Nursing 290 Final

NURSING 290 Final Transurethral resection of prostate (patient education) (Chapter 55 male reproductive) • Invasive (Surgery) • Use of excision and cauterization to remove prostate tissue cystoscopically. Remains the standard for treatment of BPH. • Advantage: Erectile dysfunction unlikely • Disadvantage: Bleeding, Retrograde ejaculation • surgical procedure • Involving the removal of prostate tissue using a resectoscope inserted through the urethra. TURP has long been considered the gold standard for surgical treatments of obstructing BPH. Although this procedure remains the most common operation performed, the number of TURP procedures done in recent years has declined due to the development of less invasive technologies. • TURP is performed under a spinal or general anesthetic and requires a 1- to 2-day hospital stay. No external surgical incision is made. A resectoscope is inserted through the urethra to excise and cauterize obstructing prostatic tissue (Fig. 55-4). A large three-way indwelling catheter with a 30-mL balloon is inserted into the bladder after the procedure to provide hemostasis and to facilitate urinary drainage. The bladder is irrigated, either continuously or intermittently, usually for the first 24 hours to prevent obstruction from mucus and blood clots • The outcome for 80% to 90% of patients is excellent, with marked improvements in symptoms and urinary flow rates. Quality of life is also improved. TURP is a surgical procedure with a relatively low risk. Postoperative complications include bleeding, clot retention, and dilutional hyponatremia associated with irrigation. Because bleeding is a common complication, patients taking aspirin, warfarin (Coumadin), or other anticoagulants must discontinue these medications several days before surgery. Neurogenic bladder (pharmacological management/outcomes for clients with neurogenic bladder) (Chapter 61 peripheral nerve & spinal cord problems) • Type of bladder dysfunction related to abnormal or absent bladder innervation. After spinal cord shock resolves, depending on the completeness of the SCI, patients usually have some degree of neurogenic bladder. Normal voiding requires nervous system coordination of urethral and pelvic floor relaxation with simultaneous contraction of the detrusor muscle. Depending on the injury, a neurogenic bladder may have no reflex detrusor contractions (areflexic, flaccid), may have hyperactive reflex detrusor contractions (hyperreflexic, spastic), or may lack coordination between detrusor contraction and urethral relaxation (dyssynergia). Common problems with a neurogenic bladder include urgency, frequency, incontinence, inability to void, and high bladder pressures resulting in reflux of urine into the kidneys. • Various drugs can be used to treat neurogenic bladders. Anticholinergic drugs (oxybutynin [Ditropan], tolterodine [Detrol]) may be used to suppress bladder contraction. α-Adrenergic blockers (e.g., terazosin [Hytrin], doxazosin [Cardura]) may be used to relax the urethral sphincter, and antispasmodic drugs (e.g., baclofen) may be used to decrease spasticity of pelvic floor muscles. Bethanechol may stimulate an atonic bladder. Ditropan-over active bladder • About 6-8 weeks after surgery, it is expected the client will adjust to the stoma and appliance, maintain stoma and appliance care, and return to previous activities Any type of bladder dysfunction related to abnormal or absent bladder innervation. o Common probs are urgency, frequency, incontinence, inability to void and high bladder pressure from reflux in urine into kidneys. Types of Neurogenic Bladder o Reflexic (spastic) has no inhibition influence time and place of voiding; bladder empties in response to stretching of bladder wall. Results from UMN injury, corticospinial tract injury, observed in spinal cord injury, stroke, brain tumor, brain trauma and MS. Cx mani is incontinence, frequency, urgency, voiding is unpredictable and incomplete. o Areflexic (autonomous, flaccid) bladder acts as if there were paralysis of all motor functions, fills w/o emptying. Results from LMN injury caused by trauma involving s2-4. If sensory intact, pt feels bladder distention, overflow o Sensory (lack of sensation need to pee) is damage to sensory limb of bladder spinal reflex arc. Seen in MS, diabetes. Cx mani is poor bladder sensation, infrequent voiding of large volume. Medication o Anticholinergic drugs (oxybutynin (Ditropan), tolterodine (Detrol) maybe used to suppress bladder contraction. Alpha adrenergic blockers may be used to relax urethral sphincter and antispasmodic rx (baclofen( used to decrease spasticity of pelvic floor ms. o Can also do bladder reflex retraining, catheter and fluid intake of 3 to 4 L/per day. o Nursing assessment important in selecting time interval between catherization. Bladder volume can be assessed before catherization; less than 200mL, time interval can be extended. More than 500mL, time shortened. 5 or 6 intermittent done per day. o Urinary diversion sx may be needed if pt has repeated UTIs or stones. o Arrange for ongoing care, give info to pt and caregiver Urinary tract infection (patient education/pharmacological mgmt) Common vaginal infections may present with UTI manifestations; vaginal candidiasis, chlamydia trachomatis, trichomonas vaginalis, Neisseria gonorrhea, herpes simplex • side effects of drugs used to • ………………………………………………………..CONTINUED……………………………………………….