due to overflow.

On the other references are divided into:
1. Grade I (congestive)

• Increased urination frequency
• nocturia
• Difficulty in starting and ending piss
• Piss off
• Dribbling
• poor stream
• Pain when urinating
• Pain has not been satisfied after urination

2. Grade II (Residual)

• Within a few months or years later the patient difficult urination or straining while urinating
• Urine is not satisfied
• Urine drips
• Nocturia
• Can not urinate
• Urinary tract infection due to residual urine in vesika
• High body temperature and potential death
• Pain in the kidney and spread to the hips

3. Grade III (Urine Retention)

• Ischuria paradorsal
• Incontinential paradorsal

4. Grade IV

• Full bladder
• Patients in pain
• Periodic urine dripping (overflow incontinensia)
• With this infection the patient may die with high heat up to 40-41 degrees Celsius
• Decreased consciousness
• Coma

If the fourth grade is not handled properly, it will eventually happen azotamia (accumulation of nitrogen waste products) and renal failure with urinary retention and a large residual volume.


EXAMINATION SUPPORT

1. Urinalysis
2. Urodinamis examination (assessing obstruction of urine flow pattern)
3. Complete blood examination
4. Assessment of cardiac and respiratory function
5. Radiological examinations plain to see an enlarged prostate
6. Ultrasonography (TRUS-transrectal ultrasonography)
7. Sistografi

MANAGEMENT

1. Catheterization (with a metal catheter)
2. Prostatekmi
3. Watch ful waiting (prostate incision intrasuretral / TUIP)
4. Balloon dilatation
5. Gap alfaInhibitor 5 - @-reductase

ASSESSMENT
1. Circulation
Blood pressure rises as the effects of kidney enlargement
2. Elimination
Decrease in strength or encouragement of urine, difficult start, urination, not satisfied in urination, nocturia, Dysuria, Hematuria, recurrent urinary tract infections, urinary tract stone disease history, Constipation
3. Enter the food / beverage
Anorexia, nausea, vomiting, weight loss.
4. Comfort
Suprapubis pain and back pain / hip
5. Security
Fever
6. Sexuality
Decrease in ejaculation

NURSING DIAGNOSIS
1. acute pain associated with muscle spasm spincter
2. changes in the pattern of elimination: urinary retention associated with secondary obstruction
3. Sexual dysfunction associated with loss of body function
4. Risk of infection associated with port de enter microorganisms through a catheter

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Nursing care in patients with diarrhea

DIARRHEA

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UNDERSTANDING
Diarrhea is the number of bowel movements with stools more than normal (normal 100-200 ml per hour) with the form of liquid or semi-liquid feces, can also be accompanied by an increased frequency defecation.
According to WHO diarrhea is watery bowel movements and more than 3 times a day.
Acute diarrhea is a sudden diarrhea and short duration, within a few hours to 7 days or until 14 days.
Chronic diarrhea is diarrhea that lasts more than 3 weeks.

ETIOLOGY
The cause is a bacterial diarrhea, parasites, or viruses (E.colli, V. cholerae, Aeromonas.SP.)
Another cause is a toxin, drug, food, chemotherapy, fecal impaction and other conditions.

CLINICAL MANIFESTATIONS
Patients with infections often experience diarrhea nausea, vomiting, abdominal pain to stomach cramps, fever and defecation increases with increasing fluid content in feces. spasmodic contraction of the pain and stretching is not effective in anal (tenesmus) can happen every defecation. lack of fluid causes the patient to feel thirsty, tongue dry, and decreased skin elasticity.
hypovolemic cause rapid pulse, decreased blood pressure, nervous, pale, cyanosis, in certain circumstances cause hypokalemia which which will lead to cardiac arrhythmia.

PATHOPHYSIOLOGY
Infectious diarrhea is usually transmitted through the fecal oral because of contaminated food or beverages feces excretion bad plus, the food is not cooked or undercooked. Transmission is person to person via aerosolization or contaminated hands.
Non-invasive bacteria produce a toxin that bound to the intestinal mucosa and increase levels of cyclic AMP in the cell causes active secretion of chloride anions into the intestinal lumen at follow water, carbonate ions, sodium and potassium cations.
Entero-invasive bacteria cause damage to the intestinal wall in the form of necrosis and ulceration, are secretory eksudatif. The liquid can be mixed with mucus and diarrhea with blood.

EXAMINATION SUPPORT

• Laboratory tests are complete
• Examination of blood gas analysis
• Examination of urine and feces

MANAGEMENT

• Rehydration as a priority treatment. on acute diarrhea can be given ORS, RL fluid or an isotonic Nacl plus 1 ampoule of 7.5% Sodium bicarbonate 50 ml.
• Identify causes of diarrhea
• Symptomatic therapy. anti-intestinal motility and secretion (loperamide / Imodium), anti-emetic (metokloperamide).
• Definitive therapy. cotrimoxazol, cloramphenicol, metronidazole, Ampisillin.

NURSING MANAGEMENT

1. Measures to control diarrhea by resting in bed, eating and drinking low-fiber to reduce the acute period, limit drinking caffeine and carbonates which stimulates intestinal motility.
2. Maintaining fluid balance and encourage oral rehydration such as water, juice and broth.
3. Reduce anxiety by supporting individual coping.
4. perianal skin care to maintain cleanliness and humidity.
5. Prevent infections that may occur and prevent the spread of disease through the hands, clothing, bed sheets and other objects.
6. Monitoring and management of potential complications with the examination of serum electrolyte levels, vital signs and general condition.

COMPLICATIONS

• Metabolic acidosis
• Hypovolemic shock
• Cardiac arrhythmias
• Acute renal tubular necrosis

NURSING

1. Physical examination: Patient's general condition: the objective data: body weakness, nausea, vomiting, abdominal pain. Subjective Data: decreased skin elasticity, cyanosis, pale, cold ektrimitas, anuria.
2. Abdomen: abdominal cramps, hyper peristalsis.
3. Skin: cold sweat, moisture, changes in skin elasticity.
4. Neurological: decreased consciousness, seizures.
5. Psychological: anxiety.
6. Cardiovascular: Tachicardi, cardiac arrhythmia, shock.

NURSING DIAGNOSIS

1. Diarrhea associated with the infection process
2. Imbalance nutrition: less than the needs of biological factors associated with nausea and vomiting
3. Fluid deficit associated with loss of fluid volume excess
4. Anxiety associated with changes in health status
5. Acute pain related to biological factors increasing intestinal motility

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Body care in AIDS patients

Body care in AIDS patients

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A. Actions in treatment room

• Align the patient's body, close your eyes, ears and mouth.
• Remove the medical equipment that is still attached.
• Each wound must be in plaster and covered well.
• Close all holes of the body with waterproof plasters.
• Clean bodies carefully.
• Give family and friends to view the corpse.
• Enter the corpse into a special plastic bag and attach the label "INFECTIOUS / HIV".
• After all the neat corpse may be sent to the morgue.

B. Actions in the morgue

• The body was bathed by a morgue worker who has been trained, then is wrapped with a cloth shroud or other packaging in accordance with the belief / religion, and then inserted into a special plastic bag labeled "infectious / HIV".
• Bodies that have been in special plastic bags should not be opened.
• The body should not be preserved in any manner or autopsy.
• In certain circumstances, an autopsy can only be done after obtaining approval from the head of the hospital.

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AIDS Patient Care

AIDS Patient Care

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The principles of Treatment:

ISOLATION
Basically, AIDS patients can be treated in the usual space infection. Sometimes AIDS patients need care in one special room for consideration:

• Protect AIDS patients from other infections both endogenous and exogenous.
• Facilitate the provision of nursing care.

REGULATION OF OFFICERS
a. Nursing team who suffered from infections, skin disorders and pregnant women should not be treating AIDS.
b. Wearing Barakshort (long underwear), masks and eye coverings and gloves for taking action:

• Bathing.
• Helping defecation and urination.
• Preparing laboratory materials.
• Changing clothes and loom.
• Expenditure measure urine, faeces or vomit.
• Doing huknah / klisma and catheterization.
• Perform procedures medical / invasive: infusion set, clearing the airway, injection and others.
• Caring for the body.

c. Wash hands before and after treatment measures despite wearing gloves and using a disinfectant under running water.
d. Reporting to the special team handling AIDS in the hospital when exposed to needle puncture scars in use in people with AIDS or splashing liquids when exposed to AIDS sufferers in the eyes, mouth or injured body part.
e. Giving plastic coating on the pillow and mattress as a shield so easy to wash.
f. Replacing the label reads "MATERIALS TRANSMITTED / HIV" in all specimen bottles that will be sent to the laboratory.
g. Cleaning the bathroom and treatment room regularly.
h. uphold the official secret.

PREVENTION OF CONTAMINATION AND CLEANING EQUIPMENT
a. All equipment used by people with AIDS should be set apart.
b. Use disposable tools in the tools such as syringes, infusion set, catheter, endotracheal(ET) tube and others.
c. Loom such as mattresses and pillows were given a plastic coating before it is used to prevent the attachment of blood or body fluids. The loom is already in use fed into a special plastic bag, labeled "INFECTIOUS MATERIAL / HIV", then tied and sent to the place of washing.
d. Gloves are used every action, straightening the bed and holding a tool that has been contaminated.
e. Tool is not the kind of disposable, should be sterilized immediately after use.
f. Masks, oxygen hose, and other breathing aids must be sterilized after use.
g. Instruments wound care or medical equipment, once used soaked with disinfectant solution and then sterilized according to the rules of sterilization.

CONTAMINATED MATERIALS
a. All remaining tissue, blood, body fluids, bandages, needles and abbocath(venous catheter) used during the action placed in hard plastic bag, double-layered, puncture resistant, waterproof and special color, and then given the label "MATERIALS TRANSMITTED / HIV" and then burned.
b. Give the guards with plastic alt on the operating table, operating coat, the base of the hands or head if done action intubation / cannulation / extubasi trachea.

PATIENT RIGHTS
a. patients may visit the facilities available in hospitals such as the television room, canteen and others.
b. Patients can receive guests at the time of visit and may be accompanied during the treatment, except in conditions of infection.
c. Patients with severe diarrhea may only use the special toilet.

COUNSELING
a. Counseling is an important aspect that aims to:

• Provides information on all matters relating to HIV infection which include, among other causes, clinical symptoms, patterns of transmission, prevention and others.
• Providing psychological and social encouragement to patients and families in dealing with problems of physical and psychological, so the patient can overcome the problems independently.
• Providing encouragement to the patient to adjust to new conditions, among others by holding a sexual behavior change, to reduce the spread of the HIV virus to others.

b. Counseling done by doctors and or nurses who have been specially trained.
c. Counseling target not only patients and families but all health workers including nurses, physicians, laboratory workers, laundry officers and others.

MAINTENANCE OFFICER ATTITUDES
a. Understand, understand and have skills in providing nursing care.
b. Be calm, fair, and not excessive but remain vigilant in helping patients.
c. Understanding the state of the patient, show empathy.
d. Be protected.

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