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Philippine College of Health and Sciences


Recto, Manila

In Partial Completion of the Requirements in


Related Learning Experience
( Case Study on Benign Prostatic Hyperplasia)

Veterans Memorial Medical Center

Submitted to:

Marilyn Lugtu, R.N, M.A.N


Clinical Instructor

Submitted by:
Aguirre, Mary Grace
Atok, Joy
Centino Ruby
Dela Cruz, Ana Rechell
Dorotan, Krystal Faye
Gasapo, Maricel
Lopez, Rosemarie
Mendoza, May
Mortiz, Cesar Ryan
Mortiz, Cherrie
Nerpio, Thomas Jay
Sunga, Richelle Anne

Group C2
BSN
Batch 2011

Saturday-Sunday (6am-6pm)
February 5, 6, 12 and 13, 2011

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Introduction
The prostate is the genital organ most commonly affected by benign and
malignant neoplasm. Benign enlargement of the prostate gland is an extremely common
process that occurs in nearly all men with functioning testes. Hyperplasia is a general
medical term referring to excess cell replication. Benign prostatic hyperplasia (BPH) is a
noncancerous growth of the prostate gland. It is the most common noncancerous form of
cell growth in men and usually begins with microscopic nodules in younger men. It
should be noted that BPH is not a precancerous condition.

Histologic evidence of prostate enlargement begins about the third decade of life
and increases proportionally with aging. Specifically, about 43% of men in their 40s will
have evidence of BPH, as will 50% of men in their 50s, 75% to 88% in their 80s, and
nearly 100% of men reaching the ninth decade of life.

Some evidence has reported a higher incidence of benign prostatic hyperplasia --


particularly fast-growing BPH -- in men with obesity, heart and circulatory diseases, and
type 2 diabetes. Diabetes and hypertension, in any case, worsens urinary tract symptoms
in men with BPH. In one study, flow rates were adversely affected by diabetes, although
residual urine volumes were not significantly greater.

The exact cause of BPH is unknown. Potential risk factors include age, family
history, race, ethnicity, and hormonal factors. Androgens (male hormones) most likely
play a role in prostate growth. The most important androgen istestosterone, which is
produced throughout a man's lifetime. The prostate converts testosterone to a more
powerful androgen, dihydrotestosterone(DHT). DHT stimulates cell growth in the tissue
that lines the prostate gland (the glandular epithelium) and is the major cause of the rapid
prostate enlargement that occurs between puberty and young adulthood. DHT is a prime
suspect in prostate enlargement in later adulthood. Additional factors also include a
defective cell death in which cells naturally self destruct, goes awry and results in cell
proliferation a process called asapoptosis.

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As BPH progresses, overgrowth occurs in the central area of the prostate called
the transition zone, which wraps around the urethra (the tube that carries urine through
the penis). This pressure on the urethra can cause lower urinary symptoms that have been
the basis for diagnosing BPH. It should be noted that BPH is not always the cause of
these symptoms. An enlarged prostate may be accompanied by few symptoms, while
severe LUTS may be present with normal or even small prostates and are most likely due
to other conditions. Symptoms of BPH may include; Difficulty in starting to pass urine
(hesitancy), a weak stream of urine, dribbling after urinating, the need to strain to pass
urine, incomplete emptying of bladder, difficulty to control the urination urge, having to
get up several times in the night to pass urine, feeling a burning sensation when passing
urine.

Sometimes a man is unaware of an obstruction until he suddenly cannot urinate


at all. This condition is called acute urinary retention. It is a dangerous complication that
can damage the kidneys and may require emergency surgery. In general, BPH progresses
very slowly and acute urinary retention is very uncommon. Men with BPH at highest risk
for this complication tend to be elderly and to have moderate to severe lower voiding
symptoms. Taking anti- hypertensive drugs (except for diuretics) or antiarrhythmic drugs
may also increase the risk. Bladder obstruction can also cause bladder stones, blood in the
urine, urinary tract infection, and incontinence. Unfortunately, no current tests can
accurately predict which men are at higher risk for complications, although men with a
weak urine stream and larger prostates are at higher risk for urinary retention.

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General and Specific Objectives

A. General Objectives

After 6 days of exposure at the VMMC, the student nurses should be able to
apply the theoretical and practical skills to provide a systematic way of collecting
information and to provide medical assistance in rendering supportive care and treatment
for health maintenance of the patient.

B. Specific Objectives

 To provide adequate physical assessment essential for understanding


the condition of the client

 Effectively discuss and elaborate actual signs and symptoms of


disease exhibited by the client.

 Thoroughly discuss, explain, and elaborate the nature of the disease


process.

 Appropriately provide nursing interventions according to the


standards of nursing practice .

 Skillfully formulate nursing care plans for the different problems


identified.

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Patient Health History

A. BIOGRAPHIC DATA

Client’s Name (initial): PF

Age: 83 y/o

Sex: Male

Address: 59 Sampaloc St., Comembo, Makati City, Philippines

Nationality: Filipino

Occupation: Retired Lieutenant

Date of Birth: September 27, 1927

Place of Birth: La Union

Religion: Roman Catholic

Date of Admission: February 4, 2011

Reliability: The client is 100% reliable because he was able to answer questions

clearly and precisely about his health.

B. CHIEF COMPLAINT

Chest pain

C. DIAGNOSIS

Benign Prostatic Hyperplasia

D. HISTORY OF PRESENT ILLNESS

One week prior to admission, Mr. F. stated to have productive cough with
whitish sputum associated with difficulty of breathing.

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E. PAST MEDICAL HISTORY

1. Immunizations:

The client cannot recall his past immunizations

2. Allergies:

Mr. F. stated that he doesn’t have any known allergies to food,


animals, medications or environmental elements.

3. Previous Surgery:

The client had appendix and cataract surgery in the past.

4. Injuries/Accidents:

The client said that he has not been involved in any major accidents or
any accidents involving serious body injuries.

5. Family History:

( - ) HPN ( - ) BA
( - ) DM ( - ) CA
( - ) PTB ( - ) COPD

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Philippine College of Health and Sciences

MODIFIED GORDON’S FUNCTIONAL HEALTH PATTERN


ASSESSMENT TOOL

Identifying Information:
Client’s initial: PF Age: 83
Sex: Male Informant: Client
Height: 5’8 Weight: 140 lbs
Allergies: NKA

Typology/Pattern Patient’s Activity/ Views Patient’s Activity/Views


(before hospitalization) (during hospitalization)
Health Perception/ Health >The client perceived >The client perceives
Management himself quite unhealthy himself as unhealthy person
because of the symptoms he because of his
is experiencing (chest hospitalization but he is
pain) .He relieves the hoping to recover soon.
symptoms through sitting, >The client stated that
drinking water and placing health is the primary gift
two pillows beneath his that man has ever received
head when lying on a flat and so, it should be taken
bed. care of.

Nutritional/Metabolic >The client states that he


Pattern >The client stated that he now knows how food can
eats at least 4 meals a day greatly affect a person’s
(breakfast, lunch, snacks, health. He also stated that
dinner). According to him he will be more cautious as
meal served in the hospital of his food preferences.
is very small that sometimes
he wanted more.
>The client also stated that
he is fond of eating
vegetables, fish and meat.
>the client dinks at least 8
cups of water daily.

Elimination Pattern >The client stated that he


>The client stated that he is hasn’t defecated ever since
constipated and the last time he was hospitalized.
he defecate was 3 weeks
ago.
>The client has a foley
>The client stated that he is catheter inserted into his
having a hard time external urethral orifice.
urinating. Evidenced by 300 ml of
yellow urine at the time of
assessment.

Activity-Exercise Pattern >The client is mostly in a


>The client stated that he semi-fowler’s position
exhibits exercise by during the hospitalization.
walking alone. Most of the However he is able to walk
time, he is the one making and can change position
the household chores. He whenever he wants to. (E.g.
sometimes watches TV and sitting, side lying)

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plays cards with his peers
during his leisure time.

Sleep/Rest Pattern >The client is sleeping most


>The client stated that he of the time and prefers to
usually sleeps at around just take a rest during the
11pm and wakes up at hospitalization.
around 6am.He takes short
naps during free time in the
afternoon usually from 3pm
to 5 pm. But during the
onset of symptoms such as
chest pain, he had difficulty
in sleeping.

Cognitive/Perceptual >The client is oriented with


Pattern >The client stated that the the time, person and place
best way for him to learn is during the interview.
by listening. He can follow > The client responses to
simple instructions and can questions, commands, and
respond to questions physical stimuli
appropriately. appropriately.

Self-perception/Self- >According to him, he feels


concept >The client was aware of very sad because of his
his present condition. condition as of the moment.
>The client states that he
>The client also stated that, wants to go back to his
he compensates the needs of normal activities of daily
his family by doing the living.
household chores.

Role/Relationship Pattern >The client’s


>The client stated that his role/relationship did not
wife died last year. He is change during the
also a father of four and a hospitalization.
modest friend to many.

Sexuality/Reproduction >Not asked/ N/A


Pattern >Not asked/ N/A

Coping/Stress Tolerance >The client states that he


Pattern >The client stated whenever manages stress by
he feels stressed, he constantly talking to his
watches TV or plays cards friends.
with his peers. He also
smokes when he feels
anxious.

Values/Belief Pattern >The client states that he


>The client is a Roman knows he is guided by God
Catholic. He believes in and that he will be in a
God as the Supreme Being. better condition soon
Conversely, he doesn’t because of Him.

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attends Sunday mass that
often.

Philippine College of Health and Sciences

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Department of Nursing
Physical Assessment

BODY PART ACTUAL FINDINGS


A. General Survey The client is a male, Filipino, 83 years old,
diagnosed with Benign Prostatic
Hyperplasia. He was conscious and
coherent upon assessment. He has a
medium built body frame with a weight of
140 lbs. and a height of 5’8 inches. He was
cooperative and was able to follow
instructions.
Vital Signs:
The patient’s vital signs upon assessment:
Feb. 5, 2011:
Temp: 36.2 C (axillary)
PR: 70 bpm regular rate & rhythm
RR: 18 breaths/min regular rate & rhythm
BP: 110/80 (Rt arm)

B. Skin Upon inspection, the client’s skin has a fair


complexion. Upon palpation, the client has
a dry and warm skin. He also have lesions
on both hands and legs with scar tissue on
the left side of the thorax and in both
extremities near the malleolus.

C. Nails Upon inspection, the angle of the nail base


of the client is 180 degrees. The fingernail
and toenail bed color is pale. The tissue
surrounding the nails are intact and without
lesions. In assessing the capillary refill with
a blanch test, nail beds are highly
vascularized because it return to it’s normal
color in less than 3 seconds.

D. Hair Upon inspection, the client has white hair


sparsely distributed. There are no scalp
lesions, no infestations of lice and
infection.

E. Skull and Face Upon inspection of the skull, the client has
a rounded normocephalic and symmetrical
smooth skull contour with frontal, parietal,
and occipital prominence. Upon palpation,
skull has a smooth uniform consistency and
absence of nodules and tenderness.

F. Eyes Upon inspection, the eyes are


symmetrically aligned. Eyebrow and
eyelashes are evenly distributed. Eyelids
close symmetrically. The cornea reveals to
be transparent, shiny and smooth. The
client’s eyes are proportional to the size of
her face, round, black in color and
symmetrical. There are no involuntary
movements. Conjunctiva is moist with
numerous small blood vessels and no

edema or tenderness over lacrimal gland.

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G. Ears Upon inspection, the client’s ears are
symmetrical in position and uniform in
color. Has no redness and swelling. Upon
palpation, it is firm and there is no
tenderness.

H. Nose and Sinuses The client’s nose is symmetrical, uniform


in color, straight and without discharge and
flaring. There are no masses and tenderness
on the client’s sinuses. Upon palpation of
pre-nasal sinuses, there is no tenderness.

I. Mouth and Oropharynx Upon inspection of the mouth the color is


pale. It is symmetrical in contour. Upon
palpation, the inner lips and buccal mucosa
is moist and smooth. In assessing the
uvula’s position, it is positioned in the
midline of the soft palate with moist
mucous membranes, with complete upper
& lower dentures, moist rough tongue with
mild white plaques on the papillary layer;
gag reflex not tested however pt can
swallow solid & liquid foods without
difficulty.

J. Neck Upon inspection, the neck was symmetrical


with intact skin and no visible pulsations,
masses and swelling. There was normal
rising of the larynx, trachea and thyroid as
the client swallows. Upon auscultation, no
bruits were heard over the carotid arteries.
The client’s thyroid gland was not palpable.

K. Thorax and Lungs Upon inspection, the client’s chest


configuration was symmetrical from side to
side. Chest wall expands symmetrically
during respirations. Skin color matches the
rest of the body’s complexion. Upon
palpation, the chest wall’s skin was warm
and dry with no tender spots or bulges.
Upon auscultation, loud, high pith
bronchial breath sounds were heard over
the trachea. Intense, medium pitched
bronchovesicular breath sounds were heard
over the mainstem bronchi between the
scapulae and below the clavicles. Fine
cracles were heard during inspiration over
most of the peripheral lung fields. Upon
assessment of the vocal fremitus, it was
loud. Upon percussion, dull sounds were
heard.

L. Cardiovascular System Upon inspection, there were no visible


pulsation except at the point of maximal
impulse (PMI). No retractions were

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detected on the four valve areas of the chest
wall. At the point of maximal impulse
(PMI), a localized tapping pulse was felt at
the start of the systole. In the epigastric
area, pulsation from the abdominal aorta
was palpable. Upon auscultation, S1 was
best heard with the diaphragm of the
stethoscope over the mitral area. Moreover,
S2 was best heard with the diaphragm of
the stethoscope in the aortic.

M. Abdomen Upon inspection, the skin has lesions


present on hands and legs, scar tissue on
the left side of the thorax, scar tissue on
both extremities near the malleolus.
Abdomen was symmetrical and no
distention was noted. Umbilicus was
positioned midway between the xiphoid
process and the symphysis pubis with a
concave hemisphere. Upon palpation, no
masses and tenderness were detected.
Abdominal musculature was free from
tenderness and rigidity.

N. Musculoskeletal There are no involuntary movements,


deformities and discolorations.

O. Neurologic Patient is alert and responds appropriately


to stimuli. Eyes move freely in coordinated
manner. Patient is oriented to place, time
and situation and is able to answer
questions properly. Memory and attention
span are intact.

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