The document summarizes topics related to the renal and urinary system, including benign prostatic hypertrophy (BPH), urinary incontinence, and nephrotic syndrome. It provides details on the pathophysiology, signs and symptoms, diagnostic tests, nursing care, and interventions for BPH. Urinary incontinence is defined and its prevalence among older populations is noted. Various diagnostic tests for incontinence are also listed.

1. Filamer Christian CollegeCollege of NursingRoxas City NCM 102 RENAL and URINARY SYSTEM Topics: Benign Prostatic HypertrophyUrinary IncontinenceNephrotic Syndrome Prepared byGroup 4- WATSON Aspera, Liza MarieBuencuchillo, KristineCesar, RoneilLacdo-o, Krisanta CamilleMontealegre, Lynmar KayeNobleza, ArgieTan, Jazel Cheene Submitted to Miss Shenell A. Delfin, RNNCM 102 Lecturer March 11, 2010Benign Prostatic Hypertrophy Enlargement of the prostate gland.

2. The term BPH is a misnomer because the actual change is a hyperplasia & not hypertrophy.

3. BPH becomes a disorder when enlargement obstructs the urinary channel and causes changes in the urinary tract with associated manifestations. The etiology of BPH is unclear.Two factors necessary for BPH to occur are: (1) endocrine control (DHT) (2) agingHormonal Alteration: The relative roles of androgen & estrogen in inducing BPH, however , are complex & not completely understood.- Prostatic enlargement eventually occurs in 80% of men. By age 50, about 50% of men have some degree of BPH. - Increased in African American men and is lower in Asians.

4. PATHOPHYSIOLOGYserum levels of Luteinizing hormone,testosterone and luteinizing hormone – releasing hormone Pituitary gland stimulation to release of LH Testosterone production Combines with 5-alpha-reductase Dihydrotestosterone (DHT) formation Muscle contraction Restriction of urine flow Bladder outlet obstruction Detrusor muscle compensates Trabeculation and bladder diverticula occur bladder wall elasticity

5. ASSESSMENTProgressive HyperplasiaCIRCULATION

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

7. ELIMINATION

8. May report:Decreased force/caliber of urinary stream; dribbling

9. Hesitancy in initiating voiding

10. Inability to empty bladder completely; urgency and frequency of urination

11. Nocturia, dysuria, hematuria, Sitting to void

12. Recurrent UTIs, history of calculi (urinary stasis)

13. Chronic constipation (protrusion of prostate into rectum) Cont. ASSESSMENT Inguinal hernia; hemorrhoids (result of increased abdominal pressure required to empty bladder against resistance)

14. May exhibit:Firm mass in lower abdomen (distended bladder), bladder tenderness FOOD/FLUID May report:Anorexia; nausea, vomiting, Recent weight lossPAIN/DISCOMFORT May report:Suprapubic, flank, or back pain; sharp, intense (in acute prostatitis), Low back pain SAFETY May report:Fever

15. Cont. ASSESSMENTSEXUALITY May report:Concerns about effects of condition/therapy on sexual abilities

16. Fear of incontinence/dribbling during intimacy

17. Decrease in force of ejaculatory contractions

18. May exhibit:Enlarged, tender prostate TEACHING/LEARNING May report: Family history of cancer, hypertension, kidney disease

19. Use of antihypertensive or antidepressant medications, OTC cold/allergy medications containing sympathomimetics, urinary antibiotics or antibacterial agents

20. Self-treatment with saw palmetto or soy products Obstructive Voiding symptoms

21. Weak stream

22. Prolonged micturition

23. Straining

24. Hesitancy

25. Intermittent stream

26. Feeling of incomplete bladder emptying

27. Irritative symptoms

28. Frequency

29. Nocturia

30. Urgency

31. Incontinence Systemic symptoms related to the UT: - Vesicoureteral reflux - Dilatation & hydronephrosis - Renal failure & symptoms of uremiaSymptoms unrelated to the UT: - hernias, hemorrhoids and vesical calculus - change in the caliber of bowl movementsSymptoms related to complications: - cystitis - pyelonephritis - bladder calculi - micro or gross hematuria.

32. DIAGNOSTICSDigital Rectal Examination (DRE) – smooth, firm, symmetric enlargement of the prostate

33. Urinalysis & microscopic examination: to R/O infection or the presence of hematuria.

34. Serum U/E & creatinine: to provide baseline information on renal function & metabolic status.

35. Uroflowmetry: At a volume of 125-150ml, normal individuals have average flow rates of 12ml/sec & peak flow close to 20ml/sec.Mild 11-15 ml/sec Moderate  7 and  10 ml/sec Severe  7ml/sec

36. Residual Urine: estimated by U/S or catheterizations. Volumes >150 ml are considered significant since they constitute approximately one-third of normal bladder volume

37. Serum Prostate-Specific Antigen (PSA) – to rule out cancer, but may also be elevated in BPH Optional diagnostics for further evaluation:Urodynamics –measures peak urine flow rate, voiding time and volume, and status of the bladder’s ability to effectively contract.Measurement of postvoid residual urine; by ultrasound or catheterization

38. Cystourethroscopy – to inspect urethra and bladder and evaluate prostatic size Ultrasonography:In BPH, it is most useful for measuring bladder & prostate volume as well as residual urine.Estimation of prostatic size is important because most urologists prefer to perform TURP for glands under 100g.TRUS must be used as it is more accurate. IVP:For UTI & complications of BPH

39. COMPLICATIONS Acute urinary retention, involuntary bladder contractions, bladder diverticula, and cystolithiasis

40. Vesicourethral reflux, hydroureter, hydronephrosis

41. Gross hematuria, urinary tract infection

42. Renal impairment

43. Bladder stones

44. Bladder damage (trabeculations, cellules, diverticula)

45. Overflow incontinence Interventions:Facilitating Urinary EliminationProvide privacy and time for patient to void

46. Assist with catheter introduction with guidewire or by way of suprapubic cystostomy as indicated.

47. Monitor intake and output

48. Maintain patency of catheter

49. Administer medications as ordered, and monitor for and teach patient about side effects.

50. Assess for and teach patient to report hematuria, signs of infectionPatient education and Health MaintenanceNURSING DIAGNOSIS1. Impaired Urinary Elimination related to obstruction of urethra.Rationale: BPH causes an enlargement that forms like a capsule in the urinary bladder that occludes urine flow causing changes in urinary elimination. The patient experiences manifestations such as frequency, urgency, hesitancy, change in stream, incontinence, retention and nocturia.