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