Case Study BPH

I. Introduction

The prostate is the genital organ most commonly affected by benign and malignant

neoplasm. Benign enlargement of the prostate gland is an extremely common process that

occurs in nearly all men with functioning testes. Hyperplasia is a general medical term referring

to excess cell replication. Benign prostatic hyperplasia (BPH) is a noncancerous growth of the

prostate gland. It is the most common noncancerous form of cell growth in men and usually

begins with microscopic nodules in younger men. It should be noted that BPH is not a

precancerous condition.

Some studies have suggested that African American men are at higher risk and Asian

men at lower risk for BPH than Caucasians, a 2000 study found no greater risk for African

Americans and only a slightly lower risk for Asians. Among Caucasians in the study, men of

southern European heritage were at greater risk while men of Scandinavian ancestry had a lower

chance of developing BPH.

Histologic evidence of prostate enlargement begins about the third decade of life and

increases proportionally with aging. Specifically, about 43% of men in their 40s will have

evidence of BPH, as will 50% of men in their 50s, 75% to 88% in their 80s, and nearly 100% of

men reaching the ninth decade of life.

Some evidence has reported a higher incidence of benign prostatic hyperplasia --

particularly fast-growing BPH -- in men with obesity, heart and circulatory diseases, and type 2

diabetes. Diabetes and hypertension, in any case, worsens urinary tract symptoms in men with

BPH. In one study, flow rates were adversely affected by diabetes, although residual urine

volumes were not significantly greater.

The exact cause of BPH is unknown. Potential risk factors include age, family history,

race, ethnicity, and hormonal factors. Androgens (male hormones) most likely play a role in

prostate growth. The most important androgen is testosterone, which is produced throughout a

man's lifetime. The prostate converts testosterone to a more powerful androgen,

dihydrotestosterone (DHT). DHT stimulates cell growth in the tissue that lines the prostate gland

(the glandular epithelium) and is the major cause of the rapid prostate enlargement that occurs

between puberty and young adulthood. DHT is a prime suspect in prostate enlargement in later

adulthood. Additional factors also include a defective cell death in which cells naturally self-

destruct, goes awry and results in cell proliferation a process called as apoptosis.

As BPH progresses, overgrowth occurs in the central area of the

prostate called the transition zone, which wraps around the urethra (the tube

that carries urine through the penis). This pressure on the urethra can cause

lower urinary symptoms that have been the basis for diagnosing BPH. It

should be noted that BPH is not always the cause of these symptoms. An

enlarged prostate may be accompanied by few symptoms, while severe

LUTS may be present with normal or even small prostates and are most

likely due to other conditions. Symptoms of BPH may include; Difficulty in

starting to pass urine (hesitancy), a weak stream of urine, dribbling after urinating, the need to

strain to pass urine, incomplete emptying of bladder, difficulty to control the urination urge,

having to get up several times in the night to pass urine, feeling a burning sensation when

passing urine.

Sometimes a man is unaware of an obstruction until he suddenly cannot urinate at all.

This condition is called acute urinary retention. It is a dangerous complication that can damage

the kidneys and may require emergency surgery. In general, BPH progresses very slowly and

acute urinary retention is very uncommon. Men with BPH at highest risk for this complication

tend to be elderly and to have moderate to severe lower voiding symptoms. Taking anti-

hypertensive drugs (except for diuretics) or antiarrhythmic drugs may also increase the risk.

Bladder obstruction can also cause bladder stones, blood in the urine, urinary tract infection, and

incontinence. Unfortunately, no current tests can accurately predict which men are at higher risk

for complications, although men with a weak urine stream and larger prostates are at higher risk

for urinary retention.

Diagnostic tests used to confirm Benign Prostatic Hyperplasia include Digital Rectal

Exam, Urinalysis, Serum Creatinine, Postvoid Residual Urine, Ultrasound, Urethrocystoscopy.

II. NURSING ASSESSMENT

A. Personal History

Mr. Ruben Juco is a 82 years old male, who resides at Purok 4 Jesus St. Pulung Bulo,

Angeles City. His religious affiliation is Roman Catholic and is married to Mrs. Rita Juco. Mr.

Juco had previously worked at Clark-air based Pampanga. He loss his job when the American

soldier leave Pampanga. Since then, he never had a job and just stays in their home. Mr. Juco

usually sleeps at 10 in the evening and wakes up at around 4 in the morning. Mr. Juco usually

spends time watching TV, dawdle in front of their house, chatting with his neighbors and going

to a market via bicycle. Mr. Juco usual viand includes chicken, fish or meat and rice. He also

loves eating bread and drinking milk. Before, he used to love eating tinapa, sardines, tocino and

bagoong. He also smokes before and is able to consume 1 pack of cigarette a day. He drinks

alcohol beverages occasionally. Regarding the finances about health he is using his

PHILHEALTH card to compensate the finances needed.

B. Family Health and Illness History

According to Mr. Juco, the familial disease that they have in the family is Diabetes

Mellitus. His mother has DM and died of natural cause while his father died of stroke. He has

seven siblings and one died due to stroke. He also added that he is the only member in the

family who has BPH.

C. History of Past and Present Illness

It is the first time of Mr. Juco to be confined in a hospital. But he always goes to Angeles

Medical Center for his routine check-up. Last 3 years ago he was diagnosed by Dr. Guzman for

having a problem in his prostate. He was advised by the doctor to stop eating foods high in salt

and rich in preservatives.

As for his present condition, he was admitted to AMC with a chief complaint of blood in

the urine and black stool and was diagnosed for having BPH or Benign Prostatic Hyperplasia

based of the diagnostic procedure he had underwent. One week prior to his admission he

experiences pain during urination and find a tinge of blood in his urine. Last Sunday, June 18,

2006 he was brought in the hospital at around 10 in the evening due to black stool and hematuria.

Upon admission he had undergone some laboratory examination such as CBC, CREA, BUN,

HGT, NA+ K+, FBS, UA, FA, 12-LEAD ECG, CBG and Chest X-ray. His initial medication is

Kepox.

D. Physical Examination

Physical Assessment done by the attending physician reveals that patient is;

Conscious and coherent

Pink palpebral conjuctiva, anisteric sclera

(-) cyanosis

(+) pain

afebrile

(+) NABS

non tender abdomen

Vital Signs upon admission (June 18, 2006)BP- 110/70 mmHgRR-21 bpm PR-80 bpm Temp-36.7 oC

Physical Assessment done by the student reveals that patient is;

Pink palpebral conjuctiva

(+) dry lips

(+) dry skin

decreased skin turgor

(+) paleness

(+) edema of hands and feet

Vital Signs upon admission (June 22, 2006)BP- 110/60 mmHgRR-21 bpm PR-80 bpm Temp-36.5 oC

III. ANATOMY AND PHYSIOLOGY

The prostate gland is located under the urinary bladder, in front of the rectum and wraps

around the urethra (the tube that carries urine through the penis). It is basically composed of

three different cell types the glandular cells, smooth muscle cells and stromal cells

The central area of the prostate that wraps around the urethra is called the transition zone.

The entire prostate gland is surrounded by a dense, fibrous capsule.

The prostate gland provides the following functions: (1) the glandular cells produce a

milky fluid, and during sex the smooth muscles contract and squeeze this fluid into the urethra.

Here, it mixes with sperm and other fluids to make semen. (2) the prostate also secretes another

substance that may have antibacterial properties. (3) the prostate gland also contains an enzyme

called 5 alpha-reductase that converts testosterone to dihydrotestosterone, another male hormone

that has a major impact on the prostate.

The prostate gland undergoes many changes during the course of a man's life. At birth,

the prostate is about the size of a pea. It grows only slightly until puberty, when it begins to

enlarge rapidly, attaining normal adult size and shape, about that of a walnut, when a man

reaches his early 20s. The gland generally remains stable until about the mid-forties, when, in

most men, the prostate begins to enlarge again through a process of cell multiplication.

Hormonal changes also occur in the prostate gland; testosterone levels fall while

dihydrotestosterone remain at normal levels.

Neurophysiology of Continence and Micturition:

The parasympathetic and sympathetic maintains an important role in urinary continence.

During bladder filling, sensory nerve endings detect progressive stretching of the bladder wall

and convey information via the parasympathetic to the spinal cord and brain which produces

reflex contractions in the bladder neck and prostatic urethra as well as in the external urethral

sphincter thereby maintaining continence.

As volume of urine increases, starting from 300-500 ml., awareness of the need to void

develops. Voluntary voiding is accomplished by stimulation of the parasympathetic nerve fibers

causing coordinated contraction of the detrusor muscle and the bladder body. Nerve impulses

passing down the sympathetic and pudental motor fibers cease momentarily, allowing relaxation

of normally tonically contracted bladder neck, prostatic urethra and external thus allowing urine

to flow.

V. DIAGNOSTIC AND LABORATORY PROCEDURE

1. Complete Blood Count (CBC)

This is to determine blood components and the response to inflammatory process

or if there is a presence of infection.

Date Ordered: 06/21/06

Date Result In: 06/21/06

Results:

Hct- 20.3 %

Platelet- 22.6

WBC- 24.4 g/l

Granulocytes- 3

Lympho/Mono- 17

Hgb- 67

Conclusion: WBC is elevated based on the normal value of 4.3-10 g/l which

confirms the presence of infection

2. Fasting Blood Sugar

This is to measure the blood glucose levels



Results:

107 mg/dl

Conclusion: the result is within normal range based on the normal value of < 126

mg/dl.

3. BUN

This is an indicator of renal function and perfusion, dietary intake of CHON and

the level of protein metabolism.



Results:

17.4 mg/dl

Conclusion: the result is within normal range based on the normal value of 7-21

mg/dl.

4. Creatinine

In men with symptoms, blood tests are performed to measure a substance called

serum creatinine, which is a marker for kidney trouble. Kidney problems exist in an average of

13.6% of BPH patients. Studies have reported rates as high as 30% and as low as 0.3%.



Results:

1.0 mg/dl

Conclusions:

The result is within normal range based on the normal value of 0.60-1.7 mg/dl.

5. Urinalysis

A urinalysis may be performed to detect signs of bleeding or infection. A

urinalysis involves a physical and chemical examination of urine. In addition, the urine is

spun in a centrifuge to allow sediments containing blood cells, bacteria, and other

particles to collect. This sediment is then examined under a microscope. Although urinary

infection is uncommon in younger men, it occurs more frequently in older men,

particularly those with BPH. A urinalysis also helps rule out bladder cancer.



Results:

Color- yellow

Specific Gravity- 0.010

pH- 7.5

Appearance- turbid

Pus cells- 1-3 hpf

Red cells- 15-25 hpf

Conclusions:

The results are almost normal but there is a presence of pus cells in the urine

which indicates the presence of infection and presence of red cells that indicates the

presence of blood in the urine.

6. Fecalysis

Aids in the evaluation of the digestive efficiency and the integrity of the stomach

and intestines.



Results:

Color- dark brown

Consistency- soft

Conclusions:

The results are normal.

7. Transcortin, also called corticosteroid binding protein or CBG

Is an alpha-globulin that has high affinity for binding cortisol. Measures urinary cortisol

and is performed in clients suspected of hyperfunction or hypofunction of adrenal gland.

8. Chest X-ray

This is to rule out respiratory cause of referred pain. May be obtained to detect

pulmonary disease and the status of respiratory problems or trauma.

9. Electrocardiogram/ECG

Is an essential tool in evaluating cardiac rhythm. Electrocardiography detects and

amplifies the very small electrical potential changes between different points on the surface of

the body as a myocardial cell depolarize to repolarize, causing the heart to contract.

10. Colonoscopy

Is the endoscopic visualization of the large intestine from rectum to cecum. It is the

visual examination of the lining of the entire colon with a flexible fiber optic endoscope.

Other diagnostic procedure that can be used to diagnosed Benign Prostatic Hyperplasia

a. Rectal examination

Palpation of the prostate through the rectum may reveal a markedly enlarged prostate. It

is dependent on the skills of the doctor. It has to be borne in mind that rectal examination can

increase PSA levels in patients without malignancy. The test helps rule out prostate cancer or

problems with the muscles in the rectum that might be causing symptoms, but it generally

underestimates the prostate's size. It is not accurate for diagnosing prostate cancer, and is never

the primary diagnostic tool for either BPH or cancer.

b. Uroflowmetry

To determine whether the bladder is obstructed, the speed of urine flow is measured

electronically using a test called uroflowmetry. The test cannot determine the cause of

obstruction, which can be due not only to BPH, but possibly also to abnormalities in the urethra,

weak bladder muscles, or other causes.

c. Urethrocystoscopy

A urethrocystoscopy, also called cystourethroscopy, may be performed in men diagnosed

with BPH, particularly if they are surgical candidates or if other urinary tract problems are

suspected. Such problems include blood in the urine, infection, interstitial cystitis, bladder

cancer, or prior surgery or injury. The physician can determine the presence of a number of

structural problems, including enlargement of the prostate, obstruction of the urethra or neck of

the bladder, anatomical abnormalities, or the presence of stones.

d. Postvoid Residual Urine

One of the important tests for urinary incontinence is the postvoid residual urine volume

(PVR), the amount of urine left after urination. Normally, about 50 mL or less of urine is left;

more than 200 mL is a definite sign of abnormalities. Measurements in between require further

tests. The most common method for measuring PVR is with a catheter, a soft tube that is inserted

into the urethra within a few minutes of urination. PVR can also be measured using

transabdominal ultrasonography.

e. Ultrasound

Ultrasound of the prostate does not require a catheter and gives an accurate picture of the

size and shape of the prostate gland. Ultrasound is very beneficial when planning surgery and

determining treatment options and gauging their effectiveness. Ultrasound may also be used for

detecting kidney damage, tumors, and bladder stones.

VI. PATIENTS CARE

a. Nursing Care Plan

1. Impaired urinary elimination related to increase urethral occlusion

Cues Nursing Diagnosis

Scientific Explanations

Objectives Nursing Interventions

Rationale Evaluation

S The patient may verbalized difficulty in urinating.

O Patient may manifest one or more of the following:- (+) nocturia- (+)

incontinence - (+) dysuria- (+) facial

grimaces upon urination

- (+) edema- pt may also be seen with an indwelling catheter

Impaired urinary elimination related to increase urethral occlusion

Due to hyperplasia of the prostate gland the urethra is being blocked causing obstruction in the flow of urine that leads to bothersome LUTS, thus an impairment in the urinary elimination.

After 3 hours of nursing intervention the patient will be able to manage the manifestation of the disease.

1. Monitor vital signs closely. Observe for hypertension, peripheral/dependent edema, changes in mentation. Maintain accurate I&O.

2. Encourage oral fluids up to 3000 mL daily, within cardiac tolerance, if indicated.

- Loss of kidney function results in decreased fluid elimination and accumulation of toxic wastes may progress to complete renal shutdown.

- *Increased circulating fluid maintains renal perfusion and flushes kidneys, bladder, and ureters of “sediment and bacteria.” Note: Initially,

-Does the patient able to manage the manifestations of the disease;

a. nocturiab. dysuriac. incontinenced. hesitancy to urinate?

connected with the urine bag

3. Encourage patient to void every 2-4 hours and when urge is noted.

4. Encourage meticulous catheter and perineal care

fluids may be restricted to prevent bladder distension until adequate urinary flow is reestablished.

- may minimize over distension of the bladder.

- reduces risk of ascending infection

2. Activity intolerance related to body malaise





S The patient may verbalize body malaise.

OPatient may manifest one or more of the following:- (+) body

malaise- (+) facial

grimaces upon moving

- (+) edema

Activity intolerance related to body malaise

Activity is a natural process and a vigorous motion of action. When one manifested insufficient physiologic and psychologic functional changes he endure a simple task this resulted to activity intolerance

After 3 hours of nursing intervention the patient will be able to verbalize understanding of the health teachings given to increase muscle strength

1. Monitor vital signs.

2. Encourage to increase fluid intake

3. Encourage to eat foods rich in vitamin C and intake of nutritious food

4. Encourage pt to perform PROM as tolerated

5. Encourage pt to change position every 2 hours

6. Encourage pt to use appropriate assistive devices

- to know the present status of the patient

- to optimize hydration status

- increase body resistance

- to promote proper blood circulation

- to optimize circulation to all tissues and to relieve pressure

- to prevent injury.

a. Does the pt able to understand the health teachings given?

b. Does he able to increase muscle strength?

3. Risk for infection related to periodic catheterization





S The patient may verbalize body malaise.

OPt. may be seen with an indwelling catheter connected with the urine bag- (+) nocturia- (+)body

malaise- (+) hematuria- (+) febrile

Risk for infection related to periodic catheterization

The pt’s disease condition causes some obstruction in the flow of urine enabling him to need catheterization to empty this bladder. Through this it enable bacteria contained within the prostatic acini to reach the bladder thus increase the risk of urinary infection

After an hour of nurse patient interaction the patient will be able to verbalize understanding on the health teachings given.

1. Monitor vital signs for fever.

2. Encourage increase fluid intake

3. Emphasize good hand washing technique for allindividuals coming in contact with patient.

4. Encourage meticulous catheter and perineal care

5. Provide sterile or freshlylaundered bed

- Indicators of sepsis requiring prompt evaluation and intervention.

- to maintain renal function and prevent development of infection

- Prevents cross-contamination; reduces risk of acquiredinfection.

- reduces risk of ascending infection

- Prevents exposure to infectious

a. Does the patient understand individual causative/ risk factors?

b. Does the patient able to identify interventions to reduce/ prevent risk of infection.

linens/gowns

6. Monitor/limit visitors, if necessary.

7. Administer antibacterial as ordered.

organisms.

- Prevents cross-contamination from visitors.

-Reduces bacteria present in urinary tract and those introduced by drainage system.

4. Sleep pattern disturbance related to urinary incontinence





S The patient may verbalize frequency in urination at night.

OPatient may manifest one or more of the following:- (+) dark circles

around the eyes

- Appears weak and irritable

- Restless- Noted frequent

yawning- (+) nocturia

Sleep pattern disturbance related to urinary incontinence

Patients with BPH often experience excessive urination at night. This symptom often indicates that the bladder outlet is obstructed. And due to this the patient sleep is being affected because he is often disturb with the urge to urinate at night.

After 3 hours of nursing intervention the patient will be able to verbalize understanding of individual appropriate intervention to promote sleep.

1. Determine clients SO’s expectations of adequate sleep

2. Encourage mid morning nap if one is required

3. Provide quiet and comfortable environment

4. Limit fluid intake in evening if nocturia is a problem

- address opportunity to address misconceptions

- napping in afternoon can disrupt normal sleep patterns

- in preparation for sleep

- to reduce nighttime elimination

a. Does the pt able to relax and gain enough sleep?b. Does he still experience nocturia?

5. Ineffective therapeutic regimen related to lack of understanding of disease, manifestations, and medical treatments





S The patient may verbalize concerns regarding his condition.

O Patient may manifest one or more of the following:- Frequently

asking question about his condition, treatment and diet

- With worried gaze

- Minimal response upon assessment and questioning

Ineffective therapeutic regimen related to lack of understanding of disease, manifestations, and medical treatments

There is some information about the disease of the patient that he does not understand that leads to ineffective follow-up with the course of therapy.

After an hour of nurse patient interaction the patient will be able to understand the course of his disease, manifestations and medical treatments.

1. Provide teachings about BPH regarding the disease process, how to prevent and alleviate its complications.

2. Encourage fluid intake.

3. Explain medications; how it works, its side effects and precautions.

- to diminish client’s anxiety regarding the process of his disease, the effects of this disease to his lifestyle, and the complications that the disease could develop.

- pt with BPH tend to limit their fluids intake to combat its manifestation needless did they know that a concentrated urine exacerbate LUTS and increase risk of UTI.- to provide knowledge about the medications being given to the patient

- Does the patient able to understand all the information given?

- Is there a significant changes that occur on the patients knowledge regarding;c. disease

conditiond. diete. treatmentf. medicationg. self-care

needs

- Does the patient able to comply with the entire therapeutic regimen given?

b. Drug Study

Name of Drug Date Ordered

Route/ Dosage and Frequency

Action Indication Adverse Reaction

Nursing Consideration

GN: CefuroximeBN: Kepox

06-18-06 IV750 mg, Q8o

- Cephalosporin - for UTI- serious infections of lower respiratory and urinary tracts

- phlebitis, nausea and vomiting, diarrhea, anorexia, hypersensitivity reactions

1. Check for doctor’s order2. Perform ANST prior to admission3. Should not be given if positive skin test4. Slow IV push5. Inform the patient about the possible side effect of the drug6. Advise patient to report any discomfort on the IV insertion site

GN: FeSO4

BN: Iberet

06-19-06 PO500 mg, cap, OD

- Hematinics - for excessive bleeding

- Nausea and vomiting, black stools, epigastric pain

1. Check for doctor’s order2. not to be given in patients with hemosiderosis3. Inform the patient about the possible side effect of the drug4. Instruct patient to take drug with food5. Advise patient to report abdominal pain or blood in stools or is vomiting.6. monitor hemoglobin, hematocrit, and retuculocyte count during therapy.





GN: Digoxin BN: Lanoxin

06-19-06 PO0.25 mg, tab, OD

- Inotropic - for heart failure- for proxysmal ventricular tachcardia

- fatigue, headache, weakness, yellow vision, nausea and vomiting

1. Check for doctor’s order2. not to be given in patients hypersensitive to drugs3. Inform the patient about the possible side effect of the drug4. Monitor apical pulse for1 full minute before administering5. Monitor intake and output ratios. Assess for peripheral edema, and auscultate lungs for rales/crackles throughout therapy6. Observe client for toxicity, including symptoms of headache, visual disturbances, nausea and vomiting, anorexia, or disorientation.7. Monitor potassium levels and encourage intake of potassium rich foods8. Taking digoxin with meals may decrease gastric irritation9. Hypothyroid clients are particularly sensitive to these drugs





GN: trimetazidine diHCLBN: Vastarel MR

06-19-06 POTab, BID

-Anti-anginal - acute anginal attacks- prevent situation that may cause anginal attacks

- Nausea and Vomiting, headache, edema

1. Check for doctor’s order2. Monitor blood pressure and pulse rate before and after giving the meds.3. Notify prescribing signs of heart failure such as swelling of hands and feet or SOB.4. Advise patient of the side effects of the drug.

GN: Tranexamic acid BN: Hemostan

06-19-06 IV500 mg, Q6 o

-anti-fibrinolytic

- prevent excessive bleeding

- Nausea, vomitivision changes, dizzinessdiarrhea,

1. Check for doctor’s order2. Perform ANST prior to admission3. Should not be given if positive skin test4. Slow IV push5. Inform the patient about the possible side effect of the drug6. Advise patient to report any discomfort on the IV insertion site7. Provide safety





GN: Vitamin KBN:

06-19-06 IV10 mg, Q8 o

-Antihemorrhagic - prevent hypoprothrombinemia related to vitamin k deficiency in long term parenteral nutrition

- Dizziness, flushing, transient hypotension after IV administration, rapid and weak pulse, pain and hematoma

1. Check for doctor’s order

2. Perform ANST prior to admission

3. Should not be given if positive skin test

4. Slow IV push

5. Inform the patient about the possible side effect of the drug

6. Monitor BP, PR, and RR before and after administration.

7. Advise patient to report any discomfort on the IV insertion site

8. Provide safety

9. teach patient that foods that provide vitamin K include cabbage, cauliflower, eggs, fish and dairy products





GN: Metronidazole BN: Flagyl

06-19-06 IV500 mg, Q6 o

-antiprotozoal - for bacterial infection caused by anaerobic microorganisms

- fever, vertigo, syncope, weakness, N/V, darkened urine, metallic taste

1. Check for doctor’s order

2. Perform ANST prior to admission

3. Should not be given if positive skin test

4. Slow IV push

5. Inform the patient about the possible side effect of the drug

6. Monitor liver function test results carefully in elderly patients.

7. Observe for edema.

8. Tell patient that metallic taste and dark or red-brown urine may occur.

9. Advise patient to report any discomfort on the IV insertion site

10. Provide safety





GN: Isosorbide DinitrateBN: Isordil

06-19-06 PO5 mg, Tab, TID

-Anti-anginal - acute anginal attacks- prevent situation that may cause anginal attacks

- Nausea and Vomiting, headache,

1. Check for doctor’s order2. Monitor blood pressure and pulse rate before and after giving the meds.3. Notify prescribing signs of heart failure such as swelling of hands and feet or SOB.4. Advise patient of the side effects of the drug.





GN: Alfuzosin HCL BN: Xatral

06-20-06 PO10 mg, OD

-alpha-blockers - for enlarged prostate gland

Headache Dry mouth postural

hypotension Drowsiness palpitations Flushing edema asthenia Chest pain tachycardia syncope Rash or

itching nausea,

vomiting, diarrhea or abdominal pain

vertigoDizziness

1. Check for doctor’s order2. Assess pt for signs of BPH (Urinary hesistancy, feeling of incomplete bladder emptying, interruption of urinary stream, impairement of sixe and force of urinary stream, terminal urinary bleeding, dysuria, urgency) before and periodically during therapy3. Monitor blood pressure and pulse rate before and after giving the meds.4. Assess patient for orthostatic reaction and syncope.5. Caution patient to avoid sudden changes in position to decrease orthostatic hypotension6. Instruct patient to take medicine with the same meal each day.7. Instruct patient of the side effect of the drug.

c. Medical/ Surgical Management

a. Intravenous Rehydration

When the fluid loss is severe or life threatening, IV fluids are used for

replacement.

b. Blood Transfusion

It may be necessary for replacement of RBC to WBC, platelets or blood

proteins

c. Folley Catheter

To facilitate accurate measurement of urinary output for critically ill

clients whose output need to be monitored hourly. It is also used to manage

incontinence when other measures have failed.

d. Lavage

The process of washing out an organ, usually the bladder, bowel,

paranasal sinuses, or stomach for therapeutic purposes.

e. Watchful Waiting.

Watchful waiting involves lifestyle changes and an annual examination. It

should be noted that even when choosing watchful waiting, an initial examination

is critical to rule out other disorders.

f. Transurethral resection of the prostate (TURP)

Involves surgical removal of the inner portion of the prostate where BPH

develops. It is the most common surgical procedure for BPH

VII. Clients Daily Progress

DAYS Admission06-18-06

Day 206-19-06

Day306-20-06

Day 406-21-06

Discharge06-22-06

Nursing Problem:Impaired urinary elimination * * * * *

Activity intolerance * * * * *Risk for infection * * * * *

Sleep pattern disturbance * * * * *Ineffective therapeutic regimen * * * * *

Vital Signs: BP- 110/70 mmHgPR- 80 bpmRR- 21 bpmTemp- 36.7 oC

BP- 110/70 mmHgPR- 80 bpmRR- 20 bpmTemp- 36.1 oC


BP- 100/60 mmHgPR- 80 bpmRR- 19 bpmTemp- 36.8oC


Dx & Lab ProceduresCBC * * *

CREA *BUN *HGT * * *

NA+, K+ *FBS *UA *FA *

12-Lead ECG *CBG * *

CX-RAY *Colonoscopy *

Medical & Surgical ManagementGarlic Lavage * *

BT *Folley catheter * * * * *

Pnss, 1L x 20 gtts/min *D5LRS, 1L x 30 gtts/min * * * *

D5050 *Drugs

Kepox * * * * *Iberet * * * *

Lanoxin * * * *Vastarel MR * * * *

Hemostan * * * *Vitamin K * * * *

Metronidazole * * * *Isordil Dinitrate * * * *

Xatral * * *Diet

DATNPO

Soft DietActivity & Exercise

CBR without BRPPROM

VIII. DISCHARGE PLANNING

M - Instructed the patient to continue medication as ordered

1. Iberet 500 mg cap once a day (8am)

2. Lanoxin 0.25 mg tab once a day (8am)

3. Vastarel MR tab 2 x day (8am-1pm)

4. Isordil 3mg tab 3 x day (8am-1pm-8pm)

5. Xatral 10 mg tab once a day (8am)

E - Instructed the patient to do exercise as tolerated such as walking

T - Instructed the patient to continue the medication

H - 1. Encouraged patient to increase fluid intake

2. Encouraged patient to eat foods rich in Vitamin C and Nutritious foods

3. Encourage patient to avoid salty and fatty foods

4. Encourage patient to have enough rest

O - Instructed to come back for follow-up check-up on June 22, 2006

Wednesday.

D - Advised the patient to a diet as tolerated but preferably avoiding salty and

fatty foods.

Documents

Case Study BPH