Nursing 211

N211: Health Differences Across the Lifespan I hematuria, nocturia and abnormal prostate found on digital rectal examination. Musculoskeletal symptoms include back pain, migratory bone pain, bone or joint pain. Neurological symptoms include nerve pain, muscle spasms, bowel or bladder dysfunction, bilateral weakness of the lower extremities. Systemic symptoms are weight loss and fatigue. Diagnostics Include elevated prostate-specific antigen (PSA). PSA test should be conducted prior to digital rectal examination so that manipulation of the prostate does not give a false positive reading. Serial blood screenings should be done to observe trends. A rise in PSA or a consistently high PSA is more reliable than a single assay. PSA levels can rise with inflammation, benign hypertrophy, or irritation, as well as in response to cancer. Elevated prostatic acid phosphatase (PAP), digital rectal examination reveals palpable nodule, transrectal ultrasound visualizes nonpalpable tumors and definitive diagnosis is by biopsy. Nursing Diagnosis • Altered urinary elimination related to urethral obstruction • Activity intolerance related to fatigue secondary to the effects of radiation therapy, chemotherapy, or surgery. • Anxiety and knowledge deficit related to diagnosis of cancer and treatments Medical Interventions Include radiation therapy or brachytherapy (radioactive seeds implanted into the prostate) is the most common treatment during the early stages of the disease; surgical intervention with a prostatectomy and hormone manipulation with androgen deprivation (anti-testosterone) and estrogen. Orchiectomy or removal of the testicles may be done as well as chemotherapy for metastasis. Orchiectomy decreases androgen production. Radical prostatectomy includes removal of the gland, capsule, ampulla, vas deferns, seminal vesicles, adjacent lymph tissues and cuff of the bladder neck. Suprapubic prostatectomy involves abdominal and bladder incisions to remove prostate tissue. Abdominal dressing may leak copious urine; change dressing as needed and maintain continuous bladder irrigation. Retropubic prostatectomy involves a low abdominal incision without opening the bladder. There is less bleeding and fewer bladder spasms with this procedure. Perineal prostatectomy involves an incision between the scrotum and anus. There is minimal bleeding but increased risk of infection; urinary incontinence is common. This procedure causes sterility.


Page 101

of 148


Made with FlippingBook - professional solution for displaying marketing and sales documents online