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 antihypertensive 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. 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. May be obtained to detect

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

2. Encourage oral fluids up to 3000 mL daily, within cardiac tolerance, if indicated.

connected with the urine bag

fluids may be restricted to prevent bladder distension until adequate urinary flow is reestablished. 3. Encourage patient to void every 2-4 hours and when urge is noted. 4. Encourage meticulous catheter and perineal care - may minimize over distension of the bladder. - reduces risk of ascending infection

2. Activity intolerance related to body malaise Cues S The patient may verbalize body malaise. O Patient may manifest one or more of the following: - (+) body malaise - (+) facial grimaces upon moving - (+) edema Nursing Diagnosis Activity intolerance related to body malaise Scientific Explanations Activity is a natural process and a vigorous motion of action. When one manifested insufficient physiologic and psychologic functional changes he endure a simple task this resulted to activity intolerance Objectives After 3 hours of nursing intervention the patient will be able to verbalize understanding of the health teachings given to increase muscle strength Nursing Interventions 1. Monitor vital signs. 2. Encourage to increase fluid intake 3. Encourage to eat foods rich in vitamin C and intake of nutritious food 4. Encourage pt to perform PROM as tolerated 5. Encourage pt to change position every 2 hours 6. Encourage pt to use appropriate assistive devices Rationale - to know the present status of the patient - to optimize hydration status - increase body resistance Evaluation a. Does the pt able to understand the health teachings given? b. Does he able to increase muscle strength?

- to promote proper blood circulation - to optimize circulation to all tissues and to relieve pressure - to prevent injury.

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

3. Emphasize good hand washing technique for all individuals coming in contact with patient. 4. Encourage meticulous catheter and perineal care 5. Provide sterile or freshly laundered bed

- reduces risk of ascending infection - Prevents exposure to infectious

linens/gowns 6. Monitor/limit visitors, if necessary. 7. Administer antibacterial as ordered.

organisms. - Prevents crosscontamination from visitors. -Reduces bacteria present in urinary tract and those introduced by drainage system.

4. Sleep pattern disturbance related to urinary incontinence Cues S The patient may verbalize frequency in urination at night. Nursing Diagnosis Sleep pattern disturbance related to urinary incontinence Scientific Explanations Patients with BPH often experience excessive urination at night. This symptom often indicates that the bladder outlet is obstructed. And due to this the patient sleep is being affected because he is often disturb with the urge to urinate at night. Nursing Interventions After 3 hours of 1. Determine nursing clients SO’s intervention the expectations of patient will be adequate sleep able to verbalize understanding of 2. Encourage individual mid morning nap appropriate if one is required intervention to promote sleep. 3. Provide quiet and comfortable environment Objectives Rationale - address opportunity to address misconceptions - napping in afternoon can disrupt normal sleep patterns - in preparation for sleep Evaluation a. Does the pt able to relax and gain enough sleep? b. Does he still experience nocturia?

O Patient may manifest one or more of the following: - (+) dark circles around the eyes - Appears weak and irritable - Restless - Noted frequent yawning - (+) nocturia

4. Limit fluid - to reduce intake in evening nighttime if nocturia is a elimination problem

5. Ineffective therapeutic regimen related to lack of understanding of disease, manifestations, and medical treatments Cues S The patient may verbalize concerns regarding his condition. O Patient may manifest one or more of the following: - Frequently asking question about his condition, treatment and diet - With worried gaze - Minimal response upon assessment and questioning Nursing Diagnosis Ineffective therapeutic regimen related to lack of understanding of disease, manifestations, and medical treatments Scientific Explanations There is some information about the disease of the patient that he does not understand that leads to ineffective follow-up with the course of therapy. Objectives After an hour of nurse patient interaction the patient will be able to understand the course of his disease, manifestations and medical treatments. Nursing Interventions 1. Provide teachings about BPH regarding the disease process, how to prevent and alleviate its complications. Rationale - to diminish client’s anxiety regarding the process of his disease, the effects of this disease to his lifestyle, and the complications that the disease could develop. Evaluation - Does the patient able to understand all the information given?

2. Encourage fluid intake.

3. Explain medications; how it works, its side effects and precautions.

- Is there a significant changes that occur on the patients knowledge - pt with BPH regarding; tend to limit c. disease their fluids condition intake to combat d. diet its manifestation e. treatment needless did they f. medication know that a g. self-care concentrated needs urine exacerbate LUTS and - Does the increase risk of patient able to UTI. comply with the - to provide entire therapeutic knowledge about regimen given? the medications being given to the patient

b. Drug Study Name of Drug GN: Cefuroxime BN: Kepox Date Ordered 06-18-06 Route/ Action Dosage and Frequency IV - Cephalosporin o 750 mg, Q8 Indication - for UTI - serious infections of lower respiratory and urinary tracts Adverse Reaction - phlebitis, nausea and vomiting, diarrhea, anorexia, hypersensitivi ty reactions Nursing Consideration 1. Check for doctor’s order 2. Perform ANST prior to admission 3. Should not be given if positive skin test 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

GN: FeSO4 BN: Iberet

06-19-06

PO 500 mg, cap, OD

- Hematinics

- for excessive bleeding

- Nausea and vomiting, black stools, epigastric pain

1. Check for doctor’s order 2. not to be given in patients with hemosiderosis 3. Inform the patient about the 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 GN: Digoxin BN: Lanoxin

Date Ordered 06-19-06

Route/ Action Dosage and Frequency PO - Inotropic 0.25 mg, tab, OD

Indication - for heart failure - for proxysmal ventricular tachcardia

Adverse Reaction - fatigue, headache, weakness, yellow vision, nausea and vomiting

Nursing Consideration 1. Check for doctor’s order 2. not to be given in patients hypersensitive to drugs 3. Inform the patient about the possible side effect of the drug 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 GN: trimetazidine diHCL BN: Vastarel MR

Date Ordered 06-19-06

Route/ Action Dosage and Frequency PO -Anti-anginal Tab, BID

Indication - acute anginal attacks - prevent situation that may cause anginal attacks

Adverse Reaction - Nausea and Vomiting, headache, edema

Nursing Consideration 1. Check for doctor’s order 2. Monitor blood pressure and pulse rate before and after giving the meds. 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: Tranexamic acid BN: Hemostan

06-19-06

IV 500 mg, Q6 o

-antifibrinolytic

- prevent excessive bleeding

- Nausea, vomiti vision changes, dizziness diarrhea,

1. Check for doctor’s order 2. Perform ANST prior to admission 3. Should not be given if positive skin test 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 GN: Vitamin K BN:

Date Ordered 06-19-06

Route/ Action Dosage and Frequency IV -Antihemorrhagic o 10 mg, Q8

Indication - prevent hypoprothrombi nemia related to vitamin k deficiency in long term parenteral nutrition

Adverse Reaction - Dizziness, flushing, transient hypotension after IV administration , rapid and weak pulse, pain and hematoma

Nursing Consideration 1. Check for doctor’s order 2. Perform ANST prior to admission 3. Should not be given if positive skin test 4. Slow IV push 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 GN: Metronidazole BN: Flagyl

Date Ordered 06-19-06

Route/ Action Dosage and Frequency IV -antiprotozoal 500 mg, Q6 o

Indication - for bacterial infection caused by anaerobic microorganisms

Adverse Reaction - fever, vertigo, syncope, weakness, N/V, darkened urine, metallic taste

Nursing Consideration 1. Check for doctor’s order 2. Perform ANST prior to admission 3. Should not be given if 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 GN: Isosorbide Dinitrate BN: Isordil

Date Ordered 06-19-06

Route/ Action Dosage and Frequency PO -Anti-anginal 5 mg, Tab, TID

Indication - acute anginal attacks - prevent situation that may cause anginal attacks

Adverse Reaction - Nausea and Vomiting, headache,

Nursing Consideration 1. Check for doctor’s order 2. Monitor blood pressure and pulse rate before and after giving the meds. 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.

Name of Drug GN: Alfuzosin HCL BN: Xatral

Date Ordered 06-20-06

Route/ Action Dosage and Frequency PO -alpha-blockers 10 mg, OD

Indication - for enlarged prostate gland

Adverse Reaction Headache • Dry mouth • postural hypotension • Drowsiness • palpitations • Flushing • edema • asthenia • Chest pain • tachycardia • syncope • Rash or itching • nausea, vomiting, diarrhea or abdominal pain • vertigo Dizziness

Nursing Consideration 1. Check for doctor’s order 2. Assess pt for signs of BPH (Urinary hesistancy, feeling of incomplete bladder emptying, interruption of urinary stream, impairement of sixe and force of urinary stream, terminal urinary bleeding, dysuria, urgency) before and periodically during therapy 3. Monitor blood pressure and pulse rate before and after giving the meds. 4. Assess patient for orthostatic reaction and syncope. 5. Caution patient to avoid sudden changes in position to decrease orthostatic hypotension 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 Admission 06-18-06 * * * * * BP- 110/70 mmHg PR- 80 bpm RR- 21 bpm Temp- 36.7 oC * * * * * * * * * * * Day 2 06-19-06 * * * * * BP- 110/70 mmHg PR- 80 bpm RR- 20 bpm Temp- 36.1 oC * * Day3 06-20-06 * * * * * BP- 130/70 mmHg PR- 60 bpm RR- 21 bpm Temp- 37.7 oC * * Day 4 06-21-06 * * * * * BP- 100/60 mmHg PR- 80 bpm RR- 19 bpm Temp- 36.8oC Discharge 06-22-06 * * * * * BP- 110/60 mmHg PR- 80 bpm RR- 21 bpm Temp- 36.5 oC

DAYS Nursing Problem: Impaired urinary elimination Activity intolerance Risk for infection Sleep pattern disturbance Ineffective therapeutic regimen Vital Signs:

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. M -

DISCHARGE PLANNING

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 T H

-

Instructed the patient to do exercise as tolerated such as walking Instructed the patient to continue the medication 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 D

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Instructed to come back for follow-up check-up on June 22, 2006 Wednesday. Advised the patient to a diet as tolerated but preferably avoiding salty and fatty foods.

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