Patient_Education_Plan_for_Benign_Prostatic_Hyperplasia

Patient Education Plan for Benign Prostatic Hyperplasia Lorena Lee, R. N. NUR/427 Health and Chronic Disease Management July 25, 2011 Dr. Shannon Smith Case History: John Smith is a 67year old White male in general good health. John came to see his doctor because of urination problems. His complaint is an urgency and the inability to urinate, at times he dribbles and when he does urinate it takes an effort and at times painful. It has begun to interrupt his life because of the feeling of a need to go to the bathroom all the time. He believes that he was having difficulty sexually. After the doctor asked John about his symptoms and did a rectal examination, the doctor ran a urine test to rule out urinary tract infection he diagnosed John with Benign Prostatic Hyperplasia (BPH). John has no history of drugs and alcohol abuse; he did smoke cigarettes, but quit 15 years ago. No reported heart or lung problems. John has not had any surgeries in his life-time, and is up-to-date with all of his immunizations. John walks one to two miles three times a week and stays active at a local senior center and church when he is not traveling with his wife. John is married, has two adult children, and four grandchildren. His family is very supportive. He has an Associate’s degree in business. He worked in a bank for 40 years, retiring six years ago. Since retirement, John and his wife traveled. His family history indicates that his father (deceased), and his only brother (living) had or has BPH. John states that he knows his brother has problems urinating, but does not know much about BPH. The doctor has decided to try oral medication at this time because the rectal examination revealed only slight enlargement of the prostate. According to Erik Erikson’s developmental stages; John is in “Late Adulthood: 55 or 65 to Death; Ego Development Outcome: Integrity vs. Despair: Basic Strengths: Wisdom” (The development Stages of Erik Erikson, para. 25-26). John fits in the integrity category of development. According to Erikson John spent much of his life preparing for middle adult-hood and the last part recovering from middle age. John appears stable and content with his life. He has stated that he has a good life and is enjoying this part of his life (retirement). Learning Needs John’s learning needs are: * An explanation of what BPH is and it cause. * Know what are some of the signs and symptoms of BPH are to watch for possible changes. * Know the risk factors, complications that could occur. * What kinds of treatments for BPH. * Know what the medication is, the dosage, and how often to take it. * Know the side effects of the medication he will be taking. When asked about the best method of learning for him, John replied was reading and viewing videos, and asking questions if he has any.. John was given written materials on BPH as he requested. The material covered what BPH is, the risk factors, how the doctor diagnoses BPH, types of treatments and concerns him and his wife may have. The nurse briefly went over the written materialand discussed the medication. What is Benign Prostatic Hyperplasia (BPH) BPH is a common condition in older men that can cause urinary problems. If untreated, it can block the urine flow out of the bladder. This can cause bladder, kidney, or urinary tract problems (Mayo Clinic Staff, 2011). The cause of BPH is unknown. Although most men continue to have prostate growth throughout their lives, at times the growth is significant enough to cause blockage of the urine. Another thought is the enlargement may be due to the changes in sex hormones as men grow older. Some factors link aging and testicles may play a part in the growth of the prostate gland. When a man has his testicles removed at a young age (for example for testicle cancer) they do not develop BPH. It has also been noted that after man develops BPH and has his testicles removed the prostate begins to shrink (ADAM Health Illustrated Encyclopedia, 2009). Risk factors Three risk factors are identified * Aging—it is rare for a man under the age of 40 to have BPH, but about half of the men over 60 have problems with it. * Family history—if a man has blood relatives with BPH, there is a very good chance that you may get BPH. * Ethnic background—BPH is most common with White and Black males. * Marital Status—it is unknown why men who are married tend to develop BPH and the single man is less likely (Sanofi Aventis, 2011). Diagnosis Neighbors and Tannehill-Jones (2006) stated, “Diagnosis is made on the basis of symptoms and digital rectal examination revealing an enlarged prostate” (Chapter 17. University of Phoenix, p. 323). The digital rectal examination is done by the doctor placing a finger into your rectum, this can determine if the prostate is enlarged and can rule out prostate cancer. There are some blood and urine test that help diagnose. * PSA—is a blood test to determine if there is any prostate problem such as prostate infection or cancer. * Urinalysis—to check for urinary tract infections or high proteins that can indicate a problem with your kidneys. * Other blood test—to check for kidney damage or anemia that can occur with severe or chronic symptoms of BPH. * The “Long and Strong” test—this test will measure your urine flow and how strong it is. There are several types of equipment used to measure the urine flow (The Prostate Cancer Institute, 2011). Treatments Several treatments are available. The treatments include surgery, medications, and minimally invasive surgery. Depending on many factors help to determine the type of treatment needed. The factors include how much the symptoms are bothering you, the size of the prostate, your age, and what you prefer to be done. These are the most common medications: * Alpha blockers--help to relax the bladder neck muscles as well as the muscle fibers of the prostate. This makes it easier to urinate * 5-alph reductase inhibitors—will shrink the prostate by preventing hormonal changes that cause the prostate to grow. Your doctor has decided to start you on oral medication. He has chosen one alpha blocker at this time. The medication is called Flomax. You will be taking 0.8 mg daily. It should start working immediately. You will need to monitor your blood pressure because Flowmax does tend to lower your blood pressure. Tell the doctor, if you have any side effects: Common Side Effects * Abnormal ejaculation * Runny nose * Dizziness * Infections—like a cold or flu * General body pain These are just a few of the possible side effects. At your next appointment, the doctor will decide to increase your medication, add a medication, or try another medication. Surgery is recommended when the medication does not work or the symptoms are very severe. There are several types of prostate surgeries. The type of surgery depends on many factors such as the size of the prostate, how severe the symptoms are and what type of treatments are available in the area. These three surgeries are what the doctor does if surgery is needed. * Transurethral resection of the prostate (TURP)—is the most common surgery. The doctor removes all except the outer part of your prostate away. This surgery usually relieves symptoms quickly. In most cases you will have a strong urine flow within a few days. A catheter may have to be in place for three to five days after having the surgery. . This surgery is usually done to treat smaller prostates. This surgery is done lapascopically. * Transurethral incision of the prostate (TUIP of TIP)—is the surgery suggested if the patient has a small or moderately enlarged prostate. This surgery the doctor makes one or two small cuts in your prostate gland to open a channel in the urethra so that urine can pass through easier. This surgery is also done laparoscopically. * Open Prostatectomy—is done in the case of a very large prostate, or if there is bladder damage or other complications. This is the removal of the prostate gland and is done with an open incision. You most likely will stay in the hospital a few days. There is always a risk, as with any surgery, of infection, and bleeding. Only light activities are allowed until you are healed and the doctor releases you. If your medication does not work, the doctor may decide you might need surgery. Concerns You may have a couple of concerns: * Continue to have difficulty going to the bathroom. Most of the medication or treatments do help to decrease that feeling. * Sexual functioning—the medications (selective alpha blockers) that are commonly given can cause problems with sexual functioning. The medications relax the smooth muscle in the prostate and may also relax the muscles in the vas deferens. This is the area that helps to propel sperm out into the urethra and penis (BPH & Me, 2011). The medication 5-alpha-reductased inhibitors side effects include impotence, decrease in sexual desire, reduced semen ejaculation and other ejaculation problems. You and your partner should talk with the doctor about these issues and others you both may have. Open communication between you and your partner is very important. This could help both of you to adjust to the changes in sexual function. * What if the medication does not work' What is next' There are other medications, or surgery may be considered. The doctor will talk with you about your options and what you want. Be open with the doctor on your wants, needs and concerns that you and your partner may have. An appointment was scheduled in one week for John to go over the written materials he was given with the nurse. The nurse discussed his medication and how to take it, explained some of the side effects, and to let the doctor know of any side effects. The nurse did verbally go over the written material with John and he gave a verbal understanding, but he wanted to take the material home and at his next visit go over it again. At that time he will ask any questions he or his wife may have. John and his wife appeared to have a good understanding of the information given to them and asked appropriate questions. References * ADAM Health Illustrated Encyclopedia. (2009). Healthline. Retrieved from http://www.healthline.com/adamcontent/ * BPH and Me. (2011). BPH and Me.com. Retrieved from http://bphandme.com/partners-intimacy.asp * Mayo Clinic Staff, (2011). Prostate gland enlargement. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/prostate-gland-enlargement/DS00027 * Harder, A. F. (2009). Learning Place Online.com. Learning Place Online.com. Retrieved from http://www.learningplaceonline.com/stages/organize/Erikson.htm * Neighbors, M., & Tannehill-Jones, R. (2006). Human Diseases second edition. [University of Phoenix Custom Edition e-Text]. Clifton Park, NY: Delmar Cengage Learning. Retrieved from,  NUR/427 website. * Sanofi Aventis. (2011). PD Prostatedisease. org. Retrieved from http://www.prostatedisease.org/bph/risk_factors.aspx * The Prostate Cancer Institute. (2011). Prostate.net. Retrieved from http://www.prostate.net/benign-prostatic-hypertrophy-bph/bph-diagnosis-tests/