Question

A Case Study on Progressive Prostatitis and Benign Prostatic Hyperplasia

Mr. Whipple is a 52-year-old male with no history of significant illness, nor disease. He weighs 95.25 kg and is 5 feet and 4 inches in height. Current vital signs are: BP- 156/97, respirations- 19 breaths/per minute, oxygen saturation- 95% on room air, temperature- 98.4 F (oral), and pulse of 89 beats/per minute, regular rhythm. Mr. Whipple has had three urinary tract infections (UTI) within the past 8 months. He also has pain with inflammation of the prostate gland during sexual intimacy with his wife. The identified organism that was isolated and found to be the cause of the UTI was Escherichia coli. Mr. Whipple has noticed that over the course of 10 months, his urinary pattern has changed. His urinary stream is narrow. He also complains of bladder pressure while voiding. After voiding, he still feels like his bladder is full. An annual physical reveals a PSA level of 4.1 ng/mL and a DRE finding reveals a tender prostate gland that is both rubbery and large in size.

1. Upon review of the Mr. Whipple’s clinical presentation, what condition(s) are these findings consistent with? Provide diagnostic, laboratory, and assessment evidence from the literature that support your nursing assessment.
2. Explain the indicated nursing interventions necessary to rule-out any potential health problems the patient may have.
3. Develop three nursing diagnostic statements that address the health problems and prioritize them based on the immediacy of your interventions as Mr. Whipple’s registered nurse.

Answer 1

Upon review of the Mr. Whipple’s clinical presentation, following are the assessment findings

· Weight : 95.25 kg

· height: 5 feet and 4 inches

· Current vital signs are: BP- 156/97, respirations- 19 breaths/per minute, oxygen saturation- 95% on room air, temperature- 98.4 F (oral), and pulse of 89 beats/per minute, regular rhythm.

· Past history of three urinary tract infections (UTI) within the past 8 months.

· He also has pain during sexual contact.

· The identified organism that was isolated and found to be the cause of the UTI was Escherichia coli.

· His urinary stream is narrow.

· He also complains of bladder pressure while voiding.

· After voiding, he still feels like his bladder is full. An annual physical reveals a PSA level of 4.1 ng/mL and a DRE finding reveals a tender prostate gland that is both rubbery and large in size.

1. what condition(s) are these findings consistent with?

Progressive Prostatitis : He also has pain during sexual contact,Past history of three urinary tract infections (UTI) within the past 8 months, The identified organism that was isolated and found to be the cause of the UTI was Escherichia coli, DRE finding reveals a tender prostate gland that is both rubbery and large in size

Benign Prostatic Hyperplasia: He also has pain during sexual contact, His urinary stream is narrow, He also complains of bladder pressure while voiding, After voiding, he still feels like his bladder is full, DRE finding reveals a tender prostate gland that is both rubbery and large in size

2. Provide diagnostic, laboratory, and assessment evidence from the literature that support your nursing assessment.

ASSESS FOR

· discharge from the urethra

· enlarged or tender lymph nodes

· a swollen or tender area

• Digital rectal examination (DRE). A DRE often reveals a large, rubbery, and nontender prostate gland.

LABORATORY AND DIAGNOSTIC TEST

• urinalysis : To detect urinary tract infection
• a prostate-specific antigen (PSA) blood test: In fact, benign prostatic hyperplasia, prostate infections, inflammation, aging, and normal fluctuations often cause high PSA levels
• urodynamic tests : uroflowmetry, which measures how rapidly the bladder releases urine

· post void residual measurement, which evaluates how much urine remains in the bladder after urination , reduced urine flow or residual urine in the bladder, which often suggests urine blockage due to benign prostatic hyperplasia

· cystoscopy

· biopsy : Biopsy is a procedure that involves taking a small piece of prostate tissue for examination with a microscope

· Cystometrogram: Measures pressure and volume in the bladder to identify bladder dysfunction unrelated to BPH.

• Cystourethroscopy: To view degree of prostatic enlargement and bladder-wall changes (bladder diverticulum).
• Cystometry: Evaluates detrusor muscle function and tone.
• Transrectal prostatic ultrasound: Measures size of prostate and amount of residual urine; locates lesions unrelated to BPH

3 Explain the indicated nursing interventions necessary to rule-out any potential health problems the patient may have.

• Relieve discomfort. Bed rest and analgesics are prescribed if a patient experiences discomfort.
• Maintain fluid balance. Fluid balance should be restored to normal.
• Urinary control. The nurse should teach the patient exercises to regain urinary control
• Avoid Valsalva maneuver. The patient should avoid activities that produce Valsalva maneuver like straining and heavy lifting.
• Avoid bladder discomfort. The patient should be taught to avoid spicy foods, alcohol, and coffee.
• Increase fluids. The nurse should instruct the patient to drink enough fluids.

4 Develop three nursing diagnostic statements that address the health problems and prioritize them based on the immediacy of your interventions as Mr. Whipple’s registered nurse.

· Impaired Urinary elimination  related to enlarged prostrate as evidenced by bladder pressure during voiding,After voiding, he still feels like his bladder is full

· Acute pain during sexual intercourse related to bladder distention as evidenced by verbalisaion

·knowledge deficit related to concern about sensitive area as evidenced by verbalisaion