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ASKEP KLIEN DENGAN BPH

Heny Suseani P., Skp., M.Kes.

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

Faktor Resiko
 Benign
o Perubahan kadar estrogen/androgen
o Laki-laki > 50 th
 Malignant
o Genetik
o Faktor hormonal
o Diet ↑ lemak
o 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 :
o Frekuensi (sering miksi)
o Nokturia
o Urgensi
o disuria
 Gejala obstuktif
o Pancaran melemah
o Rasa tidak puas setelah miksi
o Harus menunggu lama jika ingin miksi
o Mengedan, kencing terputus-putus, waktu miksi memanjang
o Retensi urin
o Inkontinen

Pemeriksaan Penunjang
 Pemeriksaan fisik : rectal examination
 Laboratorium
o Darah
o Urin
o Fungsi renal
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Semester II
PSIK B 2005
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 Radiologis
o Foto polos abdomen
o USG
o BNO-IVP
o Cystography
 Kateterisasi dan cystoscopy

Penatalaksanaan Medis
 Terapi medika mentosa
 Terapi bedah, Indikasi :
o Retensio urin berulang
o Hematuria
o Tanda penurunan fungsi ginjal
o Infeksi saluran kemih berulang
o Tanda obstruksi berat : divertikel, hidroureter dan hidronefrosis
o Ada batu saluran kemih

Pembedahan
 TURP ( Trans Urethral Resection Prostate)
 Suprapubic prostatectomy
 Retropubic prostatectomy
 Perineal prostatectomy

Pengkajian
 Data Subyektif
o sulit bak –sedikit
o BAK menetes
o Sering –urgency
o Nocturia
o Retensi
o Hematuria
 Data Objektif
o Residu urin : 25 – 50 ml setelah BAK
o Distensi kandung kemih
o Pembesaran prostat
o Lab :
 Urin : ↑ RBC, WBC
 Darah : ↑ creatinin

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

Dx. Keperawatan/Masalah Kolaboratif

 Post operasi
o Nyeri akut b/d agen injury fisik
o Resiko infeksi b/d pertahanan primer yang tidak adekuat
o Cemas b/d perubahan status kesehatan
o Kurang pengetahuan b/d keterbatasan pemahaman tentang proses penyakit

Resiko infeksi b/d pertahanan primer yang tidak adekuat

Definiton :

630705456.doc/KMB/By Baca Dewek

Semester II
PSIK B 2005
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The state in which an individual is at increased risk for being invaded by pathogenic
organism

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Semester II
PSIK B 2005
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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
 Other …..

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

Suggested NIC For Problem Resulution

 Labor induction
 Medication prescribing
 Nutritional management
 Perineal care
 Positioning
630705456.doc/KMB/By Baca Dewek
Semester II
PSIK B 2005
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 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 – Definition

Management of a patient with an external drainage device exiting the body

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
 Connect tube of suction as appropriate
 Irrigate tube,as appropriate
 Change tube routinely, as indicated by agent protocol
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Semester II
PSIK B 2005
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 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 tubeand 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

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 !
 Terjemahkan semua bahasa inggris yang saya pake menagajar, sebab dengan begitu anda
akan tau betapa pintarnya saya sebagai dosen……………….

Kepada Sahabatku yang patah hati :

Patah hati dapat berlangsung selama yang kau kehendaki, dan meninggalkan luka sedalam yang kau
inginkan.
Tantangannya bukan bagaimana kau bisa tetap hidup setelah patah hati,
tapi bagaimana kau memetik pelajaran dari peristiwa itu.

630705456.doc/KMB/By Baca Dewek

Semester II
PSIK B 2005