Urology Nurse Practitioner Helen Crowe Urology Nurse Practitioner Urology Research Nurse Australian Prostate Cancer Research Centre Epworth November 18, 2011
Nurse Practitioner Registered nurse who has completed both advanced university study at Masters Degree level and extensive clinical training to expand upon the traditional role of a Registered Nurse. Use extended skills, knowledge and experience in the assessment, planning, implementation, diagnosis and evaluation of care required. May autonomously perform advanced physical assessments, order diagnostic tests, initiate referrals to other healthcare providers, and prescribe appropriate medications and other therapies as needed. Role is clearly defined by the scope or specialty area in which the NP practices..
Nurse Practitioner Protected title for use only by those endorsed by the Nursing & Midwifery Board of Australia. Collaborative role, situated in a variety of settings, both hospital and community 595 NPs nationally, 75 within Victoria. Public sector NPs = Grade 6 2010: Access to MBS, PBS Provider #, Prescriber #, printed prescription pads. Role ideal for advanced practice nurses.
Urology Nurse Practitioner Private urology practice at Epworth Hospital Richmond, one urologist Initially general urology, now prostate cancer practice Role development: education, support, clinical management, trouble-shooting, liaison with hospital staff, other health professionals Endorsed as NP in 2007
Prostate Cancer Patient Management Shared responsibility for patient care with urologist Often combined consultations Preview referrals to practice, check appropriate, all relevant information & results available. Meet new patients at first appointment. If scheduled for prostate biopsy, give prepared information, answer queries. Attend biopsy (done under sedation in OR). If biopsy negative call patient with results
Prostate Cancer Patient Management If CaP diagnosed, initial consultation with urologist, then initial brief consultation with NP. Staged process. Discuss diagnosis, answer immediate queries Written information re CaP & Rx options, specific information about robotic surgery Information & instruction re pelvic floor exercises Recommend continence physio appointment
Prostate Cancer Patient Management If decision to proceed with surgery, further NP appointment with patient and partner scheduled what to expect: realistic expectations information about usual recovery trajectory continence products: types & availability pelvic floor exercises, physiotherapy review erectile function rehabilitation psychologist, depression hospital paperwork additional queries
Prostate Cancer Patient Management Visit inpatients, supervise acute phase recovery Contact for any concerns post-discharge, patient +/or partner IDC removal (Day 7 post-op) Incontinence management strategies PFE resumption Brace manoeuvre Pads: types, availability Fluid intake Pelvic floor fatigue Recovery trajectory Return to normal activity Psychological support, reassurance ++
Prostate Cancer Patient Management Urologist: discuss histopathology Maintain phone contact continence, recovery issues 4 weeks post-op visit, urologist & NP: monitor general recovery, incontinence, EF Rehab Post-op PSA 3 months, if undetectable reading then annually by GP, copy to urologist NP consultations as required until satisfactory continence & erectile function Open Door for any future concerns/problems Additional clinical outcomes follow-up: regular questionnaires
Advanced Prostate Cancer Management Adjuvant DXRT (localised recurrence): information Hormone therapy (systemic recurrence): information, advice re side effects d/t testosterone, management Hot flushes Lethargy, fatigue Loss of libido, erectile function Weight gain, reduced muscle mass Metabolic syndrome: altered lipid, glucose metabolism: CV disorders, diabetes Osteoporosis Cognitive dysfunction, depression
Hormone Therapy Management Side Effects Wear natural fibres, dress in layers Avoid hot flush triggers.. spicy foods, hot rooms Caltrate Plus (Calcium & Vitamin D) Weight bearing & impact exercise Healthy eating Memory aids: checklists, routines, calendars. 3/12 PSA. 3/12 appointments, liaise with GP.
Bone Metastases If castrate resistant & bone metastases, suitable for bisphosphonate therapy: reduce fracture risk risk d/t bone mets & hormone therapy 4/52 15 minute infusion Zometa Ensure pre-rx dental check: osteonecrosis of the jaw (ONJ), advice re dental hygiene Check renal function, Ca++ levels pre Rx Advice re flu-like symptoms following 1 st infusion. Monitor bone pain, any sign of weakness, change in bowel or bladder function (spinal cord compression).
NP Role Prostate Care Nurse role development Information & advice source Supervise care Trouble-shoot Triage: link between patient and urologist, radiation oncologist, medical oncologist Support for patient, and partner Professional relationship often long-term Nursing role for men at all stages of disease Awareness of psychological impact