NURS 6520 Case Study on Benign Prostatic Hypertrophy Essay

NURS 6520 Case Study on Benign Prostatic Hypertrophy Essay

Case Study on Benign Prostatic Hypertrophy

Subjective Data

A 72-year-old Caucasian male comes to the clinic with reports of increased frequency of urination and waking up frequently during the night to pass urine. He started perceiving the increased urinary frequency and nocturia roughly nine weeks ago. He recalls starting to visit the toilet after 2-3 hours despite limiting his fluid intake. The cleint further reports that he usually perceives an urgency to urinate but upon going to the toilet he is unable to initiate the urinary stream. Besides, the urine stream breaks in most cases and thus does not completely empty bladder and he usually feels that some urine has remained in the bladder.

The patient reports that he is afraid he could be having kidney issues secondary to these urinary symptoms. However, he denies experiencing dysuria, changes in urine color, or blood in the urine. He also denies having symptoms indicating a sexually transmitted infection such as penile discharge as well as symptoms of sexual dysfunction such as erectile dysfunction and ejaculatory dysfunction. He further states that the urinary symptoms affect his functioning since he cannot work still for a long time without feeling an urge to pass urine.

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The patient has no current medications but takes Calcium and Vitamin D supplements due to a history of a low bone mass density. His immunizations are up to date, his last Tetanus shot was four years ago, and the last flush shot was six months ago. The patient denies having a history of chronic illnesses. He is allergic to sulfur, which causes rash but has no food or environmental allergies. The patient had a surgical history of appendectomy when he was 46 years. He has a positive family history of hypertension (father), osteoarthritis (paternal grandmother), and type 2 diabetes (maternal grandfather). The patient is married with three children, 35, 31, and 28. He lives with his wife on his farm, where he supervises the farm. He has a history of tobacco smoking but stopped ten years ago. He admits to currently taking beer 2-3 bottles on weekends. His hobbies include watching soccer and attending book clubs.

Assessment

A male patient in his early 60s is seated on the patient’s chair. He is well-groomed and appropriately dressed for the weather and function and not in any acute distress. He has a normal gait and posture, and her speech is clear with normal tone, rate, and volume. Vital signs findings include: BP-128/70; HR- 84; RR-18; Temp-98.4; SPO2- 99%. Anthropometric measurements include height- 5’5, weight- 172 pounds, and BMI-28.6. The patient’s respiratory and cardiovascular exam findings are normal. Abdominal exam reveals a distended and palpable bladder. Digital rectal examination (DRE) findings include a non-tender and engorged prostate two fingerbreadths width with a rubbery texture.

Diagnostic tests requested for this client include Urinalysis, blood urea nitrogen (BUN), creatinine, Prostate-specific antigen (PSA) test, and abdominal ultrasound. Urinalysis results show no pus cells, leukocytes, RBCs, protein, or glucose. The levels of BUN and creatinine are within the normal range. The patient has an elevated PSA level at 4.5 ng/mL and the abdominal ultrasound visualizes a hypertrophied prostate.

Diagnosis

Pathophysiology

The patient has a primary diagnosis of BPH. BPH manifests with an enlarged or hypertrophied prostate gland. Madersbacher et al. (2019) explain that BPH begins with growth of several fibroadenomatous nodules in the periurethral area of the prostate. The vesicle of the prostatic urethra constricts and elongates, obstructing outflow of urine. In addition, the enlarged lobes of the prostate obstruct the urethra of the prostate gland, which passes through the middle of the prostate, from the bladder to the penis, causing incomplete emptying of the urinary bladder and retention of urine after micturition.

Elevated pressure due to bladder distention and micturition can advance to hypertrophy of the bladder detrusor, formation of cellule, and diverticula. In addition, progressive dilation of the ureters and kidneys (hydronephrosis) can occur (Madersbacher et al., 2019). Incomplete emptying of the bladder results in stasis and puts the person at risk of infection and calculus formation. Furthermore, continuous partial obstruction of the urinary tract can result in hydronephrosis and affect renal function (Madersbacher et al., 2019). The urinary frequency, urgency, and nocturia can be attributed to incomplete bladder emptying and fast refilling of the bladder (Langan, 2019. The reduced urinary stream force causes urinary hesitancy and interrupted urinary stream, which causes dribbling.

Differential Diagnoses

Interstitial Cystitis

Interstitial cystitis presents with daytime and nighttime urinary urgency, frequency, and pelvic pain. Patients report pain, discomfort, or pressure, in the pelvis. Besides, there is an indistinct sensation of incomplete emptying of the bladder and a constant need to void or an urge to void (Homma et al., 2020). Interstitial cystitis is a differential diagnosis based on the patient’s symptoms of urinary frequency, urgency, nocturia, and incomplete bladder emptying. However, an enlarged prostate rules out Interstitial cystitis as a primary diagnosis.

Urinary tract infection (UTI)

UTI presents with a combination of dysuria, urinary urgency, and urinary frequency. Acute onset of hesitancy, slow stream, and urinary dribbling is roughly 33% predictive for UTI (Langan, 2019). Other clinical manifestations include nocturia, fever, flank pain, tachycardia, meatal discharge, prostatic tenderness. Urinalysis test usually reveals the presence of leukocytes, pus cells, and proteinuria. UTI is a differential diagnosis based on positive symptoms of urinary frequency, urgency, hesitancy, slow stream, and urinary dribbling. However, a normal urinalysis and urine culture and lack of dysuria rule out UTI as a primary diagnosis.

Prostatitis

Prostatitis is characterized by inflammation or infection of the prostate gland. It is a differential diagnosis since the patient presents with obstructive urinary tract symptoms, which occur in prostatitis, such as nocturia, urinary frequency, urgency, hesitancy, weak stream, and incomplete voiding (Xiong et al., 2020). However, prostatitis is unlikely due to the absence of prostate inflammatory symptoms such as dysuria, fever, chills, prostatic pain, or low back pain.

Possible Complications

Possible complications due to obstruction of the bladder outlet caused by BPH include urinary retention, recurrent UTIs (caused by incomplete bladder emptying), renal insufficiency, bladder calculi, and gross hematuria (Langan, 2019).

Plan of Care

Pharmacotherapeutic

Drug therapy will include a combination of an alpha-adrenergic blocker and 5 alpha-reductase inhibitors. This is because combining the two drug classes is superior to monotherapy. It will comprise:

1. Doxazosin XR 4mg orally once daily. To alleviate the irritative and obstructive voiding symptoms related to BPH.

Doxazosin hinders postsynaptic alpha-adrenergic receptors, causing vasodilation of arterioles and veins and a reduced peripheral resistance and BP (Lokeshwar et al., 2019).

2. Finasteride (Propecia) 1 mg orally once daily. To reduce prostate size and reduce voiding symptoms. Finasteride is helpful in patients with prostates bigger than 40 g and alleviates associated symptoms, and decreases the prostatic size by 20-30% (Lokeshwar et al., 2019).

Non-Pharmacotherapeutic

Surgery will be indicated if the patient does not respond to pharmacotherapy or develop complications such as urinary calculi, recurrent UTIs, bladder dysfunction, or upper tract dilation (Miernik & Gratzke, 2020).

Patient Education

Patient education focuses on modifying lifestyle practices, including dietary habits and increasing physical exercises to promote weight loss. Weight loss addresses BPH modifiable risk factors and lowers the risk of complications (Miernik & Gratzke, 2020). The patient will also be educated to limit fluid intake in the evening to reduce nocturia symptoms.

Follow-up

The patient will be followed-up after four weeks to monitor response to treatment and assess for medication side effects (Cash & Glass, 2019).

References

Cash, C.C. & Glass, C.A. Eds. (2019). Adult gerontology practice guidelines 2ndt Edition. New York: Springer Publishing Company ISBN # 9780826195180.

Homma, Y., Akiyama, Y., Tomoe, H., Furuta, A., Ueda, T., Maeda, D., Lin, A. T., Kuo, H. C., Lee, M. H., Oh, S. J., Kim, J. C., & Lee, K. S. (2020). Clinical guidelines for interstitial cystitis/bladder pain syndrome. International Journal of urology: official journal of the Japanese Urological Association, 27(7), 578–589. https://doi.org/10.1111/iju.14234

Langan, R. C. (2019). Benign Prostatic Hyperplasia. Primary care, 46(2), 223–232. https://doi.org/10.1016/j.pop.2019.02.003

Lokeshwar, S. D., Harper, B. T., Webb, E., Jordan, A., Dykes, T. A., Neal, D. E., Jr, Terris, M. K., & Klaassen, Z. (2019). Epidemiology and treatment modalities for the management of benign prostatic hyperplasia. Translational andrology and urology, 8(5), 529–539. https://doi.org/10.21037/tau.2019.10.01

Madersbacher, S., Sampson, N., & Culig, Z. (2019). Pathophysiology of benign prostatic hyperplasia and benign prostatic enlargement: a mini-review. Gerontology, 65(5), 458-464. https://doi.org/10.1159/000496289

Miernik, A., & Gratzke, C. (2020). Current Treatment for Benign Prostatic Hyperplasia. Deutsches Arzteblatt international, 117(49), 843–854. https://doi.org/10.3238/arztebl.2020.0843

Xiong, S., Liu, X., Deng, W., Zhou, Z., Li, Y., Tu, Y., Chen, L., Wang, G., & Fu, B. (2020). Pharmacological Interventions for Bacterial Prostatitis. Frontiers in pharmacology, 11, 504. https://doi.org/10.3389/fphar.2020.00504

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Case Study
You will be assigned a medical diagnosis to develop a Case Study that will incorporate all patient symptomology characteristics relevant to the case while providing a cited explanation justifying each physical examination and diagnostic reasoning decision to fit the case (make the case). You will include the patient diagnosis and its pathophysiology. You will identify at least one potential complication that may result from the patient’s condition and include three possible differential diagnoses. You will provide a clear, accurate, and comprehensive discussion of which principles of pharmacodynamics and management should be considered for the case (rely on your Buttaro course textbook and practicum course Cash and Glass clinical practice guideline textbook for resources). Your Case Study assignment will be submitted on a word document in APA format 7th ed., student style and no more than 5 pages excluding cover page, references and any appendices. The following are suggested section headings:
• Case: subjective data.
• Assessment: objective data / physical examination and laboratory and diagnostic results.
• Diagnosis: pathophysiology of diagnosis and 3 possible differential diagnoses to rule out.
• Plan of Care (list evidence based plan of care numerically in priority order including pharmacotherapeutic and non-pharmacotherapeutic and including patient teaching.
You will utilize the rubric below as your guide to complete this assignment. APA 7th ed., student paper style is required.
I have provided the “Turn It In” plagiarism tool for you to utilize in the editing of your paper. You arepermitted unlimited access until assignment due date. You can log into Turn It In: https://turnitin.com/gateway/index.html
Class ID: 32939278
Enrollment Key: NURS6520

Case Study Presentation
You will provide a succinct and professional PowerPoint slide presentation of your Case (same section headings as in your paper) and upload your presentation to the Blackboard assignment tab. You will present your PowerPoint slides and share your case on your assigned class date. You will have 5 minutes to present your case and be prepared to answer any questions following. A brief overview of the case.

Please submit your Case Study assignment in word doc and Case Study PowerPoint Presentation assignment to the appropriate Blackboard assignment tabs.

Case Study Rubric

Criteria Novice (2pt) Competent (3.5pt) Proficient (5pt)
Patient Characteristics and Assessment

(including PE and diagnostic criteria). Accurately identifies at least one patient characteristic that should be considered relevant to the case, provides some of the physical exam and diagnostic criteria, however minimal standards met. Clearly and accurately identifies all patient characteristics that should be considered relevant to the case. Provides most physical exam and diagnostic criteria consistent to the case. Clearly and accurately identifies all patient characteristics that should be considered relevant to the case and provides a brief explanation that justifies each choice. Provides an accurate and justifiable physical exam and diagnostic criteria all relevant to
the case.
Patient Diagnosis (Include pathophysiology and differential dx) Minimally describes a diagnosis that is loosely based on information from the case. Clearly describes a justifiable diagnosis, applying evidence from the case. Clearly describes a justifiable diagnosis, applying evidence from the case.
Identifies at least one other complication that may result from the patients current
condition.
Plan of Care with rationale.

Principles of pharmacokinetics, pharmacodynamics Provides a somewhat inaccurate and limited discussion of plan of care and of which principles of pharmacokinetics and pharmacodynamics should be considered for the case, however, meets minimum standards. Lacking
patient education. Provides a clear, accurate, and thoughtful discussion of plan of care and of which principles of pharmacokinetics and pharmacodynamics and patient teaching should be considered for the case. Provides a clear, accurate, and comprehensive discussion of plan of care and which principles of pharmacodynamics and patient teaching should be considered for the case.

Presentation PowerPoint presentation had spelling and or grammar errors, more than 2 APA formatting errors, images were juvenile or not appropriate to the case. Presenter appeared unsure of the material. Student went over allotted time . PowerPoint presentation was free of spelling and or grammar, and APA formatting errors, the slides were professional, however, dense with material. Presenter appeared comfortable with the material. Student went over allotted
time < 2 minute. PowerPoint presentation was free of spelling, grammar and APA formatting errors, slides were professional and the presenter did an excellent job of sharing the information demonstrating strong knowledge of the material and within
allotted time.

Required
• Buttaro, T.M., Polgar-Bailey, P., Sandberg-Cook, J., and Trybulski, J., (2020) Primary Care: Interprofessional Collaborative Practice, 6th Edition. ISBN: 13: 978-0323570152.

Required for FNP students:
• Cash, C.C. & Glass, C.A. Eds. (2020). Family practice guidelines 5th Edition. New York: Springer Publishing Company. ISBN: 9780826135834.

Required for A-GNP students:
• Cash, C.C. & Glass, C.A. Eds. (2019). Adult gerontology practice guidelines 2ndt Edition. New York: Springer Publishing Company ISBN # 9780826195180.

Recommended FREE Resources
• Hartford Institute for Geriatric Nursing web-based APRN Try This series gerontological resources: https://hign.org/consultgeri-resources/try-this-series
• Centers for Disease Control (CDC) Stopping Elderly Accident Death and Injury Toolkit https://www.cdc.gov/steadi/index.html

Professional organizations
• American Association of Colleges of Nursing (AACN) https://www.aacnnursing.org/
• National Organization of Nurse Practitioner Faculty (NONPF) https://www.nonpf.org/?
• American Nursing Credentialing Center (ANCC) https://www.nursingworld.org/ancc/
• American Association of Nurse Practitioners (AANP) https://www.aanp.org/
• Massachusetts Coalition of Nurse Practitioners: https://mcnp.enpnetwork.com/membership/new
• Gerontological Advanced Practice Nurse Association (GAPNA):https://www.gapna.org/about-gapna
• New England GAPNA: https://negapna.enpnetwork.com/
• Sigma Theta Tau International: https://www.sigmanursing.org/why-sigma/about-sigma