Benign prostatic hyperplasia or benign prostatic hypertrophy is characterized by progressive enlargement of the prostate gland (commonly seen in men older than age 50), causing varying degrees of urethral obstruction and restriction of urinary flow. Depending on the size of the enlarged prostate, age and health of the patient, and the extent of obstruction, BPH is treated symptomatically or surgically.
Nursing Care Plans
Nursing care for patients with benign prostatic hyperplasia includes preparation for surgery (if possible) administration of medications for pain, and relieving urinary retention.
Below are five (5) Nursing Care Plans (NCP) for Benign Prostatic Hyperplasia:
- Urinary Retention
- Acute Pain
- Risk for Deficient Fluid Volume
- Fear/Anxiety
- Deficient Knowledge
- See Also and Further Reading
Urinary Retention: Incomplete emptying of the bladder
Nursing Diagnosis
- Urinary Retention
May be related to
- Mechanical obstruction; enlarged prostate
- Decompensation of detrusor musculature
- Inability of bladder to contract adequately
Possibly evidenced by
- Frequency, hesitancy, inability to empty bladder completely; incontinence/dribbling
- Bladder distension, residual urine
Desired Outcomes
- Void in sufficient amounts with no palpable bladder distension.
- Demonstrate postvoid residuals of less than 50 mL, with absence of dribbling/overflow.
Androgen inhibitors, e.g., finasteride (Proscar);Reduces the size of the prostate and decreases symptoms if taken long-term; however, side effects such as decreased libido and ejaculatory dysfunction may influence patient’s choice for long-term use.
| Nursing Interventions | Rationale |
|---|---|
| Encourage patient to void every 2–4 hr and when urge is noted. | May minimize urinary retention and overdistension of the bladder. |
| Ask patient about stress incontinence when moving, sneezing, coughing, laughing, lifting objects. | High urethral pressure inhibits bladder emptying or can inhibit voiding until abdominal pressure increases enough for urine to be involuntarily lost. |
| Observe urinary stream, noting size and force. | Useful in evaluating degree of obstruction and choice of intervention. |
| Have patient document time and amount of each voiding. Note diminished urinary output. Measure specific gravity as indicated | Urinary retention increases pressure within the ureters and kidneys, which may cause renal insufficiency. Any deficit in blood flow to the kidney impairs its ability to filter and concentrate substances. |
| Percuss and palpate suprapubic area. | A distended bladder can be felt in the suprapubic area. |
| Encourage oral fluids up to 3000 mL daily, within cardiac tolerance, if indicated. | Increased circulating fluid maintains renal perfusion and flushes kidneys, bladder, and ureters of “sediment and bacteria.” Note: Initially, fluids may be restricted to prevent bladder distension until adequate urinary flow is reestablished. |
| Monitor vital signs closely. Observe for hypertension, peripheral and dependent edema, changes in mentation. Weigh daily. Maintain accurate I&O. | Loss of kidney function results in decreased fluid elimination and accumulation of toxic wastes; may progress to complete renal shutdown. |
| Watch closely for signs of postobstructive diuresis (such as increased urine output and hypotension). | May lead to serious dehydration, lower blood volume, shock, electrolyte loss, and anuria. |
| Provide and encourage meticulous catheter and perineal care. | Reduces risk of ascending infection. |
| Recommend sitz bath as indicated. | Promotes muscle relaxation, decreases edema, and may enhance voiding effort. |
| Administer medications as indicated: | |
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Studies indicate that these drugs may be as effective as Proscar for outflow obstruction and may have fewer side effects in regard to sexual function. |
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Relieves bladder spasms related to irritation by the catheter. |
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Suppositories are absorbed easily through mucosa into bladder tissue to produce muscle relaxation and relieve spasms. |
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Given to combat infection. May be used prophylactically. |
| Catheterize for residual urine and leave indwelling catheter as indicated. | Although this is usually difficult in a patient with BPH, it relieves and prevents urinary retention and rules out presence of ureteral stricture. Coudé catheter may be required because the curved tip eases passage of the tube through the prostatic urethra. Note: Bladder decompression should be done with caution to observe for sign of adverse reaction such as hematuria (rupture of blood vessels in the mucosa of the overdistended bladder) and syncope (excessive autonomic stimulation). |
| Check catheter often (every 15 minutes for the first 2 to 3 hours). | For patency and urine color. |
| Often check dressings. | For bleeding. |
| Keep the catheter open. | To maintain returns that are clear and light pink. |
| Watch for septic shock, the most serious complication of prostatic surgery. | May cause severe fever, tachycardia, hypotension and other sign of shock. |
