Benign Prostatic Hyperplasia BPH

Benign Prostatic Hyperplasia BPH Nursing Care Plans Diagnosis and Interventions

Benign Prostatic Hyperplasia BPH NCLEX Review Care Plans

Nursing Study Guide For Benign Prostatic Hyperplasia

The prostate is a walnut-shaped organ located between the male penis and bladder.

Its primary function is the production of seminal fluid, which serves as the transport medium of the sperm during intercourse.

In benign prostatic hyperplasia (BPH) or benign prostatic hypertrophy, the prostate enlarges and in turn causes obstruction problems.

Because of its anatomical placement, urinary problems arise which in turn significantly affects the patient.

The condition is more common in men above 50 years of age.

Signs and Symptoms of Benign Prostatic Hyperplasia

Clinical manifestations of the condition worsen over time and include:

  • Urinary frequency
  • Urinary urgency
  • increased urinary frequency at night (nocturia)
  • Difficulty in starting to micturate
  • Weak stream of urine (stops and starts)
  • Urine dribbling
  • Incomplete bladder emptying – feeling of residual urine

Causes and Risk Factors of Benign Prostatic Hyperplasia

The prostate is anatomically placed between the bladder and the penis. Inside these organs lies the urethra, a narrow passage starting from the bladder though the prostate and into the penile shaft.

In normal urination, urine flows out outwards the urethra unobstructed. In BPH,, the prostate enlarges, thereby obstructing the urethra by decreasing its diameter and consequently blocking urine flow.

The real cause of BPH is not clear but is often associated with older men. With these, it has been concluded that increasing age and dropping testosterone levels plays a major role for its development.

The risk factors of BPH include the following:

  • Aging – Men aged 40 may have enlarged prostates but will not experience symptoms. Men aged 60 may develop moderate symptoms. Those 80 and above may experience sever symptoms.
  • Family history – having relatives with BPH has been linked to the development of BPH latter in life
  • Diabetes and heart disease – Diabetes and use of beta blockers (medications for heart disease) predisposes patients to BPH
  • Obesity and sedentary lifestyle play a role in BPH development.

Complications of Benign Prostatic Hyperplasia

  1. Urinary retention. Urinary stasis happens as the enlarged prostate blocks the bladder of the excretion of urine.
  2. Urinary tract infections. Due to the retention of urine in the bladder, the environment becomes conducive for opportunistic bacteria to proliferate, thereby causing infections.
  3. Bladder stones. Because of incomplete excretion of urine, waste will continuously accumulate in the bladder, thereby forming crystals that may cause injury to the thin bladder walls.
  4. Bladder damage. As the bladder cannot properly empty, its’ muscles weakens overtime. This lost in elasticity compromises its’ structure, making contraction ineffective, thereby making urination more difficult.
  5. Kidney damage. Increased pressure from urinary stasis and/or ascending infections from the bladder will reach the kidneys, thereby causing damage overtime.

Diagnosis of Benign Prostatic Hyperplasia

Diagnosing BPH involves a variety of techniques and are listed below:

  • Digital rectal examination (DRE) – DRE is the most significant part of a physical exam when diagnosing BPH. The healthcare provider can easily assess for size, contour, presence of nodules or areas suggestive of malignancy, just by performing this exam.
  • Laboratory studies involves the following:
  • Urinalysis – utilized to assess for presence of bacteria, blood, WBC’s, protein or glucose that can suggest for urinary retention caused by BPH.
  • Urine culture – Utilized to exclude infections of the urinary tract when abnormal findings where first detected in urinalysis (e.g. presence of WBC’s)
  • Prostate-specific antigen (PSA) – PSA is an enzyme and cancer marker for Prostate cancer. Though BPH does not cause prostate cancer, men with the former diagnosis are also at risk for the latter.
  • Electrolytes, Blood urea nitrogen (BUN) and creatinine – These studies are useful to evaluate renal health, especially for those patients who have high post void residual (PVR) urine volumes.
  • Ultrasound – Ultrasound of the whole abdomen, including the kidneys and thru the transrectal approach will help to evaluate the bladder, prostate size, and signs of renal insufficiency.
  • Endoscopy of the lower urinary tract – Involves the direct visualization of the structures (cystoscopy) to assess for internal structures.
  • Other tests includes:
  • Flow rate – utilized to determine effectivity of treatment
  • PVR urine volume – utilized to measure severity of bladder decompensation
  • Urodynamic and pressure flow studies – utilized to measure pressures inside the bladder and the overall functionality of bladder tissues
  • Biopsy – to rule out prostate cancer

Treatment for Benign Prostatic Hyperplasia

Treatment for BPH involves pharmacologic and surgical interventions and they are the following:

  1. The goal of pharmacological treatment for BPH is to prevent further complications. The options are:
  2. Alpha-adrenergic receptor blockers – hinder or block effects of postganglionic synapses of the smooth muscles and exocrine glands
  3. 5-alpha reductase inhibitors – treat symptomatic BPH by inhibiting the conversion of testosterone to DHT (dihydrotestosterone), thereby dropping DHT levels and decreasing prostate size
  4. phosphodiesterase-5 enzyme inhibitors – These agents improve the symptoms of BPH by relaxing the smooth muscles of the lower urinary tract
  5. Anticholinergic agents – Historically not used for treatment of BPH due to concerns of retention of urine in the bladder; however, trials on patients administered the agents showed slight increase in post-void residual (PVR) urine amount when using anticholinergics.
  6. Combination therapy – Both an alpha-adrenergic receptor blocker and 5-alpha reductase inhibitor may be given if single agents may prove ineffective in addressing BPH symptoms.
  7. Surgery
  8. Transurethral resection of prostate (TURP) – Involves utilizing a scope inserted through the urethra in order to remove the inner tissues of the prostate except the outermost layer.
  9. Open prostatectomy – Traditional surgical removal of the enlarged prostate.
  10. Minimally invasive treatment
  11. Transurethral incision of the prostate (TUIP) – minimally invasive procedure performed for patients with moderately enlarged prostates.
  12. Laser treatment – utilizes lasers to cut prostate tissues
  13. Transurethral microwave therapy (TUMT) – utilizes heat energy to cause cell death, thereby reducing the BPH size
  14. Transurethral needle ablation of the prostate (TUNA) – involves the use of needles embedded into the prostate, wherein radio waves will be used to to heat the needle and destroy excess prostate tissue.
  15. Prostatic stents – involves the use of a flexible material to open up the passage of urine past the prostate.
  16. Laparoscopic prostatectomy – involves small incisions in the abdomen to remove the enlarged prostate
  17. Prostatic urethral lift (PUL) – Utilizes special tags placed around the area, thereby compressing the sides of the prostrate. This allows for passage of urine.
  18. Prostate artery embolization – involves cutting of the blood supply in the prostate with the goal of reducing its size for BPH patients. This procedure is still on the experimental stages.

Nursing Care Plans for Benign Prostatic Hyperplasia

Nursing Care Plan 1

Nursing Diagnosis: Infection related to urinary retention secondary to BPH as evidenced by presence of leukocytes and nitrates in the urine upon urinalysis, positive bacteria urine culture result, foul-smelling urine, temperature of 38.9 degrees Celsius, and increased frequency of urination

Desired Outcome: The patient will be able to avoid the development of an infection.

InterventionsRationales
Assess vital signs and monitor the signs of infection.To establish baseline observations and check the progress of the infection as the patient receives medical treatment.
Administer the prescribed antibiotic for UTI. The antibiotic choice is based on the result of the urine culture and sensitivity test. The usual course of antibiotics for UTI runs for 7 to 10 days.To treat the underlying infection.
Obtain a urine sample for urinalysis once the antibiotic therapy has been completed.To confirm that the infection has been completely treated, or if there is a need to continue the same antibiotic therapy or shift to a different treatment.
Teach the patient some lifestyle changes related to UTI prevention., including proper hygiene, adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fitting.Good oral hydration results to more urine production leading to flushing of bacteria from the bladder once the urine is eliminated. Undergarments that are made of non-breathing materials or are tight-fitting promote moisture formation. This encourages bacterial growth.  

Nursing Care Plan 2

Nursing Diagnosis: Impaired Urinary Elimination related to frequent urination and urgency secondary to BPH as evidenced by dysuria and urinary frequency

Desired Outcome: The patient will be able to achieve normal pattern of urinary elimination.

InterventionsRationales
Assess the patient’s current pattern of elimination and compare with his/her normal pattern/To establish baseline data on urinary elimination pattern.
Administer the prescribed medications for BPH, such as Alpha-adrenergic receptor blockers, 5-alpha reductase inhibitors, and phosphodiesterase-5 enzyme inhibitors.To treat the underlying disease.
Palpate the bladder and observe for bladder distention.To check for bladder distention and bladder retention.
Encourage the patient to void every 2 to 3 hours.To facilitate flushing of bacteria from the bladder and avoid urine accumulation.
Teach the patient some lifestyle changes related to UTI prevention, including proper hygiene, adequate oral hydration (at least 2 liters of fluids per day, if not contraindicated), and avoidance of undergarments that have non-breathing materials or are constricting/ tight-fitting.Good oral hydration results to more urine production leading to flushing of bacteria from the bladder once the urine is eliminated. Undergarments that are made of non-breathing materials or are tight-fitting promote moisture formation. This encourages bacterial growth.  

Nursing Care Plan 3

Nursing Diagnosis: Disturbed Sleep Pattern related to nocturia secondary to BPH as evidenced by verbalization of inability to sleep, delayed sleep onset, bladder pain or discomfort, frequent urination, restlessness, and irritability

Desired Outcome: The patient will report an improved rest/sleep pattern and verbalize feeling well-rested.

InterventionsRationales
Assess the patient’s current pattern of sleep and rest and compare with his/her normal pattern.To establish baseline data on rest/sleep pattern.
Administer the prescribed medications for BPH, such as Alpha-adrenergic receptor blockers, 5-alpha reductase inhibitors, and phosphodiesterase-5 enzyme inhibitors.To treat the underlying disease.
Encourage the patient to limit oral hydration during nighttime. Advise the patient to avoid caffeine-containing drinks in the evening.To reduce urinary frequency during bed time. Caffeine blocks sleep-inducing chemicals produced in the brain, thereby increasing level of alertness.
Reduce sleep disturbance in the environment such as room temperature, noise and light. Provide comfort measures such as back rub, warm bath, and relaxation techniques.To provide a sleep-conducive environment.  

Other possible nursing diagnoses:

  • Anxiety
  • Acute Pain
  • Deficient Knowledge

Nursing References

Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier.  Buy on Amazon

Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon

Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier.  Buy on Amazon

Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier.  Buy on Amazon

Disclaimer:

Please follow your facilities guidelines and policies and procedures.

The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes.

This information is not intended to be nursing education and should not be used as a substitute for professional diagnosis and treatment.

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