Polytechnic College of Davao del Sur

McArthur Highway, Digos City

A Case Presentation on Enlarged Prostate secondary to Benign Prostatic Hyperplasia

Presented By: Amoyo, Therese Aumada, Vermie Loyd Baquiran, Roy Capangpangan, Tonie Michael Comilang, Olimark Jon Corpuz, Rino John

I. Introduction It is common for the prostate gland to become enlarged as a man ages. Doctors call this condition benign prostatic hyperplasia (BPH), or benign prostatic hypertrophy. As a man matures, the prostate goes through two main periods of growth. The first occurs early in puberty, when the prostate doubles in size. At around age 25, the gland begins to grow again. This second growth phase often results, years later, in BPH. Though the prostate continues to grow during most of a man's life, the enlargement doesn't usually cause problems until late in life. BPH rarely causes symptoms before age 40, but more than half of men in their sixties and as many as 90 percent in their seventies and eighties have some symptoms of BPH. As the prostate enlarges, the layer of tissue surrounding it stops it from expanding, causing the gland to press against the urethra like a clamp on a garden hose. The bladder wall becomes thicker and irritable. The bladder begins to contract even when it contains small amounts of urine, causing more frequent urination. Eventually, the bladder weakens and loses the ability to empty itself, so some of the urine remains in the bladder. The narrowing of the urethra and partial emptying of the bladder cause many of the problems associated with BPH.

Many people feel uncomfortable talking about the prostate, since the gland plays a role in both sex and urination. Still, prostate enlargement is as common a part of aging as gray hair. As life expectancy rises, so does the occurrence of BPH. In the United States in 2000, there were 4.5 million visits to physicians for BPH.The National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) was established by Congress in 1950 as one of the National Institutes of Health (NIH), whose mission is to improve human health through biomedical research. NIH is the research branch of the U.S. Department of Health and Human Services. The NIDDK conducts and supports a variety of research in diseases of the kidney and urinary tract. Much of the research targets disorders of the lower urinary tract, including BPH, urinary tract infection, interstitial cystitis, urinary obstruction, prostatitis, and urinary stones. The knowledge gained from these studies is advancing scientific understanding of why BPH develops and may lead to improved methods of diagnosing and treating prostate enlargement. One such study was the Medical Therapy of Prostatic Symptoms Trial, which ended in 2003. We chose a patient who is experiencing this kind of condition to expand our study. The researchers are not just thinking on how to expand their study but also on how to help the patient with his condition.

IDENTIFICATION OF THE CASE A. Personal Information Name Birth Date Age Sex Civil Status Religion Nationality Address Occupation Name of spouse : : : : : : : : : : H.F October 10, 1943 64 years old Male Married Apostolic Ministry for Christ Filipino P5 Bucana, Brgy.76-A, Davao City Farmer H.H : : : : August 1, 2008/10am Difficulty in Urinating Enlarged Prostate t/c BPH Dr. Dimalen,Muhammad Sidir M.

Admission Date and Time Chief Complaint Diagnosis Physician

B. Background / History DM HPN Maternal Paternal Legend (-) (-) : (+) (+) () (+)

CANCER (-) (-) absent present

ASTHMA (-) (+)

UTI (-) (-)

The maternal and the paternal side have a history of hypertension. The paternal side has a history of asthma. Past Medical History The patient was delivered through a normal spontaneous vaginal delivery and has an incomplete immunization. During his childhood stage he experienced chicken pox, fever, cough and flu but they only do home management to treat that certain illness. Last 1995 Mr. H.F was diagnosed of PTB and was treated. Mr.H.F. is a smoker that can consume of 60 packs a year and he also an alcoholic person. D. History of Present Illness Six months prior to admission, onset of LUTS initially with no improvement and positive for hypertension and asthma, complain of difficulty in urinating prior to admission. Socio-economic background Our Patient has six siblings; the family belongs to the middle sector. Mr. H.F. is a former farmer and his wife is a housekeeper. Recently, they engaged into ornamental plants and seedlings business. The income of Mr. H.F. Depend on the income sales of their products. Sometimes when a bidding of seedlings was awarded to them, the couple can get an income of P100,000 per bidding. Their children were already living on their own.

III. DEFINITION OF TERMS Anesthesia: A substance that prevents pain from being felt, given before an operation. Anus: The opening of the rectum where solid waste leaves the body. Bladder: The muscular bag in the lower abdomen where urine is stored. Catheter: A tube inserted through the penis to the bladder in order to drain urine from the body. Cystoscope: A tube-like instrument used to view the interior of the bladder. Ejaculation: Discharging semen from the penis during sexual climax. Gland: An organ that makes and releases substances to other parts of the body. Hormone: A substance that stimulates the function of a gland. Impotent: Unable to have an erection. Incontinence: The inability to control urination. Obstruction: A clog or blockage that prevents liquid from flowing easily. Rectum: The last part of the large intestine (colon) ending in the anus. Reproductive system: The bodily systems that allow men and women to have children. Scrotum: The sac of skin that contains the testes. Semen: The fluid, containing sperm, which comes out of the penis during sexual excitement. Sterile: Unable to father children. Testes: The male reproductive glands where sperm are produced. Ultrasound: A type of test in which sound waves too high to hear are aimed at a structure to produce an image of it. Urinary tract: The path that urine takes as it leaves the body. It includes the kidneys, ureters, bladder, and urethra. Urination: Discharge of liquid waste from the body. Urethra: The canal inside the penis that urine passes through as it leaves the body.

Anatomy and Physiology Anatomy

Physiology The prostate is a small gland approximately the size of a large walnut located underneath the bladder and in front of the rectum. It is made up of thousands of tiny fluid-producing glands. Specifically, the prostate is an exocrine gland. Exocrine glands are so-called because they secrete through ducts to the outside of the body (or into a cavity that communicates with the outside). Sweat glands are another example of an "exocrine gland." The fluid that the prostate gland produces forms part of semen, the fluid that transports the sperm during orgasm. This fluid, produced in the prostate is stored with sperm in the seminal vesicles. When a man climaxes, muscular contractions cause the prostate to secrete this fluid into the urethra, where it is expelled from the body through the penis. In addition, the prostate produces a protein called "Prostate specific antigen" commonly referred to as "PSA". PSA is released with the ejaculatory fluid and can also be traced in the blood stream. It is this testing of PSA levels in the blood that is used to detect prostate cancer. Urine Flow: in addition to the prostate's role in producing ejaculate, (cum) it also plays a part in controlling the flow of urine. The prostate wraps itself around the urethra as it passes from the bladder to the penis. Muscular fibers in the prostate, contract to slow the flow of urine.

V. ETIOLOGY

Precipitating Factors

Actual

Rationale

Age

Mr. HF age was in range of the affected male population from 30-70 years old.

BPH generally begins in a man's 30s, evolves slowly, and most commonly only causes symptoms after 50.

Alcoholism

Mr. HF engaged in alcoholic beverages intake when he was still at his adolescence stage at the age of 25.

Alcoholism can affect cell's normal functions as age increases.

Cigarette smoking

Mr. HF started smoking since he was at the age of 10 years old.

Smoking damages cells and can cause certain diseases.

Race

Mr. HF belongs to the Asian race that is included in the risk factors of the disease

Asians have an incidence of 82.2 cases per 100,000 people.

Predisposing Factors

Actual

Rationale

Testosterone

As

age increases, a decrease testosterone level is significant.

of

As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen

Estrogen

As age increases, increase of estrogen level is significant.

High estrogen levels also play a role in the development or exacerbation of benign prostatic hyperplasia, or BPH, and prostate cancer, by enlarging the prostate gland.

Dihydrotestosterone (DHT),

As age increases, production of DHT alters.

Older men continue to produce and accumulate high levels of DHT in the prostate.

VI. SYMPTOMATOLOGY

Signs & Symptoms Dysuria Nocturia

Actual

Remarks Patient experienced difficulty in urinating More than two or more urinating at night.

Interruption of the urinary stream

It is a common and distressing problem, which may have a profound impact on quality of life.

Fatigue

Is weariness caused by exertion. It can describe a range of afflictions, varying from a general state of lethargy to a specific work-induced burning sensation within one's muscles.

Polyuria

The excessive passage of urine (at least 2.5 liters per day for an adult) resulting in profuse urination and urinary frequency (the need to urinate frequently). Mr. HF felt a sudden, compelling urge to urinate.

Urgency

VII. COMPLICATIONS
Complication


Meaning Biological abnormally that refers to an elevation of the blood urea nitrogen (BUN) and creatinine level and less important compounds. Produced by many renal disorders but also arises from extrarenal disorders When azotemia becomes associated with a constellation of clinical signs and biological abnormalities. Characterized by bacteriuria and pyuria and it may affect the bladder.


Clinical Manifestation

Azotemia

Increase blood urea nitrogen

Uremia

Nocturia Low back pain dysuria Dysuria,spasms or cramps of the bladder, flank pain,itching,nocturia, urinary discharge for males, low back pain,fevers,chills,inflammation of the bladder. Dysuria,spasms or cramps of the bladder,itching,a feeling of warmth during urination, noucturia ,urinary discharge for males,low back pain,fever, chills,malaise,inflammation of the bladder. Urgency,frequency, Burning during urination,dysuria,nocturia,hematuria.Urine may appear cloudy and have a ammoniacal or fishy odor,high fever,shaking chills,flak pain,anorexia and generl fatigue. Reanal colic,hematuria Pain,uretharal obstruction,hematuria,oliguria,anuria Difficulty and frequency of urination,urinary retention,decreased size and forbe of the urinary steraem,blood in the urine or semen,and painful in ejaculation.

Urinary Tract Infection

Cystitis

Inflammation of the bladder

 

Pyelonephritis

Renal interstitial injury caused by bacterial infection A renal disorder affecting the tubules interstitium and renal pelvis Renal stone Recurrent stone formation Having a calculus or stone in the urinary bladder Is the most common cancer in the men other than nonmelanoma skin cancer and the second most common cause of cancer death in American men older than 55 years old

Nephrolithiasis Cystolithiasis

Prostate Cancer

VIII. PATHOPHYSIOLOGY Diagram

Precipitating Factors: Age Alcoholism Cigarette smoking Race

Predisposing Factors: Testosterone levels Estrogen levels Dihydrotestosterone (DHT)

Stroma cells (Composed of smooth muscle fibers and fibrous connective tissue)

Homonal changes

Altered hormonal function

Proliferation of stroma and epithelial cells

Changes in periurethral glandular tissue

Enlarged prostate

Benign Prostatic Hyperplasia

If not treated: Azotemia

Uremia UTI Cystitis Pyelonephritis Nephrolithiasis Cystolithiasis Prostate Cancer



If treated: Prevent complications Normalize urinary function

Good Prognosis

Poor Prognosis

Recovery

Death

Narrative The cause of BPH is not well understood. No definite information on risk factors exists. For centuries, it has been known that BPH occurs mainly in older men and that it doesn't develop in men whose testes were removed before puberty. For this reason, some researchers believe that factors related to aging and the testes may spur the development of BPH. Throughout their lives, men produce testosterone, an important male hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in the blood decreases, leaving a higher proportion of estrogen. Studies done on animals have suggested that BPH may occur because the higher amount of estrogen within the gland increases the activity of substances that promote cell growth. Another theory focuses on dihydrotestosterone (DHT), a substance derived from testosterone in the prostate, which may help control its growth. Most animals lose their ability to produce DHT as they age. However, some research has indicated that even with a drop in the blood's testosterone level, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage the growth of cells. Scientists have also noted that men who do not produce DHT do not develop BPH.

IX. MEDICAL MANAGEMENT IDEAL: Nutritional and Supportive Therapy >Doctor's Management; (Digital Rectal Examination) >An IV line is inserted and fluids are given >If extremely ill, more medical case may be given Treatment Management Lifestyle > Decrease fluid intake before bedtime. > Moderate the consumption of alcohol and caffeine-containing products Medication >Alpha blockers ( 1-adrenergic receptor antagonists) > 5 -reductase inhibitors (finasteride dutasteride) Surgery > Transurethral resection of prostate (TURP) surgery Laboratory Results > Urine culture >Urinalysis >Blood cultures >Urinary tract imaging

ACTUAL: A.)Doctors Order Hospital number: 1211778 Date/Time 8/1/08 10am 8/2/08 > Please admit to Uro Ward > On DAT > TPR/I&O every shift > refer Dr. Dimalen,MD >For OR schedule > give ambedipine one tablet once a day B.)Laboratory Clinical Microscopy Date: July 25, 2008 Specimen: urine Findings: A.Physical Exam Color: Dark Yellow Appearance: clear Reaction: 6.0 Specific Gravity: 1.015 C.Microscopic Exam Squamos: few Pus cells: 0-2hpf RBC: 0-1hpf Crystal: Urates-few B. Chemistry Exam Albumin: trace Sugar: (-)

07/28/08 Result Test OPD Hematology CBC Hemoglobin 154.0 g/L 135.0-175.0 Normal If increased transfusion reactions paroxysmal nocturnal hemoglobinuria, intravascular hemolysis, suboptimal glucose control. If decrease anemia pregnancy, chronic renal failure may occur. A decreased in hematocrit level is seen in massive or prolonged blood loss, anemia, leukemia, and excessive rapid intravenous fluid administration. Hematocrit levels are elevated in conditions that cause an increase in the percentage of RBC includes, hemoconcentration caused by severe burns, surgery, or shock. Increased in severe diarrhea and dehydration, polycythemia, pulmonary fibrosis. Decreased in all anemias in leukemia and after hemorrhage when blood volume has been restored. A rise in the WBC is usually caused by conditions that stimulate the bone marrow to produce white blood cells to fight off invading organisms a fall in the white cells count usually indicates that bone marrow depression is occurring ,because of toxic chemicals Unit Reference ranges Remarks Clinical significance

Hematocrit

0.46

0.40-0.52

Normal

RBC count

4.87

X10^6/uL

4.2-6.1

Normal

WBC count

6.50

X10^3/uL

5.0-10.0

High

Differential count Neutrophil L51 55-75 Low Neutrophils increased with a cure infections, trauma or surgery, leukemia, malignant disease, necrosis; decreased with viral infections, bone marrow suppression, and primary bone marrow disease.

Lymphocytes

32

20-35

Normal

Increased with infectious mononucleosis, viral and some bacterial infectious, hepatitis; decreased with aplastic anemia, SLE, immunodeficiency including AIDS. Increased with viral infections, parasitic disease, collagen and hemolytic disorders; decreased with use of corticosteroids, RA, HIV infection. Increased in allergy, parasitic disease, collagen disease,subacute infections; decreased with stress, use of some medications.(ACTH,epinephrine,thyroxine Increased with acute leukemia and following surgery or trauma; decreased with allergic reactions, stress, allergy, parasitic disease, use of corticosteroids. Increase the cells are macrocytic or pernicious anemia. folic acid or deficiency of vitamin B12 Decrease the cells are microcytic or iron deficiency anemia Increase in macrocytic anemia Increase MCHC is spherocytosis Decrease MCHC is microcytosis

Monocytes

2-10

Normal

Eosinophils

1-6

Low

Basophil

0-1

Normal

OMCV

H 93.60

FI

79.0-92.2

High

OMCH OMCHC

31.60 33.80

Fg g/dl

25.7-32.2 32.36.5

Normal Normal

MCHC L 29.7 PT PTPAT PTINR PTACT PTCTRL 10.5 0.9 124.9 12.0 seconds 10.0-14.0 Normal seconds g/dl 32.30-36.50 Low

Immunology H 5.100 PSA 07/28/08 1.42 A/G Ratio 1.102.50 Normal The AG ratio may be elevated in Hypothyroidism High protein/high carbohydrate diet with poor nitrogenretention.Hypogammaglobulinemia (lo Glucocorticoid excess (can be from taking medications with cortisone effect, the adrenal gland overproducing cortisol, or a tumor that produces extra cortisol like compounds, low globulin) The AG ratio may be decreased in:Liver dysfunction The globulin level may be elevated in Chronic infections (parasites, some cases of viral and bacterial infection) Liver disease (biliary cirrhosis, obstructive jaundice) Carcinoid syndrome Rheumatoid arthritis Ulcerative colitis Multiple myelomas, leukemias, Waldenstrom's macroglobulinemia Autoimmunity (Systemic lupus, collagen diseases Kidney dysfunction (Nephrosis. The serum globulin level may be decreased in: Nephrosis (A Condition in which the kidney does not filter the protein from the blood and it leaks into the urine) Acute hemolytic anemia Liver dysfunction mg/ml 0.00-4.00 High

Globulin

29.90

g/L

23.030.0

Normal

Potassium Sodium

4.0 146.00

mmol/L mmol/L

3.5-5.5 136-155

Normal Normal

If increase potassium it result hyperkalemia.if decrease it result hypokalemia Decreased urinary sodium levels may indicate dehydration, congestive heart failure, liver disease, or nephrotic syndrome. Increased urinary sodium levels may indicate diuretic use or Addisons disease. Low albumin levels can reflect diseases in which the kidneys cannot prevent albumin from leaking from the blood into the urine and being lost. In this case, the amount of albumin (or protein) in the urine also may be measured. High albumin levels usually reflect dehydration. Increase in serum total protein reflects increases in albumin, globulin, or both. Generally significantly increased total protein is seen in volume contraction, venous stasis, or in hypergammaglobulinemia.Decrease in serum total protein reflects decreases in albumin, globulin or both Increase in serum creatinine is seen any renal functional impairment. Because of its insensitivity in detecting early renal failure, the creatinine clearance is significantly reduced before any rise in serum creatinine occurs. The renal impairment may be due to intrinsic renal lesions, decreased perfusion of the kidney, or obstruction of the lower urinary tract. Deranged metabolic processes may cause increases in serum creatinine, as in acromegaly and hyperthyroidism Greater than normal levels (hyperglycemia) may indicate:Acromegaly (very rare), Cushing syndrome (rare), Diabetes mellitus ,Impaired fasting glucose (prediabetes) ,Hyperthyroidism ,Pancreatic cancer,Pancreatitis,Pheochromocytoma (very rare),Too little insulin,Excessive food intake Lower than normal levels (hypoglycemia) may indicate:Hypopituitarism,Hypothyroidism Insulinoma (very rare),Too much insulin, Insufficient dietary intake

Albumin

42.50

g/L

34-50

Normal

Total Protein

72.40

g/L

64-82

Normal

Creatinine

53.60

mmol/L

53-115

Normal

FBS

6.01

3.9-6.1

Normal

IMAGING STUDIES ROENTGENOLOGICAL REPORT 08/01/08 Ref number 195552

Chest PA: Comparative study with chest pa taken 03/03/08 shows no significant interval change in the hazy and streaky densities in the right lung and left lower lung field. Tracheal air column is at the midline. The heart is not culcurged. The right costophrenic sulcus is blunted. The left costophrenic sulcus and both hemidiaphragus are intact. The rest of the included structures are unremarkable. Impression: >Fluids suggestive of ptb.sputum AFB correlation suggested >Minimal pleural fluid us pleural reaction right.

07/28/08 ELECTROCARDIOGRAPHIC REPORT SUMMARY: Serial and Implication IMPRESSION: 1.Sinus Rhythm 2. Persistent

X. NURSING CARE PLAN cues date/time S> Mga 3-4 ka oras ra akong tulog diri as pt. Verbalized. O> dry lips noted > Poor groomong noted. > Restlessness noted. >Irritability noted. > Body weakness noted. S A F E T Y A N D S E C U R I T Y Sleep pattern disturbance r/t normal changes associated with aging needs Nursing diagnosis Scientific basis A disruption in the individual's usual diurnal pattern of sleep and wakefulnes s that may be temporary or chronic. Such disruptions may result in both subjective distress and apparent impairment in functional abilities. Goals of criteria @ my 8 hrs span of care, pt will be able to achieves optimal amount of sleep as evidenced by a) rested appearance b) Verbalization of feeling comfort. c) Improvement of sleeping pattern at least 6-7 hrs of sleep at night. intervention rationale evaluation

> establish rapport > monitor vital signs. > provide environment conducive to sleep. > instruct to avoid bedtime foods. > instruct to limit fluid intake before bedtime. > discourage pattern of daytime nap. > place in comfortable position. > encourage adequate rest period. > encouraged verbalization of feelings of discomfort.

> to gain trust to the pt. >to have baseline data. > to provide comfortable sleep. > it can interfere with sleep > to reduce need for voiding during night. >it can distrust normal sleep pattern. > to provide comfort. > to have restful appearance > for immediate intervention.

Goal met; as evidenced by > pt able to slept 6 hours at night. > c rested appearance .

date/tim e

cues

needs

Nursing diagnosis Acute pain r/t obstructed urinary canal secondary to BPH

Scientific basis A highly subjectiv e state in which a variety of unpleas ant sensatio ns and wide range of distressi ng factors may be experien ced by the sufferer.

Goals of criteria @ my 8 hrs span of care pt will able to relieve pain when urinating c the pain scale from 6/10 to 2/10 mild.

intervention

rationale

evaluation

S> sakit i-ihi as verbalized. O> pale lips noted >frequent urination c urine output of 50 cc/hr >dysuria noted >good skin turgor noted. > Grimace moted. > restlessness notes > pail scale of 6/10 as 1-3 mild, 4-7 moderate, 8-10 severe

S A F E T Y A N D S E C U R I T Y

> establish rapport > monitor vital signs .> encouraged verbalizat ion of feelings about pain. > perform pain assessm ent each time of pain occurs. >Encourage diversion ary activities. >encourage deepbreathing exercises . > Encourage to have adequate rest.

> To gain trust to the pt. > to have baseline data. > For immedia te intervent ion. > To evaluate the severity of pain. > To divert the pain he felt. > it can help alleviate pain.

Goal partially met; as evidenc ed by pt verbaliz ation sakit gamay dili pareha ganiha ka sakit i-ihi c a painsca le 6/10 to 3/10.

date/tim e

cues S> putol-putol akong pagihi as verbalized. O> pale lips noted >frequent urination c urine output of 50 cc/hr >dysuria noted >good skin turgor noted. > grimace moted. > restlessness notes > pail scale of 6/10 as 1-3 mild, 4-7 moderate, 8-10 severe

needs P H Y S I O L O G I C

Nursing diagnosis Urinary retention r/t inability to empty bladder secondary to BPH

Scientific basis The state which an individu al experie nces incompl ete emptyin g of the bladder.

Goals of criteria @ my 8 hrs span of care, pt will a) Demon strate techniq ues to alleviate or prevent retentio n. b) Void in sufficien t amount c no palpabl e bladder distenti on.

intervention > establish rapport > monitor vital signs. > monitor I&O > encourage to use ice techniqu es & stroking inner thigh. > encouraged increase OFI. >establish regular voiding. > encourage use of valsalva' s manueve r. > encouraged verbaliza tion of feelings of discomfo rt.

rationale > to gain trust to the pt. > to have baseline data. >To indicate retention . >to stimulate reflex arc. > to maintain hydration . > to prevent reflux and renal pressure . > to increase intraabdomin al pressure . > for immediat e interventi on.

evaluation Goal met; as evidence d by > pt demonst rated techniqu es to alleviate retention such as such as using of ice techniqu es and stroking inner thigh but cant void freely .

Time/date

Cues S> mitaas na pud akong BP ganina as pt verbaliz ed. O> restless ness noted. >dry lips noted. > c foley catheter attached to Urobag; c blood tinged colored urine @ 200 cc level , patent and intact

Need S A F E T Y A N D S E C U R I T Y

Nursing Diagnosis Risk for injury r/t uncontrolle d hypertensi on.

Scientific basis Sustained elevatio n of arterial pressur e above normal upper limit of 140/90 or 20 points above that consider ed normal one's age.

Goals of criteria @ my 8 hrs span of care, pt will be Free from injury. Resumed optimal cardiac output as evidence d by regular RR, (-) in respirator y distress, Decrease elevated BP to at least 130/80.

intervention Established rapport. Monitor vital sign. Monitor I&O. Place pt in semifowlers position. Instruct to avoid high cholesterol foods. Encourage deep breathing exercise. Instruct to avoid valsava maneuver. Encourage frequent fluid intake. >

rationale to gain trust to the pt. > to havr baselin e data. > to reduce intracra inial pressur e. . > to avoid high cholest erol level > to relax the pt. > to prevent potenti al intracra nial pressur e. > to maintain adequa te cardiac output.

Evaluation Goal met; pt. was free from injury & c BP of 130/80 mmhg

Time/ d a t e S>

Cues

need s

Nursing Diagnosi s

Scientific basis

Goals of criteria

intervention

rationale

Evaluation

medyo sakit akong bat-ang, putolputol ang akong pah-ihi as pt. verbalized O> diagnosis: enlarged prostate t/c BPH > dry lips noted > Poor oral hygiene noted. > c WBC count of 6.50 x 10 ^g/L > c initial Vs of T: 37 PR: 81 RR: 22 BP: 130/90

P H Y S I O L O G I C N E E D

Risk

for infection r/t prostatic urethral obstructi on secondar y to enlarged prostate

At increased risk for being invade d by pathog en.

@ my 8 hrs span of care, pt will remain free from infectio n as evidenc ed by normal temper ature & clear urine.

Establish rapport. Monitor vital signs. Monitor I&O. Monitor color & odor of urine. Encourage full bladder emptying. Encourage increase OFI Encourage intake of protein and calorie rich foods. Instructed to report any signs & symptoms of infection.

> to gain trust to the pt. > to have baseline data. >To indicate retention . > foulsmelling urine determin e pathoge n present. > to prevent urinary retention . > to maintain hydratio n. > to maintain nutrition al status. > for immedia te intervent ion.

Goal met; pt remaine d free of infectio n as evidenc ed by normal temper ature, clear urine & voiding freely. c latest Temp of 37 c c yellow colored urine

XII. NURSING THEORY Watson's theory: According to Watson, nursing is concern with promoting health, preventing illness, caring for sick and restoring health, Nursing focuses on health promotion as well as treatment of disease. She sees nursing as having to move educationally into areas of stress and developmental conflict to provide holistic health care, which she believes is central to the practices of caring in nursing. Nursing is face with the explosion of technology, the increase in the acuity the patient a long with a decrease of length of hospital stay. This entire factor has an impact in the practitioner's ability to focus beyond the cure factor to the care factor. The relationship between the nurse and the patient entails several unique features base upon mutual expectation. The client certainly expects the nurse to follow what ever orders there are for but also expects the nurse to be humane and caring. We choose the theory of Watson, because her goal is to promote health, restore client to help and prevent illness. With this as nurses caring process requires that the nurse be knowledgeable about human behavior and human response to actual or potential health problems, individual needs, how to respond to others and strength and limitation of the client and family. We can relate his theory to our patient because he suffered a disease that really affects his health, which we agreed to her when she states that health care should be diagnosing of disease, treatment of illness and prescription of drugs and true health care focuses life style and social condition. SOAPIE: >Received Pt.on bed; awake and responsive, Without IVF S >Medyo sakit akong bat-ang, putol-putol pud ang akong pag-ihi as pt. Verbalized O >Dry Lips >Poor Oral hygiene noted >with WBC count of 6.50 x 10 g/L >with initial VS: T: 37c, PR: 81, RR:22, BP: 130/90mmHg >Dry skin noted >poor skin turgor noted A > Risk for Infection r/t Prostatic Urethral Obstruction secondary to Enlarged Prostate P >@ the end of my 8hrs span of nursing care, pt. will be able to: a.) Be free from infection b.) Maintain normal temperature and a clear urine I > Established rapport > VS checked and recorded; afebrile > Bedside care done; linen stretched & tucked > Monitored I & O and recorded > Monitored color & odor of urine; yellow color > Encouraged full bladder emptying > Encouraged increased OFI > Encouraged intake of protein and calorie rich foods > Instructed pt. To report any signs and symptoms of infection > Watched for any unusualities E > Goal met; pt. Remained free of infection as evidenced by normal temperature and clear urine, voiding freely

Hilegard Peplau Peplau emphasis the nurse-client relationship as a foundation of nursing practice. He research emphasizing the need for partnerships is seen by many as evolutionary. The essence of Pep Laus theories is the creation of shared experience. The nurses could facilitate this through observation, description, formation, interpretation, validation, and intervention. Pep Lau's model has prove of great use to later nurse theorists and clinicians in developing more sophisticated and therapeutic nursing intervention. SOAPIE: > Received pt. Siting on chair awake and coherent, without IVF S > Mitaas na pud akong BP ganina as pt. Verbalized. O > Restlessness noted > Poor oral hygiene noted > Dry Lips noted > With foley catheter attached to urobag with bloody tinged colored urine, patent and intact @ the level of 200cc > with initial VS: T: 36.5c, RR: 21, PR: 80, BP: 150/90mmHg >Dry skin noted > Not in respiratory distress A > Risk for Injury r/t uncontrolled hypertension P > @ the end of my 8hrs. Span of nursing care, pt. Will be: a.) Free from injury b.) Resumed optimal cardiac output as evidenced by regular RR, (-) in Respiratory distress. c.) decreased elevated BP to atlest 130/80mmHg I > Established rapport > Vs checekd and recoreded; afebrile > Bed side care done; linen stretched and tucked. > I & O monitored and recorded > Placed pt. In semi-fowler's position. > Instructed to avoid high cholesterol foods. > Encouraged deep breathing exercise. 6:00pm > P.O. Meds given; Mefinamic 500mg & Ciprofloxacin 500mg., tolerated well. > Instructed to avoid valsalva manuever > Encouraged frequent fluid intake > Watched for unusualities E > Goal met; pt. was free from injury and with BP of 130/80mmHg

XIII. NURSING ASSESSMENT/ PHYSICAL I. General Appearance: Received lying on bed, awake. Patient is poorly groomed II. Vital Signs: T- 36.60C PR 95 bpm CR 97 bpm RR 21 cpm BP 130/90 mmHg III. Skin: His skin is fair in complexion, cold clammy skin IV. Head Head is normocephalic in configuration, with white colored hair, no lesions or abnormalities noted. Eyes is normal, with clear vision, pupils are equally round and reactive to light. No lesions, swelling & discharges on ears noted but have a slight difficulty hearing. Lips is dry, pale in color. With missing teeth, unclean dentures and with dental caries noted. V. Neck Neck muscle was symmetrical. Trachea is located midline.No usual swelling and was able to move from left to right. There is no enlargement of the thyroid glands. VI. Chest Chest expands symmetrically. With normal respiratory rate of 21 cycles/min. VII. Abdomen Patient is on DAT, with good appetite. No complaints of gastro-intestinal pain. VIII. Genitourinary Patient has normal urine output. With yellow colored urine. IX. Extremities Peripheral pulses are symmetrical. No lesions noted. X. Neurological Patient is coherent, responsive, and oriented to person, place and present condition. XI. Present behavior Patient is cooperative

XIV. HEALTH TEACHINGS Primary: Health education on how to prevent complications. Encouraged to have yearly physical check up. Instructed patient to eat foods rich in zinc such as sea foods, fish, eggs, and poultry. Encouraged patient to eat soy foods like taho and tufo. Advised immediate family member to be observant for any unusualities. Discuss the effect of soy foods and zinc to the hormones. Secondary: Instructed patient and family members to comply all prescribe medications and requirements for operation. Encouraged patient to participate in diagnostic test and screening. Discuss the importance of surgery to the patient and how it promotes wellness to his condition. Explained the purpose of blood transfusion. Tertiary: Encouraged daily wound dressing. Encouraged early ambulation. Discuss the post-op complications and how it will be prevented. Discuss the importance of medicines of treatment regimen. Encouraged patient to have followed up check up, clinic visit to the physician.

XV. DISCHARGE PLAN Medication Explain to the patient the mode of actions of the drug and uses. Explain the adverse effect of the drugs that will be given. Instruct patient to report any unusualities observed or felt. Instruct the patient to continue the medication according to the duration or treatment. Exercise Limit physical activity Encourage use of relaxation techniques Deep breathing exercise Any activity that causes fatigue is prohibited Treatment Compliance of medication Instruct the patient that rest is one of the most beneficial remedies. A well balance diet and vitamins must be apply in advance. Hygiene Take a bath everyday using warm water Maintain personal hygiene Output order The significant others must follow all the medication prescribe and follow up check-up. Follow up clinic check-up

Diet Foods high in zinc and soy foods Moderate to high in protein Moderate take in sodium Weight gain is regulated Cut caffeine Limit OFI

Significant others Advice s/o to let the pt. Rest and avoid emotional and physical stress Maintained a healthy weight Instruct significant others to assess patient for local and systemic and symptoms of infection Discuss the complications. Limit OFI Significant others Advice s/o to let the pt. Rest and avoid emotional and physical stress Maintained a healthy weight Instruct significant others to assess patient for local and systemic and symptoms of infection Discuss the complications.

XVI. PROGNOSIS Prognosis is further complicated by the presence of associated disorders, the timeless of diagnosis and the success of treatment. Actual: Fair Good Poor Justification

Duration

Patient able to identify his illness at early stage.

Onset of the illness

Patient experience dysuria, polyuria, nocturia and interruption of the urinary stream.

Compliance to medication

Patient able to provide the necessary medicines ordered by the physician.

Family support

His family is their to visit him in the hospital with all the support. / Patient lived in a peaceful environment in a urban area.

Environment

Age

Patient age was in the susceptible group of disease.

Precipitating factors

Patient acquired the disease due to some reasons like smoking, race may affect and oth

Summary Good- 3/7 x 100=42.85 Fair- 1/7 x 100=14.28 Poor- 3/7 x 100= 42.85

Patients prognosis was fair since some parameters are good with the same percentage of being poorly complied.

Ideal: Benign Prostatic Hyperplasia can be treated with different medical procedures and right medicine. During the first signs and symptoms of the disease, supportive care from the family is very essential to hasten health recovery of the patient. A strict compliance of medicines prescribed should be observed to promote wellness. A good environment is essential in the community.

XVII. IMPLICATIONS Nursing practice

As the focus on the promotion of health continues to grow, nursing students will feel confident with those strategies for building healthy lifestyle, healthy communities and healthy environments. This research will assisst individuals as they look to excel in their promotion. Nursing education One important aspects of any disease management plan is through education. It serves as the guidelines for those who are at risk for this significant disease BPH as well as to family member in order to be more aware about the symptoms of BPH.

Nursing Research It develops knowledge and expertise to detect BPH. Through research, the nurse can convey to the family members regarding the nature, the issue of the problem, the step being taken, the new methods of disease management, and the health and the welfare of the patient.

XVIII. EVALUATION Interactive communication with the client has been done and history has been obtained properly. Significant health teaching toward the clients convalescence have been adequately given. Promotion, prevention, cure and rehabilitation concepts have been relayed t the client contributing to a deeper knowledge of health activities. Analysis of the case has been thoroughly studied and presented to co-group members and instructors. All group members have completely contributed to the success of the study.

Daghang Salamat sa inyong pagpaminaw.