Prostatic neoplasms / cancer

• Behavioral Objectives– Describe etiology, pathophysiology, clinical

manifestations, nursing management and patient education for Prostatic neoplasms / cancer

• Brunner and Suddarth’s Medical Surgical Nursing pg 1752-61

Prostatic neoplasms / cancer

Pathophysiology– Most common cancer in men – Risk Factors• Increased age• African American Men• A familial predisposition

Prostatic neoplasms / cancer

Clinical manifestations• Early stages– asymptomatic

• Late stage– Urinary obstruction Dysuria, hesitancy,

dribbling– Blood in the urine– Painful ejaculation

• Metastasis to bone, lymph,

Prostatic neoplasms / cancer

Assessment and diagnostic procedures

• DRE > 40• PSA

Prostatic neoplasms / cancer

Nursing process / Diagnosis / Interventions• Anxiety related to concern and lack of knowledge

about the diagnosis, treatment plan and prognosis Uncertain outcomes, sexual dysfunction– Assess– Provide – Teach

Prostatic neoplasms / cancerUrinary retention related to urethral obstruction secondary to Prostatic

enlargement or tumor and loss of bladder tone due to prolonged distention/retention

• Baseline• S&S of retention – urine output– frequency– Supra-pubic distention– C/O urgency

Urinary retention cont.

Catheterize to check residual– Sterile – Irrigate– Monitor

• Position for urination: normal• Administer meds • Monitor effects

Prostatic neoplasms / cancer

Deficient knowledge related to the diagnosis of cancer, urinary difficulties and treatment modalities

• Enc. communication• Teach– Terminology (anatomy)– Catheter care

Prostatic neoplasms / cancerImbalanced nutrition: less than body requirements related to

decreased oral intake because of anorexia, nausea and vomiting caused by cancer or its treatment

• Assess % food • Weights• Food preferences• Recognize effect of medications and treatment on

appetite• N/V– Antiemetics & Oral care

• Frequent small meals

Prostatic neoplasms / cancer

Sexual dysfunction related to effects of therapy: chemotherapy, hormonal therapy, radiation therapy surgery– Assess sexual function– Inform of treatments effects on sexuality– Include the partner

Prostatic neoplasms / cancer

Pain related to progression of disease and treatment modalities

• Evaluate pain• Avoid activities that pain• Administer analgesics/Opiates

Prostatic neoplasms / cancerImpaired physical mobility and activity intolerance related to

tissue hypoxia, malnutrition and exhaustion and to spinal cord or nerve compression from metastases

• Assess factors causing limited mobility • Administer pain relief• Encourage use of assistive devices• ROM• Positioning• Walking• Assess nutritional status

Prostatectomy

Transurethral resection of the prostate: TURP• Most common • Endoscopy

– Surgical & optic scope urethra prostate

• Gland removed in small chips

TURPAdvantages• No abd. incisions• Risks • Shorter hospital• morbidity rate• pain

Disadvantages• Recurrent obstruction– stricture

• Delayed bleeding • Erectile dysfunction

TURP

Specific nursing implications• Monitor for hemorrhaging• Observe for urethral stricture– Dysuria– Straining– Weak urinary stream

Nursing Process - TURP

Assessment• How affected pts life• Urinary problems?• Pain?• Erectile dysfunction?

Nursing Dx - TURP

• Preoperatively– Anxiety about surgery and its outcome– Acute pain related to bladder distention– Deficient knowledge about factors related to

the disorder and the treatment protocol

Nursing Dx - TURP

• Postoperative– Acute pain related to the surgical incision,

catheter placement and bladder spasms– Deficient knowledge about postoperative care

and management

Nursing Interventions

• Reducing anxiety– Assess support & coping– Est. & enc communication– Assess knowledge - educate– Inform routines– Privacy

Nursing Interventions

• Relieving discomfort– Bed rest– Analgesic – Assess bladder distention

Nursing Interventions

• Preparing the patient– Elastic compression stocking – Enema– No aspirin

Nursing Interventions

• Maintaining fluid balance d/t irrigation of surgical site– I&O• irrigation

– Check BP – Confusion– Respiratory distress crackles • = fluid overload

Nursing Interventions

• Relieving pain d/t bladder spasms – Day 1 dangle legs– Day 2 ambulate– Meds to relax bladders– Warm compresses to pubis– Sitz baths– Analgesics – Do not sit for a long time– Stool softeners

Nursing Interventions

• Monitoring and managing potential complication of hemorrhaging– Drainage red pink It pinks with in 24 hours– Monitor V/S– IV– Blood component treatment /transfusion – I&O

Nursing Interventions

• Monitoring and managing potential complication of infection– Monitor Temp & Vital signs – Heat lamp – Sitz bath– Antibiotics (Prophylactic)– Dysuria, urinary frequency, urgency– Aseptic technique with catheter– I&O

Nursing Interventions

• Monitoring and managing potential complication of Deep vein Thrombosis– Prophylactic low dose heparin – Elastic compression socks– Monitor for DVT• Homan Sign• Check pedal pulses

– Early ambulation

Nursing Interventions

• Monitoring and managing potential complication of Obstructed Catheter– Lasix (Furosemide) – Increase fluids– Assess pain –– Check catheter for kinks, loops, placement– Decreased BP / increased pulse

Nursing Interventions

• Monitoring and managing potential complication of sexual dysfunction– Meds– Privacy– Sex therapy– Determine history of level of functioning– Include partner