TransurethraI Resection of the Prostate (TURP)

s a quick and simple procedure without an external incision.

t involves insertion of a resectoscope through the urethra and into the bladder to
remove hyperplastic tissues.
Considered the most effective treatment for Benign Prostatic Hyperplasia.

Purposes:
O To prevent kidney malfunction.
O To empty bladder.
O To relieve compression on the urethra.
O To remove excessive hyperplastic tissue, leaving behind only the capsule of the
prostate.
escription of the procedure:
Performed under general or local anesthesia.
Surgeon inserts resectoscope through the urethra and into the bladder and
removes the hperplastic tissues.
Surgeon inserts a catheter into the bladder through the urethra for subsequent
withdrawal of urine.
Patient preparation:
1. Explain the procedure and the purpose of the TURP.
2. Tell patient that he'll receive either local or general anesthesia. (if the patient
receives local anesthesia he can be awake during treatment.)
3. nform pt. that he'll have an indwelling catheter in place for 1-5 days after the
procedure.
Contraindication:
Not safe for ct. with cardiac problem. (due to bleeding which is the complication
of the surgery)
Client with metastatic bladder cancer.




onitoring and after care:
1. Monitor fluid intake and output.
2. Observe urine drainage for blood. (Slight hematuria usually occurs directly after
TURP for the first 24 hours.)
3. Notify physician if hematuria seems excessive. ( this indicate fresh bleeding due
to trauma)
4. Assess for unusual severe and persistent pain. ( it may indicate perforation of the
bladder)
5. Give special attention to the catheter and tubing. (to sure if it is open and draining
freely)
6. Continous or intermittent irrigation using sterile technique.( to prevent
accumulation of microorganism in the catheter)
7. Before administering any analgesic for relief of bladder pain, first note whether
the catheter is draining as it should.
Home care instructions:
Before discharge, instruct pt. to:
1. Report bleeding or hematuria , fever and chills that lasts longer than several
weeks. (this may indicate UT)
2. Drink plenty of water (10 glasses daily ) and void every 2-3 hours to reduce the
risk of clot formation, urethral obstruction and UT.
3. Heed the urge to urinate.
4. Refrain from sexual or other sternous activities, avoid lifting anything heavier
than 10 lbs.(4.5 kg) to prevent bleeding or perforation of the bladder.
5. Continue taking stool softener or other laxative as ordered to prevent
constipation and straining.

Submitted by:
ayaon, ShenaIyn B.
BSN V






eukemia
O Malignant neoplasm of WBC that infiltrate bone marrow, peripheral blood and
other organs (kidney, skin and G tract).
O A type of cancer of the blood or bone marrow characterized by an abnormal
increase of WBC.
n year 2000, approximately 256,000 children and adults around the world
developed some form of leukemia, and 209,000 died from it. About 90% of all leukemias
are diagnosed in adults.
TRIVIA:
O Leukemia was first observed by pathologists Rudolf Virchow and John Hughes
Bennett in 1845.
O Virchow called the condition Leukmie in German, which he formed from the 2
greek words leukos- white and aima-blood.
CIassifications:
A. 1. Acute Ieukemia
Characterized by a rapid increase in the no. of immature blood cells.
Crowding makes the bone marrow unable to produce healthy blood cells.
mmediate treatment is required due to rapid progression and accumulation of
malignant cells.
Most common form of leukemia in children.
. Chronic Ieukemia
Characterized by excessive build up of relatively mature, but still abnormal
WBC.
Taking months to years to progress.
Cells are produced at a much higher rate than normal cells, resulting in many
abnormal WBC in the blood.
Monitored for sometime before treatment to ensure maximum effectiveness
of therapy.
Occurs mostly in older people, but can theoretically occur in any age group.



B. Accdg. To ceII type:
O ymphocytic Ieukemia
Cancerous change takes place in a type of marrow cell that normally
goes on to form lymphocytes.
Uncontrolled proliferation of immature cells (lymphoblasts) derived
from the lymphoid stem cell.
O yeIocytic Ieukemia
Cancerous change takes place in a type of marrow cell that normally
goes on to form RBC.
There's a defect in the hematopoietic stem cell that differentiates into
all myeloid cells: monocytes, granulocytes and platelets.
Types of Ieukemia:
1. Acute Iymphocytic Ieukemia (A)
O Most common type of leukemia in young children (boys 4 years old- peak
incidence)
O Results from uncontrolled proliferation of immature cells (lymphoblasts)
derived from the lymphoid stem cells.
O Survival rate 85%
. Chronic Iymphocytic Ieukemia (C)
O Common malignancy of older adults over the age of 55.
O Two- thirds of affected people are men.
O t is incurable.
O Average survival for pt. is 14 years(early stage) to 2.5 years ( late stage).
. Acute myeIoid Ieukemia (A)
O Results from a defect in the hematopoietic stem cell.
O All age groups are affected
O Peak incidence- 60 years old
O Treated with chemotherapy
O Survival rate: 2-5 months if untreated and 1 year if treated.
. Chronic myeIoid Ieukemia (C)
O Arises from a mutation in the myeloid stem cells.
O Occurs mainly in adults
O Uncommon before age 20
O Survival rate: 4 year

Causes:
Exposure to radiation or known carcinogen ( benzene, alkylating
chemotherapeutic agents)
Genetic predisposition( down syndrome, neurofibromatosis)
Viruses ( human T- lymphotropic virus)

PathophysioIogy:
Repeated exposure to carcinogen

Somatic mutations in DNA

Activation of oncogenes

Deactivating tumor suppressor genes

Disrupting the regulation of cell death and division

Excessive accumulation of the cells in the marrow and circulation


Myeloid stem cells Lymphoid stem cell
Signs and symptoms:
O Weight loss
O Fever
O Frequent infections
O fatigue
O Easy shortness of breath
O easy bleeding and
bruising
O purplish patches or spots
O pallor and anemia
O joint pain or tenderness
O splenomegaly
O hepatomegaly
O lymph nodes swelling
O headache
O visual disturbance



iagnostic procedures:
O CBC decrease erythrocyte and platelet
O Bone marrow exam- excess immature blats cells (>30%)
O Lymph node biopsy- to diagnose certain types of leukemia
O Blood chemistry- to determine the degree of liver and kidney damage.
O X-ray- to determine the effect of leukemia on bone
O MR- to determine the effect of leukemia in brain
PharmacoIogicaI treatment:
Acute myeIoid Ieukemia (A)
A. nduction chemotherapy- to eradicate leukemic cells and for complete
remission.
t involves high doses of:
O Cytarabine ( cytosar, Ara- C)
O Daunorubicin (daunomycin, cerubidine) or mitoxantrone or
idarubicin
O Etoposide (VP- 16)
Supportive care:
O administration of blood products (RBC and platelets)
O corticosteroids (prednisone)
B. Consolidation therapy eliminate any residual leukemia cells
diminishing chance for recurrence of leukemia
multiple treatment cycles of various agents are used, containing some
form of cytarabine using lower dosages.
C. Bone marrow transplantation



Chronic myeIoid Ieukemia (C)
Aim of treatment is to correct chromosomal abnormality and convert the
malignant stem cell back to normal.
Treatment uses interferon and cytosine subcutaneous injections.
Oral chemotherapeutic agents:
O Hydroxyurea and busulfan- for the reduction of WBC count to a
more normal level.
O Daunomycin (antracycline chemotherapeutic agents)- to bring the
WBC count quickly down to a safer level.
Bone marrow transplantation

Acute Iymphocytic Ieukemia (A)
Prophylaxis with cranial irradiation or intrathecal chemotherapy
Chronic Iymphocytic Ieukemia (C)
Chemotherapy with corticosteroids and chlorambucil (leukeran)
Other agents:
O Cyclophosphamide
O Vincristine
O Doxorubicin
f the pt. does not respond to above medications, he will achieved
remission with fludarabine for prolong bone marrow suppression.
V treatment with immunoglobulin to prevent recurrent infection.
ursing management:
1. Avoid possible trauma.
2. Provide oral hygiene.
3. Monitor for manifestations of infection such as fever and pain.
4. Assess nutritional status and encourage adequate nutritional intake.
5. Administer pain meds. As ordered.
6. Encourage pt. to discuss concerns about diagnosis ; provide counseling as
needed.
7. Provide pt. teaching covering:
O Recognition of bleeding
O Scheduled of treatment
O Manifestation of infections

Submitted by:
ayaon, ShenaIyn B.
BSN V


Steven Johnson Syndrome (SJS)

O Also called erythema multiforme, erythema multiforme majus and ectodermosis
erosive pluriorificialis.
O A serious systemic allergic reaction with a characteristic rash involving the skin
and mucous membrane including the buccal mucosa. The disease is due to
hypersensitive reaction to one of a number of immunologic stimuli including
drugs and infectious agents.
O SJS is named for Albert Mason Steven and Frank Chambliss Johnson, American
pediatricians.
O SJS is a rare condition with a reported incidence of around 2.6-6.1 cases per
million people per year.
O SJS is thought to arise from a disorder of the immune system.
tioIogy:
Exact mechanism is unknown (idiopathic)
nfections ( herpes simplex virus and histoplasmosis)
Adverse effects of medications ( sulfonamides and anticonvulsant)
PathophysioIogy:
Etiology

Altered drug metabolism

Formation of reactive metabolites in the cell

Alter cell protein

Activation of cytotoxic T cells

Cell death

Signs and symptoms:
O Within 1-3 weeks after the start of the offending drug, pt. develop:
Malaise
Fever
Headache
Cough
Conjunctivitis
sore throat
O macules, often in a target configuration then appear suddenly, usually on face,
neck, upper trunk
O coalesce into large flaccid bullae
O nails and eyebrows may be lost along with epithelium
O ulcers and lesions in mucous membrane of mouth and lips but also in genital and
anal regions.
iagnostic test:
histologic studies of frozen skin cells
cytodiagnosis of cells from a freshly denuded area.
mmunofluorescent studies for atypical epidermal autoantibodies.
edicaI management:
Surgical debridement or hydrotherapy is used initially to remove involved skin.
ntravenous fluids are prescribed to maintain fluid and electrolyte balance.
Fluid replacement is accomplished by nasogastric tube and orally as soon as
possible.
Systemic corticosteroids are given early in the disease process.
Skin is protected with topical agents.
Topical antibacterial and anesthetic agents are used to prevent wound sepsis.
Temporary biologic dressing or plastic semipermeable dressings (Vigilon) are
applied.
Meticulous oropharyngeal and eye care is essential when there is severe
involvement of mucous membrane and eyes.



ursing management:
Apply warm compress gently if prescribed to denuded areas.
Perform oral hygiene carefully.
Place pt. on a circular turning frame bed to prevent skin from becoming
denuded.
Observe for signs of hypovolemia: vital signs, urine output, and sensorium.
Provide enteral nourishment or, if necessary, parenteral nutrition.
Work rapidly and efficiently when large wounds are exposed for wound care to
minimize shivering and heat loss.
Maintain patient comfort and body temperature with cotton blankets, ceiling-
mounted heat lamps or heat shields.
ursing diagnosis:
mpaired tissue integrity related to epidermal shedding
Deficient fluid volume related to loss of fluids from denuded skin
Hypothermia related to heat loss secondary to skin loss
Acute pain related to denuded skin and oral lesions
Anxiety related to physical appearance and prognosis



Submitted by:
ayaon, ShenaIyn B.
BSN V