1. 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

2. 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

3. 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

4. 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 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.

5. Divided urinary specimen
Clean glans of penis
Void 10-15ml – 1st container
Urethral Urine
Without interrupting the urinary stream, collect 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 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.

6. 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 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

7. Prostatitis Bladder sedatives Sitz baths Stool softeners
Colace
Anti-inflammatory

8. 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

9. 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

10. 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

11. 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

12. 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

13. Orchitis
Signs & Symptoms
Pain
Swollen

14. 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

15. 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

16. 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

17. 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

18. 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)

19. 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.

20. 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

21. 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!

22. 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