I.

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.
Some studies have suggested that African American men are at higher risk and Asian men
at lower risk for BPH than Caucasians, a 2000 study found no greater risk for African Americans
and only a slightly lower risk for Asians. Among Caucasians in the study, men of southern
European heritage were at greater risk while men of Scandinavian ancestry had a lower chance
of developing BPH.
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 is testosterone, 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 as apoptosis.

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.

Diagnostic tests used to confirm Benign Prostatic Hyperplasia include Digital Rectal
Exam, Urinalysis, Serum Creatinine, Postvoid Residual Urine, Ultrasound, Urethrocystoscopy.
 II. NURSING ASSESSMENT

A. Personal History
Mr. Ruben Juco is a 82 years old male, who resides at Purok 4 Jesus St. Pulung Bulo,
Angeles City. His religious affiliation is Roman Catholic and is married to Mrs. Rita Juco. Mr.
Juco had previously worked at Clark-air based Pampanga. He loss his job when the American
soldier leave Pampanga. Since then, he never had a job and just stays in their home. Mr. Juco
usually sleeps at 10 in the evening and wakes up at around 4 in the morning. Mr. Juco usually
spends time watching TV, dawdle in front of their house, chatting with his neighbors and going
to a market via bicycle. Mr. Juco usual viand includes chicken, fish or meat and rice. He also
loves eating bread and drinking milk. Before, he used to love eating tinapa, sardines, tocino and
bagoong. He also smokes before and is able to consume 1 pack of cigarette a day. He drinks
alcohol beverages occasionally. Regarding the finances about health he is using his
PHILHEALTH card to compensate the finances needed.

B. Family Health and Illness History

According to Mr. Juco, the familial disease that they have in the family is Diabetes
Mellitus. His mother has DM and died of natural cause while his father died of stroke. He has
seven siblings and one died due to stroke. He also added that he is the only member in the
family who has BPH.

C. History of Past and Present Illness

It is the first time of Mr. Juco to be confined in a hospital. But he always goes to Angeles
Medical Center for his routine check-up. Last 3 years ago he was diagnosed by Dr. Guzman for
having a problem in his prostate. He was advised by the doctor to stop eating foods high in salt
and rich in preservatives.
As for his present condition, he was admitted to AMC with a chief complaint of blood in
the urine and black stool and was diagnosed for having BPH or Benign Prostatic Hyperplasia
based of the diagnostic procedure he had underwent. One week prior to his admission he
experiences pain during urination and find a tinge of blood in his urine. Last Sunday, June 18,
2006 he was brought in the hospital at around 10 in the evening due to black stool and hematuria.
Upon admission he had undergone some laboratory examination such as CBC, CREA, BUN,
HGT, NA+ K+, FBS, UA, FA, 12-LEAD ECG, CBG and Chest X-ray. His initial medication is
Kepox.

D. Physical Examination
Physical Assessment done by the attending physician reveals that patient is;
• Conscious and coherent
• Pink palpebral conjuctiva, anisteric sclera
• (-) cyanosis
• (+) pain
• afebrile
• (+) NABS
• non tender abdomen
Vital Signs upon admission (June 18, 2006)
BP- 110/70 mmHg
RR-21 bpm
PR-80 bpm
Temp-36.7 oC

Physical Assessment done by the student reveals that patient is;

• Pink palpebral conjuctiva
• (+) dry lips
• (+) dry skin
• decreased skin turgor
• (+) paleness
• (+) edema of hands and feet

Vital Signs upon admission (June 22, 2006)

BP- 110/60 mmHg
RR-21 bpm
PR-80 bpm
Temp-36.5 oC
 III. ANATOMY AND PHYSIOLOGY

The prostate gland is located under the urinary bladder, in front of the rectum and wraps
around the urethra (the tube that carries urine through the penis). It is basically composed of
three different cell types the glandular cells, smooth muscle cells and stromal cells

The central area of the prostate that wraps around the urethra is called the transition zone.
The entire prostate gland is surrounded by a dense, fibrous capsule.

The prostate gland provides the following functions: (1) the glandular cells produce a
milky fluid, and during sex the smooth muscles contract and squeeze this fluid into the urethra.
Here, it mixes with sperm and other fluids to make semen. (2) the prostate also secretes another
substance that may have antibacterial properties. (3) the prostate gland also contains an enzyme
called 5 alpha-reductase that converts testosterone to dihydrotestosterone, another male hormone
that has a major impact on the prostate.

The prostate gland undergoes many changes during the course of a man's life. At birth,
the prostate is about the size of a pea. It grows only slightly until puberty, when it begins to
enlarge rapidly, attaining normal adult size and shape, about that of a walnut, when a man
reaches his early 20s. The gland generally remains stable until about the mid-forties, when, in
most men, the prostate begins to enlarge again through a process of cell multiplication.
Hormonal changes also occur in the prostate gland; testosterone levels fall while
dihydrotestosterone remain at normal levels.
Neurophysiology of Continence and Micturition:

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 parasympathetic 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 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. Nerve impulses
passing down the sympathetic and pudental motor fibers cease momentarily, allowing relaxation
of normally tonically contracted bladder neck, prostatic urethra and external thus allowing urine
to flow.
 V. DIAGNOSTIC AND LABORATORY PROCEDURE

1. Complete Blood Count (CBC)

This is to determine blood components and the response to inflammatory process
or if there is a presence of infection.
Date Ordered: 06/21/06
Date Result In: 06/21/06
Results:
Hct- 20.3 %
Platelet- 22.6
WBC- 24.4 g/l
Granulocytes- 3
Lympho/Mono- 17
Hgb- 67
Conclusion: WBC is elevated based on the normal value of 4.3-10 g/l which
confirms the presence of infection
2. Fasting Blood Sugar
This is to measure the blood glucose levels
Date Ordered: 06/19/06
Date Result In: 06/19/06
Results:
107 mg/dl
Conclusion: the result is within normal range based on the normal value of < 126
mg/dl.
3. BUN
This is an indicator of renal function and perfusion, dietary intake of CHON and
the level of protein metabolism.
Date Ordered: 06/19/06
Date Result In: 06/19/06
Results:
17.4 mg/dl
 Conclusion: the result is within normal range based on the normal value of 7-21
mg/dl.
4. Creatinine
In men with symptoms, blood tests are performed to measure a substance called
serum creatinine, which is a marker for kidney trouble. Kidney problems exist in an average of
13.6% of BPH patients. Studies have reported rates as high as 30% and as low as 0.3%.

Date Ordered: 06/22/06

Date Result In: 06/22/06
Results:
1.0 mg/dl
Conclusions:
The result is within normal range based on the normal value of 0.60-1.7 mg/dl.

5. Urinalysis
A urinalysis may be performed to detect signs of bleeding or infection. A
urinalysis involves a physical and chemical examination of urine. In addition, the urine is
spun in a centrifuge to allow sediments containing blood cells, bacteria, and other
particles to collect. This sediment is then examined under a microscope. Although urinary
infection is uncommon in younger men, it occurs more frequently in older men,
particularly those with BPH. A urinalysis also helps rule out bladder cancer.

Date Ordered: 06/22/06

Date Result In: 06/22/06
Results:
Color- yellow
Specific Gravity- 0.010
pH- 7.5
Appearance- turbid
Pus cells- 1-3 hpf
Red cells- 15-25 hpf
 Conclusions:
The results are almost normal but there is a presence of pus cells in the urine
which indicates the presence of infection and presence of red cells that indicates the
presence of blood in the urine.

6. Fecalysis
Aids in the evaluation of the digestive efficiency and the integrity of the stomach
and intestines.
Date Ordered: 06/19/06
Date Result In: 06/19/06
Results:
Color- dark brown
Consistency- soft
Conclusions:
The results are normal.

7. Transcortin, also called corticosteroid binding protein or CBG

Is an alpha-globulin that has high affinity for binding cortisol. Measures urinary cortisol
and is performed in clients suspected of hyperfunction or hypofunction of adrenal gland.

8. Chest X-ray
This is to rule out respiratory cause of referred pain. May be obtained to detect
pulmonary disease and the status of respiratory problems or trauma.

9. Electrocardiogram/ECG
Is an essential tool in evaluating cardiac rhythm. Electrocardiography detects and
amplifies the very small electrical potential changes between different points on the surface of
the body as a myocardial cell depolarize to repolarize, causing the heart to contract.
 10. Colonoscopy
Is the endoscopic visualization of the large intestine from rectum to cecum. It is the
visual examination of the lining of the entire colon with a flexible fiber optic endoscope.

Other diagnostic procedure that can be used to diagnosed Benign Prostatic Hyperplasia
a. Rectal examination

Palpation of the prostate through the rectum may reveal a markedly enlarged prostate. It
is dependent on the skills of the doctor. It has to be borne in mind that rectal examination can
increase PSA levels in patients without malignancy. The test helps rule out prostate cancer or
problems with the muscles in the rectum that might be causing symptoms, but it generally
underestimates the prostate's size. It is not accurate for diagnosing prostate cancer, and is never
the primary diagnostic tool for either BPH or cancer.

b. Uroflowmetry

To determine whether the bladder is obstructed, the speed of urine flow is measured
electronically using a test called uroflowmetry. The test cannot determine the cause of
obstruction, which can be due not only to BPH, but possibly also to abnormalities in the urethra,
weak bladder muscles, or other causes.

c. Urethrocystoscopy

A urethrocystoscopy, also called cystourethroscopy, may be performed in men diagnosed

with BPH, particularly if they are surgical candidates or if other urinary tract problems are
suspected. Such problems include blood in the urine, infection, interstitial cystitis, bladder
cancer, or prior surgery or injury. The physician can determine the presence of a number of
structural problems, including enlargement of the prostate, obstruction of the urethra or neck of
the bladder, anatomical abnormalities, or the presence of stones.

d. Postvoid Residual Urine

One of the important tests for urinary incontinence is the postvoid residual urine volume
(PVR), the amount of urine left after urination. Normally, about 50 mL or less of urine is left;
more than 200 mL is a definite sign of abnormalities. Measurements in between require further
tests. The most common method for measuring PVR is with a catheter, a soft tube that is inserted
into the urethra within a few minutes of urination. PVR can also be measured using
transabdominal ultrasonography.

e. Ultrasound

Ultrasound of the prostate does not require a catheter and gives an accurate picture of the
size and shape of the prostate gland. Ultrasound is very beneficial when planning surgery and
determining treatment options and gauging their effectiveness. Ultrasound may also be used for
detecting kidney damage, tumors, and bladder stones.
 VI. PATIENTS CARE

a. Nursing Care Plan

1. Impaired urinary elimination related to increase urethral occlusion

Cues Nursing Scientific Objectives Nursing Rationale Evaluation

Diagnosis Explanations Interventions
S Impaired Due to After 3 hours of 1. Monitor vital - Loss of kidney -Does the
The patient may urinary hyperplasia of nursing signs closely. function results patient able to
verbalized elimination the prostate intervention the Observe for in decreased manage the
difficulty in related to gland the patient will be hypertension, fluid elimination manifestations
urinating. increase urethra is being able to manage peripheral/dependent and of the disease;
urethral blocked causing the edema, changes in accumulation of a. nocturia
occlusion obstruction in manifestation of mentation. Maintain toxic wastes b. dysuria
O the flow of urine the disease. accurate I&O. may progress to c.
Patient may that leads to complete renal incontinence
manifest one or bothersome shutdown. d. hesitancy
more of the LUTS, thus an to urinate?
following: impairment in 2. Encourage oral - *Increased
- (+) nocturia the urinary fluids up to 3000 mL circulating
- (+) elimination. daily, within cardiac fluid
incontinence tolerance, if maintains
- (+) dysuria indicated. renal
- (+) facial perfusion and
grimaces flushes
upon kidneys,
urination bladder, and
- (+) edema ureters of
- pt may also be “sediment
seen with an and bacteria.”
indwelling Note:
catheter Initially,
connected with fluids may be
the urine bag restricted to
prevent
bladder
distension
until adequate
urinary flow
is
reestablished.

3. Encourage - may minimize

patient to void every over distension
2-4 hours and when of the bladder.
urge is noted.

4. Encourage - reduces risk

meticulous catheter of ascending
and perineal care infection
 2. Activity intolerance related to body malaise

Cues Nursing Scientific Objectives Nursing Rationale Evaluation

Diagnosis Explanations Interventions
S Activity Activity is a After 3 hours of 1. Monitor vital - to know the a. Does the pt
The patient may intolerance natural process nursing signs. present status of able to
verbalize body related to body and a vigorous intervention the the patient understand
malaise. malaise motion of action. patient will be the health
When one able to verbalize 2. Encourage to - to optimize teachings
O manifested understanding of increase fluid hydration status given?
Patient may insufficient the health intake b. Does he able
manifest one or physiologic and teachings given to increase
more of the psychologic to increase 3. Encourage to - increase body muscle
following: functional muscle strength eat foods rich in resistance strength?
- (+) body changes he vitamin C and
malaise endure a simple intake of
- (+) facial task this resulted nutritious food
grimaces to activity
upon moving intolerance 4. Encourage pt - to promote
- (+) edema to perform proper blood
PROM as circulation
tolerated

5. Encourage pt - to optimize
to change circulation to all
position every 2 tissues and to
hours relieve pressure

6. Encourage pt - to prevent
to use injury.
appropriate
assistive devices
 3. Risk for infection related to periodic catheterization

Cues Nursing Scientific Objectives Nursing Rationale Evaluation

Diagnosis Explanations Interventions
S Risk for The pt’s disease After an hour of 1. Monitor vital - Indicators of a. Does the
The patient may infection related condition causes nurse patient signs for fever. sepsis requiring patient
verbalize body to periodic some obstruction interaction the prompt understand
malaise. catheterization in the flow of patient will be evaluation and individual
urine enabling able to verbalize intervention. causative/
him to need understanding on risk factors?
O catheterization to the health 2. Encourage - to maintain b. Does the
Pt. may be seen empty this teachings given. increase fluid renal function patient able
with an bladder. intake and prevent to identify
indwelling Through this it development of interventions
catheter enable bacteria infection to reduce/
connected with contained within prevent risk
the urine bag the prostatic 3. Emphasize - Prevents cross- of infection.
- (+) nocturia acini to reach the good hand contamination;
- (+)body bladder thus washing reduces risk of
malaise increase the risk technique for all acquired
- (+) of urinary individuals infection.
hematuria infection coming in
- (+) febrile contact with
patient.

4. Encourage - reduces risk of

meticulous ascending
catheter and infection
perineal care

5. Provide - Prevents
sterile or freshly exposure to
laundered bed infectious
linens/gowns organisms.

6. Monitor/limit - Prevents cross-

visitors, if contamination
necessary. from visitors.

7. Administer -Reduces
antibacterial as bacteria present
ordered. in urinary tract
and those
introduced by
drainage system.
 4. Sleep pattern disturbance related to urinary incontinence

Cues Nursing Scientific Objectives Nursing Rationale Evaluation

Diagnosis Explanations Interventions
S Sleep pattern Patients with After 3 hours of 1. Determine - address a. Does the pt
The patient may disturbance BPH often nursing clients SO’s opportunity to able to relax and
verbalize related to urinary experience intervention the expectations of address gain enough
frequency in incontinence excessive patient will be adequate sleep misconceptions sleep?
urination at urination at able to verbalize b. Does he still
night. night. This understanding of 2. Encourage - napping in experience
symptom often individual mid morning nap afternoon can nocturia?
indicates that the appropriate if one is required disrupt normal
bladder outlet is intervention to sleep patterns
O obstructed. And promote sleep.
Patient may due to this the 3. Provide quiet - in preparation
manifest one or patient sleep is and comfortable for sleep
more of the being affected environment
following: because he is
- (+) dark often disturb 4. Limit fluid - to reduce
circles with the urge to intake in evening nighttime
around the urinate at night. if nocturia is a elimination
eyes problem
- Appears
weak and
irritable
- Restless
- Noted
frequent
yawning
- (+) nocturia
 5. Ineffective therapeutic regimen related to lack of understanding of disease, manifestations, and medical treatments

Cues Nursing Scientific Objectives Nursing Rationale Evaluation

Diagnosis Explanations Interventions
S Ineffective There is some After an hour of 1. Provide - to diminish - Does the
The patient may therapeutic information nurse patient teachings about client’s anxiety patient able to
verbalize regimen related about the disease interaction the BPH regarding regarding the understand all
concerns to lack of of the patient patient will be the disease process of his the information
regarding his understanding of that he does not able to process, how to disease, the given?
condition. disease, understand that understand the prevent and effects of this
manifestations, leads to course of his alleviate its disease to his - Is there a
and medical ineffective disease, complications. lifestyle, and thesignificant
O treatments follow-up with manifestations complications changes that
Patient may the course of and medical that the disease occur on the
manifest one or therapy. treatments. could develop. patients
more of the knowledge
following: 2. Encourage - pt with BPH regarding;
- Frequently fluid intake. tend to limit c. disease
asking their fluids condition
question intake to combat d. diet
about his its manifestation e. treatment
condition, needless did they f. medication
treatment know that a g. self-care
and diet concentrated needs
- With worried urine exacerbate
gaze LUTS and - Does the
- Minimal increase risk of patient able to
response upon UTI. comply with the
assessment and 3. Explain - to provide entire therapeutic
questioning medications; knowledge about regimen given?
how it works, its the medications
side effects and being given to
precautions. the patient
 b. Drug Study

Name of Drug Date Route/ Action Indication Adverse Nursing Consideration

Ordered Dosage and Reaction
Frequency
GN: 06-18-06 IV - Cephalosporin - for UTI - phlebitis, 1. Check for doctor’s order
o
Cefuroxime 750 mg, Q8 - serious nausea and 2. Perform ANST prior to
BN: infections of vomiting, admission
Kepox lower respiratory diarrhea, 3. Should not be given if
and urinary tracts anorexia, positive skin test
hypersensitivi 4. Slow IV push
ty reactions 5. Inform the patient about the
possible side effect of the drug
6. Advise patient to report any
discomfort on the IV insertion
site

GN: 06-19-06 PO - Hematinics - for excessive - Nausea and 1. Check for doctor’s order
FeSO4 500 mg, bleeding vomiting, 2. not to be given in patients with
BN: cap, OD black stools, hemosiderosis
Iberet epigastric 3. Inform the patient about the
pain possible side effect of the drug
4. Instruct patient to take drug
with food
5. Advise patient to report
abdominal pain or blood in
stools or is vomiting.
6. monitor hemoglobin,
hematocrit, and retuculocyte
count during therapy.
Name of Drug Date Route/ Action Indication Adverse Nursing Consideration
Ordered Dosage and Reaction
Frequency
GN: 06-19-06 PO - Inotropic - for heart failure - fatigue, 1. Check for doctor’s order
Digoxin 0.25 mg, - for proxysmal headache, 2. not to be given in patients
BN: tab, OD ventricular weakness, hypersensitive to drugs
Lanoxin tachcardia yellow vision, 3. Inform the patient about the
nausea and possible side effect of the drug
vomiting 4. Monitor apical pulse for1 full
minute before administering
5. Monitor intake and output
ratios. Assess for peripheral
edema, and auscultate lungs for
rales/crackles throughout therapy
6. Observe client for toxicity,
including symptoms of
headache, visual disturbances,
nausea and vomiting, anorexia,
or disorientation.
7. Monitor potassium levels and
encourage intake of potassium
rich foods
8. Taking digoxin with meals
may decrease gastric irritation
9. Hypothyroid clients are
particularly sensitive to these
drugs
Name of Drug Date Route/ Action Indication Adverse Nursing Consideration
Ordered Dosage and Reaction
Frequency
GN: 06-19-06 PO -Anti-anginal - acute anginal - Nausea and 1. Check for doctor’s order
trimetazidine Tab, BID attacks Vomiting, 2. Monitor blood pressure and
diHCL - prevent situation headache, pulse rate before and after giving
BN: that may cause edema the meds.
Vastarel MR anginal attacks 3. Notify prescribing signs of
heart failure such as swelling of
hands and feet or SOB.
4. Advise patient of the side
effects of the drug.

GN: 06-19-06 IV -anti- - prevent - Nausea, 1. Check for doctor’s order

Tranexamic 500 mg, fibrinolytic excessive vomiti 2. Perform ANST prior to
acid Q6 o bleeding vision admission
BN: changes, 3. Should not be given if
Hemostan dizziness positive skin test
diarrhea, 4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Advise patient to report any
discomfort on the IV insertion
site
7. Provide safety
Name of Drug Date Route/ Action Indication Adverse Nursing Consideration
Ordered Dosage and Reaction
Frequency
GN: 06-19-06 IV -Antihemorrhagic - prevent - Dizziness, 1. Check for doctor’s order
o
Vitamin K 10 mg, Q8 hypoprothrombi flushing,
BN: nemia related to transient 2. Perform ANST prior to
vitamin k hypotension admission
deficiency in after IV
long term administration 3. Should not be given if
parenteral , rapid and positive skin test
nutrition weak pulse,
pain and 4. Slow IV push
hematoma
5. Inform the patient about the
possible side effect of the drug

6. Monitor BP, PR, and RR

before and after administration.

7. Advise patient to report any

discomfort on the IV insertion
site

8. Provide safety

9. teach patient that foods that

provide vitamin K include
cabbage, cauliflower, eggs, fish
and dairy products
Name of Drug Date Route/ Action Indication Adverse Nursing Consideration
Ordered Dosage and Reaction
Frequency
GN: 06-19-06 IV -antiprotozoal - for bacterial - fever, 1. Check for doctor’s order
Metronidazole 500 mg, infection caused vertigo,
BN: Q6 o by anaerobic syncope, 2. Perform ANST prior to
Flagyl microorganisms weakness, admission
N/V, darkened
urine, metallic 3. Should not be given if
taste positive skin test

4. Slow IV push

5. Inform the patient about the

possible side effect of the drug

6. Monitor liver function test

results carefully in elderly
patients.

7. Observe for edema.

8. Tell patient that metallic taste

and dark or red-brown urine may
occur.

9. Advise patient to report any

discomfort on the IV insertion
site

10. Provide safety

Name of Drug Date Route/ Action Indication Adverse Nursing Consideration
Ordered Dosage and Reaction
Frequency
GN: 06-19-06 PO -Anti-anginal - acute anginal - Nausea and 1. Check for doctor’s order
Isosorbide 5 mg, Tab, attacks Vomiting, 2. Monitor blood pressure and
Dinitrate TID - prevent headache, pulse rate before and after giving
BN: situation that the meds.
Isordil may cause 3. Notify prescribing signs of
anginal attacks heart failure such as swelling of
hands and feet or SOB.
4. Advise patient of the side
effects of the drug.
Name of Drug Date Route/ Action Indication Adverse Nursing Consideration
Ordered Dosage and Reaction
Frequency
GN: 06-20-06 PO -alpha-blockers - for enlarged • Headache 1. Check for doctor’s order
Alfuzosin HCL 10 mg, OD prostate gland • Dry mouth 2. Assess pt for signs of BPH
BN: • postural (Urinary hesistancy, feeling of
Xatral hypotension incomplete bladder emptying,
• Drowsiness interruption of urinary stream,
• palpitations impairement of sixe and force
• Flushing of urinary stream, terminal
• edema urinary bleeding, dysuria,
• asthenia urgency) before and
• Chest pain periodically during therapy
• tachycardia 3. Monitor blood pressure and
• syncope pulse rate before and after
• Rash or giving the meds.
itching 4. Assess patient for
• nausea, orthostatic reaction and
vomiting, syncope.
diarrhea or 5. Caution patient to avoid
abdominal sudden changes in position to
pain decrease orthostatic
• vertigo hypotension
Dizziness 6. Instruct patient to take
medicine with the same meal
each day.
7. Instruct patient of the side
effect of the drug.
c. Medical/ Surgical Management

a. Intravenous Rehydration
When the fluid loss is severe or life threatening, IV fluids are used for
replacement.

b. Blood Transfusion
It may be necessary for replacement of RBC to WBC, platelets or blood
proteins

c. Folley Catheter
To facilitate accurate measurement of urinary output for critically ill
clients whose output need to be monitored hourly. It is also used to manage
incontinence when other measures have failed.

d. Lavage
The process of washing out an organ, usually the bladder, bowel, paranasal
sinuses, or stomach for therapeutic purposes.

e. Watchful Waiting.
Watchful waiting involves lifestyle changes and an annual examination. It
should be noted that even when choosing watchful waiting, an initial examination
is critical to rule out other disorders.

f. Transurethral resection of the prostate (TURP)

Involves surgical removal of the inner portion of the prostate where BPH
develops. It is the most common surgical procedure for BPH
 VII. Clients Daily Progress

DAYS Admission Day 2 Day3 Day 4 Discharge

06-18-06 06-19-06 06-20-06 06-21-06 06-22-06
Nursing Problem:
Impaired urinary elimination * * * * *
Activity intolerance * * * * *
Risk for infection * * * * *
Sleep pattern disturbance * * * * *
Ineffective therapeutic regimen * * * * *
Vital Signs: BP- 110/70 BP- 110/70 BP- 130/70 BP- 100/60 BP- 110/60
mmHg mmHg mmHg mmHg mmHg
PR- 80 bpm PR- 80 bpm PR- 60 bpm PR- 80 bpm PR- 80 bpm
RR- 21 bpm RR- 20 bpm RR- 21 bpm RR- 19 bpm RR- 21 bpm
Temp- 36.7 oC Temp- 36.1 oC Temp- 37.7 oC Temp- 36.8oC Temp- 36.5 oC
Dx & Lab Procedures
CBC * * *
CREA *
BUN *
HGT * * *
NA+, K+ *
FBS *
UA *
FA *
12-Lead ECG *
CBG * *
CX-RAY *
Colonoscopy *
 Medical & Surgical Management
Garlic Lavage * *
BT *
Folley catheter * * * * *
Pnss, 1L x 20 gtts/min *
D5LRS, 1L x 30 gtts/min * * * *
D5050 *
Drugs
Kepox * * * * *
Iberet * * * *
Lanoxin * * * *
Vastarel MR * * * *
Hemostan * * * *
Vitamin K * * * *
Metronidazole * * * *
Isordil Dinitrate * * * *
Xatral * * *
Diet
DAT
NPO
Soft Diet
Activity & Exercise
CBR without BRP
PROM
 VIII. DISCHARGE PLANNING

M - Instructed the patient to continue medication as ordered

1. Iberet 500 mg cap once a day (8am)
2. Lanoxin 0.25 mg tab once a day (8am)
3. Vastarel MR tab 2 x day (8am-1pm)
4. Isordil 3mg tab 3 x day (8am-1pm-8pm)
5. Xatral 10 mg tab once a day (8am)
E - Instructed the patient to do exercise as tolerated such as walking
T - Instructed the patient to continue the medication
H - 1. Encouraged patient to increase fluid intake
2. Encouraged patient to eat foods rich in Vitamin C and Nutritious foods
3. Encourage patient to avoid salty and fatty foods
4. Encourage patient to have enough rest
O - Instructed to come back for follow-up check-up on June 22, 2006
Wednesday.
D - Advised the patient to a diet as tolerated but preferably avoiding salty and
fatty foods.