Professional Documents
Culture Documents
Benign Prostatic
Hyperplasia
MAIN OBJECTIVE
To gain extensive knowledge and enhance
understanding in regards to Obstructive
Uropathy and its correlation to Benign
Prostatic Hyperplasia, especially in geriatric
cases.
In order to achieve this, comprehension and
analysis were done throughout the course of this
case presentation, in adherence to the following
specific objectives:
SPECIFIC OBJECTIVES
Understanding of the basics in regards to the case; its definition,
etiologies, signs and symptoms
Presentation of the patients data, including the demographics,
pertinent patient health history,
Cognizance of the disease process at hand with regards to the
condition of the patient, identification of risks and correlation the
s/sx and intrinsic/extrinsic factors for the pathophysiology to
emerge.
Draw comparisons from the anatomy and physiology to the
pathophysiology
Analysis of the diagnostic studies and associating it to the disease
process
Identification of problems present; discussion of the treatment;
presentation of appropriate nursing care plans and discharge plans
OVERVIEW
This case study revolved around a male
geriatric patient afflicted with a disease that
is deemed common to his age group.
Senescence is a life process in which all of us
are bound to go through in our lives. In this,
our bodily and mental function tend to
deteriorate overtime.
INTRODUCTION
Obstructive uropathy is structural or functional
hindrance of normal urine flow, sometimes
leading to renal dysfunction (obstructive
nephropathy). Symptoms, less likely in chronic
obstruction, may include pain radiating to the
T11 to T12 dermatomes and abnormal voiding
(e.g., difficulty voiding, anuria, nocturia, and/or
polyuria). Obstructive uropathy is a very broad
term in itself. It has an array of causes.
DEMOGRAPHIC PROFILE
NAME: Patient PP
BIRTH DATE: November 15, 1930
BIRTH PLACE: Sta. Monica, Surigao del Norte
AGE: 84 years old
SEX: Male
ADDRESS: Purok 3, Magsaysay, Sta. Monica, Surigao del Norte
CIVIL STATUS: Married
CITIZENSHIP: Filipino
RELIGION: Roman Catholic
DATE AND TIME OF ADMISSION: November 3, 2015, 8:14AM
CHIEF COMPLAINT: Scanty Urine, Unable to Defecate for 3 days
AMITTING DIAGNOSIS: Functional Constipation
other)
PHYSICAL EXAMINATION
Vital Signs
Blood Pressure: 140/90 mmHg
Pulse Rate: 89 bpm
Respiratory Rate: 31 cpm
Temperature: 37.1oC
PHYSICAL EXAMINATION
Overall Appearance
Patient has a skinny body build, with noted
slight distention of the lower abdominal area.
Patient has minimal body odor and slightly foul
breath odor. Patient is weak and restless.
Mental Status
Patient is responsive but incoherent in
thoughts. Is in an irritable mood, disoriented to
time and place.
PHYSICAL EXAMINATION
Head (Skull, Scalp and Hair)
Patients head is round, proportionate to the size of
the body, normocephalic and symmetrical in all
areas. No noted formation of masses, nodules and
depressions upon palpation. Patient has think and
coarse hair, receding hairline noted, and white hairs.
To signs of lice infestation observed.
Face
The face appears rough and the skin looks loose and
is symmetrical in facial movements upon inspection.
Grimace noted at times.
PHYSICAL EXAMINATION
Eyes
The eyes appeared sunken, pupils both
round and reactive to light
accommodation, slightly asymmetrical,
cloudy white sclera. Tearing is present,
conjunctiva appeared smooth yet pale in
color.
Nose
No discharges, no flaring noted.
PHYSICAL EXAMINATION
Mouth
Chapped and slightly pale lips, no sores on
mouth noted. Sometimes uses mouth to breathe.
Ears
Parallel, and symmetrical. No discharges
observed. Cartilage is firm to touch,. Skin
color is same as the surroundings.
PHYSICAL EXAMINATION
Skin
Patient has poor skin turgor, relative to aging.
Cool to touch. Has light brown skin color. Flaking
of skin noted
Nails
Pale nailbeds, convex in shape and smooth.
Has slightly poor capillary refill of 4 seconds.
PHYSICAL EXAMINATION
Lungs
Has crackles sounds upon auscultation,
productive cough, symmetrical chest expansion.
Heart
Has normal heart sounds, and regular rhythm.
Peripheries: noted weak radial pulse
PHYSICAL EXAMINATION
Abdomen
No bowel movements, with flatus. Distention of the abdomen and below
noted, pain upon palpation noted as evidenced by grimacing and nonverbal
cues.
Back and torso
Noted redness, bed creases formation, skin discoloration (bluish on some
areas), pressure wound (>4mm in size) near the spinal area, and moist
warmth were noted in assessing the back. Shoulders are hunched
Extremities
Symmetrical in size and shape, weakness noted. No presence of
deformities.
PATHOPHYSIOLOGY
As the prostate enlarges, the surrounding capsule prevents
it from radially expanding, potentially resulting in urethral
compression. However, obstruction-induced bladder
dysfunction contributes significantly to Obstructive
Uropathy. The bladder wall becomes thickened and
irritable when it is forced to hypertrophy and increase its
own contractile force. In the physiological point of view, as
the prostate enlarges, it compresses the urethra,
preventing the outflow of urine and contributing to the
common lower urinary tract
symptoms.
PATHOPHYSIOLOGY
LABORATORY RESULTS
Hematology: 11/3/15; 9:09
Component
Result
Normal Values
Indication
Hemoglobin
15.1
12.0-18.0g/dL
Normal
Hematocrit
44.4
27-54%
Normal
RBC
4.60
4.0-6.0x1012/L
Normal
WBC
12.8
4.5-10.0x109/L
Indicative of Infection
Platelet
154
150-450x109/L
Normal
Lymphocyte
11.0
17-57%
low on infection
resistance
LABORATORY RESULTS
Blood Chemistry: 11/4/15; 11:24
Component
Result
Normal Values
Indication
Glucose (FBS)
79.8
70-105mg/dL
Normal
Uric Acid
6.04
3.5-7.2mg/dL
Normal
Cholesterol
103
140-220mg/dL
Ketoacidosis
Triglyceride
59
40-200mg/dL
Normal
HDL - Cholesterol
41
30-75mg/dL
Normal
LDL - Cholesterol
50.2
0-130mg/dL
Normal
LABORATORY RESULTS
Blood Chemistry: 11/3/15; 11:05
Test
Result
Normal Values
Indication
Renal Insufficiency
Creatinine
1.68mg/dL
0.73-1.36mg/dL
LABORATORY RESULTS
Blood Chemistry: 11/5/15; 12:05
Test
Result
Normal Values
Indication
Renal Insufficiency
Creatinine
1.92mg/dL
0.73-1.36mg/dL
LABORATORY RESULTS
Urinalysis: 11/3/15; 11:05
COLOR: Yellow
WBC: 0-2
TRANSPARENCY: Cloudy
pH: 6.0
SPECIFIC GRAVITY: 1.015
LABORATORY RESULTS
Ultrasound: 11/5/15; 10:30
Drug Study
NAME
Generic Name:
Ranitidine (500mg
IVTT q8)
Classification:
Anti-ulcer agents
MECHANISM OF
ACION
INDICATION/CON
TRAINDICATION
SIDE EFFECTS
NURSING
RESPONSIBILITY
Indication:
Treatment and
prevention of
heartburn, acid
indigestion, and sour
stomach.
CNS:
Confusion,
dizziness,
drowsiness,
hallucinations,
headache
CV:
Arrhythmias
GI:
Altered taste, black
tongue,
constipation, dark
stools, diarrhea,
drug-induced
hepatitis, nausea
GU:
Decreased sperm
count, impotence
ENDO:
Gynecomastia
HEMAT:
Agranulocytosis,
Aplastic Anemia,
Assess patient
for epigastric or
abdominal pain
and frank or
occult blood in
the stool,
emesis, or
gastric aspirate.
Inform patient
that it may cause
drowsiness or
dizziness.
Inform patient
that increased
fluid and fiber
intake may
minimize
constipation.
Inform patient
that medication
may temporarily
cause stools and
tongue to
Contraindicated:
Hypersensitivity,
Cross-sensitivity
may occur; some
oral liquids contain
alcohol and should
be avoided in
patients with
known intolerance
NAME
Generic Name:
Domperidone
(10mg tab TID)
Classification:
Antidopaminergic
Antiemetic
MECHANISM OF
ACION
INDICATION/CON
TRAINDICATION
Symptomatic
management of upper
gastrointestinal
motility disorders
associated with
chronic and subacute
gastritis and diabetic
gastroparesis.
Contraindicated in
patients with
known sensitivity
orintolerance to
the drug.
Domperidone
should not be used
whenever
gastrointestinal
stimulation might
be dangerous, i.e.,
gastrointestinal
hemorrhage,
mechanical
obstruction or
SIDE EFFECTS
NURSING
RESPONSIBILITY
Serum prolactin
Obtaining
level may increase
medical
resulting in
attention if
galactorrhoea in
fainting,
females(increasing
dizziness,
of milk production,
irregular
probably by
heartbeat or
increasing prolactin
pulse, or other
production by the
unusual
pituitary gland) &
symptoms occur
less frequently
gynaecomastia in
males.
Gastrointestinal
(2.4%):abdominal
cramps, diarrhea,
regurgitation,
changes
inappetite, nausea,
NAME
Generic Name:
Lactulose (30CC
q12)
Classification:
gastrointestinal
agent;
hyperosmotic
laxative
MECHANISM OF
ACION
INDICATION/CON
TRAINDICATION
Potent central
dopamine receptor
antagonist.
Structurally related
to procainamide
but has little
antiarrhythmic or
anesthetic activity.
Exact mechanism
of action not clear
but appears to
sensitize GI smooth
muscle to effects
of acetylcholine by
direct action.
Osmotic effect of
organic acids causes
laxative action, which
moves water from
plasma to intestines,
softens stools, and
stimulates peristalsis
by pressure from
water content of stool.
CI:
Diabetes mellitus;
concomitant use with
electrocautery
procedures
(proctoscopy,
colonoscopy); older
adult and debilitated
patients; pediatric
use.
SIDE EFFECTS
NURSING
RESPONSIBILITY
NAME
MECHANISM OF
ACION
INDICATION/CON
TRAINDICATION
Generic Name:
Metoclopramide (1
amp IVTT q8)
Potent central
dopamine receptor
antagonist.
Structurally related
to procainamide
but has little
antiarrhythmic or
anesthetic activity.
Exact mechanism
of action not clear
but appears to
sensitize GI smooth
muscle to effects
of acetylcholine by
direct action.
Classification:
gastrointestinal
agent; prokinetic
agent (GI
stimulant)
Contraindicatons
Sensitivity or
intolerance to
metoclopramide;
allergy to sulfiting
agents; history of
seizure disorders;;
SIDE EFFECTS
NURSING
RESPONSIBILITY
Report
Serum prolactin
level may increase
immediately the
resulting in
onset of
galactorrhoea in
restlessness,
females(increasing
involuntary
of milk production,
movements,
probably by
facial grimacing,
increasing prolactin
rigidity, or
production by the
tremors.
pituitary gland) &
Extrapyramidal
less frequently
symptoms are
gynaecomastia in
most likely to
males.
occur in
children, young
Gastrointestinal
adults, and the
(2.4%):abdominal
older adult and
cramps, diarrhea,
with high-dose
regurgitation,
treatment of
changes in
vomiting
appetite, nausea,
associated with
cancer
chemotherapy.
Symptoms can
NAME
Generic Name:
Cefuroxime (250
mg IVTT q6)
Classification:
Antibiotic
MECHANISM OF
ACION
INDICATION/CON
TRAINDICATION
SIDE EFFECTS
NURSING
RESPONSIBILITY
Second-generation
cephalosporin that
inhibits cell-wall
synthesis,
promoting osmotic
instability; usually
bactericidal.
Indication:
infections of the
urinary and lower
respiratory tracts,
Streptococcus
pneumoniae and S.
pyogenes,
Haemophillus
influenzae,
Staphylococcus
aureus, Escherichia
coli.
Contraindicated:
Contraindicated in
patients
hypersensitive to
drug.
Use cautiously in
patients
hypersensitive to
penicillin because
of possibility of
cross-sensitivity
with other betalactam antibiotics.
Use with caution
inbreast-feeding
Body as a Whole:
Thrombophlebitis
(IV site);
Determine
history
ofhypersensitivi
ty reactions to
cephalosporin,
penicillin and
history of
allergies
particularly to
drugs before
therapy is
initiated.
Absorption
ofcefuroxime is
enhanced by
food.
Notify prescriber
about rashes
GI:
Diarrhea, nausea,
antibioticassociated colitis.
Skin:
Rash, pruritus,
urticaria.
ASSESSMENT
Objective:
- Distended
abdomen noted
- Scanty amounts
of urine upon
checking FBC
patency
Subjective
- Difficulty in
urination as
verbalized by SO
DIAGNOSIS
Urinary Retention
r/t prostate
enlargement
secondary to
bladder distention
DESIRED
OUTCOME
INTERVENTIONS
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient will void in
sufficient amounts
with less palpable
bladder distension.
Encourage patient
to void every 24
hr and when urge
is noted.
Percuss and
palpate
suprapubic area.
Encourage oral
fluids up to 1000
mL daily, within
cardiac tolerance,
if indicated.
Monitor vital signs
closely. Observe
for hypertension,
peripheral/depend
ent edema,
changes in
mentation. Weigh
daily. Maintain
accurate I&O (250300cc)
Monitor lab
EVALUATION
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient was able
to void but still in
scant amount
(300cc) and
bladder
distention was
still present
ASSESSMENT
DIAGNOSIS
DESIRED
OUTCOME
INTERVENTIONS
Provide catheter
care, note an any
accumulations on
the tube. Note
quality of flow
Administer
medications as
indicated:
Antibiotics and
antibacterials.
Irrigate catheter
as indicated, if
there is noted
obstruction in
tube. Check
catheter often
(every 2 to 3
hours).
EVALUATION
ASSESSMENT
Objective:
Facial grimacing
and restlessness
noted
Abdominal and
suprapubic
distention present
Subjective:
Nonverbal cues of
pain
DIAGNOSIS
Acute Pain r/t
bladder distention
as evidenced by
restlessness and
grimacing
DESIRED
OUTCOME
INTERVENTIONS
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to show signs of
relief from pain, is
able to fully rest.
Assess pain,
noting location,
intensity (scale of
010), duration.
Recommend
bedrest if pain
recurs as
indicated.
Provide comfort
measures, e.g.,
back tapping,
helping patient
turn to sides or
assume position of
comfort.
Suggest use of
relaxation/deepbreathing
exercises,
diversional
activities, enlisting
the help of the SO.
Provide
EVALUATION
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient was able
to rest for a short
period of time
and appear
relaxed.
ASSESSMENT
DIAGNOSIS
- Impaired Skin
Objective:
- Inability to move
Integrity r/t
whole body
physical
- Breathing
immobilization
through mouth
2o disease
while attempting
process as
to move
manifested by
extremities
general body
- General body
weakness,
weakness
pressure wound,
- Poor skin turgor
and poor skin
relative to aging
turgor
- Noted redness,
bed creases
formation, skin
discoloration
(bluish on some
areas), pressure
wound (>4mm in
size) and moist
warmth at his back
DESIRED
OUTCOME
INTERVENTIONS
Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to participate in
prevention
measures for the
timely healing of
wounds without
getting
complications
Identify underlying
conditions for
appropriate
interventions to
follow
Note general
debilitation,
reduced extent of
mobility, changes
in skin and mass,
problems with selfcare and impaired
cognition
Note skin color,
texture and turgor.
Palpate for lesions,
its size,
temperature and
hydration.
Perform turning to
sides every 2 hours
Maintain
appropriate
EVALUATION
Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient
participated in
some preventive
measures
(turning to sides,
backtapping)
ASSESSMENT
DIAGNOSIS
- Impaired Skin
Objective:
- Inability to move
Integrity r/t
whole body
physical
- Breathing
immobilization
through mouth
2o disease
while attempting
process as
to move
manifested by
extremities
general body
- General body
weakness,
weakness
pressure wound,
- Poor skin turgor
and poor skin
relative to aging
turgor
- Noted redness,
bed creases
formation, skin
discoloration
(bluish on some
areas), pressure
wound (>4mm in
size) and moist
warmth at his back
DESIRED
OUTCOME
INTERVENTIONS
Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to participate in
prevention
measures for the
timely healing of
wounds without
getting
complications
Identify underlying
conditions for
appropriate
interventions to
follow
Note general
debilitation,
reduced extent of
mobility, changes
in skin and mass,
problems with selfcare and impaired
cognition
Note skin color,
texture and turgor.
Palpate for lesions,
its size,
temperature and
hydration.
Perform turning to
sides every 2 hours
Maintain
appropriate
EVALUATION
Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient
participated in
some preventive
measures
(turning to sides,
backtapping)
ASSESSMENT
DIAGNOSIS
DESIRED
OUTCOME
INTERVENTIONS
Objective:
Lab results
- Cloudy urine
- Hematuria
(blood in the
urine)
- Increased
creatinine levels
(1.92)
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to maintain
adequate
hydration as
evidenced by
stable vital signs,
palpable peripheral
pulses, good
capillary refill
Administer IV fluids
as ordered,
regulating it to
ordered rate. Check
patency for
assurance of fluids
passing
EVALUATION
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient was able
to drink 3 glasses
of water and has
stable vital signs
(BP 130/80, PR
94). Capillary
beds still looked
pale
Discharge Plan
MEDICATION
Advice patient to adhere to the medications
given by the doctor.
Discharge Plan
ENVIRONMENT
Teach importance of environmental
cleanliness to the significant other, since
patient has impaired skin integrity, it is
important to avoid occurrence of
complications and infections since
Obstructive Uropathy in itself is
Discharge Plan
TREATMENT
[If no surgical procedures were done and only
noninvasive/pharmacologic interventions were
made] Teach SO catheterization once difficulty
of urination persists/recurs. Present the steps
clearly, the materials needed and highlight the
importance of sterility. If condition worsens,
advise to seek hospitalization and reconsider
surgical procedures.
Discharge Plan
Health Teachings
Teach patient the importance of
maintaining adequate hydration to prevent
recurrence of constipation and urination
problems
Minimize long hours of sitting as it may
affect the voiding process
Discharge Plan
Out-Patient Follow Up Care
Instruct the patient to seek or return upon
experiencing any signs and symptoms like
severe abdominal pain, hematuria, difficulty
in urination
Discharge Plan
DIET
Moderating the consumption of alcohol
and caffeine-containing products
Less intake of fluids before bedtime