Askep klien dengan BPH

Asuhan Keperawatan Dengan Benigna Prostat Hiperplasia (BPH)

Definisi BPH :
Malfungsi saluran perkemihan akibat lesi (benign/malignat) dari kelenjar prostat
Hiperplasi ≠ hipertropi

Faktor resiko

Benign
Perubahan kadar estrogen/androgen
Laki-laki > 50 th
Malignant
Genetik
Faktor hormonal
Diet ↑ lemak
Terpapar karsinogen kimia
Patofisiolologi
Pembesaran prostat (↑ jumlah sel)



Resistensi pada leher kandung kemih dan prostat ↑



Otot destrusor menebal dan merenggang (fase kompensasi)



Destrusor menjadi lelah dan mengalami dekompensasi, tdk dpt berkontraksi



Retensio urin



Hydroureter, hidronephrosis



Komplikasi
Gangguan pengeluaran urin
Refluks urin
Gejala

Gejala iritatif :
Frekuensi (sering miksi)
Nokturia
Urgensi
disuria

Gejala obstuktif
Pancaran melemah
Rasa tidak puas setelah miksi
Harus menunggu lama jika ingin miksi
Mengedan, kencing terputus-putus, waktu miksi memanjang
Retensi urin
Inkontinen
Pemeriksaan penunjang
Pemeriksaan fisik : rectal examination

Laboratorium
Darah
Urin
Fungsi renal

Radiologis
Foto polos abdomen
USG
BNO-IVP
Cystography
Kateterisasi dan cystoscopy
Penatalaksanaan Medis
Terapi medika mentosa

Terapi bedah, Indikasi :
Retensio urin berulang
Hematuria
Tanda penurunan fungsi ginjal
Infeksi saluran kemih berulang
Tanda obstruksi berat : divertikel, hidroureter dan hidronefrosis
Ada batu saluran kemih
Pembedahan
TURP ( Trans Urethral Resection Prostate)
Suprapubic prostatectomy
Retropubic prostatectomy
Perineal prostatectomy
Laparoscopic radical prostatectomy
Robotic-assisted radical prostatectomy

ASUHAN KEPERAWATAN

Pengkajian
Data Subyektif
sulit bak –sedikit
BAK menetes
Sering –urgency
Nocturia
Retensi
Hematuria
Data Objektif
Residu urin : 25 – 50 ml setelah BAK
Distensi kandung kemih
Pembesaran prostat

Lab :
Urin : ↑ RBC, WBC
Darah : ↑ creatinin

Dx. Keperawatan
Pre operasi :
Retensi urin b/d adanya sumbatan, tingginya tekanan urethral karena lemahnya otot destrusor
Kerusakan eliminasi urin b/d obtruksi anatomis
Nyeri akut b/d agen injury fisik

Dx. Keperawatan/masalah kolaboratif
Post operasi
Nyeri akut b/d agen injury fisik
Resiko infeksi
Cemas b/d perubahan status kesehatan
Kurang pengetahuan b/d keterbatasan pemahaman tentang proses penyakit
Resiko infeksi, Definiton : The state in which an individual is at increased risk for being invaded by pathogenic organism
NOC : Suggested outcome
Dialisis Access Integrity
Immobility consequences : physiological
Immune status
Immunization behavior
Knowledge : infection control
Nutritional status
Risk control
Risk control : Sexually transmitted diseases (STD)
Risk Detection
Tissue Integrity : Skin & mucous membranes
Treatmen behavior : illness or injury
Wound healing : primary intention
Wound healing secondary intention
Wound healing : primary intention
Domain - physiologic helath
Class – tissue integrity
Scale – none to complete, Definiton : the extent which cell and tissue have regenerated following intentionl closure
Wound healing : primary intention, Indicator :
Skin approximation
Resolution of purulent drainage
Resulution of serous drainage from wound
Resulution of sanguineous drainage from wound
Resulution of sanguineous drainage from drain
Resulution of serosanguineous drainage from drain
REsulution of surrounding skin erythema
Resulution of periwound edema
Resulution of skin temperature elevation
Resulution of wound odor
Suggested NIC for problem resulution
Amnioinfusion
Bathinbg
Cough enhancement
Electrolite monitoring
Environmental management
Exercise promotion
Fertility preservation
Fluid/electrolit management
High-risk pregnancy care immunization/vaccination administration
Infection control
Infection control : intraoperative
Infection protection
Labor induction
Medication prescribing
Nutritional management
Perineal care
Positioning
Surveillance
Tube care : umbilical line
Wound care
Wound care : closed drainage
Additional optional interventions : …
Tube care
Tube care : urinary
Tube care, Definition : management of a patient with an external drainage defice exiting the body
Wound care – definition : Prevention of wound complications and promotion of wound healing
Wound care – activities
Remove adhesive tape and debris
Shave the hair surrounding the affected area, as needed
Note characteristics of the wound
Note characteristics of any drainage
Clean with antibacterial soap, as appropriate
Soak in saline solution, as appropriate
Administer IV site care, as appropriate
Administer hickman line care, as appropriate
Administer centeral venous line site care, as appropriate
Provide incision site care, as needed
Administer skin ulcer care, as needed
Massage the area around the wound to stimulate circulation
Wound care – activities
Apply TENS unit for wound healing enhancemen, as appropriate
Maintain patency of any drainage tubes
Apply an appropriate ointment to the skin/lesion, as appropriate
Bandage appropriately
Apply an occlusive dressing, as appropriate
Reinforce the dressing, as needed
Maintain sterile dressing technique when doing wound care
Inspect the wound with each dressing change
Compare and record regularly any changes in the wound
Position to avoid placing tension on the wound, as appropriate
Tech patient or family member(s) wound care procedures :
Tube care – Activities:
Maintain patency of tube, as appropriate
Keep the drainage container at the proper level
Provide sufficient long rubing to allow freedom of movement, as appropriate
Secure tube, as appropriate, to prevent pressure an accidental removal
Monitor patency of catheter, nothing any difficulty in drainage
Monitor amount, color, and consistency of drainage from tube
Empty the collection applinace, as appropriate
Ensure proper placement of tube
Assure function of tube ans associated equipment
Tube care – Activities
Connect tube of suction as appropriate
Irrigate tube,as appropriate
Change tube routinely, as indicated by agent protocol
Inspect the area around the tube insertion site for redmess and skin brekdown, as appropriate
Administer skin care at the tube insertion site, as appropriate
Assist the patient in securing tube(s) and/or drainage devices while walking, siting, and stending, as appropriate
Encourage periods of increased activity, as appropriate
Monitor patient's and family members' response to presence of external drainage device
Clamp tubing, if appropriate, to facilitate ambulation
Teach patient and family the purpose of the tube and how to care for it, as appropriate
Provide emotional support to deal with long-term use of tubes and/or external drainage devices, as appropriate