m 6





Mr. V.P., a 76 year old male patient has come to Our Lady of
Mt. Carmel Medical Center to sought medical attention with a
chief complaint of urinary retention. His initial vital signs were
taken wherein BP: 160/80, HR: 78bpm, RR: 24cpm and temp:
36.6°C. He weighs 62 in kilogram. Mr. V.P resides in Sta.Cruz,
Porac, Pamapanga. He was then advised to be admitted, dated
January 18, 2011.

Mr. V.P.·s familial history shows that he has no background of

cancer, diabetes mellitus, asthma, heart problems, neither
hypertension. He just had an operation on the late 80·s called
appendectomy.
P P  
„ Mr. V.P is a father of 4 children and has a good relationship
with them. He may be considered as a good husband to a 68 year old wife.
They all live on a single house showing a good Filipino trait of good family ties.
 
   ² Due to Mr. V.P.·s age, the frequency and amount of his voiding
and defecation shows some irregularities especially now because of his
complaint of urinary retention.
   
 ² Mr. V.P. usually sleeps 6 hours a day. His rest varies
everyday depending on what activities he has to do for a living. He sometimes
experience sleep deprivation.
 
 ² He usually gets less interest when it comes to sexual activities
because of his age. Satisfaction is not very important as he stated.
    ² He breaths normally and with good and patent airway.
6 6 
  ² Mr. V.P eats at least 3 times a day. He sometimes don·t get all the
needed nutrients and shows some of its inadequacy.
m Physical assessment done by the attending physician
reveals that the patient is:
ÑConscious and coherent
ÑHas pink palpebral conjunctiva, anisteric sclera
Ñ(„ cyanosis
Ñ(+ pain
ÑAfebrile
Ñ(+
ABS
Ñ
on„tender abdomen
m Physical assessment done by the student reveals:
ÑPink palpebral conjunctiva
Ñ(+ dry lips
Ñ(+ dry skin
ÑPoor skin turgor
Ñ(+ paleness
Ñ(„ edema on hands and feet
 The prostate is a male reproductive gland that produces the
fluid that carries sperm during ejaculation. It surrounds the urethra,
the tube through which urine passes out of the body.

An enlarged prostate means the gland has grown bigger.

Prostate enlargement happens to almost all men as they get older. As
the gland grows, it can press on the urethra and cause urination and
bladder problems.

An enlarged prostate is often called benign prostatic

hyperplasia (BPH or benign prostatic hypertrophy. It is not cancer,
and it does not raise your risk for prostate cancer.

BPH is is a noncancerous increase in the size of the prostate

gland in middle„aged and elderly men, and is one of the most
common health problems men deal with as they grow older.
 The size of a man's prostate remains fairly constant from the
time of puberty throughout early adult life. But by age 50, when
hormonal changes occur, the prostate begins to grow larger. This
condition is referred to as benign prostatic hyperplasia (BPH .

As the prostate grows, it puts pressure on the urethra³the

tube that carries urine and semen out of the penis. This
increasing pressure on the urethra may cause bothersome
urinary symptoms or in some men can lead to serious medical
problems over time. BPH can cause urine retention and strain on
the bladder which can lead to urinary tract infections, bladder or
kidney damage, bladder stones, and incontinence³the inability
to control urination. If the bladder is permanently damaged,
treatment for BPH may be ineffective. When BPH is found in its
earlier stages, there is a lower risk of developing such
complications.
 ‰rine retention is a condition in which the bladder
does not empty completely, or at all, despite an urge to
urinate. This can happen because the prostate is
enlarged and thus obstructing the flow of urine from
the bladder, through the urethra. Sometimes this
happens suddenly to older men after they have taken an
over„the„counter cold or allergy medicine. ‰rinary
retention can develop gradually or suddenly. If you
can't urinate at all, you should get medical help right
away.
 BPH is not a sign of cancer, but the early symptoms
are the same for both conditions, so it's essential that a
health care provider be seen for evaluation of new
symptoms. According to the
ational Cancer Institute
(
CI , other than skin cancer, prostate cancer is the
most common form of cancer and the second leading
cause of cancer„related deaths among men in the ‰nited
States. But doctors' recommendations on screening for
the disease vary. Some encourage annual screenings for
men older than age 50; others recommend against routine
screening.
 The parasympathetic and sympathetic maintains an
important role in urinary continence. During bladder filling,
sensory nerve endings detect progressive stretching of the
bladder wall and convey information via the sympathetic to the
spinal cord and brain which produces reflex contractions in the
bladder neck and prostatic urethra as well as in the external
urethral sphincter thereby maintaining continence.
As the volume of urine increases, starting from 300„500 ml,
awareness of the need to void develops. Voluntary voiding is
accomplished by stimulation of the parasympathetic nerve fibers
causing coordinated contraction of the detrusor muscle and the
bladder body.
erve impulses passing down the sympathetic and
pudendal motor cease momentarily allowing relaxation of
normally tonically contracted bladder neck, prostatic urethra
and external thus allowing urine to flow.
·  



  

 
 



 
 
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  (also known as T‰RP,
plural T‰RPs and as a transurethral prostatic resection,
T‰PR is a urological operation. It is used to treat benign
prostatic hyperplasia (BPH . As the name indicates, it is
performed by visualizing the prostate through the urethra and
removing tissue by electrocautery or sharp dissection. This is
considered the most effective treatment for BPH. This
procedure is done with spinal or general anesthetic. A large
triple lumen catheter is inserted through the urethra to
irrigate and drain the bladder after the surgical procedure is
complete. Outcome is considered excellent for 80„0% of BPH
patients.
 6  P

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 January 18, 2011
„ ©

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„ r© 5 x 10 x 10 gL 11.3 Increased WBC

Typical ECG tracing of

$% January 1, 2011 the cardiac cycle was
done (normal



  January 20, 2011 20 grams
„ 


 Prostate gland grade IV Enlargement of the

 
 (15.4 g ejaculatory prostate gland
  

 duct, cyst (R

ôP January 21, 2011

 $  6
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& The patient   Due to After 3 hours of Monitor vital „loss of kidney The pt. is able to
verbalized  


  hyperplasia of the nursing signs closely. function results in manage the
difficulty of 

   prostate gland, intervention, the Observe for decreased fluid manifestations of
urinating.
 

the urethra is pt. will be able to hypotension, elimination and the disease.
being blocked manage the edema, changes in accumulation of („ incontinence
&pt. manifests: causing manifestation of mentation. toxic wastes may („ dysuria
(+ incontinence obstruction in the the disease by the Maintain I & O. progress to („ facial grimace
(+ dysuria flow of urine that absence of pain. complete renal upon urinating
(+ facial grimace leads to shutdown.
upon urination bothersome
L‰TS, thus an Catheter care. „hygiene and to
impairment in prevent infection.
theurinary
elimination. Encourage oral „increased
fluids up to circulating fluid
3000ml daily maintains renal
within cardiac perfusion and
tolerance if flushes kidneys,
indicated. bladder and
ureters of
sediments and
bacteria.
 $  6
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!   
     

& The patient 3 




 Due to After 24 hours of Monitor vital „to draw baseline The pt. showed
verbalized  

  hyperplasia of the nursing signs closely.. data for no signs of
difficulty of    

prostate gland, intervention, the comparison of infection.
urinating. the urethra is pt. will not show normal to having („ redness
being blocked any signs of abnormalities. („ swelling
&pt. manifests: causing infection. Observe
ormal
(+ incontinence obstruction in the perineum for any „ladderized temperature
(+ dysuria flow of urine that physical observation of
(+ facial grimace leads to changes.(Color, infection.
upon urination bothersome swelling,
L‰TS, thus an temperature
impairment in the
urinary Catheter care. „hygiene and to
elimination. prevent infection.

Administer „to prevent

medication as development of
ordered. infection.
 6       $ 
    
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%
6 ' Inhibits the Treatment of Contraindicated GI > abdominal upset >Assess pt. to ensure
Dutasteride intracellular symptomatic BPH with allergy to any G‰> impotence, that problem is BPH
enzyme (5„alpha with an extreme component of the decreased libido, and that other
(
6 ' reductase that enlargement of the product, other 5 decreased volume of disorders have been
Avodart prostate gland. alpha reductase; ejaculation. ruled out.
converts
women, children, Others: breast
testosterone into a
!
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' pregnancy and enlargement, breast >Administer without
Androgen hormone
potent androgen lactation. tenderness regards to meals;
inhibitor (DHT does not ‰se cautiously with ensure that the p.
affect androgen hepatic impairment. swallows capsule
!  ' receptors in the whole. Do not crush,
0.5 mg daily body; the prostate cut or chew the
gland is dependent capsule.
on DHT for its
development and >Monitor urine flow
maintenance. and output.
 6       $ 
    
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6 ' Inhibits D
A„ Infections of Hypersensitivity to GI> hepatoxicity, >Assess pt. for
Ciprofloxacin gyrase in urinary tract, ciprofloxacin or pseudomembranous infection prior and
susceptible middle ear, sinuses, other quinolones. colitis, abdominal during the therapy.
(
6 ' organism, inhibits eyes, kidneys, and Children, pain, diarrhea, >Obtain specimen
Ciprobay relaxation of genital organs, adolescent, nausea. for culture and
supercoiled D
A abdomen, skin and pregnancy and G‰> interstitial sensitivity before
!
$
' and promotes soft tissues, bones lactation. cystitis, vaginitis. initiating therapy.
Antibiotic breakage of double and joints. >Observe pt. for
stranded D
A. signs and
!  ' symptoms of
500 mg BID anaphylaxis.
 6

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6 '
ot entirely known „musculoskeletal >hypersensitivity cardiac > >Give medication
Diclofenac but it is thought complaints, esp. against diclofenac myocardial with food to
that the primary arthritis, dental infarction prevent upset of
(
6 ' mechanism pain, gout attacks >history of allergic stomach.
Cataflam, Difen responsible for its and pain reaction following GI> ulcerations,
anti„inflammatory, management in the use of aspirin or bleeding >Give medicine
!
$
' antypyretic and cases of kidney another
SAID with a full glass of

on„steroidal anti„ analgesic action is stones and gall Hepatic> hepatitis water.
inflammatory drug inhibition of stones. >3rd
trimester
prostaglandin „commonly used to pregnancy Renal> acute renal >Have the client
!  ' synthesis by treat mild to failure swallow long
75 mg every 12 inhibition of moderate post >severe liver acting products
hours BID cyclooxegynase. operative or post insufficiency Others> leucopenia, whole.
traumatic pain, agrunolocytosis,
particularly when >inflammative thrombopenia,
inflammation is intestinal disorders aplastic anemia.
present. such as crohn·s
disease.
m    
Mefenamic Acid ² pain reliever

ubain
Ciprobay
m  
 „ Rest as often as you need to the first few weeks after surgery but you should also do
regular, short periods of movements to build up your strength. You may also have regular
short walks.
m ô ô
 
Drink plenty of water to help flush fluids into the bladder (8„10 glasses of water per day and
avoid coffee, soft drinks and alcohol.
Monitor urine output.
m  
 „ You may experience some problems after discharge on the operated part. You can only
continue activities gradually after 3„6 weeks.
m      

Call your doctor or nurse if:
„ You have pain in your belly that is not relieved by pain medications.
„ Your urine has a thick, yellow, green or milky drainage.
„ You have signs of infection.
m ! ! „ Eat a normal, healthy diet with plenty of fiber. You may use a stool softener or fiber
supplement to help prevent constipation which can delay the healing process.
m  
 
Avoid any sexual activity for 3„4 weeks.