Homework answers / question archive / Case Study   Benign Prostatic Hyperplasia Difficulty: Beginning     Setting: Clinic Index Words: benign prostatic hyperplasia (BPH), laboratory values, assessment, medications, sexuality, patient education Giddens Concepts: Care Coordination, Elimination, Patient Education, Sexuality HESI Concepts: Assessment, Care Coordination, Elimination, Patient Education, Sexuality/Reproduction   Scenario S

Case Study   Benign Prostatic Hyperplasia Difficulty: Beginning     Setting: Clinic Index Words: benign prostatic hyperplasia (BPH), laboratory values, assessment, medications, sexuality, patient education Giddens Concepts: Care Coordination, Elimination, Patient Education, Sexuality HESI Concepts: Assessment, Care Coordination, Elimination, Patient Education, Sexuality/Reproduction   Scenario S

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Case Study   Benign Prostatic Hyperplasia Difficulty: Beginning

 

 

Setting: Clinic

Index Words: benign prostatic hyperplasia (BPH), laboratory values, assessment, medications, sexuality, patient education

Giddens Concepts: Care Coordination, Elimination, Patient Education, Sexuality

HESI Concepts: Assessment, Care Coordination, Elimination, Patient Education, Sexuality/Reproduction

 

Scenario

S.M. is a 68-year-old man who is being seen at your clinic for routine health maintenance and health pro-motion. He reports that he has been feeling well and has no specific complaints, except for some trouble "emptying my bladder." Vital signs at this visit are 148/88, 82, 16, 96.9° F (36.1° C). He had a complete blood count and complete metabolic panel completed 1 week before his visit, and the results are listed in the chart

Chart View

Laboratory Test

Sodium     140mEq/L

Potassium  4.2mEq/L

Chloride    100mEq/L

Bicarbonate  26mEq/L

BUN    19mg/dL

Creatinine   0.8mg/dL

Glucose     94mg/dL

RBC5    .2 million/mm3

WBC     7400/mm3

Hgb    15.2g/dLHct46%

Platelets    348,000/mm3

Prostate-specific antigen (PSA)     4.23ng/mL

Urinalysis Within normal limits

 

1.What can you tell S.M. about his lab work?

 

2.What is the significance of the PSA result?

 

3.What other specific examination will S.M. need to have along with the PSA test?

 

CaSE StuDy ProGrESS

While obtaining your nursing history, you record no family history of cancer or other genitourinary 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."

 

4.Why did S.M. try taking the saw palmetto, and why do you think he stopped taking it?

 

5.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?

 

Case Study Progress

The primary care provider (PCP) performs a digital rectal examination (dRE) and asks for a post-void resid-ual (PVR) urine test.

 

6.Which of these findings from the digital rectal examination indicate BPH? Select all that apply

 

a. Prostate is symmetrically enlarged.

 

b. Prostate feels firm.

 

c. Prostate feels hard.

 

d. Prostate is nodular.Prostate feels smooth.

 

7.You use a bedside bladder scanner and document that S.M. voided 60mL and his PVR is 110mL. You report the PVR to the PCP. What is the significance of his PVR?

 

8.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?

 

9.The PCP orders tamsulosin (Flomax) 0.4mg/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

a. Dizziness

b. Diarrhea

c. Dry mouth

d. Headache

e. Heartburn

f. Orthostatic hypotension

 

 

10.S. M. asks, "Will this condition affect my relationship with my wife?" What should you tell him?

 

 

11.What would you expect S.M. to report if the medication was successful?

 

 

Case Study Progress

 

.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.

 

12.What surgical options are available to S.M.? Name at least three.

 

 

 

 

Case Study outcome

 

S.M. chose an outpatient procedure. He did well postoperatively and was discharged to home.