Askep klien dengan BPH

1. Definisi BPH :
   

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

1. 
   
   Faktor resiko
   
   1. 
      
      Benign
      
      1. Perubahan kadar estrogen/androgen
         
      2. Laki-laki > 50 th
         
   2. Malignant
      

• Genetik
  
• Faktor hormonal
  
• Diet ↑ lemak
  
• Terpapar karsinogen kimia
  

1. 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


 

1. Komplikasi
   

• Gangguan pengeluaran urin
  
• Refluks urin
  

1. 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
    

1. Pemeriksaan penunjang
   

• Pemeriksaan fisik : rectal examination
  
• 
  
  Laboratorium
  
  • Darah
    
  • Urin
    
  • Fungsi renal
    
• 
  
  Radiologis
  
  • Foto polos abdomen
    
  • USG
    
  • BNO-IVP
    
  • Cystography
    
• Kateterisasi dan cystoscopy
  

1. 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
    

1. Pembedahan
   

• TURP ( Trans Urethral Resection Prostate)
  
• Suprapubic prostatectomy
  
• Retropubic prostatectomy
  
• Perineal prostatectomy
  
• Laparoscopic radical prostatectomy
  
• Robotic-assisted radical prostatectomy
  

1. 
   
   ASUHAN KEPERAWATAN
   
   1. 
      
      Pengkajian
      
      1. 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
    

1. 
   
   Dx. Keperawatan
   
   1. 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
  

1. 
   
   Dx. Keperawatan/masalah kolaboratif
   
   1. 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
  

1. 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
  

1. 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
  

1. 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
  

1. Additional optional interventions : …
   

• Tube care
  
• Tube care : urinary
  

1. Tube care, Definition : management of a patient with an external drainage defice exiting the body
   
2. 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 :
  

1. 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
  

1. Kasus
   

Th J, 64 th. Masuk ke RS dengan keluhan nyeri saat BAK. Hari ini hari 1 post operasi open prostatectomy. Saat ners Juli melakukan pengkajian, Tn J mengeluh adanya nyeri di tempat operasi, Skala nyeri 4 . Terdapat luka operasi di bagian bawah abdomen, panjang 10 cm, letak vertikal. Terpasang folley kateter untuk iragasi. Output irigasi berwarna merah. Tn J mengatakan takut untuk bergerak, khawatir luka operasinya terbuka. Dari instruksi post operasi klien sudah boleh mulai miring kiri-kanan sejak jam 10 tadi pagi, Irigasi 70 – 80 tpm. Injeksi Ceftriaxone 1 x 1gr, Pronalges 3 x 1 ampul.

Tugas

• Identifikasi diagnosa keperawatan/ masalah kolaboratif yang muncul pada Tn. J !
  
• Buat perencanaan Asuhan Keperawatan untuk Tn J !