Elimination-Sim-Prep PDF

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Department of Nursing STUDENT PREP for Elimination Concept Simulation: Urinary Obstruction (BPH) Name:

Date:

Objectives for the Simulation Based Learning Experience: 1. Design and plan care for the patient after surgical treatment of obstructive benign prostatic hypertrophy. 2. Conduct appropriate assessments and reduce risk for complications related to urinary flow (output). 3. Display professional and respectful manner when providing personal hygiene or treatments to patient’s genital-rectal area. Complete this Preparation Worksheet: Review assigned readings for Elimination Concept. This simulation will focus on “management of symptoms of benign prostatic hypertrophy and post-operative care following a transurethral resection of the prostate”. Skills Review:  Irrigating a urinary catheter  Applying a urinary leg bag collection device  Maintaining continuous bladder irrigations 1. When the patient is known to have benign prostatic hypertrophy (BPH), what questions should the nurse include in the focused urinary elimination assessment? How often do you urinate, is it more frequent overnight? When you urinate, is it an adequate amount, a lot, or just a little? Do you feel that you empty your bladder fully when you urinate? What is the color/concentration of your urine? Do you experience pain during urination? Problems with erections or sexual activity? Weak, or start/stop stream? Blood in urine or semen? Hx of UTI? 2. What substances, including over the counter medications should be avoided as those substances or drugs worsen the symptoms of BPH, making urination difficult? Allergy pills, antidepressants, pain medication (opiates), testosterone supplements, decongestants, diuretics, anticholinergic (dries everything out), muscle relaxants, alcohol, caffeine, opioids (constipation) Student Prep –Elimination Concept Simulation: Urinary Obstruction (BPH)

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3. Medications are the first line treatment for the problems of urinary elimination related to BPH. What information regarding how the medications improve urinary function and side effects to monitor will the nurse include when teaching the patient to take these medications at home? Generic (Brand) Name

Classification

finasteride (Proscar) Steroid – use gloves when reductase admin bc can cause Inhibitor fertility problems if even slightly ingested

tamsulosin (Flomax)

saw palmetto - DON’T take with any other BPH med

Alpha-adrenergic blockers (such as) doxazosin mesylate (Cardura) terazosin (Hytrin) prazosin (Minipress) oxybutynin (Ditropan) – don’t exceed 20mg/day

Alpha blocker

Expected Action to Improve Altered Urinary Function Makes prostate gland smaller to relieve urinary problems – prevents testosterone into protosterone? Which causes enlargement of prostate

Relaxes muscles in the prostate and bladder neck, making it easier to urinate, decrease s/s of BPH

Nursing Implications for this Patient Decrease exposure to women, risk for cancer, take at night bc can lead to HTN Do not want to handle if it is crushed Hypotension, lightheadedness, dizziness Administer ½ hour before same meal each daily, caps never crushed or opened

Reduces urinary frequency, increases urinary flow, decreases nighttime urination

Hypotension, lightheadedness, dizziness Occasional adverse GI effects. Monitor for changes as complications unknown

Relaxes muscles in prostate and bladder neck, making it easier to urinate. Lowers blood pressure

If their taking, do not want on Flomax, because reduces effectiveness Orthostatic hypotension, educate patient on symptoms of dizziness, fainting, not driving

Antispasmodic, Reduces muscle spasms anticholinergic of the bladder and urinary tract, treats overactive bladder,

Used cautiously for elderly, patients with renal impairment, myasthenia gravis. May

Herbal

Alphaadrenergic blockers

Student Prep –Elimination Concept Simulation: Urinary Obstruction (BPH)

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frequency, urgency, incontinence, nighttime urination

Belladonna & Opium Suppositories

Anticholinergic

Decreases muscle activity, treats severe muscle spasms in the ureters

aggravate hyperthyroidism, CHD, CHF, HTN, prostatic hypertrophy, DO NOT TAKE if you have neuroangle glaucoma or myostiniagravis or GI obstructions (illieums) Contraindicated in patients with glaucoma, severe breathing problems, liver/kidney disease, seizures, drug/alcohol dependence

4. Diagnostic testing is essential before decisions regarding further intervention can be made. Describe the following tests and what would be normal verses abnormal results: a. Prostatic Specific Antigen (PSA) Normal levels: 4.0 and below. Released by the prostate, values are abnormally high in men with prostate cancer, biopsy to determine. Start screening at 50, start at 40 if AA or having s/s. Proscar lowers level, TURP lowers, recent UTI increases, ejaculation 24hrs prior to blood draw can increase, don’t do rectal exam first has to be second to blood draw b. Urodynamic Pressure Flow Studies (Uroflowmetry) with post-voiding residual Assess the function of the bladder and urethra, useful in UTI diagnosis. Objective information regarding normal and abnormal function of the urinary tract, pelvic floor Pressure in bladder, bladder scan 5. The spouse of the patient asks the nurse, why there is no skin incision after surgery (the patient had a transurethral resection of the prostate or TURP). How does the nurse explain the surgical procedure to the patient and spouse? This procedure is done through inserting a resectoscope through the tip of the penis, this has a camera on the end and allows surgeon to see what needs to be resected, and therefore no incision needs to be made 6. In the post-operative period, the nurse will need to monitor the patient closely for what complications associated with the TURP? Blood in the urine, painful/difficult urination, infection, retrograde ejaculation, bleeding, risk for dvt pneumonia 7. Spinal anesthesia is often used during the TURP surgery and this type of anesthesia presents different post-procedure risks than general anesthesia. The nurse will need to anticipate potential problems and plan ahead: Student Prep –Elimination Concept Simulation: Urinary Obstruction (BPH)

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a. What assessments and precautions should be completed before ambulating the patient for the first time post-operatively? Slip resistant socks, sensation in legs, capillary refill, pulses, edema. POST OP TURP: don’t ^ HOB more than 45 degrees, need to lay flat for 4 hours post op bc you want them to feel everything, don’t let them sit up for more than 20 minutes *** b. Would it be a good idea to have the patient sit up in a chair for an hour? Why or why not? No, lack of sensation to the legs due to decreased blood flow because of medication c. How would the surgical TURP procedure and the spinal anesthesia affect return of voiding sensation and control of the urinary sphincter? The spinal anesthesia would decrease return of voiding sensation and incontinence may occur. The common TURP procedure complications may be masked due to this affect 8. The nurse can expect ordered interventions to maintain urinary outflow via a larger diameter urinary catheter with a larger (30mL) retention balloon connected to continuous bladder irrigation solution and/or frequent need to hand irrigate the urinary catheter to maintain patency. List the key nursing responsibilities for these procedures: Continue irrigation as necessary, depending on degree of hematuria, empty urinary drainage bag after each completion, record output on fluid balance chart, regular catheter care to minimize risk of UTI, progress notes on patient comfort, urine color, degree of hematuria, urine output, presence of clots 9. In a previous nursing course, you learned about evidence-based guidelines to prevent Catheter Associated Urinary Tract Infections (CAUTI). Describe those CAUTI Prevention Guidelines below: Use only for appropriate occasions, minimize duration, avoid use in home residents, and follow sterile procedure

Student Prep –Elimination Concept Simulation: Urinary Obstruction (BPH)...