NCP Benign Postatic Hyperplasia (BPH)

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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.


Community level, with more acute care provided during outpatient procedures.



Psychosocial aspects of care

Renal failure: acute

Patient Assessment Database


May exhibit: Elevated BP (renal effects of advanced enlargement)


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)


May report: Anorexia; nausea, vomiting

Recent weight loss


May report: Suprapubic, flank, or back pain; sharp, intense (in acute prostatitis)

Low back pain


May report: Fever


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


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

May need assistance with management of therapy, e.g., catheter

Refer to section at end of plan for postdischarge considerations.


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/mm3, indicating infection if patient is not immunosuppressed.

Uroflowmetry: Assesses degree of bladder obstruction.

IVP with postvoiding film: Shows delayed emptying of bladder, varying degrees of urinary tract obstruction, and presence of prostatic enlargement, bladder diverticuli, and abnormal thickening of bladder muscle.

Voiding cystourethrography: May be used instead of IVP to visualize bladder and urethra because it uses local dyes.

Cystometrogram: Measures pressure and volume in the bladder to identify bladder dysfunction unrelated to BPH.

Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum).

Cystometry: Evaluates detrusor muscle function and tone.

Transrectal prostatic ultrasound: Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH.


1. Relieve acute urinary retention.

2. Promote comfort.

3. Prevent complications.

4. Help patient deal with psychosocial concerns.

5. Provide information about disease process/prognosis and treatment needs.


1. Voiding pattern normalized.

2. Pain/discomfort relieved.

3. Complications prevented/minimized.

4. Dealing with situation realistically.

5. Disease process/prognosis and therapeutic regimen understood.

6. Plan in place to meet needs after discharge.

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