Question

CLINICAL SCENARIO: Incontinence/Benign Prostatic Hyperplasia (BPH)

Mr. X 65 male living in a hospice care, a hypertensive patient for 20 years, with maintenance medication of Captopril, Amlodipine, Furosemide and Celecoxib for arthritis. Mr. X does not participate in social activities in the hospice and he almost resist to drink plenty of fluids. The nurse noticed that he can’t control to micturate and before he reach the comfort room his pants gets wet. Since he suffered incontinence the patient became inactive and seldom participate in their socialization. Patient was diagnose with BPH and with prescription of Tamsulosin. Her nurse advised him to limit caffeine intake and do a daily Kegel’s exercise, don’t hesitate to go to CR. Diagnostics and laboratory procedure: Prostate Specific Antigen (PSA) elevated.

1. Create 3 Nursing Diagnosis, with Intervention and Expected outcomes based on the case scenario.

Answer 1

benign prostatic hypertrophy is characterized by progressive enlargement of the prostate gland (commonly seen in men older than age 50), causing varying degrees of urethral obstruction and restriction of urinary flow.

1.NURSING DIAGNOSIS

urinary incontinence related to weak pelvic floor musculature and tissue atrophy as evidenced by patient cannot control maturation, get wet before reaching to toilet.

Expected outcome

• Remain dry between voidings and at night.
• Demonstrate improved perineal muscle strength.
• Regain and maintain perineal skin integrity.
• Return to his previous level of social activity.

Nursing Interventions

• Teach how to identify pelvic floor muscles and how to perform
Kegel exercises.

Avoid caffeinated drinks like tea coffee
• Suggest drinking decaffeinated tea and noncitrus fruit juices
(grape, apple, and cranberry).
• Encourage to minimize fluid intake after evening meal.
• Change afternoon dose of furosemide from 9:00 P.M. to 3:00 P.M.

2.

Acute pain

May be related to:

• Mucosal irritation: bladder distension, renal colic
• Urinary infection
• Radiation therapy

Possibly evidenced by:

• Reports of pain (bladder/rectal spasm)
• Narrowed focus; altered muscle tone, grimacing; distraction behaviors, restlessness
• Autonomic response. Desired outcome:
• Report pain relieved/controlled.
• Appear relaxed.
• Be able to sleep/rest appropriately. INTERVENTIONS
• Assess pain, noting location, intensity (scale of 0–10), duration.
• Provide adequate bedrest
• Provide calm and quiet environment
• Provide medications as per doctor's order
• Help the patient with comfort measures and sitz bath , etc to reduce pain 3.
• NURSING DIAGNOSIS

• Risk for Fluid Volume Deficiency

  May be related to:

• Postobstructive diuresis from rapid drainage of a chronically overdistended bladder
• Endocrine, electrolyte imbalances (renal dysfunction) or
• Patients is not taking sufficient fluid Expected outcomes
• Maintain adequate hydration as evidenced by stable vital signs, palpable peripheral pulses, good capillary refill, and moist mucous membranes.
• NURSING INTERVENTION
• Monitor output carefully. Note outputs of 100–200 mL/hr.
• Encourage increased oral intake based on individual needs.
• Monitor BP, pulse. Evaluate capillary refill and oral mucous membranes
• Administer IV fluids (hypertonic saline) as needed.
• Regular check up especially BP monitoring
• Never skip any medication
• Administer medications as per doctor's order
• Provide psychological support and help to get participated in social activites