Question

S. M. is a 68-year old man who is being seen at your clinic for routine health maintenance and health promotion. He reports that he has been feeling very well and has no specific complaints except for some trouble “emptying his bladder.” He had a CBC and chemistry survey completed 1 week before his visit, and the results are as follow: Na 140 mEq/L, K4.2 mEq/L, Cl 100 mEq/L, HCO3 26 mEq/L, BUN 22 mg/dL, creatinine 0.8 mg/dL, glucose 94 mg/dL, RBC 5.2 mm3, WBC 7.4 mm3, Hgb 15.2 g/dL, Hct 46%, platelets 348 mm3. His VS at this visit are 148/88, 82, 16.
1. What can you tell S. M. about his lab work?
While obtaining your nursing history, you discover that there is no family history of cancer or other genitourinary problems. During further questioning you discover that S. M. has had progressive symptoms over the past 6 months, which include the urge to urinate frequently, decreased ability in starting the stream of urine, and decrease in the force of the urinary stream. The health care provider examines S. M. and reports that his prostate is enlarged and gives a tentative diagnosis of benign prostatic hypertrophy (BPH). The health care provider also orders a clean-catch urine and PSA test.
2. S. M. is curious why this condition would affect his urination. What would you teach him?
3. Why were the additional tests of the UA and PSA ordered?
4. What concepts would you include in teaching S. M. to obtain a clean-catch urine specimen for UA?
S. M.’s UA returns with results that are within normal limits (wnl). His PSA is 2.0 ng/mL. The health care provider informs S. M. his blood work was normal. S. M. tells you he still has several questions. What information would you include in answering the following questions?
5. S. M. asks you, “Do I have cancer?”
6. “Will this condition affect my relationship with my wife?” what do you tell him?
7. Before being discharged, the health care provider gives S. M. a prescription for doxazosin (Cardura) with instructions to take 1 mg/dL x 7 days, then 2 mg/dL x 7 days, and then 4 mg/dL thereafter. What type of drug is Cardura, and what are the indications for the use of this drug?
8. What are the most common side effects for this drug class?
9. From a safety standpoint, what information does S. M. need to know about his treatment with Cardura?

Answer 1

Solution:

Question 1

Answer: Being a nursing professional I should assure the patient that all the lab test results are in normal range at his age. Although the probable diagnosis is benign prostatic hypertrophy (BPH) which means prostate enlargement for that the patient is facing problem during urinate and for the confirmatory test the patient need to undergo clean catch urine and PSA test for ruling out the chances of cancer as the patient’s history does not indicate any kind of family background for that particular disease.

Question 2

Answer: I must inform the patient as BPH is generally age associated enlargement of prostate gland that often cause difficulty in urination and further I must ensure the patient that this type of enlargement is not thought to the precursor or any kind of deadly diseases including cancer and there are effective treatment strategy including medication or minimal invasive surgical procedures.

Question 3

Answer: The UA and PSA tests need to be done for detecting any abnormalities including presence of prostate-specific antigen (PSA) that is responsible for prostate cancer for concluding the diagnosis and possible early intervention if any.

Question 4

Answer: Clean catch urine is denoted as a collection of urine sample in an aseptic way generally prevents the contamination of any kind of microorganisms from the skin of the penis/vagina to the urine sample. As the specific test for urine analysis might hamper owing to the cross contamination of the samples and the obtained result might be anomalous.