NURSING SYSTEM DISTURBANCE ON CLIENT

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NURSING SYSTEM DISTURBANCE ON CLIENT

NURSING SYSTEM DISTURBANCE ON CLIENT

urinal: benign prostatic hyperplasia (BPH)

Introduction:
Problems that are often experienced a elderly men associated with urinal system is benign prostatic Hyperlasia (BPH). The prostate is an organ of urination that is often experienced neoplasms: benign or malignant.
This problem often occurs in 50% of men over the age of 50 years, and 75% of men over 70 years. In Indonesia, these incidents will be found in connection with the increasing number of elderly due to increased life expectancy. Thus many cases this will stay hospitalization indicated that in general surgery.
In this condition, as a nurse will often be confronted with the problem of nursing associated with BPH cases mainly associated with surgery. Therefore, nurses need to have enough knowledge to handle clients of BPH, especially in perioperative nursing care (pre-surgical, intra-surgical, and post-surgery).

Etiology:
BPH is the enlargement of the prostate gland tissue that is benign. Although not known for certain the cause is universal because it occurs in the elderly. However demikiandiperkirakan that the increased number of prostate cells as a result of endocrine changes associated with aging. Dihydroxytestosteron accumulation (hormonm main androgen in the prostate gland), estrogen stimulation, and other local growth hormone activity is considered a role in the occurrence of BPH (Lewis, Heitkemper & Dirksen, 2000)
Similarly, factors related to diet, the influence of chronic inflammation, socioeconomic factors, hereditary, and races can all be considered role in the occurrence of BPH (Black & Jacobs, 1997).

Risk Factors:
BPH is often found in an elderly man, therefore there is no primary prevention. Men with kastraksi or who have hypogonadism before puberty or early adulthood in men rarely have BPH. The incidence is increased in black men, and less on Asian men (Black & Jacobs, 1997).
The main one is early detection is the best secondary prevention. Early detection is needed to address quickly so as to prevent the occurrence of complications associated with lower urinary tract obstruction.
Better prostate examination was carried out at the age of 40 years.

Pathophysiology:
Enlarged prostate that are junak is abnormally increased number of normal cells (hyperlasia) in the prostate, presumably also occur enlargement of prostate cells (hypertrophy).
Periurethral glands are experiencing hiperplasi in the elderly is gradually growing and pressing on surrounding tissue of normal prostate gland that encourages the fore, and formed capsule.
Complications that may occur due to enlarged prostate including urinary flow resistance and will also result in urinary reflux (backwards flow) that will lead to decompensation uretrovesical junction.
As a result of decompensation causes an increase in bladder pressure of time, the bladder wall thinning due to stretching and facilitate the occurrence of bladder infections or bladder stone formation.
Due to pressure of the bladder, ureter will experience the pressure and obstruction that can lead to hydroureter and subsequent may cause hydronephrosis, kidney and kaliks result trophies will experience distension and renal parenchymal tissue will atrophy. Further obstruction that occurs when prolonged or experiencing reflux will cause renal insufisensi.

Clinical manifestations:
BPH usually occurs slowly so that its development is sometimes not perceived as a nuisance. Please note that in the elderly, will increase the frequency of urination. When someone complained that the number and strength of the flow of urine does not occur normally, then suspect the occurrence of BPH and need to do further assessment.
In BPH, the swift flow of urine is reduced, the flow seems weak and sometimes only a trickle. Clients will feel less satisfied in micturition. It may also have blood in the urine.
Due to prostate enlargement, would be very dangerous occurrence obstuksi complete urinal and retention occurs. Retention can be triggered by:

1. Fever
2. Alcohol drinkers
3. Infection
4. Barriers to discharge
5. Purebred lying.

Some drugs can lead to retention, such as drugs that are decongestants, anticholinergic, and antidepressants.
Obstruction can cause severe pain and need immediate catheter placement.
Several attempts to assess BPH:

1. Perform general physical examination, including digital rectal examination (DRE).
2. Laboratory tests: Blood, urine, and kidney function.
3. X-ray including intravenous pyelogram and cystosgraphy
4. procedures other actions: for example kakaterisasi and cystoscopy.

Complications:
Client BPH will increase the risk of urinary tract infections due to bladder emptying does not have perfect obstruction caused by partial or total in the proximal urethra. Urine residue would be a good environment as breeding grounds for bacteria.
Stone can teerbentuk as a result of alkalinization of urine residue. Robekanpembuluh blood due to excessive stretching will cause hematuria. Increased pressure on the bladder will cause the bladder wall and cause the formation of experience stretching diverticula.
Complications are very serious due to urinary retention is bladder dysfunction, hydroureter, renal parenchymal tissue damage due to hydronephrosis, and pyelonephritis occurred. And complications of the above can cause kidney failure.

Medical Action:
The purpose of medical treatment which is to improve the flow of urine from the bladder, reduce / eliminate the symptoms, and prevent or manage complications due to BPH.
If found clients indicated improvement urethra obstruction, carried out in accordance with an indication of remedial action. Various acts as a BPH treatment options can be categorized in the act of treatment, nonsurgical invasive (without invasive surgery, and invasive surgical (invasive surgery).
1. Therapeutic Treatment:
Giving the hormone to reduce / inhibit growth via inhibition of hormone adrogen network. Treatment carried out continuously. Side effects of this medication is erectile dysfunction, which found 10% of clients has decreased libido (Lewis, Heitkemper & Dirksen, 2000).
Herbal remedies can be used for client BPH.
2. Invasive Nonsurgical:
Installation of temporary indwelling catheter can be used to reduce symptoms. Catheter placement in a long time to be avoided to prevent risk of infection. Installation Balloon dilatation of the urethra to stretch the urethra so that urine flow into the free and smooth. Ballon installation action is an action that is not permanent (temporary).
3. Surgical Therapy:
Surgery is done to mnengatasi urinary obstruction due to BPH. Part of the prostate gland that causes obstruction of disebutProstatectomy removal. Prostatectomy Indications are as follows;

1. Upper urinary tract dilatation experience (hydroureter, hydronephrosis) and the presence of impaired renal function.
2. Severe pain.
3. Total urinary obstruction.
4. Treatment is given less respond.
5. The presence of bladder stones, as evidence of obstruction of the old connection with BPH and an infection.
6. Obstruction of the old with the existence of hydroureter and hydronephrosis that disrupt kidney function.
7. A long and severe hematuria.
8. The reduced quality of life as a result of BPH.
9. Chronic urinary retention.
10. The presence of urinary tract infection recurring.

Pre-Surgical Treatment:
The purpose of pre-surgical preparation clients is to maintain urine output and prevent complications.
Clients who experienced acute retention requiring surgery. Usually in this condition should be considered catheter placement.
Surgical procedure performed to remove enlarged prostate tissue, namely:

1. Transurethral resection of the prostate (TURP).
2. Suprapubic prostatectomy.
3. Retropubic Prostatectomy.
4. Perineal prstatectomy.

The above procedure is determined by the size of the prostate and general health condition of the client.
a. Transurethral resection of the Prostate (TURP) is tinmdakan which is often done by lifting some of the prostate. No external incision is made, because it is done through a resectoscope through the urethra and prostate tissue cautery take place .. Having performed this action via three-way indwelling catheter inserted sterile fluid as much as 30-60 ml to hemostasis and facilitating the flow of urine. Kemi bladder irrigation done 24 jan first in order to prevent obstruction of blood clots. This action is used when clients have an enlarged prostate is.
The advantage of this action is not carried out an external incision and does not cause sexual dysfunction (erection problems), and does not cause incontinence long.
Kerugiannmya ie not all prostate tissue removed will memebrikan potential to re-experience hyperplasia, and prostate cancer can occur.
b. Transurethral Incision of the Prostate (TUIP).
Performed on clients with high risk, as well as mild obstruction, or at the client's age is still easy. Incision made into the prostate tissue to reduce the obstruction at the bladder neck. The incision can be made unilaterally or bilaterally. Conducted monitor urine output and possibly hematuria conducted in the first 24 hours via indwelling catheter.
c. Suprapubic resection.
Tissue mass lifter performed widely (over 60 g) usually performed on prostate cancer. The incision made at the bottom of the abdomen through the midline of the bladder to the front of the prostate. This action by menggangkat whole gland and urethral then sewn to the bladder. After surgery, catheters placed in the suprapubis mounted through the abdominal incision which aims to prevent terkanan on ahitan and menungkin for bladder healing. Indwelling catheter placed into the bladder through the urethra to prevent stricture. Bladder irrigation done in the first 24 hours.
This action is at risk of urinary tract infection, bladder spasm, and bleeding.
d. Retropubic resection
Used to lift radically performed on prostate cancer. Incision on the bottom line of the abdomen to the prostate gland. After surgery, indwelling catheter placed through the urethra into the attached bladder. Installed drain in the abdominal incision area in order to remove fluid through the area. In this action does not do an incision of the bladder. This procedure is at risk of bleeding. On the client who are overweight, somewhat difficult and retropubis suprapubis resection.
e. Perineal resection.
This action is rarely done, but done on prostate cancer. The incision is made through the scrotum and the anus. Because of the possibility to extend to the client area of ​​the rectum previously done huknah, given antibiotics, and diets low in fiber. After surgery indwelling catheter placed through the urethra. Installed drain on the area cast changes every time insisi.Dilakukan defecation to prevent infection in the incision area.
Disadvantages: Although all measures of erectile dysfunction risk, but action perineal resection is the highest incidence, urinary incontinence, the risk of infection because adjacent to the anus.
Nursing in BPH Client:
Nurses are very interested in nursing care of clients, because in general client-patient BPH stay in hospital for surgery. The focus of nursing care, especially in pre-surgical and post-surgery.
Nursing Assessment:
Objective data and subjective data should be collected from clients BPH, namely:
Subjective Data:
- Information on health status: Medicine: testosterone and estrogen are given to clients as the treatment of BPH.
- Perception of health: knowledge in connection with BPH, less drinking, the pattern of elimination: the urge to urinate (urgency uninary), a weak urinary stream, feeling of incomplete urination, dripping urine, urinary retention, incontinence, nocturia
- Cognitive Perception: dysuria, feel less comfortable in the bladder.
- Reproduction / Sexual: Anxiety about sexual dysfunction.
Objective Data:
- Generally occurs in elderly men.
- Distention kandungkemih palpable on palpation, and palpable enlargement of the prostate (rectal examination).
- Found an enlarged prostate on ultrasonography, laboratory tests found presence of leucocytes, bacteria, or hematuria, increased BUN and serum creatinine.
Nursing care before surgery:
Assessment:
Clients may be vaguely aware of why the prostate gland enlarges, and the client may feel fear in relation to the assessment / test and the results. Be careful to explain every part of the process undertaken pengakajian. When you need to show the client / family drawings of reproductive organs and the prostate gland and describe the influence of the enlarged prostate with urine ekresi.
Ask the client's clinical manifestations that occur on the client, including the pattern of urination, the urgency, frequency, decrease or interruption of urine flow, barriers to urinate, and nocturia. Ask also the possibility of hematuria.
1. NDx: Urinary retention associated with prostate enlargement / obstruction of the urethra.
Objective: Clients will be free from the symptoms of BPH is characterized by: did not find any frequency, urgency, hesitancy, weak flow, retention, or nocturia.
Implementation;
- Observation of the power flow of urine.
Rational: The flow is weaker, suggesting an obstruction in the lower urinary tract.
- Perform percussion / palpation suprapubis area.
Rational: distension of the bladder can be felt in the area suprapubis.
- Monitor vital signs, observation of the possibility of hypertension, peripheral edema, change of consciousness.
Rationale: Loss of renal function will result in decreased elimination of fluid and accumulation of toxic substances.
- Give a warm bath when there are indications.
Rationale: Allows muscle relaxation, menurnkan edema, and may encourage emptying.
- Replace the indwelling catheter as indicated.
Rational: Indwelling catheter as a tool memperetahankan flow of urine from the bladder adequately / well.
2. NDx: Acute pain in relation to the mucosal irritation as a result of bladder distension
Objective: The client will report pain controlled / reduced, marked by;
- Client appears to relaxation.
- Getting enough sleep.
- Report the pain is gone / reduced.
- Vital SGN within normal limits.
Implementation:
- Assess the pain.
Rational: Pain due to urinary tract obstruction is felt in the area around the bladder / suprapubis.
- Perform actions such as deep breathing relaxation exercise or pengalihkan attention by providing a variety of activities.
Rationale: The increased relaxation, distraction will meningkatkankemampuan koiping client.
- Use warm water depth, especially in the genital and surrounding areas.
Rational: warm stimuli would result in vasodilation, which will happen relaxation.
- Maintain bed rest.
Rational: Pain will increase the stress so that energy use will increase. The energy required to push the power / pressure urine output.
- Replace the indwelling catheter.
Rationale: Removing the urine will reduce the distention of the bladder and prevent anxiety clients.
- Discuss with your doctor about medication:
- Group of narcotics
Rationale: Provide physical and mental relaxation.
- Antibiotics
Rationale: Prevent the bacteria in the urinary tract.
3, NDx: Lack of knowledge in relation to the lack of information / understanding of the disease, its manifestations, and action.
Objective: Clients will increase their knowledge about penyaki, manifestations and actions taken, which is characterized by:
- Clients shows compliance in undergoing the action / treatment.
- Client client statement supporting the actions provided.
- Clients are able to explain again about the knowledge, manfestasi illness and action taken.
Implementation:
- Encourage client to express fears / feelings and concern.
Rationale: The client was given serious attention, the client believes will help with a good nurse.
- Provide information that the disease is not due to sexual relations.
Rational; adequate information will reduce anxiety.
- Suggest: to avoid alcoholic beverages / stimulants.
Rational: Stimulants will increase the GFR, so that the product will be increased so that the distended urinary bladder will increase.
- Discuss with your doctor about giving information about the disease and actions.
Rationale: Understanding the misrepresentation of the disease and the action / treatment will increase the anxiety or less cooperative in the action taken.
Perioperative Nursing:
Assessment:
Assess client's ability to empty his bladder. Bladder palpation clients the possibility of bladder distension emih. Palpation suprapubis done in the area. If clients can not urinate properly, consider the possibility of installation of indwelling catheters. Therefore, examine the need for catheter placement.
In the pre-surgical assessment, assessment notice relating to the physical and psychosocial aspects. Assess client's knowledge level in relation to surgery and results. Because many types of surgery that can be done, so maybe the client does not understand the implications of the actions to be taken.
implications of the actions that the client accepted.
1. NDx: Fear in connection with the problems experienced at this time, action and sexual function
Objective: Clients will be able to control his fears are marked with the statement in connection with an adequate understanding, the ability to ask the obvious, and the ability to berisitrahat well.
Implementation:
2, NDx: Acute Pain related to invasive / traumatic edema region. Marked by: Client reported pain, anxiety, moody, focused attention, the response of autonomy. on himself, muscle tension.
Objective: The client will report that the pain controlled / reduced., Characterized by:
- Client appears to relaxation.
- Getting enough sleep.
- Calm down.
Implementation:
- Assess the level of pain, radiation, and vital signs.
Rationale: The high score kearak increasingly shows the level of severe pain. If found increased vital signs show a client in a state of stress due to pain.
- Explain to the client occurrence of pain.
Rationale: Understanding the misrepresentation of the pain will increase the stress so that the pain will increase in intensity.
- Assess the possibility of bladder distention after surgery.
Rational: bladder distention occurs as a result of blockage of a blood clot in the urinary tract. Stretching of the bladder will cause pain.
- Collaboration: Drug analgesic or antispasmodik.
Rational: This medicine will relieve pain and prevent the occurrence of bladder spasm
- Provide high-fiber diet.
Rational: low-fiber diet will encourage the client straining during defecation, giving rise to tension / strain on the seam area or cause bleeding.
3. NDx: The risk of injury associated with the catheter placement, irrigation or drai on suprapubis.
Objective: Clients will be free from injury such as infection, catheter blockage, or injury due to catheter placement. Marked by;
- There is no fever.
- Laboratory of normal leucocytes.
- Good surgical wound healing.
- Katater function properly.
- Tidakj there is bleeding.
- Urine flow smoothly.
Implementation:
- Review the flow of urine through the catheter.
Rational: ketidaklancaran flow of urine through Kater as a result of blockage of blood bekiuan the lumen of the catheter.
- Perform bladder irrigation through a catheter.
Rational: irrigation will maintain the smooth flow and clean the bladder of blood clots and other nekrotis tissue so that urine color returned to normal urine, and prevent the occurrence of bladder overdistensi which can cause bleeding.
- Provide information to clients about the installation of drains and catheters.
Rationale: Lack of knowledge client about the action taken will enable clients attract / hold the catheter / drain.
- Observation of the surgical wound state whether there are signs of inflammation.
Rational: The presence of edema, redness on the skin surface in the area of ​​surgery showed the occurrence of secondary infection.
- Maintain aseptic technique, especially when the surgical wound care, avoid doing enemas, rectal tube, rectal thermometer or installation.

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