Nursing Care Plan | NCP Prostatitis
Prostatitis, an inflammation of the prostate gland, is classified in four categories. Acute bacterial prostatitis is an acute, usually gram-negative, bacterial infection of the prostate gland, generally in conjunction with acute bacterial cystitis. Chronic bacterial prostatitis is a subclinical chronic infection of the prostate by bacteria that can be localized in prostatic secretions and is the most common recurrent urinary tract infection in men. Nonbacterial prostatitis is a chronic prostatitis for which there is no identifiable organism. Prostatodynia is a condition in which the patient experiences irritation and pelvic pain on voiding; the symptoms suggest an acute inflammatory process, but there is no evidence of inflammatory cells in the prostatic secretions.
The most common complication of prostatitis is a urinary tract infection. If it is left untreated, a urinary tract infection can progress to prostatic edema, urinary retention, pyelonephritis, epididymitis, and prostatic abscess.
Both acute and chronic prostatitis can result from either the ascent of bacteria in the urethra, the reflux of infected urine, or the spread of bacteria from the rectum via the lymph nodes. Instrumentation (the process of spreading infection during procedures such as cystoscopy or urinary catheterization) is a less common cause. Prostatitis can also occur from sexual intercourse. Escherichia coli causes approximately 80% of bacterial prostatitis. Other common bacteria that are involved include pseudomonas, klebsiella, proteus, Serratia, and Enterobacter. The cause of prostatodynia is uncertain.
Nursing care plan assessment and physical examination
Take a careful history to elicit genitourinary symptoms. Generally, patients with suspected acute bacterial prostatitis have symptoms that are similar to those of a urinary tract infection: dysuria, frequency, urgency, and nocturia. In addition, patients report perineal pain radiating down to the sacral region of the back, down the penis and suprapubic area, and possibly into the rectal area. Hematuria or a purulent urethral discharge may be present. The patient may also complain of fever, chills, myalgia (muscle aches), arthralgia (painful joints), and malaise. Patients with chronic bacterial prostatitis are usually asymptomatic but complain of chronic cystitis.
Although some patients are asymptomatic, the patient may appear acutely ill with fever, muscle ache, weakness, and malaise. Inspect the urethra for redness, swelling, or discharge. Inspect the urine for cloudiness, purulence, or hematuria. The nurse practitioner or physician palpates the prostate rectally to determine the degree of tenderness and consistency of the gland and to rule out the presence of a perirectal abscess, tumor, or foreign body. In acute bacterial prostatitis, the prostate may feel warm, firm, indurated, swollen, and tender to palpation. In chronic prostatitis, the prostate may be normal or feel boggy or indurated. Prostatic massage should not be performed because of the risk of bacteremia. Patients with chronic bacterial prostatitis have varying symptoms, often symptoms similar to those of acute bacterial prostatitis but milder.
Discuss the patient’s fear of sexually transmitted disease and impotence related to this illness. Assess the patient’s ability to cope with a painful, prolonged illness with a high probability of recurrence or chronicity. If the patient has chronic bacterial prostatitis, assess the patient’s and partner’s coping strategies and support systems.
Nursing care plan primary nursing diagnosis: Pain (acute/chronic) related to prostate inflammation and infection.
Nursing care plan intervention and treatment plan
Most physicians prescribe antibiotic therapy based on the results of the bacterial cultures; sometimes parenteral antibiotics are required if the infection is systemic. Bedrest and local measures such as 20-minute sitz baths two or three times a day can assist in reducing pain. Regular sexual intercourse or ejaculation helps drainage of prostatic secretions and lessens infection and pain after the acute inflammation subsides. For acute episodes, and once antibiotics have been started, some physicians recommend regular prostatic massage for several weeks.
If drug therapy for chronic bacterial prostatitis is unsuccessful, on rare occasions the patient may undergo a transurethral resection of the prostate (TURP) to remove all infected tissue. Because this procedure may lead to retrograde ejaculation and sterility, it is usually done on older men. A total prostatectomy also has the risk of causing impotence and incontinence and is performed only when necessary.
The most important nursing interventions for patients with acute or chronic bacterial prostatitis focus on preventing complications. Monitor for urinary retention; for persistence of fever, perineal pain, or difficulty voiding; and for recurring urinary tract infection. If the patient is not on fluid restriction, encourage the patient to drink at least 3 L of fluid a day to facilitate elimination.
Suggest strategies to increase comfort. If the patient exhibits a decreased ability to void, encourage him to void while in a warm water bath with the pelvic muscles relaxed. To assist with pain control, use relaxation techniques and diversionary activities.
Patient teaching is essential. Some patients prefer to have someone of the same gender talk about sexual functioning. In periods of acute infection and inflammation, the patient is usually encouraged to abstain from sexual intercourse. If the patient has chronic bacterial prostatitis, encourage him to be sexually active to promote drainage of the prostate gland. During periods of known infection, the patient should use a condom. Answer the patient’s and partner’s questions thoroughly. If possible, encourage the patient to speak with other men with prostatitis to learn how others have coped with the illness.
Nursing care plan discharge and home health care guidelines
Explain the need to drink fluids to facilitate kidney function and to avoid food and drinks that have diuretic action or are prostatitic. If the physician has prescribed sitz baths, the patient or family needs to know that sitz baths should be taken for 10 to 20 minutes several times daily.
Be sure the patient understands the need to take all prescribed antibiotics. The patient should understand all medications, including the dosage, route, action, and any adverse effects. Remind the patient that the entire course of antibiotics should be completed before stopping the drug.
Instruct the patient to report fever, hematuria, urinary retention, or difficulty voiding. The patient needs to understand the need for prolonged follow-up to avoid recurrence.
If the patient has had surgery or a TURP, teach that urinary dribbling, frequency, and occasional hematuria are not unusual. Explain that the patient will gradually regain urinary control. Remind the patient to avoid heavy lifting, strenuous exercise, or long automobile or plane trips. These situations may place the urinary system under high pressures from bladder distension or abdominal pressure that may lead to bleeding. Usually, the physician requests that the patient abstain from sexual activity for several weeks after the procedures.
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