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Benign prostatic hyperplasia - BENIGN PROSTATIC...

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BENIGN PROSTATIC HYPERPLASIA (BPH) Benign prostatic hyperplasia 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. CARE SETTING Community level, with more acute care provided during outpatient procedures. RELATED CONCERNS Prostatectomy Psychosocial aspects of care Renal failure: acute Patient Assessment Database CIRCULATION May exhibit: Elevated BP (renal effects of advanced enlargement) ELIMINATION May report: Decreased force/caliber of urinary stream; dribbling Hesitancy in initiating voiding Inability to empty bladder completely; urgency and frequency of urination Nocturia, dysuria, hematuria Sitting to void Recurrent UTIs, history of calculi (urinary stasis) Chronic constipation (protrusion of prostate into rectum) May exhibit: Firm mass in lower abdomen (distended bladder), bladder tenderness Inguinal hernia; hemorrhoids (result of increased abdominal pressure required to empty bladder against resistance) FOOD/FLUID May report: Anorexia; nausea, vomiting Recent weight loss PAIN/DISCOMFORT May report: Suprapubic, flank, or back pain; sharp, intense (in acute prostatitis) Low back pain SAFETY May report: Fever SEXUALITY May report: Concerns about effects of condition/therapy on sexual abilities Fear of incontinence/dribbling during intimacy Decrease in force of ejaculatory contractions May exhibit: Enlarged, tender prostate TEACHING/LEARNING May report: Family history of cancer, hypertension, kidney disease Use of antihypertensive or antidepressant medications, OTC cold/allergy medications containing sympathomimetics, urinary antibiotics or antibacterial agents Self-treatment with saw palmetto or soy products Discharge plan DRG projected mean length of stay: 3.7 days considerations: May need assistance with management of therapy, e.g., catheter
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Refer to section at end of plan for postdischarge considerations. DIAGNOSTIC STUDIES Urinalysis: Color: Yellow, dark brown, dark or bright red (bloody); appearance may be cloudy. pH 7 or greater (suggests infection); bacteria, WBCs, RBCs may be present microscopically. Urine culture: May reveal Staphylococcus aureus, Proteus, Klebsiella, Pseudomonas, or Escherichia coli. Urine cytology: To rule out bladder cancer. BUN/Cr: Elevated if renal function is compromised. Prostate-specific antigen ( PSA ) : Glycoprotein contained in the cytoplasm of prostatic epithelial cells, detected in the blood of adult men. Level is greatly increased in prostatic cancer but can also be elevated in BPH. Note: Research suggests elevated PSA levels with a low percentage of free PSA are more likely associated with prostate cancer than with a benign prostate condition. WBC: May be more than 11,000/mm 3 , indicating infection if patient is not immunosuppressed.
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