Prostate Cancer Nursing Care Plans Diagnosis and Interventions
Prostate Cancer NCLEX Review and Nursing Care Plans
Prostate cancer is the most often diagnosed cancer in men around the world. The American Cancer Society (ACS) predicts that 268,490 men in the United States will be newly diagnosed with prostate cancer in 2022.
The prostate is a tiny gland that lies behind the bladder and surrounds the urethra in a man’s lower abdomen and is controlled by the hormone testosterone.
The prostate gland also generates seminal fluid, also called semen. The sperm-containing substance that escapes the urethra during ejaculation is known as sperm.
Prostate cancer occurs when an abnormal, malignant growth of cells, known as a tumor, arises in the prostate. As the disease progresses, these tumor cells have the potential to spread to other parts of the body.
Because the cancer is made up of prostate cells in these circumstances, it is still called prostate cancer.
Stages of Prostate Cancer
A staging method can help the doctor determine how far cancer has spread.
Prostate cancer is staged using the American Joint Committee on Cancer (AJCC) TMN staging system. The system, like many other types of cancer, stages it by:
- the tumor’s size or location
- involvement of lymph nodes
- whether cancer has migrated to other locations or organs (metastasized)
- PSA concentration at the time of diagnosis
- Gleason rating
Prostate cancer has 4 stages with stage 4 being the most advanced stage of the disease.
Signs and Symptoms of Prostate Cancer
Because some types of prostate cancer are non-aggressive, the patient may experience no symptoms. Advanced prostate cancer, on the other hand, frequently creates symptoms. Furthermore, other illnesses, such as benign prostatic hyperplasia (BPH), might mimic the symptoms of prostate cancer, so the patient will need to consult the doctor to get a proper diagnosis. Urinary difficulties, sexual problems, as well as discomfort, and numbness are all symptoms of prostate cancer.
- Urinary issues. The prostate is placed beneath the bladder and it surrounds the urethra, therefore urinary issues are prevalent. Because of its location, a tumor on the prostate that gets large enough can press on the bladder or urethra, causing complications.
- Sexual issues. Prostate cancer symptoms include erectile dysfunction. Often known as impotence, erectile dysfunction causes the patient to be unable to obtain and maintain an erection. Prostate cancer can also be indicated by blood in the sperm after ejaculation.
- Numbness and pain. The patient may feel numbness or weakness in the legs and feet. If the cancer has spread and has put pressure on the spinal cord, the patient may lose control of the bladder and intestines.
Causes of Prostate Cancer
The cause of prostate cancer is unknown. Prostate cancer develops when cells in the prostate have DNA alterations, according to doctors. The alterations cause the cells to divide and expand more quickly than normal cells. Aberrant cells grow continuously and form a tumor, which can spread and invade neighboring tissue. Some aberrant cells can break away and spread to other places of the body (metastasize).
Risk Factors to Prostate Cancer
Predisposing factors may increase the risk of developing prostate cancer.The risk factors for developing prostate cancer are as follows:
- Old age. the risks of acquiring prostate cancer rise as the patient get older. It gets increasingly common beyond the age of 50.
- Race. For unexplained causes, black men have a higher risk of prostate cancer than other races. Black males are also more likely to have aggressive or advanced prostate cancer.
- Family background. A family history of prostate cancer increases one’s risk. Furthermore, if the patient have a strong family history of breast cancer or a gene that raises the risk of breast cancer (BRCA1 or BRCA2), the chances of developing prostate cancer are higher.
- Obesity. Obese people may have a higher risk of prostate cancer than people who are regarded to be of normal weight, while studies have produced inconsistent results. Furthermore, this risk group is also prone to develop a more aggressive caner posttreatment.
Diagnosis of Prostate Cancer
A screening test is one of the most effective ways to detect cancer before any symptoms arise.
- Prostate Specific Antigen (PSA). PSA is a blood test that determines how many prostate proteins are present in the blood. It’s possible that a high level indicates prostate cancer. the doctor can use the PSA test to determine whether or not the PSA levels indicate prostate cancer. This is a significant benefit because early detection is critical for cancer treatment. For patients who want to be screened for prostate cancer, the test is relatively easy and generally available.
- Rectal digital examination (DRE). The doctor inserts their lubricated, gloved finger into the rectum to feel for any lumps, rigidity, or enlarged parts of the prostate during a DRE. This approach can detect prostate cancer since it generally starts at the rear of the gland. It is more effective than a PSA test in men who have an average PSA level but nevertheless have prostate cancer.
- Prostate ultrasound. Prostate cancer can be detected using modern imaging techniques such as MRI or ultrasound. Improved technologies, according to scientists in a 2018 research article, can now catch it earlier – and better determine its stage.
- Prostate biopsy. If the doctor suspects cancer or discovers an increased PSA level during an exam, he or she may recommend a prostate biopsy. The doctor extracts a small sample of the prostate tissue during the biopsy to examine the cells. If the cells are malignant, they can use this information to determine how quickly they will spread and grow. They do this by calculating the Gleason score. The Gleason score is a very useful tool for predicting the future, but it isn’t perfect. When predicting the spread and course of the disease, there are other criteria to consider, with experts using the scoring system in different ways. To be sure, additional factors such as the physical exam and tumor imaging, in addition to the Gleason scores, play a role in determining the prognosis.
Treatment for Prostate Cancer
Based on the age, health status, and cancer stage, the doctor will establish a suitable treatment strategy to treat and control prostate cancer:
If the cancer is non-aggressive, the doctor may propose active surveillance, often known as careful waiting. If the doctor decides to use active surveillance to monitor cancer, they will assess the PSA every six months and perform an annual DRE. They may also repeat the biopsy and imaging 1 to 3 years following the first diagnosis.
When just observing the disease, the doctor actively observes the symptoms to see if treatment is required.
More aggressive cancers may be treated with different methods, such as:
- hormone replacement treatment
- radiosurgery with stereotactic accuracy
Doctors use risk categories to guide the therapy if the prostate cancer has not advanced to stage 1-3. Advanced phases, on the other hand, may require more or less treatment. Other factors, such as age and overall health, may also play a role. Chemotherapy is performed after hormonal therapy has failed to address the condition.
Prevention of Prostate Cancer
The following measures can help prevent or decrease the risk of developing prostate cancer.
- Consume a healthy diet. A diet reduced in dairy and calcium, for example, may help minimize the risk of prostate cancer. The following foods may help reduce the risk of prostate cancer: broccoli, brussels sprouts, and kale, fish, soy, olive oil, which contains omega-3 fatty acids.
- Choose healthy foods over supplements. To date, no studies reported a decreased risk of prostate cancer with supplement use. As an alternative, eat meals that are high in vitamins and minerals to keep the vitamin levels in check.
- Exercise regularly. Exercise can also help the patient reduce weight, which is important because obesity has been linked to prostate cancer according to a 2016 study. Aim for 30 minutes of exercise most days of the week with the doctor’s consent.
- Consult with the healthcare provider regarding the risk of developing prostate cancer. According to certain studies, 5-alpha reductase inhibitors such as finasteride (Propecia, Proscar) and dutasteride (Avodart) may reduce the overall risk of prostate cancer. These medications are intended to prevent prostate enlargement and hair loss.
However, some evidence suggests that men who take these drugs may be at a higher risk of developing a more serious form of prostate cancer (high-grade prostate cancer). Advise the patient to check with the doctor if he/she is concerned about the risk of developing prostate cancer.
Nursing Diagnosis Prostate Cancer
Nursing Care Plan for Prostate Cancer 1
Nursing Diagnosis: Impaired Urinary Elimination related to mechanical obstruction (i.e., blood clot, edema, trauma), catheter/balloon pressure and irritation, loss of bladder tone due to preoperative overdistension or prolonged decompression secondary to prostate cancer as evidenced by urgency, hesitation, dysuria, incontinence, retention, suprapubic soreness, and bladder fullness
- The patient will void normal amounts of urine without retention.
- The patient will demonstrate behaviors to restore normal bladder/ urinary control.
|Nursing Interventions for Prostate Cancer||Rationale|
|Evaluate urine output and drainage system during bladder irrigation.||Edema in the surgical area, blood clots, and bladder spasms can all induce retention.|
|Assist the patient in assuming a typical voiding position. After the catheter is withdrawn, instruct the patient to stand and walk to the restroom at regular intervals.||Encourages urine flow and restores a sense of normalcy.|
|Check the dressing, incision, and drainage for excessive bleeding on a regular basis. Be vigilant in observing for the presence of bleeding or infection.||Sutures may need to be reopened.|
|After the catheter is withdrawn, keep track of the duration, amount of voiding, and stream size. Be aware of complaints of bladder fullness, failure to void, and urgency.||The catheter is normally withdrawn 2–5 days following surgery, but urethral edema and loss of bladder tone may make voiding difficult for a while.|
|Encourage the patient to void whenever an urge arises, but no more frequently than every 2–4 hours, as per protocol.||Urinary retention is avoided by urinating on the urge. Limiting voids to once every four hours (if tolerated) improves bladder tone and helps with bladder retraining.|
|If a suprapubic catheter is present, measure residual volumes with Doppler ultrasonography.||The efficacy of bladder emptying is monitored. If the residuals are greater than 50 mL, the catheter should be kept in place until bladder tone improves.|
|As tolerated, increase fluid intake to 3000 mL. Once the catheter has been removed, limit fluids in the evening.||Maintains urine flow by ensuring enough hydration and renal perfusion. Reduced fluid intake on a regular basis reduces the need to void and disrupts sleep at night.|
|Instruct the patient to do perineal exercises such as clenching the buttocks and stopping and beginning the urine flow.||Reduces incontinence by helping to regain bladder, sphincter, or urine control.|
|Advise the patient that “dribbling” is normal once the catheter is withdrawn and will go away as the recovery develops.||Correct and timely information assists the patient in dealing with the issue. Normal functioning may be restored in 2–3 weeks; however, it may take 8 months to recover from a perineal approach.|
|In the early postoperative period, maintain continuous bladder irrigation (CBI) as directed.||Removes blood clots and debris from the bladder to keep the catheter and urine flow open.|
Nursing Care Plan for Prostate Cancer 2
Nursing Diagnosis: Risk for Infection related to invasive procedures (e.g., instrumentation during surgery, catheter insertion, frequent bladder irrigation) and traumatized tissue from surgical incision (e.g., perineal) secondary to prostate cancer
- The patient will demonstrate the absence of signs of infection.
- The patient will achieve appropriate healing.
|Nursing Interventions for Prostate Cancer||Rationale|
|Keep the catheter system sterile. Use soap and water to clean the catheter and the meatus on a regular basis. Around the catheter site, apply antibiotic ointment.||These are measures that ensure the prevention of the spread of microorganisms that might cause infection or sepsis.|
|Ambulate using drainage bag dependent.||Backward urine reflux, which can introduce bacteria into the bladder, is avoided.|
|Keep an eye on vital signs for low-grade fever, chills, fast pulse and respiration, restlessness, irritability, and disorientation.||Patients who have had a cystoscopy or TURP are more likely to get surgical or septic shock as a result of the manipulation and instrumentation.|
|Observe wound leakage surrounding the suprapubic catheter.||As shown by erythema and purulent discharge, the presence of drains and a suprapubic incision raises the risk of infection.|
|Frequently change dressings (suprapubic or retropubic and perineal wounds), properly washing and drying the skin each time.||Wet dressings irritate the skin and provide a breeding ground for bacteria, increasing the risk of infection.|
|Use skin barriers designed for ostomies.||Protects the skin around it, limiting excoriation and lowering the chance of infection.|
|Antibiotics should be given as directed.||Because of the increased risk of infection after prostatectomy, it may be given prophylactically.|
Nursing Care Plan for Prostate Cancer 3
Risk for Deficient Fluid Volume
Nursing Diagnosis: Risk for Deficient Fluid Volume related to difficulty controlling bleeding, restricted intake preoperatively, post-obstructive diuresis, and vascular nature of surgical area secondary to prostate cancer.
- The patient will demonstrate adequate hydration as evidenced by stable vital signs, palpable peripheral pulses, excellent capillary refill, moist mucosal membranes, and urine output within the normal range.
- The patient will demonstrate the absence of active bleeding.
|Nursing Interventions for Prostate Cancer||Rationale|
|Observe the patient’s input and output.||This parameter reflects fluid balance and replacement needs. Monitoring is critical for calculating blood loss and precisely quantifying urine output with bladder irrigations. Note: During the early recovery phase after the release of the urinary tract obstruction, significant diuresis may occur.|
|Monitor the patient’s vital signs. Increased pulse and respiration, lowered blood pressure, diaphoresis, pallor, delayed capillary refill, and dry mucous membranes should all be noted.||To avoid approaching shock, dehydration or hypovolemia must be treated quickly. Hypertension, bradycardia, nausea, and vomiting are all symptoms of “TURP syndrome,” which necessitates rapid medical attention.|
|Examine restlessness, perplexity, and behavioral changes.||May suggest cerebral edema due to excessive solution absorbed into the venous sinusoids during the TUR procedure or represent decreased cerebral perfusion (hypovolemia) (TURP syndrome).|
|Avoid excessive manipulation by anchoring the catheter.||Movement or pulling on the catheter can result in bleeding, clot development, and catheter clogging, as well as bladder distension.|
|Examine catheter drainage for heavy or persistent bleeding.||Except for the perineal approach, bleeding is common throughout the first 24 hours. Continued excessive bleeding or the resumption of active bleeding necessitates medical attention.|
|Examine the wound coverings and drains. If necessary, weigh the dressings. Hematoma formation is visible.||Bleeding may be visible or hidden within the perineum’s tissues.|
|Avoid using rectal tubes/enemas and taking rectal temperatures.||Referred irritation to the prostatic bed and increased pressure on the prostatic capsule may occur, increasing the risk of bleeding.|
Nursing Care Plan for Prostate Cancer 4
Nursing Diagnosis: Anticipatory Grieving related to change in lifestyle, anticipated loss of physiological well-being (e.g., loss of body part; change in body function), and perceived potential death of patient secondary to prostate cancer as evidenced by alterations in eating habits, changes in sleep pattern, level of activity, libido and communication patterns, and denial of possible loss, stifled emotions and rage.
- The patient will recognize and express emotions appropriately.
- The patient will continue with his/her daily routine, thinking ahead and planning for the future one day at a time.
- The patient will express their understanding of the dying process and sentiments of being supported in grief work.
|Nursing Interventions for Prostate Cancer||Rationale|
|Following a cancer diagnosis and traumatic procedures, expect a period of shock and disbelief (disfiguring surgery, colostomy, amputation).||Only a small percentage of patients are adequately prepared for the alterations that can occur.|
|Examine the patient and the significant other for the current stage of sorrow. Explain the procedure as needed.||Knowledge of the grieving process might help patients deal with their feelings and reactions more effectively by reassuring them that they are normal.|
|Create a welcoming, nonjudgmental environment. Use active listening, acknowledgment, and other therapeutic communication techniques.||Encourages and promotes open and honest discussion of feelings and problems.|
|Accept expressions of sadness, anger, and rejection and encourage verbalization of views or worries. Recognize that these feelings are normal.||The realization that profound and frequently conflicting emotions are common and experienced by others in this tough position may help the patient articulate his or her sentiments.|
|Be on the lookout for mood swings, aggression, and other outbursts. Set boundaries for unacceptable behavior and divert negative thinking.||These indicate poor coping and the need for additional interventions. Preventing self-destructive behavior allows the patient to preserve control and self-esteem.|
|Be on the lookout for debilitating depression. Directly inquire about the patient’s mental state.||Many cancer patients, according to studies, are at increased risk of suicide. When they have recently been diagnosed and discharged from the hospital, they are especially susceptible.|
Nursing Care Plan for Prostate Cancer 5
Nursing Diagnosis: Situational Low Self-Esteem related to biophysical factors such as disfiguring surgery, chemotherapy, or radiotherapy side effects and psychosocial such as threat of death, doubt regarding acceptance by others, fear, anxiety, and feeling lack of control secondary to prostate cancer as evidenced by alteration in self-perception, lack of follow-through, not taking responsibility of self-care, verbalization of change in lifestyle, and feelings of helplessness, hopelessness and powerlessness.
- The patient will verbalize and express an understanding of body changes and self-acceptance of the situation.
- The patient will start developing coping mechanisms to effectively deal with problems.
- The patient will demonstrate adaptation to changes or events that occurred as evidenced by setting realistic goals and active participation in leisure activities and personal relationships as appropriate.
|Nursing Interventions for Prostate Cancer||Rationale|
|Discuss how the diagnosis and treatment are influencing the patient’s personal life, home, and work activities with the patient and SO.||Aids in clarifying issues so that the problem-solving process can begin.|
|Examine potential adverse effects of a treatment, such as effects on sexual activity and a person’s sense of attractiveness and desirability (alopecia, disfiguring surgery). Inform the patient that not all side effects will occur, and that some can be reduced or controlled.||Anticipatory advice can aid the patient and SO in adjusting to the new state and anticipating some side effects (buy a wig before radiation, schedule time off from work as indicated).|
|Encourage people to talk about their worries about how cancer and its treatments may affect their roles as a homemaker, wage worker, parent, and so on.||This approach may aid in the reduction of issues that obstruct treatment acceptance or promote illness development.|
|Recognize any issues the patient may be having. Provide information about the importance of counseling in the adaptation process.||Validates the patient’s feelings as real and gives permission to take whatever steps are necessary to cope with the situation.|
|Examine the available and utilized support structures for the patient and their significant other.||Aids in the planning of care both while in the hospital and after discharge.|
|During the diagnostic and treatment phases, provide emotional support to the patient and their significant other.||Although some patients adapt to cancer effects or therapeutic side effects, many require additional assistance during this time.|
|If the patient agrees, use touch during interactions and maintain eye contact.||Patients’ emotions of uncertainty and self-doubt can be reduced by affirming their distinctiveness and acceptance.|
|Advise the patient to seek professional counseling as needed.||If the patient’s and their significant other’s support networks are degrading, it may be required to re-establish and maintain a positive psychosocial structure.|
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. (2022). 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. (2020). 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
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