5 Benign Prostatic Hyperplasia (BPH) Nursing Care Plans

Urinary Retention

Urinary retention in patients with benign prostatic hyperplasia (BPH) is typically due to mechanical obstruction caused by an enlarged prostate, which makes it difficult for urine to flow through the urethra. If the condition is left untreated, the bladder may become unable to contract efficiently, resulting in incomplete bladder emptying and urinary retention. Additionally, the detrusor muscle that controls bladder contraction may undergo decompensation, leading to further difficulty in emptying the bladder.

Nursing Diagnosis

• Urinary Retention

May be related to

• Mechanical obstruction; enlarged prostate
• Decompensation of detrusor musculature
• The inability of the bladder to contract adequately

Possibly evidenced by

• Frequency, hesitancy, inability to empty the bladder completely; incontinence/dribbling
• Bladder distension, residual urine

Desired Outcomes

• The client will void in sufficient amounts with no palpable bladder distension.
• The client will demonstrate postvoid residuals of less than 50 mL, with the absence of dribbling/overflow.

Nursing Assessment and Rationales

1. Observe the urinary stream, noting size and force.
Useful in evaluating the degree of obstruction and choice of intervention.

2. Percuss and palpate suprapubic area.
A distended bladder can be felt in the suprapubic area.

3. Monitor vital signs closely. Observe for hypertension, peripheral and dependent edema, and 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.

4. Watch closely for signs of post-obstructive diuresis (such as increased urine output and hypotension).
This may lead to serious dehydration, lower blood volume, shock, electrolyte loss, and anuria.

5. Check the catheter often (every 15 minutes for the first 2 to 3 hours).
For patency and urine color.

6. Have the patient document the 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.

7. Watch for septic shock, the most serious complication of prostatic surgery.
May cause severe fever, tachycardia, hypotension, and other sign of shock.

Nursing Interventions and Rationales

1. Encourage the patient to void every 2–4 hr and when the urge is noted.
May minimize urinary retention and overdistension of the bladder.

2. Ask the patient about stress incontinence when moving, sneezing, coughing, laughing, or lifting objects.
High urethral pressure inhibits bladder emptying or can inhibit voiding until abdominal pressure increases enough for urine to be involuntarily lost.

3. 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 re-established.

4. Provide and encourage meticulous catheter and perineal care.
Reduces risk of ascending infection.

5. Recommend sitz bath as indicated.
Promotes muscle relaxation, decreases edema, and may enhance the voiding effort.

6. Administer medications as indicated:

• 6.1. Alpha-adrenergic antagonists: tamsulosin (Flomax), prazosin (Minipress), terazosin (Hytrin), doxazosin mesylate (Cardura)
  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.

• 6.2. Antispasmodics: oxybutynin (Ditropan)
  Relieves bladder spasms related to irritation by the catheter.

• 6.3. Rectal suppositories (B & O)
  Suppositories are absorbed easily through the mucosa into bladder tissue to produce muscle relaxation and relieve spasms.

• 6.4. Antibiotics and antibacterials.
  Given to combat infection. May be used prophylactically.

7. Catheterize for residual urine and leave an indwelling catheter as indicated.
Although this is usually difficult in a patient with BPH, it relieves and prevents urinary retention and rules out the presence of ureteral stricture. A Coudé catheter may be required because the curved tip eases the passage of the tube through the prostatic urethra. Note: Bladder decompression should be done with caution to observe for signs of adverse reaction such as hematuria (rupture of blood vessels in the mucosa of the overdistended bladder) and syncope (excessive autonomic stimulation).

8. Keep the catheter open.
To maintain returns that are clear and light pink.