NURS 334 FINAL EXAM 2025 NURSING CARE OF ADULTS II CARRIE MONAGHAN BLUE PRINT GRADED A+ DU

NURS 334 FINAL EXAM 2025 NURSING CARE OF
ADULTS II CARRIE MONAGHAN BLUE PRINT
GRADED A+ DU

Benign Prostatic Hyperplasia (BPH)

Prostate Gland: Consists of two lobes surrounded by outer layer of tissue.

Location: In front of rectum, below bladder, surrounds the urethra

Function:

Pumps fluid into the urethra during ejaculation

Produces PSA – prostate specific antigen

Controls urine flow

Produces hormone DHT – dihydrotestosterone

Secretes fluid -

Secretes alkaline fluid that joins with the semen traveling from testes

BPH:

Enlargement of prostate gland

Very common with aging

BPH Pathophysiology:

-> Two Growth Periods of Prostate Gland:

At puberty = doubles in size.

25 = grows very slowly during the rest of life

Prostate gland enlarges

↓

,Bladder becomes thicker and more irritable

↓

Bladder contracts with just small amounts of urine

↓

Bladder weakens

BPH Incidence:

1. Age > 60 –– ½ of men will have some symptoms

2. Age 70s-80s – 80% can have symptoms

3. Family history

4. Location - American and Australian men

BPH Key Urinary Symptoms:

1. Incomplete Emptying - sensation of not emptying

2. Frequency – urinating more than every 2 hours

3. Intermittency - stopping and starting several times

4. Urgency – difficult to postpone

5. Weak Stream

6. Straining – strain to start urination

7. Nocturia – frequently at night

BPH Diagnosis:

1. Patient History –

International Prostate Symptom Score (I-PSS)

2. Digital Rectal Examination (DRE) - checking enlargement and tenderness

3. Transabdominal ultrasound and/or transrectal ultrasound (TRUS) – transducer on abdomen
(transabdominal) and into rectum (transrectal) to view prostate and around it

Possible biopsy if needed

,4. Bladder Ultrasound – look for residual urine

5. Urodynamic Pressure Flow Study –obstructions and muscle function

6. Cystoscopy – tube goes into urethra, view urethra and bladder and size of prostate gland



BPH continued

BPH Treatment:

1. Drug Therapy

a. 5-alpha reductase inhibitors (5-ARI) - Finasteride (Proscar) and dutasteride (Avodart)

- Inhibits production of the hormone DHT

- Prevents progression of growth of prostate

- Side effects: ED and decreased libido

b. Alpha Blockers - Doxazosin (Cardura),

tamsulosin (Flomax), and alfuzosin (Uroxatral)

-> Relax smooth muscle of the prostate and bladder

2. Nonsurgical Therapy

a. Transurethral needle ablation (TUNA) – use of low-level radiofrequency energy =

shrinks portion of enlarged prostate

b. Transurethral microwave therapy (TUMT) – high temperatures to heat and destroy excess prostate
tissue.

c. Interstitial laser coagulation (ILC) –

Laser gets rid of excess prostate gland

d. Electrovaporization –

electrical current to vaporize excess tissue

3. Surgical Management - Transurethral Resection of the Prostate (TURP)

a. Indications –

, Chronic urinary retention, chronic UTIs, hematuria, meds not working

b. Procedure – resectoscope inserted through urethra – and breaks up part of the enlarged prostate

BPH – Post TURP Nursing Care:

Foley catheter – 24-48 hours

Continuous Bladder Irrigation (CBI)

-> 3-way foley cath. 3 ports – saline, bag drainage, balloon

Patient teaching

-> Normal for blood tinged and clots

Disadvantages of TURP

-> Retrograde ejaculation: semen goes back into bladder after ejaculation instead of through urethra

-> Remaining prostate tissue can grow

BPH Treatment: Holmium Laser Enucleation of the Prostate (HoLEP)

Peels away prostate tissue (think peeling an orange) and is broken down in the bladder

Less bleeding risk

Less likely to regrow prostate tissue

Prostate Cancer

2nd most common type of cancer in men in the U.S.

Growth rate –

Slow growing, some aggressive

Early detection -

High success rate if found early, when confined to gland

Risk Factors

1. Age - > 65

2. Race – African American increased risk