Prostatitis Behavioral Objective: Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for prostatitis Brunner and Suddarth’s Medical Surgical Nursing pg 1750 Behavioral Objective: Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for prostatitis Brunner and Suddarth’s Medical Surgical Nursing pg 1494

Prostatitis Pathophysiology Inflammation of the prostate gland cause by infectious agents E. coli is the most common Microorganisms are usually carried to the prostate from the urethra prostatitis Brunner and Suddarth’s Medical Surgical Nursing pg 1494 Pathophysiology Inflammation of the prostate gland cause by infectious agents bacteria fungi mycoplasms E. coli is the most commonly isolated organism Microorganisms are usually carried to the prostate from the urethra

Prostatitis Clinical manifestations Perineal discomfort Burning, urgency, frequency & pain after ejaculations Prostate pain Dysuria May produce Fever and chills Rectal or low back pain Clinical manifestations Perineal discomfort Burning, urgency, frequency and pain after ejaculations Pain in the prostate Pain on voiding May produce Fever and chills Perineal, rectal or low back pain Dysuria, frequency, urgency and nocturia, cloudy urine

Prostatitis Assessment and diagnostic findings History Culture Histological examination of the tissue D.R.E. Swollen, tender & firm Assessment and diagnostic findings Careful history Culture of prostate fluid or tissue When do you get prostate fluides? With semen. When do you get Semen with ejaculation Sometimes a histological examination of the tissue DRE What does DRE stand for? Digital rectal Exam Prostate is extremely swollen, very tender and firm Collect a divided urinary specimen for segmental urine culture Clean glans of penis Void 10-15ml into urine container (urethral urine) Without interrupting the urinary stream, collect 50-75 ml of urine in a second container (bladder urine) With Prostatitis the UA is often with WBC and bacteria present Dr immediately performs a Prostatic massage and collects any Prostatic fluid that is expressed into a third container. IF not possible to collect the patient is asked to void a small amount – it may contain the bacteria present in the Prostatic fluid.

Divided urinary specimen Clean glans of penis Void 10-15ml – 1st container Urethral Urine Without interrupting the urinary stream, collect 50-75 ml of urine -2nd container Bladder Urine Results: UA is often + WBC & bacteria present Prostatic massage Prostatic fluid – 3rd container Collect a divided urinary specimen for segmental urine culture Clean glans of penis Void 10-15ml into urine container (urethral urine) Without interrupting the urinary stream, collect 50-75 ml of urine in a second container (bladder urine) With Prostatitis the UA is often with WBC and bacteria present Dr immediately performs a Prostatic massage and collects any Prostatic fluid that is expressed into a third container. IF not possible to collect the patient is asked to void a small amount – it may contain the bacteria present in the Prostatic fluid.

Prostatitis Medical management A broad-stectrum antibiotic Trimethroprim sulfamethoxazole (Bactrim) Cirpfloxacin (Cipro) Bed rest Analgesic agents Antispasmodic medications Medical management Goal is to avoid abscess formation and septicemia What is the Cause? Infection usually bacterial e-coli. So what will be the medical management #1 -- Antibiotics A broad-stectrum antibiotic agent is administered for 10-14 days (sometimes up to 4 weeks) May need to be IV to get high doses Hard to get antibiotics into the prostate – diffuse poorly from the plasma into the prostate Trimethroprim sulfamethoxazole (Bactrim) Cirpfloxacin (Cipro) Encourages to remain on bed rest to alleviate symptoms Analgesic agents to relieve pain Antispasmodic medications Bladder sedatives Sitz baths Stool softeners Anti-inflammatory agents

Prostatitis Bladder sedatives Sitz baths Stool softeners Colace Anti-inflammatory

Prostatitis Nursing process of Patients with Prostatitis Assessment Diagnosis Pain related to inflammation, bladder spasms, Urinary retention, related to obstruction Sexual dysfunction r/t discomfort Anxiety r/t uncertain outcome Planning and Goals Nursing process of Patients with Prostatitis Assessment Diagnosis Pain related to inflammation, bladder spasms, Urinary retention, related to obstruction Sexual dysfunction r/t discomfort Anxiety r/t uncertain outcome Planning and Goals Nursing Interventions Administration of prescribed antibiotics Comfort measures Analgesic agents Sitz baths Do not force fluids – need to have high concentration of meds in the urine – OK to drink Foods and liquids that have diuretic actions or that increase Prostatic secretion should be avoided (if acute bacterial prostatitis) Alcohol Coffee Tea Chocolate Cola Spices Arousal and intercourse should be avoided Avoid sitting for long periods Evaluations/Expected patient outcomes

Prostatitis Nursing process of Patients with Prostatitis Nursing Interventions Admin. meds Comfort measures: Sitz baths Fluids: Do not force fluids – Nursing Interventions Administration of prescribed antibiotics Comfort measures Analgesic agents Sitz baths Do not force fluids – need to have high concentration of meds in the urine – OK to drink Foods and liquids that have diuretic actions or that increase Prostatic secretion should be avoided (if acute bacterial prostatitis) Alcohol Coffee Tea Chocolate Cola Spices Arousal and intercourse should be avoided Avoid sitting for long periods Evaluations/Expected patient outcomes

Prosatitis AVOID Foods and liquids that have diuretic actions or that increase Prostatic secretion should be avoided Alcohol Coffee Tea Chocolate Cola Spices Avoid intercourse Avoid sitting for long periods

Orchitis Behavioral Objective Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education Orchitis Brunner and Suddarth’s Medical Surgical Nursing pg 1769 Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education Orchitis Brunner and Suddarth’s Medical Surgical Nursing pg 1508

Orchitis Orchitis is an inflammation of the testes. Etiology Mumps Testicular congestion Viral Parasitic Trauma Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education Orchitis Brunner and Suddarth’s Medical Surgical Nursing pg 1508 Orchitis is an inflammation of the testes. Causes Mumps Testicular congestion Remember the testes are a collection of small tubes. Anything that blocks the tubes  congestion  inflammation Viral Parasitic Traumatic

Orchitis Signs & Symptoms Pain Swollen

Orchitis Treatment Rest - bed Elevate scrotum Ice pack Antibiotics? Analgesics Anti-inflammatory Treatment Medication specific to the infecting organism Rest - bed Elevation of the scrotum Ice pack to reduce scrotal edema Antibiotics Analgesic agents Anti-inflammatory medication

Benign Prostatic hyperplasia Behavioral Objective: Describe etiology, pathophysiology, clinical manifestations, nursing management and patient education for Prostatic hypertrophy / Benign Prostatic Hyperplasia / enlarged prostate Brunner and Suddarth’s Medical Surgical Nursing pg 1751-52

Prostatic hypertrophy Benign Prostatic Hyperplasia Pathophysiology Prostate gland enlargement urinary obstruction Age > 50 Prostatic hypertrophy / Benign Prostatic Hyperplasia / enlarged prostate Brunner and Suddarth’s Medical Surgical Nursing pg 1494 Pathophysiology In many patients older than 50 years, the prostate gland enlarges, (due to the increased number of epithelial cells) extending upward into the bladder and obstructing the outflow of urine This condition is known as benign Prostatic Hyperplasia It is one of the most common pathologic conditions in older men

Prostatic hypertrophy Benign Prostatic Hyperplasia Clinical Manifestations prostate gland large rubbery non tender Urinary retention Dilation of the ureters and kidneys Results in UTI Clinical Manifestations Examination reveals a prostate gland that is large rubbery and non tender Hypertrophied lobed obstruct the urethra causing incomplete emptying of the bladder and urinary retention This results in gradual dilation of the ureters and kidneys UTI may result from urinary stasis

Prostatic hypertrophy Benign Prostatic Hyperplasia Assessment and diagnosis Digital Rectal exam BPH develops in the inner prostate Cancer develops on the outside of prostate Urinalysis (U/A) Renal function test Complete blood studies (CBC) Assessment and diagnosis Digital Rectal exam Benign PH develops in the inner portion of the prostate whereas cancer develops on the outside. Urinalysis Renal function test Complete blood studies (because hemorrhage is a major problem post op and we need to know where they are from the get go)

Prostatic hypertrophy Benign Prostatic Hyperplasia Medical Management Catheterization Prostatectomy TURP - Transurerthral Resection of the Prostate Laser resection of the prostate. Ultrasound & Lasers Tissue vaporizes or necrotic  sloughs. Medical Management Depends of severity Admitted because he can not void, he is immediately catheterized (normal catheter may not work, to soft to get through, so the DR puts in a wire and “forces his way through”) Prostatectomy – frequently performed: TURP - Transurerthral Resection of the Prostate Talk about more in detail Alpha-adrenergic receptor blockers relax the smooth muscle of the bladder neck and prostate. Help reduce obstruction in many patients Laser resection of the prostate. With ultrasound guidance, resection of the prostate can be accomplished with lasers. The treated tissue either vaporizes of becomes necrotic and sloughs.

Prostatic hypertrophy Benign Prostatic Hyperplasia Nursing process Assessment Diagnosis / Nursing Interventions Acute pain related to bladder distention secondary to enlarged prostate as manifested by complaints of discomfort Catheter I & O Percuss bladder for distention Maintain patency of catheter Asses pain * Break into small groups ID nrusing interventions for a Nursing diagnosis. Write on board

Prostatic hypertrophy Benign Prostatic Hyperplasia Risk for infection (urinary tract) related to indwelling catheter, environmental pathogens, and urinary stasis Assess for elevated temperature; urine cloudy or foul-smelling U/A Enc fluids Strict aseptic technique Make sure you collect the UA before administering the antibiotic!

Prostatic hypertrophy Benign Prostatic Hyperplasia Fear, related to actual or potential sexual dysfunction, possible diagnosis of cancer, and lack of knowledge regarding surgical procedure and postoperative care as manifested by verbalization of fear about impact of surgery on sexuality, questioning or inaccurate comments about surgical care. Teach Assess Provide opportunity to talk