You are on page 1of 8

I . I n t r o d u c t i o n T h e p r o s t a t e i s t h e g e n i t a l o r g a n m o s t c o m m o n l y a f f e c t e d b y b e n i g n a n d m a l i g n a n t n e opl as m. B e ni g n enl ar g e m e nt of t h e pr ostat e g l an d i s a n e xtr e m el y co m m on p r oce ss tha toccurs in nearly all men with functioning testes.

Hyperplasia is a general medical term referringto ex ces s c el l r ep l i cati on . Be ni g n pr ost ati c hy p er pl asi a (BPH ) i s a no nca nc er o us g r ow t h o f t h e pr ostat e g l an d. I t i s t h e m ost c o mm o n n on can cer ou s for m of c el l g r ow th i n me n an d usu al l y b e g i n s w i t h m i c r o s c o p i c n o d u l e s i n y o u n g e r m e n . I t s h o u l d b e n o t e d t h a t B P H i s n o t a precancerous condition.Some studies have suggested that African American men are at higher risk and Asian menat lower risk for BPH than Caucasians, a 2000 study found no greater risk for African Americansa n d o n l y a s l i g h t l y l o w e r r i s k f o r A s i a n s . A m o n g C a u c a s i a n s i n t h e s t u d y , m e n o f s o u t h e r n Eur op ea n h er i tag e w er e at g r eat er r i sk w hi l e m e n of Scan di n avi an a nce str y ha d a l ow er c han ce of developing BPH.H i st ol og i c e vi d enc e of pr ostat e e nl ar g e m en t b eg i ns ab o ut th e thi r d de cad e o f l i f e an di n cr eas es pr op or ti onal l y w i th ag i n g . S p eci fi cal l y, a bo ut 43% o f m en i n t h ei r 40s w i l l hav eevidence 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.S o m e e v i d e n c e h a s r e p o r t e d a h i g h e r i n c i d e n c e o f b e n i g n p r o s t a t i c h y p e r p l a s i a - - particularly fastgrowing BPH -- in men with obesity, heart and circulatory diseases, and type 2di ab et es . Di ab et es a nd h yp er t en si o n, i n a ny cas e, w or se ns ur i n ar y tr a ct sy mp to ms i n me n w i th BPH . I n o n e st ud y, fl ow r at es w er e a dv er sel y af fe ct ed b y di ab et es , al tho ug h r esi d ual ur i n evolumes were not significantly greater.Th e e x act c aus e o f BPH i s un kn ow n. P ot en ti al r i sk fac tor s i ncl u de ag e, fa mi l y hi st or y,r ac e, et hni ci t y, an d h or mo nal fact or s. A ndr og e ns ( mal e hor m on es) mo st l i kel y pl ay a r ol e i n pr os tat e g r ow th . T he mo st i m por t ant a ndr og e n i s testosterone , w hi ch i s pr od uc ed t hr o ug ho ut am a n ' s l i f e t i m e . T h e p r o s t a t e c o n v e r t s t e s t o s t e r o n e t o a m o r e p o w e r f u l a n d r o g e n , dihydrotestosterone ( DHT ). DHT stimulates cell growth in the tissue that lines the prostate gland( th e g l an dul ar e pi t hel i u m) a nd i s t he maj or ca us e of t h e r api d pr ostat e enl ar g e m en t tha t occ ur s between puberty and young adulthood. DHT is a prime suspect in prostate enlargement in later ad ul t ho o d. A ddi ti o nal f act or s al s o i ncl ud e a d ef ecti v e c el l d eat h i n w hi c h cel l s na tur al l y sel f destruct, goes awry and results in cell proliferation a process called as apoptosis . A s B P H p r o g r e s s e s , o v e r g r o w t h o c c u r s i n t h e c e n t r a l a r e a o f t h e prostate called the transition zone, which wraps around the urethra (the tubethat carries urine through the penis). This pressure on the urethra can causel o w e r u r i n a r y symptoms that have been the basis for diagnosi ng BPH. Itshould be noted that BPH is not always t h e c a u s e o f t h e s e s y m p t o m s . A n enlarged prostate may be accompanied by few symptoms, while severe LUTSmay be present with normal or even small prostates and are most likely duet o ot h er c o n di ti o ns . Sy mpt o ms o f BPH ma y i ncl u d e; Difficulty in starting to passur i n e ( h esi ta ncy) , a w eak str ea m of ur i ne , dr i b bl i ng aft er ur i nati ng , t he ne e d to s tr ai n to pass urine, incomplete emptying of bladder, difficulty to control the urination urge, having to get upseveral times in the night to pass urine, feeling a burning sensation when passing urine.So m eti mes a man i s u n aw ar e of a n o bstr u cti o n u nti l h e su d de nl y can n ot ur i nat e at al l .This condition is called acute urinary retention. It is a dangerous complication that can damageth e ki d n eys an d ma y r eq ui r e e m er g e ncy s ur g er y. I n g e n er al , BPH pr og r ess es v er y s l ow l y a nd acu te ur i nar y r et e nti o n i s v er y u nc o mm o n. Me n w i th B PH at hi g h est r i sk for t hi s co m pl i cati o nt e n d t o b e e l d e r l y a n d t o h a v e m o d e r a t e t o s e v e r e l o w e r v o i d i n g s y m p t o m s . T a k i n g a n t i - hy per t e nsi ve dr ug s ( exc e pt f or di ur e ti cs) or a nti ar r hyt h mi c dr ug s may al s o i ncr ea se t h e r i sk . Bladder obstruction can also cause bladder stones, blood in the urine, urinary tract infection, andincontinence. 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.Di ag n osti c t est s us ed to c onfi r m Be ni g n Pr osta ti c H y p er pl asi a i ncl ud e Di g i tal Rec tal Exam, Urinalysis, Serum Creatinine, Postvoid Residual Urine, Ultrasound, Urethrocystoscopy I I . N U R S I N G A S S E S S M E N T A . P e r s o n a l H i s t o r y Mr . Ru b e n Ju c o i s a 8 2 y ea r s ol d ma l e, who r e si d e s a t Pu r ok 4 Je su s St. Pu lu n g Bu l o, Angeles City. His religious affiliation is Roman Catholic and is married to Mrs. Rita Juco. Mr.Ju c o ha d pr e vi ou sl y wo rk e d a t Cla rk -a ir ba se d Pa m pa nga . H e l o ss h i s jo b wh en t h e Ame ri ca n sol di er lea v e Pa m pa nga . Si n c e th e n , h e n e v er ha d a j o b a n d ju st sta y s i n t h e ir h o m e. M r. Ju c ou su a l ly sl e e p s a t 1 0 in t h e e v en i ng a nd wa k e s u p a t a r ou n d 4 i n t h e m or ni n g. Mr. Ju co u su a lly spends time watching TV, dawdle in front of their house, chatting with his neighbors and goingt o a ma rk et v ia bi c y cl e. Mr. Ju c o u su a l v ia n d i n clu d e s c hi ck e n, fi sh o r m ea t a n d ri ce . He a l soloves eating bread and drinking milk. Before, he used to love eating

tinapa, sardines, tocino and bagoong. He a l so sm ok e s b e for e a n d i s a b l e t o co n su m e 1 pa ck o f ci ga r et t e a da y. H e dri nk sa l c o h o l b e v e r a g e s o c c a s i o n a l l y . R e g a r d i n g t h e f i n a n c e s a b o u t h e a l t h h e i s u s i n g h i s PHILHEALTH card to compensate the finances needed.B . F a m i l y H e a l t h a n d I l l n e s s H i s t o r y A c c o r d i n g t o M r . J u c o , t h e f a m i l i a l d i s e a s e t h a t t h e y h a v e i n t h e f a m i l y i s D i a b e t e s M e lli tu s. Hi s m ot h er ha s D M a nd di e d o f na tu ra l ca u se whi l e hi s fa t h er d i e d o f str ok e. H e ha ss e v e n s i b l i n g s a n d o n e d i e d d u e t o s t r o k e . H e a l s o a d d e d t h a t h e i s t h e o n l y m e m b e r i n t h e family who has BPH.C .Hi st or y o f Pa st a n d Pr e se nt Ill n e ssIt is the first time of Mr. Juco to be confined in a hospital. But he always goes to AngelesMedical 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 saltand rich in preservatives.As for his present condition, he was admitted to AMC with a chief complaint of blood inth e u ri n e a n d bla ck st o ol a n d wa s dia g n o sed for ha v i ng B PH o r B e ni g n Pr o sta ti c H y pe rp la sia b a s e d o f t h e d i a g n o s t i c p r o c e d u r e h e h a d u n d e r w e n t . O n e w e e k p r i o r t o h i s a d m i s s i o n h e ex p er i en c e s pa i n du ri n g u rina ti o n a n d fin d a t i ng e o f bl o o d in hi s u ri n e. La st Su n da y, Ju n e 1 8 ,2006 he was brought in the hospital at around 10 in the evening due to black stool and hematuria. Up o n a d mi ssi on he ha d u n d er g o n e so m e la bo ra t or y e xa mi na t i o n su c h a s CB C, CR E A, B UN,HGT, NA+ K+, FBS, UA, FA, 12-LEAD ECG, CBG and Chest X-ray. His initial medication isKepox.D . P h y s i c a l E x a m i n a t i o n 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 abdomenVital Signs upon admission (June 18, 2006)BP- 110/70 mmHgRR-21 bpmPR-80 bpmTemp-36.7 o CPhysical Assessment done by the student reveals that patient is; Pink palpebral conjuctiva (+) dry lips (+) dry skin decreased skin turgor (+) paleness (+) edema of hands and feetVital Signs upon admission (June 22, 2006)BP- 110/60 mmHgRR-21 bpmPR-80 bpmTemp-36.5 o C I I . A N A T O M Y A N D P H Y S I O L O G Y The prostate gland is located under the urinary bladder, in front of the rectum and wrapsa r ou n d t h e u r e th ra ( th e tu b e t ha t ca rr i e s u ri n e t hr ou g h t h e p e ni s) . It i s ba si ca l l y c o m po se d o f three different cell types the glandular cells, smooth muscle cells and stromal cellsThe 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.T h e pr o sta te gla n d pr o vi d e s th e fol lo wi n g fu n ct io n s: (1 ) t h e gla n d u la r c ell s pr o du c e 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 enzymecalled 5 alpha-reductase that converts testosterone to dihydrotestosterone, another male hormonethat has a major impact on the prostate.T he pr o sta te gla n d u nd e rg o e s ma n y c ha n g e s du r i ng t h e c ou r se o f a ma n 's l i fe. At bir th ,t h e pr o sta t e i s a b ou t t h e si z e o f a p ea . I t gr o ws on ly sl i gh tl y u nt il pu b e rt y, whe n i t b eg i n s to e n l a r g e r a p i d l y , a t t a i n i n g n o r m a l a d u l t s i z e a n d s h a p e , a b o u t t h a t o f a w a l n u t , w h e n a m a n r ea c h e s hi s ea rl y 2 0 s. T h e gla nd g en e r a lly r e ma i n s sta bl e u n til a bou t t h e mi d -for ti es, wh e n,

in m o s t m e n , t h e p r o s t a t e b e g i n s t o e n l a r g e a g a i n t h r o u g h a pr ocess of cell multiplica tion.H o r m o n a l c h a n g e s a l s o o c c u r i n t h e p r o s t a t e t e s t o s t e r o n e l e v e l s f a l l w h i l e dihydrotestosterone remain at normal levels.

gla nd;

Neurophysiology of Continence and Micturition:The parasympathetic and sympathetic maintains an important role in urinary continence.Du ri n g bla d d er fi lli n g, se n so r y n er v e e n di n g s d et e ct pr o gr e ssi v e str et c h in g o f t h e b la d d er wa l la n d co n v e y in for ma ti o n via t h e pa ra sy m pa t h et i c t o t h e spi na l cor d a n d bra in whi c h pr o du c e sr e fl e x c o ntra c ti o n s in t h e b la d d er n e ck a nd pr o sta t i c u r et hra a s we ll a s in t h e e xt e rna l u r et hra l sphincter thereby maintaining continence.As v olu m e o f u ri n e in cr ea se s, sta rt in g fr o m 3 0 0 -5 0 0 ml ., a wa r en e ss o f t h e n e ed t o v oi d develops. Voluntary voiding is accomplished by stimulation of the parasympathetic nerve fibersca u si n g c o or di na t e d c o ntra c ti o n o f th e d e tru sor mu scl e a nd t h e bla d d er b o d y. N er v e im pu l se s passing down the sympathetic and pudental motor fibers cease momentarily, allowing relaxationof normally tonically contracted bladder neck, prostatic urethra and external thus allowing urineto flow. V.DIAGNOSTIC AND LABORATORYPROCEDURE1 . C o m p l e t e B l o o d C o u n t ( C B C ) This is to determine blood components and the response to inflammatory processor if there is a presence of infection.Date Ordered: 06/21/06Date Result In: 06/21/06Results:Hct- 20.3 %Platelet- 22.6WBC- 24.4 g/lGranulocytes- 3Lympho/Mono- 17Hgb- 67C o n c l u s i o n : W B C i s e l e v a t e d b a s e d o n t h e n o r m a l v a l u e o f 4 . 3 - 1 0 g / l w h i c h confirms the presence of infection2 . F a s t i n g B l o o d S u g a r This is to measure the blood glucose levelsDate Ordered: 06/19/06Date Result In: 06/19/06Results:107 mg/dlConclusion: the result is within normal range based on the normal value of < 126mg/dl.3 . B U N This is an indicator of renal function and perfusion, dietary intake of CHON andthe level of protein metabolism.Date Ordered: 06/19/06Date Result In: 06/19/06Results:17.4 mg/dl Conclusion: the result is within normal range based on the normal value of 7-21mg/dl.4. CreatinineI n me n wit h sy m p to m s, b lo o d t e st s a re p er fo r m ed t o mea su re a su b sta n c e ca ll e d seru m cr ea ti ni n e, whi c h i s a ma rk er fo r k i d n e y t rou bl e . Ki dn e y p ro bl e m s e xi st i n a n a ve ra g e o f 13.6% of BPH patients. Studies have reported rates as high as 30% and as low as 0.3%.Date Ordered: 06/22/06Date Result In: 06/22/06Results:1 . 0 m g / d l Conclusions:The result is within normal range based on the normal value of 0.60-1.7 mg/dl.5 . U r i n a l y s i s A u r i n a l y s i s m a y b e p e r f o r m e d t o d e t e c t s i g n s o f b l e e d i n g o r i n f e c t i o n . A urinalysis involves a physical and chemical examination of urine. In addition, the urine iss p u n i n a c e n t r i f u g e t o a l l o w s e d i m e n t s c o n t a i n i n g b l o o d c e l l s , b a c t e r i a , a n d o t h e r particles to collect. This sediment is then examined under a microscope. Although urinaryi n f e c t i o n i s u n c o m m o n i n y o u n g e r m e n , i t o c c u r s m o r e f r e q u e n t l y i n o l d e r m e n , part icularly those with BPH. A urinalysis also helps rule out bladder cancer.Date Ordered: 06/22/06Date Result In: 06/22/06Results:ColoryellowSpecific Gravity- 0.010 pH- 7.5Appearance- turbidPus cells- 1-3 hpf Red cells- 15-25 hpf Conclusions:T h e r e s u l t s a r e a l m o s t n o r m a l b u t t h e r e i s a p r e s e n c e o f p u s c e l l s i n t h e u r i n e whi c h i nd i ca t e s th e p re se n c e o f i n fe c ti o n a n d pr e se n c e o f r ed c ell s t ha t i n di ca te s t h e presence of blood in the urine.6 . F e c a l y s i s Aids in the evaluation of the digestive efficiency and the integrity of the stomachand intestines.Date Ordered: 06/19/06Date Result In: 06/19/06Results:Color- dark brownConsistency- softConclusions:The results are normal.7 .T ra n sc or ti n, a l so ca ll e d c ort i co st er oi d b in d in g p ro t ei n or C BGIs an alpha-globulinthat has high affinity for bindingcortisol. Measures urinary cortisoland is performed in clients suspected of hyperfunction or hypofunction of adrenal gland.8 . C h e s t X - r a y T h i s i s t o r u l e o u t r e s p i r a t o r y c a u s e o f r e f e r r e d p a i n . M a y b e o b t a i n e d t o d e t e c t pulmonary disease and the status of respiratory problems or trauma.9 . E l e c t r o c a r d i o g r a m / E C G I s a n e s s e n t i a l t o o l i n e v a l u a t i n g c a r d i a c r h y t h m . E l e c t r o c a r d i o g r a p h y d e t e c t s a n d a m p l i fi e s t h e v er y sma ll e l e ctr i ca l p ot e nt ia l c ha n g e s b et we e n di ffe r en t p oi nt s o n t h e su r fa c e o f the body as a myocardial cell depolarize to repolarize, causing the heart to contract.

1 0 . C o l o n o s c o p y I s t h e e n d o sco p i c vi su a l i za ti o n o f t h e la r g e i nt e st i ne fr o m r e ctu m t o c e cu m. It i s t h evisual 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 Hyperplasiaa.Rectal examinationPalpation of the prostate through therectummay reveal a markedly enlarged prostate. Iti s d e p en d e nt on t h e sk i ll s o f t h e d o ct or . It ha s t o b e b or n e i n m in d t ha t r e cta l exa mi na ti on ca ni n cr ea se PS A le v e l s i n pa ti e nt s wi t hou t ma l i gna n c y. T h e t e st h e lp s ru l e ou t pr o sta t e ca n c er or p r o b l e m s w i t h t h e m u s c l e s i n t h e r e c t u m t h a t m i g h t b e c a u s i n g s y m p t o m s , b u t i t g e n e r a l l y 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 . U r o f l o w m e t r y T o d e t er mi n e wh e th e r t h e b lad d er i s o b stru ct e d , t h e sp e e d o f u ri n e fl o w i s m ea su r e d e l e c t r o n i c a l l y u s i n g a t e s t c a l l e d u r o f l o w m e t r y . T h e t e s t c a n n o t d e t e r m i n e t h e c a u s e o f obstruction, which can be due not only to BPH, but possibly also to abnormalities in the urethra,weak bladder muscles, or other causes.c. UrethrocystoscopyA urethrocystoscopy, also called cystourethroscopy, may be performed in men diagnosedwit h B PH, pa rti cu la rl y i f t h e y a re su r gi ca l ca n d ida t e s or i f ot h er u r ina ry tra c t pr o bl e m s a r e su sp e c t ed . Su ch pr ob l e m s i nc lu d e bl o od i n t he u rin e , i n fe c ti o n, i nt er stit ia l cy sti ti s, bla d d er ca n c er, or pr io r su rg er y or i nju r y. T h e p h y si c ia n ca n d et er m in e t h e pr e se n c e o f a nu m b er o f 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 UrineOne of the important tests for urinary incontinence is the postvoid residual urine volume (PVR), t h e am o un t of ur i ne l e ft aft er ur i na ti o n. Nor mal l y, ab o ut 50 mL or l e ss of ur i n e i s l e ft; 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 insertedi n t o t h e u r e t h r a w i t h i n a f e w m i n u t e s o f u r i n a t i o n . P V R c a n a l s o b e m e a s u r e d u s i n g transabdominal ultrasonography.e . U l t r a s o u n d Ultrasound of the prostate does not require a catheter and gives an accurate picture of thesi z e a n d sha p e of t h e pr os tat e g l and . Ul tr as ou nd i s v er y b en efi ci a l w h en pl an ni ng sur g er y an d determining treatment options and gauging their effectiveness. Ultrasound may also be used for detecting kidney damage, tumors, and bladder stones

c. Medical/ Surgical Managementa.Intravenous RehydrationWhen the fluid loss is severe or life threatening, IV fluids are used for replacement. b.Blood TransfusionIt may be necessary for replacement of RBC to WBC, platelets or blood proteinsc.Folley Catheter To facilitate accurate measurement of urinary output for critically illclients whose output need to be monitored hourly. It is also used to manageincontinence when other measures have failed.d. LavageThe process of washing out an organ, usually the bladder, bowel, paranasalsinuses, or stomach for therapeutic purposes.e. Watchful Waiting .Watchful waiting involves lifestyle changes and an annual examination. Itshould be noted that even when choosing watchful waiting, an initial examinationis critical to rule out other disorders.f.Transurethral resection of the prostate (TURP)Involves surgical removal of the inner portion of the prostate where BPHdevelops. It is the most common surgical procedure for BPH

VIII.DISCHARGE PLANNINGM-Instructed the patient to continue medication as ordered1. 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 walkingT-Instructed the patient to continue the medicationH-1. Encouraged patient to increase fluid intake2. Encouraged patient to eat foods rich in Vitamin C and Nutritious foods3. Encourage patient to avoid salty and fatty foods4. Encourage patient to have enough restO-Instructed to come back for follow-up check-up on June 22, 2006Wednesday.D- Advised the patient to a diet as tolerated but preferably avoiding salty andfatty foods.

You might also like