SM 68-Year-Old Benign Prostatic Hyperplasia Case Study
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages to Order 5-10 Pages Description/Paper Instructions
S.M. is a 68-year-old man who is being seen at your clinic for routine health maintenance and health promotion. He reports that he has been feeling well and has no specific complaints, except for some trou-ble “emptying my bladder.” Vital signs (VS) at this visit are 148/88, 82, 16, 96.9° F (36.1° C). He had a CBC and complete metabolic panel (CMP) completed 1 week before his visit, and the results are listed below.
- Chart View
Laboratory Test Results
Sodium 140mEq/L Potassium 4.2mEq/L Chloride 100mEq/L Bicarbonate 26mEq/L BUN 19 mg/dL Creatinine 0.8 mg/dL Glucose 94 mg/dL RBC 5.2 million/mm 3 WBC 7400/mm3 Hgb 15.2 g/dL Hct 46% Platelets 348,000/mm3 Prostate-specific antigen (PSA) 0.23 ng/mL Urinalysis WNL
- What can you tell S.M. about his lab work?
All S.M.’s lab results are within normal ranges.
- What is the significance of the PSA result?
The PSA is a glycoprotein that is present in all males, but levels are greatly increased in patients with prostate cancer. S.M.’s results are normal.
- What other specific examination will S.M. need to have along with the PSA?
S.M. will need a digital rectal examination of the prostate gland. The blood test alone is not specifi-cally diagnostic for cancer because other factors can increase the PSA level.
CASE STUDY PROGRESS
While obtaining your nursing history, you record no family history of cancer or other genitourinary (GU) problems. S.M. reports frequency, urgency, and nocturia × 4; he has a weak stream and has to sit to void. These symptoms have been progressive over the past 6 months. He reports he was diagnosed with a
large prostate a number of years ago. Last month, he began taking saw palmetto capsules but had to stop taking them because they “made me sick.”
- Why did S.M. try taking the saw palmetto, and why do you think he stopped taking it?
Saw palmetto is an herbal product (classified as a dietary supplement by the FDA) that has been used to reduce prostate growth. It has antiandrogenic, anti-inflammatory, and antiproliferative prop-erties. It can cause loss of appetite, nausea, dizziness, constipation, diarrhea, headache, and impo-tence. The side effects, plus the realization that his symptoms were getting worse, might have caused him to stop taking it.
- S.M. is curious why his enlarged prostate would affect his urination. He is concerned that he has prostate cancer. What would you teach him?
- BPH is caused by nodular hyperplasia (increase in the number of cells) and hypertrophy (increase in size of the existing cells) of the prostate gland. As the gland increases in size, the tissues that surround the prostatic urethra compress it, causing the symptoms of urethral obstruction and secondary irritative symptoms.
- Frequently, patients’ biggest fear is that they have cancer. Until this fear is alleviated, they will not be ready to learn additional information. You should tell S.M. that his blood test results indicate it is very unlikely he has prostate cancer, and again reinforce the previous teaching about BPH.
- The primary care provider (PCP) asked for a postvoiding residual (PVR) urine test. You use a bedside bladder scanner and document that S.M. voided 60 mL and his PVR is 110 mL. You report the PVR to the PCP. What is the significance of his PVR?
S.M. is not completely emptying his bladder. The normal residual urine ranges from 0 to 20 mL. His volume is unacceptably high and indicated retention of urine.
- Commonly used medications for BPH are 5-alpha reductase inhibitors, such as finasteride (Proscar) and alpha-blocking drugs, such as tamsulosin (Flomax). How do these drugs differ?
Both drugs work to improve urinary flow in men with enlarged prostate glands. The 5-alpha reduc-tase inhibitors lower the level of dihydrotestosterone (DHT), which can shrink the enlarged pros-tate, and prevent further growth. The alpha-blocking drugs cause the prostate gland to constrict, which leads to reduced urethral pressure and improved urine flow. It can take up to 6 months for the 5-alpha reductase inhibitors to take action, while the alpha-blocking agents can work right away.
- The PCP ordered tamsulosin (Flomax) 0.4 mg/day PO. You enter S.M.’s room to teach him about this medication. What side effects will you tell S.M. about? (Select all that apply.)
- Dizziness b. Diarrhea c. Dry mouth d. Insomnia e. Heartburn
- Orthostatic hypotension
Answers: A, D, F
The most frequently reported side effects of this medication are dizziness, drowsiness, headache, anxiety, and orthostatic hypotension.
- S. M. asks, “Will this condition affect my relationship with my wife?” What should you tell him?
Patients are often embarrassed to ask questions about their condition and how it might affect their sexuality. The nurse needs to be aware that phrases such as “relationship with my wife” frequently refer to the ability to have an erection or ejaculate. You need to clarify your patient’s question and
offer answers in a professional, clear manner. BPH should not affect S.M.’s ability to have an erection or affect his sexual function; however, the side effects of tamsulosin can cause rare occurrences of impotence. If he experiences sexual side effects, he should discuss this with his physician for a pos-sible medication change.
- What would you expect S.M. to report if the medication was successful?
Decreased symptoms of frequency, urgency, nocturia, and improved stream. He might also report that he can void standing up.
CASE STUDY PROGRESS
S.M. returns in 8 months to report that his symptoms are worse than ever. He has tried several different medications, but medication management failed, and he is told that surgical intervention is necessary.
- What surgical options are available to S.M.?
Transurethral resection of the prostate (TURP): The physician uses a monopolar instrument to enter the urethra and core the prostate. The area is then cauterized to stop the bleeding. This procedure requires inpatient hospitalization because of the increased chance of bleeding. An indwelling catheter is placed overnight or longer as needed.
Gyrus TURP: A standard TURP is performed with a bipolar Gyrus instrument that both cuts and cauterizes the prostate.
KTP laser: KTP is a type of laser that cores the prostate and cauterizes as the procedure is done, thereby decreasing the chances of bleeding. It can be done with a person taking warfarin (Coumadin), if stopping anticoagulants is an issue. It is an outpatient procedure.
Saline TURP: This is similar to a PTCA in that a balloon is positioned inside of the prostate and inflated to open the urethra and compress the prostatic tissue away from the urethra. This procedure might require an overnight stay.
Transurethral microwave thermotherapy (TUMT): Intense heat is transferred to the prostate through
a urethral probe. This procedure is usually an outpatient procedure. Patients might experience an irritative voiding pattern (frequency) for months following the procedure. There is no tissue to examine for pathology after this procedure; thus, if the person has prostate cancer and BPH, the prostate cancer might go undetected.
Transurethral needle ablation (TUNA): A needle is placed into the prostate and prostate tissue is ablated. Again, there is no tissue to examine for pathology after this procedure. It can be done in situations where surgery is needed, but the person might not tolerate a larger surgery like a TURP.
CASE STUDY OUTCOME
S.M. elected to undergo a Gyrus transurethral resection of the prostate (TURP). He did well postopera-tively and was discharged to home.
RUBRIC
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