Benign Prostatic Hyperplasia

Introduction The process of urination is vital to the body for the removal of certain waste products. commonly, when the bladder gets full, pee is emptied from the body through the urethra in a process called urination. In urinary guardianship, a persons bladder fills up and thither is an actuate to urinate plainly he is unable to completely empty his bladder. With continuing urinary retention, a person may be able to urinate, but he has some trouble starting a stream or emptying your bladder completely.He may urinate frequently, may smell an urgent need to urinate but have little victory when he gets to the toilet or he may feel he still have to go after having finished urinating. With acute urinary retention, he so-and-sot urinate at all compensate though he has a full bladder. dandy urinary retention is a medical exam emergency requiring prompt action. Acute urinary retention (AUR) is an extremely uneasy and potentially life-threatening precondition characterized by a sudden unfitness to urinate associated with intense suprapubic discomfort.It is closely often secondary to obstructer, but may similarly be related to trauma, medication, neurologic disease, infection, and occasionally psychological issues. Acute urinary retention (AUR) is one of the most significant, uncomfortable and inconvenient aftermath in the natural history of benign prostatic hyperplasia (benign prostatic hyperplasia). BPH is the virtual(prenominal) universal overgrowth of the prostatic gland gland gland in workforce as they age. Various factors affecting BPH are age, genetic makeup, testosterone levels, and environment. As the prostate gland enlarges it com straighten outes the urethra causing obstruction to water supply flow.The urinary stream becomes baseborner there may be difficulty in initiating the stream, dribbling, and intermittent flow, frequency of urination, getting up at night to void (nocturia), inability to empty, or even inability to void at all (retention). Patients indite Name c Age 69 Address Civil side Married Chief Complaint Difficulty in urinating ptc and joby peeing few days ptc Tentative Diagnosis Acute urinary retention prob. Secondary to BPH level of Present Illness a. Present History Patient is 69 years old male retiree, a house physician of PS Tagas, Tabaco City admitted at BRTTH with a chief complaint of dysuria. whiz week prior to consultation he had difficulty in urinating and front man of blood in the urine b. Medical History The patient role claimed that he has hypertension and diabetes mellitus type II. Anatomy and Physiology Prostate gland The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is made of 2 lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is located in front of the rectum and just below the bladder, where urine is stored.The prostate also surrounds the urethra, the canal through which urine passes o ut of the body. Scientists do non know all the prostates functions. One of its primary(prenominal) roles, though, is to squeeze silver into the urethra as sperm cell move through during sexual climax. This fluid, which helps make up semen, energizes the sperm and makes the vaginal canal less acidic. urinary Bladder The urinary bladder is a muscular sac for storing urine. The triangular base of the bladder, the trigone, is defined by the two ureters that deliver the urine and the one urethra that drains the urine.When empty, the bladder collapses, and folds (called rugae) from in the bladder wall. As it fills, the folds become distended and the bladderbecomes spherical. The wall of the bladder consists of three layers identical to those ofthe urethra the mucosa, the muscularis (here called the detrusor muscle), and the adventitia. Circular smooth muscle fibers around the urethra form the internal urethral sphincter. As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size.At around age 25, the gland begins to grow again. This second growth bod often results, years later, in BPH. Though the prostate continues to grow during most of a mans life, the enlargement doesnt usually cause problems until late in life. BPH rarely causes symptoms before age 40, but to a greater extent than half of men in their sixties and as many as 90 pct in theirseventies and eighties have some symptoms of BPH. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to shake up against the urethra like a clamp on a garden hose.The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself. Urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH. Pathophysiology Urinary retention can be caused by an obstruction in the urinary tract or by nerve problems that interfere with signals between the hit and the bladder.If the nerves arent working properly, the brain may non get the meat that the bladder is full. Even if you know that your bladder is full, the bladder muscle that squeezes urine out may not get the signal that it is time to push, or the sphincter muscles may not get the signal that it is time to relax. A weak bladder muscle can also cause retention. As a man ages, his prostate gland may enlarge. Doctors call the condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy.As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. As a result, the bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amount s of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so urine remains in the bladder. The pathophysiology of bladder outlet obstruction in men with BPH has been attributed to both static and dynamic factors.The static obstruction is due to the bulk enlargement of the prostate encroaching upon the prostatic urethra and bladder outlet, whereas the dynamic obstruction is related to the tension of prostate smooth muscle. symptomatic Evaluation and Lab Examination a. Ultrasound of whole abdomen * Normal * Gassy epigastria, gassy filled bowel loops * Empty bladder b. blood profile WBC 8. 1 RBC 4. 16 Hemoglobin 103 Hematocrit 0. 31 Platelet 273 c. Urinalysis Specific gravity 1. 025 pH 5. 0 dent (-) RBC 13-15 Medical Treatment and Evaluation Treatment a. Admit to functional ward. b. Labs Ultrasound -CBC -Urinalysis c. I O q 4H d. Intravenous Rehydration e. Indwelling Catheter To facilitate close measurement of urinary outp ut for critically ill patients, Drug reading Ciprofloxacin Action Interferes the conversion of intermediate DNA fragments into high-molecular-weight DNA in bacteria DNA gyrase inhibitor. Indication Adult urinary tract infections (including complicated) continuing bacterial prostitis acute sinusitis lower respiratory skin, bone, joint infections infectious diarrhea, exposure to inhalation anthrax conjunctivitis, corneal ulcers (ophthalmic).Dose PO 500mg q12h Adverse effects CNS Headache, dizziness, fatigue, insomnia, depression, restlessness, seizures, confusion. GI Nausea, constipation, increased ALT, AST, flatulence, insomnia, heartburn, vomiting, diarrhea, oral candidasis, dysphagia, pseudomembranous colitis, dry mouth INTEG Rash, pruritis, uriticaria, photosensitivity, flushing, fever, chills, MISC Anaphylaxis,Stevens-Johnson Syndrome MS Tremor, arthalgia, tendon rupture Nursing Considerations * Assess patient for previous sensitivity reaction Identify urine output if decreas ing, notify prescriber (may picture nephrotoxicity) also check for increased BUN, creatinine. Nursing Care Management Ongoing assessment * Monitor Intake and Output. * Assess Vital signs Provides information about fluid balance, renal function as well as guidelines for fluid replacement. BP, Pulse, RR, and Temperature indicate response to fluid status. Diet * Low Sodium diet A diet high in sodium may raise blood pressure and cause fluid retention, resulting in swelling of the legs and feet. Sex world sexually active may help keep the urethra open. But the patient should not get sexually aroused without ejaculating because the urethra may get blocked. any(prenominal) treatments may also cause sexual problems. These problems usually do not last forever and most can be helped. Complications * Urinary tract Infection * Bladder Damage * Chronic Kidney Disease Urine is usually sterile, and the normal flow of urine usually prevents bacteria from growing in the urinary tract. When ur ine stays in the bladder, however, bacteria have a chance to grow and infect the urinary tract.If the bladder becomes stretched too further or for long periods, the muscle may be permanently modify and lose its ability to contract. If urine backs up into the kidneys, permanent kidney damage can lead to reduced kidney function and chronic kidney disease. If you lose too ofttimes of your kidney function, you will need dialysis or a kidney transplant to stay alive. References Mosby, Elsevier. Mosbys Guide for Nurses, 6th edition. 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