Tuesday, April 13, 2010

Nursing Care Plans for Prostate Cancer. Prostate cancer is the most common neoplasm in males older than age 50; it’s a leading cause of male cancer death. Adenocarcinoma is the most common form; only seldom does prostate cancer occur as a sarcoma. Most prostate cancers originate in the posterior prostate gland, with the rest growing near the urethra. Malignant prostatic tumors seldom result from the benign hyperplastic enlargement that commonly develops around the prostatic urethra in older males. 
Slow-growing prostate cancer seldom produces signs and symptoms until it’s well advanced. Typically, when primary prostatic lesions spread beyond the prostate gland, they invade the prostatic capsule and then spread along the ejaculatory ducts in the space between the seminal vesicles or perivesicular fascia. When prostate cancer is fatal, death usually results from widespread bone metastases. 

Stage of Prostate Cancer 

  1. Stage A or I: Prostate cancer that is only found by elevated PSA and biopsy, or at surgery for obstruction. It is not palpable on DRE. It is usually found accidentally during surgery for other reasons, such as BPH, usually curable, especially if it is a relatively low Gleason grade. 
  2. Stage B or II: can be felt on rectal examination and is click to enlargelimited to the prostate. Other tests, such as bone scans or CT/MRI scans, may be needed to determine this stage, especially if the PSA Blood tests is significantly elevated or the Gleason grade is 7 or greater 
  3. Stage C or III: Cancer has already spread beyond the capsule of the prostate into localclick to enlarge organs or tissues, but has not yet metastasized or jumped to other sites 
  4. Stage D or IV: Cancer has already spread, first site usually pelvic and perivesicular lymph nodes and bones of the pelvis, sacrum, and lumbar spine 

Stage of Prostate Cancer

Causes for Prostate Cancer 
Risk factors for prostate cancer include age (the cancer seldom develops in males younger than age 40) and infection. Endocrine factors may also have a role, leading researchers to suspect that androgens speed tumor growth. 
Complications for Prostate Cancer 
Progressive disease can lead to spinal cord compression, deep vein thrombosis, pulmonary emboli, and myelophthisis. 

Nursing Assessment 
The patient’s history may reveal urinary problems, such as dysuria, frequency, retention, back or hip pain, and hematuria. The patient with these complaints may have advanced disease, with back or hip pain signaling bone metastasis. The patient usually has no signs or symptoms in early disease. Inspection may reveal edema of the scrotum or leg in advanced disease. During digital rectal examination (DRE), prostatic palpation may detect a nonraised, firm, nodular mass with a sharp edge (in early disease) or a hard lump (in advanced disease). 

Diagnostic tests for Prostate Cancer 
The American Cancer Society advises a DRE and a blood test to detect prostate-specific antigen (PSA) yearly for males age 50 and older with a life expectancy of at least 10 years. These screenings may be done for males at high risk of the disease beginning at age 40 to 45, depending on their risk factors. Blood tests may show elevated levels of PSA. Although most males with metastasized prostate cancer have an elevated PSA level, the finding also occurs with other prostatic disease, so the PSA level should be assessed in light of DRE findings. Transrectal prostatic ultrasonography may be used for patients with abnormal DRE and PSA test findings. Bone scan and excretory urography are used to determine the disease’s extent. Magnetic resonance imaging and computed tomography scanning can help define the tumor’s extent. 

Treatment for Prostate Cancer 
Therapy varies by cancer stage and may include radiation, prostatectomy, orchiectomy (removal of the testes) to reduce androgen production, and hormonal therapy with synthetic estrogen (diethylstilbestrol). Radical prostatectomy is usually effective for localized lesions without metastasis. A transurethral resection of the prostate may be performed to relieve an obstruction. Radiation therapy may cure locally invasive lesions in early disease and may relieve bone pain from metastatic skeletal involvement. It may also be used prophylactically for patients with tumors in regional lymph nodes. Alternatively, internal beam radiation may be recommended because it permits increased radiation to reach the prostate but minimizes the surrounding tissues’ exposure to radiation. If hormonal therapy, surgery, and radiation therapy aren’t feasible or successful, chemotherapy may be tried. Chemotherapy for prostate cancer (combinations of cyclophosphamide, doxorubicin, fluorouracil, cisplatin, etoposide, and vindesine) offers limited benefits. Researchers continue to seek the most effective chemotherapeutic regimen. 

Nursing Diagnosis 
Common nursing diagnosis found in Nursing Care Plans Prostate Cancer: 

  • Acute pain 
  • Anxiety 
  • Fear 
  • Impaired urinary elimination 
  • Ineffective coping 
  • Risk for infection Sexual dysfunction 

Nursing Key Outcomes 
The patient will voice increased comfort. The patient will report that he feels less anxious. The patient will verbalize concerns and fears related to his diagnosis. The patient will maintain an adequate urine output. The patient will demonstrate positive coping mechanisms. The patient will remain free from signs and symptoms of infection. The patient will acknowledge a problem in sexual function. 

Nursing interventions  
Provide encourage the patient to express his fears and concerns, including those about changes in his sexual identity, owing to surgery. Offer reassurance when possible. Give analgesics as necessary Administer ordered. Provide comfort measures to reduce pain. Encourage the patient to identify care measures that promote his comfort and relaxation. 

After prostatectomy 
Regularly check the dressing, incision, and drainage systems for excessive blood. Also watch for signs of bleeding (pallor, restlessness, decreasing blood pressure, and increasing pulse rate). Be alert for signs of infection (fever, chills, inflamed incisional area). Maintain adequate fluid intake (at least 2,000 ml daily). Give antispasmodics, as ordered, to control postoperative bladder spasms. Also provide analgesics as needed. Because urinary incontinence commonly follows prostatectomy, keep the patient’s skin clean and dry. 

After suprapubic prostatectomy 
Keep the skin around the suprapubic drain dry and free from drainage and urine leakage. Encourage the patient to begin perineal exercises between 24 and 48 hours after surgery. Allow the patient’s family to assist in his care and encourage them to provide psychological support. Give meticulous catheter care. After prostatectomy, a patient usually has a three-way catheter with a continuous irrigation system. Check the tubing for kinks, mucus plugs, and clots, especially if the patient complains of pain. Warn the patient not to pull on the tubes or the catheter. 

After transurethral resection 
Watch for signs of urethral stricture (dysuria, decreased force and caliber of urine stream, and straining to urinate). Also observe for abdominal distention (a result of urethral stricture or catheter blockage by a blood clot). Irrigate the catheter, as ordered. 

After perineal prostatectomy 
Avoid taking the patient’s temperature rectally or inserting enema or other rectal tubes. Provide pads to absorb draining urine. Assist the patient with frequent sitz baths to relieve pain and inflammation. 

After perineal or retropubic prostatectomy 
Give reassurance that urine leakage after catheter removal is normal and subsides in time. 

After radiation therapy 
Watch for the common adverse effects of radiation to the prostate. These include proctitis, diarrhea, bladder spasms, and urinary frequency. Internal radiation of the prostate almost always results in cystitis in the first 2 to 3 weeks of therapy. Encourage the patient to drink at least 2,000 ml of fluid daily. Administer analgesics and antispasmodics to increase comfort. 

After hormonal therapy 
When a patient receives hormonal therapy with diethylstilbestrol, watch for adverse effects (gynecomastia, fluid retention, nausea, and vomiting). Be alert for thrombophlebitis (pain, tenderness, swelling, warmth, and redness in calf). 

Patient teaching and home health guide 
Before surgery, discuss the expected results. Explain that radical surgery always produces impotence. Up to 7% of patients experience urinary incontinence. To help minimize incontinence, teach the patient how to do perineal exercises while he sits or stands. To develop his perineal muscles, tell him to squeeze his buttocks together and hold this position for a few seconds; then relax. He should repeat this exercise as frequently as ordered by the physician. Prepare the patient for postoperative procedures, such as dressing changes and intubation. If appropriate, discuss the adverse effects of radiation therapy. All patients who receive pelvic radiation therapy will develop such symptoms as diarrhea, urinary frequency, nocturia, bladder spasms, rectal irritation, and tenesmus. Encourage the patient to maintain a lifestyle that’s as nearly normal as possible during recovery. When appropriate, refer the patient to the social service department, local home health care agencies, hospices, and other support organizations.

Posted bay Lifenurses. Contact me mail lifenurses


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