INTRODUCTION

&
OBJECTIVES

Oncology Rotation | Prostate Cancer

INTRODUCTION
You gain strength, courage, and confidence by every experience in which you really
stop to look fear in the face. You must do the thing which you think you cannot do
-Eleanor Roosevelt
Cancer is not a single disease with a single cause; rather, it is a group of distinct
diseases with different causes, manifestations, treatments and prognoses. Cancer
nursing practice covers all age group and nursing specialties and is carried out in a
variety of health care settings, including the home, community, acute care institutions,
outpatient

centers,

rehabilitations,

and

long-term

care

facilities.

The

scope,

responsibilities and goals of cancer nursing, also called oncology nursing, are as
diverse and complex as those of any nursing specialty. Because many people associate
cancer with pain and death, nurses need to identify their own reactions to cancer and
set realistic goals to meet the challenges inherent in caring for patients with cancer.
Lastly, cancer nurses must be prepared to support patients and families through a wide
range of physical, emotional, social, cultural, and spiritual crises. (Smeltzer & Bare,
2008)
Prostate Cancer is among the most common male cancers, but the incidence
varies greatly worldwide. More than 95% of prostatic neoplasms are adenocarcinoma
and most occur in the periphery of the prostate. The cause of prostatic cancer is poorly
understood. Prostatic cancer is a disease of aging; more than 80% of all prostate
cancers are diagnosed in men older than 65 years; rarely in men less than 40 years;
incidence increases with advancing age. Most of the androgen-metabolizing enzymes
undergo a significant age dependent alteration. According to World Cancer Research
Fund International, in the year 2012 there has been 1.1 million cases reported
worldwide. In 2012, prostate cancer is now the third leading cause of death among
Filipino men. The National Kidney and Transplant Institute said 19.3 out of every
100,000 Filipino men are afflicted with the disease.
The subject for this case study is JPH, 69 years old male who was diagnosed
with Prostate Cancer Stage IV. We chose him as the subject for our case study since
we are on our cancer rotation and we will be able to make use of this case to expound
Oncology Rotation | Prostate Cancer

our knowledge on the disease process of prostate cancer and cancer itself. With this,
we student nurses can exemplify the right attitude in dealing with patients with prostate
cancer in the future and provide holistic approach in giving health teachings and
interventions to patients with the same case.
Through this case study, we will be able to appreciate the nursing education on
how prostate cancer is being managed in a late stage. Also provided with the education,
we will be able to rationalize each step in the disease process that will eventually help
us provide the nursing interventions that is intended to our patient. The nursing practice
is very important because it is where we can put into action the interventions that we
learned inside the classroom such as performing procedure that can help improve our
patient's present health condition. With the help of nursing research, we will be able to
provide evidence based care that will help our patient recover from her present health
condition. According to the research by Dr. Zong, Testosterone replacement therapy
(TRT) is a widely accepted form of treatment worldwide for aging men with lateonset hypogonadism syndrome. Urologists have been concerned about the possibility of
TRT causing prostate cancer.

Oncology Rotation | Prostate Cancer

OBJECTIVES

General Objectives:
The BSN 4A- Group 1 Subgroup 1 aims that within the 4 weeks exposure at San
Pedro Hospital San Lorenzo Ward, the group will be able to apply the theories and perform
nursing responsibilities for the improvement of our client's health. Moreover, the group will be
able to formulate a case study about Prostate Cancer its complications and proper handling

At the end of our rotation, our group specifically aims to:

Recognize the presence of hereditary diseases by tracing the genogram

Compose a comprehensive physical assessment of the client.

Define the patient's diagnosis in order to understand her condition.

Identify the etiology and symptomatology of the client.

Outline the pathophysiology of the client's diagnosis using diagram and narration.

State the rationalization on the doctor's order.

Relate the laboratory results of the patient to her present health condition.

Give an example of the different drugs taken by the client to be knowledgeable to the
usage, effects, precautions and contraindications.

Oncology Rotation | Prostate Cancer

Recall information about client's data by examining the congruence between subjective
and objective data to formulate nursing care plan with five problems.

Construct appropriate nursing interventions to achieve the results specified by the goals
and expected outcomes.

Illustrate an age-appropriate discharge plan which will aid the client during the recovery.

Interpret a prognosis on the client's condition.

Combines all sources that being used in the entire case study

Oncology Rotation | Prostate Cancer

INITIAL DATA BASE

Oncology Rotation | Prostate Cancer

Biographical Data
Name

: JPH

Gender

: Male

Age

: 69 years old

Birthday

: June 08, 1945

Birthplace

: Pangasinan

Nationality

: Filipino

Address

: Peace Avenue, Bangkal Davao City

Type of Community

: Urban

Religion

: Catholic

Educational Attainment

: College Graduate

Marital Status

: Widowed

Number of siblings

: 14

Ordinal Rank

: 5th among 14 siblings

Fathers name

: BH

Mothers name

: IH

Clinical Data
Chief Complaint

Date of admission
Time of admission
How admitted
Attending Physician
Admitting Diagnosis
Final Diagnosis

: Anuria, Oliguria
: August 11, 2014
: 05:15pm
: per wheelchair
: Dr. Dela Victoria
: Prostate Cancer Retention
: Prostate Cancer Stage IV

Oncology Rotation | Prostate Cancer

PAST HEALTH HISTORY

JPH was born via Normal Spontaneous Vaginal Delivery in Pangasinan. He stayed with
his parents until he was in 2nd year college and was sent to University of Mindanao for college.
He is currently staying at Bangkal with his children. According to him, he was not a fully
immunized child because according to him, immunizations werent known yet. He experienced
common cough, colds, and fever during his childhood days and self-medicated it with over the
counter drugs such as paracetamol, neozep, and robitussin, as what their family is used to do.
The patient also added that he was not yet able to experience chicken pox and dengue and
does not have any allergies. Their family believed in hilots and herbal meds such as lagundi and
tawa-tawa. But still, during times of illnesses they prefer to consult the doctor immediately.
For the love of food, JPH does not have any problem when it comes to his meals. His
favorite foods are pinakbet, grilled foods, and adobo, and he can eat 3 to 4 times per day. He
includes fruits to his meal. He also loves to eat salty foods and manggang hilaw. He also loves
to drink softdrinks, but learned to stop when he was in 1st year high school because he was
afraid to develop UTI.
When it comes to bowel pattern, patient JPH believed that because of guava that he is
eating everyday, he could defecate on a daily basis. And does not have any complaints about it.
But there are still times that he is experiencing LBM but lasted for about 2-3 days only and selfmedicated it with diatabs. And when it comes to his urinary pattern, patient can urinate well
without complaints of pain or any discomfort. His urine is amber in color and in normal amount
of about 1-2 liters per day. He also added that he does not experience UTI before.
Patient JPH does not have any vices. He doesnt smoke nor drink even occasionally. His
routine includes waking up at 4am to prepare for the day, eat breakfast, and go to the farm
where he worked as an operation manager for 15 years. Afterwards, he goes back to their
home, rest, watch tv, sleep at 10pm and wakes up at 4am again. He is only having an 6-hour of
sleep everyday. He is not fond of going to the mall during weekends, instead, he stays at their
house in and gave time to his family, watch movie, sleep, and relax.
When it comes to family and social relationships, he doesnt have any problems with it.
He is very close to his mother and father before when his parents are still alive, but now, he
focuses his closure to his children. Patient JPH admitted that he is shy when it comes to making

Oncology Rotation | Prostate Cancer

friends with other people but still he remained approachable. That is why even if he is not that
friendly, he can still gain friends and was able to mingle with them very well.

PRESENT HEALTH HISTORY

Year 2000, patient JPH was admitted and undergone his first surgery, TURP.
Year 2010, patient undergone biopsy under the service of Dr. Dela Victoria, 11 months
after the biopsy, patient experienced abdominal pain and was admitted @ Limso Hospital under
the service of Dr. Benignos and undergone another TURP, his second surgery.
Year 2011, patient experienced blood when urinating, and was admitted again and was
given medications, but he cannot remember anymore the medications that was given to our
patient.
Year 2012, admitted again under the service of Dr.Pasia because he was unable to
urinate and undergone again TURP, his third surgery.
6 hours PTA, patient was admitted because he was unable to urinate.
Patient is diagnosed as Prostate Cancer Stage IV.

DEVELOPMENTAL DATA
A. Erik Eriksons Psychosocial Theory
Erik Erikson Psychosocial theory is regarded to be one of the most significant
theories in a persons life because it has a big contribution in order for a person to grow
better and become more mature since life is a series of lessons and challenges that a
person must undergo. In this theory, Erikson identified eight stages that consist different
crisis in which a person should experience in order for him/her to become better.
According to Erikson, if a person fails a certain stage, he/she might have the difficulty to
proceed or to become successful to the next tasks that needs to be done. These tasks
might be supportive to the persons ego but, failure to resolve the crisis might damage
the persons ego.
Our patient JPH who is 69 years old belongs to the late adulthood stage
Late Adulthood: 65 up to the end of life
Oncology Rotation | Prostate Cancer

Ego Development Outcome: Integrity vs. Despair

Basic Virtue: Wisdom
Maladaption: Reflecting back on his life

During this period of time, our patient reflects back on the life they have lived and
come away with either a sense of fulfillment from a life well lived and he feel proud of
his accomplishments. Successfully completing this phase means looking back with few
regrets and a general feeling of satisfaction.
Patient attains wisdom, even when confronting death. Those who feel proud of
their accomplishments will feel a sense of integrity. Successfully completing this phase
means looking back with few regrets and a general feeling of satisfaction. These
individuals will attain wisdom, even when confronting death.

B. Robert Havighursts Developmental Task

Robert Havighurst believed that learning is very important and basic to life and
people continue to learn throughout their life. His theory has six stages that will help a
person to grow and develop during their existence. A person who is successful in this
task will experience happiness but when he/she fails, this leads to unhappiness,
disapproval by society, and difficulty with later tasks.
Our patient JPH who is 69 years old belongs to the late adulthood stage which
has different tasks that needs to be accomplished or meet. And these are:
Developmental Tasks of Later Maturity
1. Adjusting to decreasing physical strength and health
a. TASK MET according to our patient, Pag tigulang naman gud ka,
daghan naka ug ginabati sa lawas ug maluya naka samot na kung naa
gyud kay sakit na ginadala.
Oncology Rotation | Prostate Cancer

10

2. Adjusting to retirement and reduced income

a. TASK MET - our patient is a retired operation manager at a farm. He
stated that he find it hard at first because he got used to working but he
seemed fulfilled that he got out of stress. He still receives his pension.
3. Adjusting to death of a spouse
a. TASK MET patient was able to adjust his stage when he didnt already
have his wife, Dira man gyud ta padulong tanan, ng mamatay ta as
verbalized by patient.
4. Establishing an explicit affiliation with ones age group
a. TASK MET - He spends visiting the farm where he previously worked. He
also finds time keeping in touch with his previous workmates.
5. Establishing satisfactory physical living arrangement
a. TASK MET patient is living with his children. He is happily living together
with them.

Oncology Rotation | Prostate Cancer

11

Oncology Rotation | Prostate Cancer

12

GENOGRAM
MATERNAL

PATERNAL

FH
BH

BZ

JN

LEGEND:
D
S

K
A

F
W

E
JPH
D

FR

Prostate Cancer

Male
Female
Patient

Deceased
Diabetes Mellitus

Narrative Genogram:
In the paternal side, BH died due to prostate cancer at the age of 67, and
his deceased wife have 2 daughters and 1 son namely B-died also due to prostate
cancer at the age of 64 which is the father of the patient; BZ-died due to DM; and JNdeceased. On the maternal side, U died due to vehicular accident at the age of 70 and
his wife died due to DM at the age of 80 with 2 daughters and 2 sons namely A-died due
to mental problem; L died at the age of 60; I-died at the age of 70 which is the mother of
our patient and M-deceased. B which is the father of our patient and L which is the
mother of our patient got married and blessed with 14 children; 12 daughters and 2
sons namely S-died at the age of 60s due to myoma; M-55; A-57; E-59; R-died at birth;
ER-65; C-died at the age of 66 due to breast cancer; T1&T2 are twins-died at birth; Ldied at the age of 52 due to CVA; ML-68; JPH-69 our patient, diagnosed having
prostate cancer stage IV; G-71 & EV-73.

PHYSICAL
ASSESSMENT

PHYSICAL ASSESSMENT

General Survey/
The patient JPH is 69 years old. He looked appropriate to his age. The
patient has no obvious physical deformities; his body is symmetrical and normal for
his age. His body built is mesomorph, his height is 169cm and he weighs 76Kg. No
body odor or breath odor was noted. Brownish pigmentation noted on his face, neck,
and arms; with senile skin turgor; skin is warm to touch.
The patient was awake and coherent upon assessment. He was
cooperative during our interview. The patient was not respiratory distress;
adventitious breath sounds was noted upon auscultation; With an IVF D5Nss 1L @
80cc/ hr infusing well @ left metacarpal vein @ 460cc level. Foley Catheter attached
to urobag draining to 700cc yellow colored urine with cytoclysis of PNSS 1L @
100cc/hr.

Vital signs
VITAL SIGNS

RESULT

INTERPRETATION

NORMAL VALUES

Temperature

36. 6 C

Afebrile

35.6 37.5 C

Pulse Rate

76 bpm

Strong and Palpable

60 100 bpm

Respiratory Rate

24 cpm

Above normal range

16 20 cpm

Cardiac Rate

80 bpm

Strong and Regular

60 100 bpm

Blood Pressure

100/80 mmHg

Within Normal Range

90/70 130/90 mmHg

I.

Skin

From the time we saw our patient, we observed that he has brown skin
color and lentigenes was noted on his face, neck, and arms. He has senile
skin turgor; skin is warm to touch. Edema was not noted

II.

Head and Face

Hair is evenly distributed. Has variable amount of hair on all body

surfaces. Hair growth and distribution on the scalp is even among each
regions and areas and with no evidence of any deficits such as bald spots.
Hair is gray in color. No presence of nits and lice noted. No tenderness
noted upon palpation. Deformities of the head contour were not noted.

III.

Eyes

Our patients eyebrows are evenly distributed. His eyelashes are equally
distributed, and slightly curled outward. His bulbar conjunctivas are
transparent, with capillaries evident in the palpebral fissure. The palpebral
conjunctivas are shiny, smooth, and pale in color and have no lesions.
Upon palpation of the nasolacrimal duct, no edema, tenderness or tearing
was observed. His cornea is transparent, and shiny, and with details of the
iris visible. He has pupils equally round measures 2mm bilaterally and are
briskly reactive to light and accommodation. Both of his eyes are
coordinated, moves in the same direction together and are aligned.

IV.

Ears

The auricles are symmetrical in shape and color is same with facial skin.
The pinna of both ear are in line with the outer canthus of her eyes.
Lesions, swelling, masses nor serous discharges not noted. Upon
palpation, his ears are firm and can recoil immediately after folding it. He
has a good hearing acuity.

V.

Nose
Nasal flaring, deviations, or discharges were not observed. Upon palpation of the
external nose, tenderness, lesions, masses and displacements of bone and
cartilage were not noted. His nares are both symmetrical and patent.

VI.

Mouth and Throat

Lips are symmetrical, pinkish in color and moist. The tongue is in midline,
moist and free from swelling or lesions. Gums, Mucosa and palate are
pinkish in color. Uvula rises as client says ahh.

VII.

Neck

Appearance of lesions, masses, swelling was not noted. The muscles of

the neck are equal in size. The patient was able to move his head from
center to chest, extend head upward, and turn head from right to left and
vice versa. Also, resistance was felt when the patient was asked to turn
his head to the side while one of us tried to put force against it. The thyroid
gland was not visible and palpable, and there were no tenderness and
swelling noted

VIII.

Arms, Hands, and Fingers

Upon inspection, there were no visible masses and lesions, and no

tenderness noted. Resistance was felt after we apply force to the shoulder
of the patient. Pulsations of the patient have amplitude of 2+ - Normal
(Obliterate with moderate pressure). The strength of his hands was strong;
we tested the strength of it by asking him grip the hands of my classmate
simultaneously.

IX.

Chest

Upon inspection, thorax and chest is symmetric, vertically aligned, and

has no signs of deformities. Chest wall intact and no tenderness, masses
and bulges noted.

X.

Breast

There were no presence of engorgement and tenderness of the breast.

Shape is symmetrical. The areola is brown in color. Skin is uniform in
color, smooth and intact. Cracks, discharges and sores not noted on his
nipples.

XI.

Heart
The apical pulsation of patient was strong and normal in rhythm. S1and S2 was
clearly heard upon auscultation. And there were no irregularities noted.

XII.

Abdomen
The skin of the abdomen was uniform in color and scar was noted below the
umbilicus. There was no evidence of liver enlargement. Ascites was not noted.
Upon auscultation, bowel sounds were heard and has 28 bowel movements per
minute. Pain was felt upon palpation on the epigastric, left and right iliac region.

XIII.

Legs, Feet, and Toes

Varicosities were noted on his feet and popliteal area.

XIV.

Genito-urinary

The skin is intact and no lesions. No pubic hair noted. No discharges or foul odor noted.
Distended urinary bladder was noted upon palpation.

DEFINITION
OF
DIAGNOSIS

DEFINITION OF DIAGNOSIS
Prostate Cancer

Prostate Cancer is the most common cancer in men other than nonmelanoma skin
cancer. It is the second most common cause of cancer death in American men, exceeded only
by lung cancer, and is responsible for 10% of cancer related deaths in men.
Prostate cancer are usually adenocarcinomas that begin in the periphery of the posterior
lobe of the gland, whereas BPH occurs centrally and the gland is large by the time it restricts
urination.

Smeltzer.S.,Bare,B., Hinkle, J., & Cheever, K. (2010). Brunner &Suddarths Textbook of

Medical Surgical Nursing. Philadelphia.Lippincott Williams & Wilkins, a Wolters
Kluwer business
Prostate cancer is the most common nonskin cancer in Canada and is third to lung
cancer and colon/rectal cancer as a cause of cancer-related death in men. The incidence of
prostate cancer increases with age and is greater in men of African ancestry of all ages. Most
prostate cancers are asymptomatic and are incidentally discovered on rectal examination.

Hannon R., Pooler C., Porth C..(2010). Porth Pathophysiology. Canadas Nursing
Publisher
Prostate cancer is cancer that occurs in a man's prostate a small walnutshaped gland that produces the seminal fluid that nourishes and transports sperm.
Prostate cancer is one of the most common types of cancer in men. Prostate
cancer usually grows slowly and initially remains confined to the prostate gland, where it
may not cause serious harm. While some types of prostate cancer grow slowly and may
need minimal or no treatment, other types are aggressive and can spread quickly.
Mayo Staff. (2013). Mayo Clinic. Prostate Cancer. Last retrieved August 18, 2014 from
http://www.mayoclinic.org/diseases-conditions/prostatecancer/basics/definition/con-20029597

ANATOMY
&
PHYSIOLOGY

REPRODUCTIVE SYSTEM
Functions of the Reproductive system:
1. To produce, maintain, and transport sperm (the male reproductive cells) and
protective fluid (semen)
2. To discharge sperm within the female reproductive tract during sex
3. To produce and secrete male sex hormones responsible for maintaining the male
reproductive system
Formation of Sex Cells
Sex cells, or gametes, are unique to organisms that reproduce sexually. In
animals and plants (fungi are somewhat different in this regard) there are two types of
sex cells: male and female. The male sex cells are sperm, while the female sex cells
are eggs. Sex cells are formed from special body cells that are typically located in sex
organs. In most animals, sperm are formed in the testes of males, and eggs are formed
in the ovaries of females. The formation of sex cells in males and females occurs by a
special type of cell division called meiosis. For both males and females, meiosis begins
in cells that contain 23 pairs of chromosomes (46 chromosomes) and ends with
gametes containing 23 chromosomes.
Spermatogenesis is the process of meiosis as it takes place in the testes, the
site of sperm production.Within each testis are seminiferous tubules that contain
spermatogonia, which are stem cells that generate sperm. A spermatogonium divides by
mitosis to form two cells, one of which will remain in place as a stem cell, while the other
differentiates (specializes) to become a primary spermatocyte that will undergo
meiosis
Male Reproductive System
The male reproductive system consists of the testesand a series of ducts and glands.
Sperm are produced in the testes and are transported through the reproductive ducts:

epididymis, ductus deferens, ejaculatory duct, and urethra (Fig. 203). The reproductive
glands produce secretions that become part of semen, the fluid that is ejaculated from
the urethra. These glands are the seminal vesicles, prostate gland, and bulbourethral
glands.

TESTES
The testes are located in the scrotum, a sac of skin between the upper thighs.
The temperature within the scrotum is about 96_F, slightly lower than body temperature,
which is necessary for the production of viable sperm. In the male fetus, the testes
develop near the kidneys, then descend into the scrotum just before birth.
Cryptorchidism is the condition in which the testes fail to descend, and the result is
sterility unless the testes are surgically placed in the scrotum.
Each testis is about 1.5 inches long by 1 inch wide (4 cm by 2.5 cm) and is
divided internally into lobes. Each lobe contains several seminiferous tubules, in
which spermatogenesis takes place. Among the spermatogonia of the seminiferous
tubules are sustentacular (Sertoli) cells, which produce the hormone inhibin when
stimulated by testosterone. Between the loops of the seminiferous tubules are

interstitial cells, which produce testosterone when stimulated by luteinizing hormone

(LH) from the anterior pituitary gland. Besides its role in the maturation of sperm,
testosterone is also responsible for the male secondary sex characteristics, which begin
to develop at puberty (Table 201). A sperm cell consists of several parts, which are
shown in Fig. 201. The head contains the 23 chromosomes. On the tip of the head is
the acrosome, which is similar to a lysosome and contains enzymes to digest the
membrane of an egg cell. Within the middle piece are mitochondria that produce ATP.
The flagellum
provides motility, the capability of the sperm cell to move. It is the beating of the
flagellum that requires energy from ATP. Sperm from the seminiferous tubules enter a
tubular network called the rete testis, then enter the epididymis, the first of the
reproductive ducts.

EPIDIDYMIS

The epididymis (plural: epididymides) is a tube about 20 feet (6 m) long that is

coiled on the posterior surface of each testis. Within the epididymis the sperm complete
their maturation, and their flagella become functional. Smooth muscle in the wall of the
epididymis propels the sperm into the ductus deferens.
DUCTUS DEFERENS
Also called the vas deferens, the ductus deferens extends from the epididymis
in the scrotum on its own side into the abdominal cavity through the inguinal canal.
This canal is an opening in the abdominal wall for the spermatic cord, a connective
tissue sheath that contains the ductus deferens, testicular blood vessels, and nerves.
Because the inguinal canal is an opening in a muscular wall, it is a natural ] weak spot,
and it is the most common site of hernia formation in men. Once inside the abdominal
cavity, the ductus deferens extends upward over the urinary bladder, then down the
posterior side to join the ejaculatory duct on its own side. The smooth muscle layer of
the ductus deferens contracts in waves of peristalsis as part of ejaculation
EJACULATORY DUCTS
Each of the two ejaculatory ducts receives sperm from the ductus deferens and
the secretion of the seminal vesicle on its own side. Both ejaculatory ducts empty into
the single urethra.
SEMINAL VESICLES
The paired seminal vesicles are posterior to the urinary bladder. Their secretion
contains fructose to provide an energy source for sperm and is alkaline to enhance
sperm motility. The duct of each seminal vesicle joins the ductus deferens on that side
to form the ejaculatory duct.
PROSTATE GLAND
A muscular gland just below the urinary bladder, the prostate gland is about 1.2
inches high by 1.6 inches wide by 0.8 inch deep (3 cm by 4 cm by 2 cm, about the size
of a walnut). It surrounds the first inch of the urethra as it emerges from the bladder. The

glandular tissue of the prostate secretes an alkaline fluid that helps maintain sperm
motility. The smooth muscle of the prostate gland contracts during ejaculation to
contribute to the expulsion of semen from the urethra.
BULBOURETHRAL GLANDS
Also called Cowpers glands, the bulbourethral glands are about the size of
peas and are located below the prostate gland; they empty into the urethra. Their
alkaline secretion coats the interior of the urethra just before ejaculation, which
neutralizes any acidic urine that might be present. You have probably noticed that the
secretions of the male reproductive glands are alkaline. This is important because the
cavity of the female vagina has an acidic pH created by the normal flora, the natural
bacterial population of the vagina. The alkalinity of seminal fluid helps neutralize the
acidic vaginal pH and permits sperm motility in what might otherwise be an unfavorable
environment.
URETHRAPENIS
The urethra is the last of the ducts through which semen travels, and its longest
portion is enclosed within the penis. The penis is an external genital organ; its distal
end is called the glans penis and is covered with a fold of skin called the prepuce or
foreskin. Circumcision is the surgical removal of the foreskin. This is a common
procedure performed on male infants, and though there is considerable medical debate
as to whether circumcision has a useful purpose, some research studies have found
fewer cases of HIV infection among circumcised men, compared with men who are
uncircumcised. Within the penis are three masses of cavernous (erectile) tissue. Each
consists of a framework of smooth muscle and connective tissue that contains blood
sinuses, which are large, irregular vascular channels.
When blood flow through these sinuses is minimal, the penis is flaccid. During sexual
stimulation, the arteries to the penis dilate, the sinuses fill with blood, and the penis
becomes erect and firm. The dilation of penile arteries and the resulting erection are
brought about by the localized release of nitric oxide (NO) and by parasympathetic
impulses. The erect penis is capable of penetrating the female vagina to deposit sperm.

The culmination of sexual stimulation is ejaculation, a sympathetic response that is

brought about by peristalsis of all of the reproductive ducts and contraction of the
prostate gland and the muscles of the pelvic floor.
SEMEN
Semen consists of sperm and the secretions of the seminal vesicles, prostate
gland, and bulbourethral glands; its average pH is about 7.4. During ejaculation,
approximately 2 to 4 mL of semen is expelled. Each milliliter of semen contains about
100 million sperm cells.

LYMPHATIC SYSTEM
Functions of the Lymphatic system:
1. Fluid balance
2. Fat Absorption
3. Defense. Microorganisms and other foreign substances are filtered from lymph
nodes and from blood by the spleen. In addition, lymphocytes and other cells are
capable of destroying microorganisms and foreign substances.
LYMPHATIC CAPILLARIES AND VESSELS
The lyhmphatic system, unlike the circulatory system, does not circulate fluid to
and from tissues. Instead, the lymphatic system carries fluid in one direction, from
tissues to the circulatory system. Fluid moves from blood capillaries into tissue spaces.
Most of the fluid returns to the blood, but some of the fluid moves from the tissue
spaces into lymphatic capillaries to become lymph. The lymphatic capillaries are tiny,
close-ended vessels consisting of simple squamous epithelium. The lymphatic
capillaries are more permeable than blood capillaries because they lack a basement
membrane, and fluid moves easily into the lymphatic capillaries. Overlapping squamous
cells of the lymphatic capillary walls act as valves that prevent the back-flow of fluid.
After fluid enters lymphatic capillaries, it flows through them.
Lymphatic capillaries are in most tissues of the body;

 Lymphatic

capillaries

drains

the

dermis and hypodermis, and a deep

group drains muscle, viscera, and
other deep structures;
Lymphatic capillaries join to form
larger

lymphatic

vessels,

which

resemble small veins;

Compression of lymphatic vessels
causes lymph to

move

forward

through them;
Three factors cause compression of
the lymphatic vessels are :
1. Contraction of surrounding skeletal muscle during activity;
2. Periodic contraction of smooth muscle in the lymphatic vessel wall; and
3. Pressure changes in the thorax during respiration.

LYMPHATIC ORGANS
Include the tonsils, lymph nodes, the spleen, and thymus glands;
Lymphatic tissue, which consists many lymphocytes and other cells such as
macrophages, is found within lymphatic organs;
When the body is exposed to microorganisms or foreign substances; and
The increased number of lymphocytes is part of the immune response that
causes destruction of microorganisms and foreign substances.
Tonsils
3 groups of tonsils, the palatine tonsils are located on each side of the posterior
opening of the oral cavity. They usually are referred to as the tonsils. The
pharyngeal tonsil is located near the internal opening of the nasal cavity, when it

is inflammed to as the adenoid. The lingual tonsils is on the posterior surface of

the tongue;
Tonsils form a protective ring of lymphatic tissue around the openings between
nasal and oral cavities and the pharynx; and
They provide protection against pathogens and other potentially harmful material
entering from the nose and mouth.
Lymph nodes
Lymph nodes are distributed are distributed along the various lymphatic vessels
and most lymph pasees through at least one lymph node before entering the
blood;
Inguinal nodes are in the groin, axillary nodes and cervical nodes in the neck;
and
The newly produced lymphocytes are released into the lymph and evetually
reach the blood, where they circulate and enter other lymphatic tissues. The
lymphocytes are part of the adaptive immune response that destroys
microorganisms and foreign substances; and
Another function of lymph nodes is the removal of microorganisms and foreign
substances from the lymph by macrophages.
Spleen
The spleen filters blood instead of lymph
instead of lymph;

 Cells within the spleen detect

and

respond

to

foreign

substances in the blood and

destroy

worn-out

red

blood

cells; andSpleen also functions

as a blood reservoir, holding a
small volume of blood.
Thymus
A site for the production and
maturation of lymphocytes; and
Large numbers of lymphocytes are produced in the thymus.
IMMUNITY
Is the ability to resist damage from foreign substances;
Immunity is characterized as innate or adaptive immunity;
the body recognizes and destroys certain foreign substances, but the response
to them is the same each time the body is exposed to them; and
Adaptive immunity the body recognizes and destroys foreign substances, but the
response to them improves each time the foreign substance is encountered.

INNATE IMMUNITY
Innate immunity is accomplished by mechanical mehanisms, chemical
mediators, cells, and the inflammatory response.
MECHANICAL MECHANISMS
Prevent the entry of microorganisms and chemicals into the body in two ways
[1]

the skin and mucous membranes from barriers that prevent their entry, and

[2]

tears,

saliva, and urine act to wash them from the surfacesof the body. Microorganisms cannot
cause a disease if they cannot cause a disease if they cannot get into the body.

CHEMICAL MEDIATORS
Molecules responsible for many aspects of innate immunity. Some chemicals that
are found on the surface of cells kill microorganisms or prevent their entry into the cells.
Lysozome in tears and saliva kills certain bacteria,and mucus on the mucous
membranes prevents the entry of some microorganisms. Other chemical mediators,
such as histamine, complement, prostaglandins and leukotrienes, promote inflammation
by causing vasodilation, increasing vascular permeability, and stimulating phagocytosis.
In addition, interferons protects against viral infect
Immune System

Antigen (Ag) is any substance capable of exciting our immune system and
provoking an immune response. Most antigens are large, complex molecules that are
not normally present in our bodies. They are also called as foreign intruders or nonself.
Variety of substances that can act as antigen but the strongest is protein. Our cells are
richly studded with a variety of protein molecules called self-antigens, they do not trigger
immune response in us, they are antigenic to other people that is why our body

reject

cells of transplanted organs or foreign grafts unless special measures are taken

to

cripple or stiffen the immune response.

Lymphocytes and Macrophages are crucial cells in immune response.

Lymphocytes has two major flavors, the B lymphocytes (B cells) which produce
antibodies and oversees humoral immunity, and T lymphocytes (T cells) which is nonantibody producing lymphocytes

that constitute to cell mediated arm of immunity.

Macrophages are the big eaters, in the non specific defense system is to engulf foreign
particles and rid them from the area. They act as a antigen presenters in the specific

defense system. Activated T cells, in turn release chemicals that cause macrophages to
be killer macrophages.
Antibodies or immunoglobulins are soluble proteins secreted by activated B cells
or by their plasma cell offspring in response to an antigen, and they are capable of
binding specifically with that antigen. Antibodies are formed in response to a huge
number of different antigens, they all have a similar basic anatomy that allows them to
be grouped into five Ig classes, and each is different in structure and function.

IMMUNOGLOBIN CLASSES
Class

IgD

Structure

Where found

Virtually

Biological Function

always Cell surface receptor of

attached to B cell

immunocompetent

cell;

in

important

activation of B cell
When bound to B cell
IgM

membrane, serves as
Attached to B cell; free antigen receptor; first Ig
in plasma

class

released

to

plasma by plasma cells

during

primary

response;

potent

agglutinating

agent;

fixes complement
Most
IgD

antibody

abundant Main antibody of both

in

plasma; primary and secondary

represents 75-85% of responses;

circulating antibodies

crosses

placenta and provides

passive

immunity

to

fetus; fixes complement

Some (monomer) in Bathes

IgA

plasma;

and

protects

dimer mucosal surfaces from

insecretions such as attachment of patjo

saliva, tears, intestinal

Functions of Cells and Molecules involved in Immunity

Element
Cells
B cell

Function in the Immune System

Lymphocyte that resides in the lymph nodes, spleen, or

Lymphnoid tissues, where it is induced to

replicate

by

Antigen-binding and helper T cell interactions; its progeny

(clone members) from

plasma

cells and

memory

cells.
Plasma cell

Antibody producing machine; produces huge

numbers of

the same antibody; represents further specification of B cell

Helper T cell

clone descendants
A regulatory T cell that binds with a specific antigen presented
by a macrophage; it stimulates the

production of other

immune cells to help fight the invader; acts both directly and
Cytotoxic cell

indirectly by releasing lymphokines.

Also called a killer T cell; activity enhanced by helper T cells;
its specialty is killing virus invaded
as

Suppressor
cell
Memory Cell

body cells, as well

body

cells

that

have

become cancerous; involved in graft rejection.

T Slows or stops the activity of B and T cells once the infection
has been conquered.
Descendant of an activated B cell or T cell;

generated

during the initial immune response; may exist in the body for
years thereafter, enabling it to respond quickly and efficiently

to
Macrophage

subsequent

infections

or

meetings with the same

antigen.
Engulfs and digests antigens that it encounters and
presents parts of them on its
plasma membrane for recognition by T cells bearing receptors
for the same antigen

Molecules
Antibody

Protein produced by a B cell or its plasma cell offspring

released into the body fluids,

Lymphokines

and

where it attaches to antigens,

causing neutralization, precipitation or

agglunitation which

marks the antigens for destruction by

phagocytes

or

complement.
Cytokine chemicals released by sentisized T cells:
Macrophage migration inhibiting factor (MIF)Inhibits macrophage migration and keeps them in

the

local area.
Interleukin2- Stimulates T cells and B cells to proliferate
Helper factors - Enhance antibody formation by plasma cells.
Suppressor factors- Suppress antibody formation or T cell
mediated immune response.
Chemotactic factors- Attract leukocytes and into inflamed
area.
Gamma interferon - Helps make tissue cells resistant to viral
infection;
Monokines

activates

macrophages;

activates

NK

cells;

enhances maturation od cytotoxic T cells.

Cytokine chemicals released by activated
macrophages:
Interlekin1- stimulates T cells to proliferate and causes fever.
Tumor necrosis factor (TNF) - like perforin, causes
cell
killing; attracts granulocytes; activates T cells

and

macrophages.
Complement Group of bloodborne proteins activated after
binding to antibody - covered antigens; when activated,
complement
Antigen

causes lysis

of the microorganisms and

enhances
inflammatory response.
Substance capable of provoking an immune response,
typically a large complex molecule not normally present
the body.

in

PATHOPHYSIOLOGY

Pathophysiology

I.

Etiology
A. Predisposing Factors
FACTOR
Sex

PRESENT

RATIONALE
Prostatic cancer is the most common male cancer
in the US.
Prostate cancer is a disease of aging. The

Age

incidence increases rapidly after 50 years of age;

more that 80% of all prostate cancers are
diagnosed in men older than 65 years of age.
The incidence of prostate cancer varies markedly

Race

from country to country and varies among races in

the same country. African American men have the
highest reported of incidence for prostate cancer
at all ages. Asians and Native American men have
Family

the lowest rate.

The incidence of prostate cancer appears to be

history

higher in relatives of men with prostate cancer. It

has been estimated that men who have an
affected first-degree relative and an affected
second-degree relative have an eightfold increase
in risk.

B. Precipitating Factors
FACTOR
High-fat diet

PRESENT

RATIONALE
A diet high in fat or physical inactivity may promote
an increase in body fat and thus enhance the risk

Environment

to develop cancer.
The environment in which an individual lives and
works may contribute to the development of
cancer. Environment factors include air pollutants,
bacteria, and pollutants in water, and exposures to
some environmental chemicals, viruses and
bacteria, radiation, asbestos, certain medical

Lifestyle

drugs, and hormones.

Environmental tobacco smoke has been linked to

( smoking

cancer. Cigarette smoke contains more than 100

and drinking)

cancer-causing agents. Excessive intake of

alcohol, partially two or more drinks daily, can
contribute to the development of head, neck,

Hormonal

laryngeal, esophageal, and hepatocellullar cancer.

Androgens are believed to play a role in the

levels

pathogenesis of prostate cancer. Evidence

favoring a hormonal influence includes the
presence of steroid receptors in the prostate, the
requirement of sex hormones for normal growth
and development of the prostate, and the fact the
prostate cancer almost never develops in men
who have been castrated. The response of
prostatic cancer to estrogen administration or
androgen deprivation further supports a
correlation between the disease and testosterone
levels.

II.

Symptomatology
SIGN AND

PRESENT

RATIONALE

SYMPTOM
S
Bone pain

Weight loss

Cancer of the prostate gland often grows slowly,

especially in older men. Symptoms may be mild
and occur over many years. Sometimes the first
symptoms are from prostate cancer which has
spread to your bones but this is not common.
Prostate cancer cells in the bone may cause pain
in your back, hips, pelvis,other bony areas.
Prostate cancer doesnt affect just your prostate, it
can take a toll on your whole body. As the disease
progresses, for example, you may find that mouth
sores make chewing and swallowing too painful,
or that you simply have no appetite. As a result,
you may lose weight, more than is healthy for

Difficulty
/Trouble

someone battling prostate cancer.

The urethrathe tube that carries urine from your
bladder and through your penispasses through

urinating

the middle of the prostate gland camera.gif. When

the prostate presses against the urethra, you can
have trouble passing urine. This could include
trouble getting started (urinary hesitancy),
incomplete emptying, or a weak urine stream.
Sometimes, a urinary problem is caused by a
prostate cancer tumor that is pressing on the

Low urine
output
(Oligoria )

urethra.
the oliguria is more likely caused by food
infections or bacteria, also urinary tract
obstruction, such as may result from an enlarged
prostate, or other types of urinary tract
inflammation and blockage can be the cause of
reduced urine flow. kidney damage or
inflammation is usually suspected in chronic

Blood in the
urinme
(Hematuria )

oliguria.
Visible urinary bleeding may be a sign of
advanced kidney, bladder or prostate cancer.
Unfortunately, you may not have signs or
symptoms in the early stages, when these cancers

Discomfort

are more treatable.

If prostate cancer spreads to the bone, it weakens

in pelvic

the bone and can cause pain. The first areas of

area

bone to be affected are likely to be those closest

to your prostate, including your pelvic bone, hips,
lower spine and upper thighs. Pain in these areas
can make it painful to walk and move around. The
pain might remain in only one area, but over time

Slow urinary

it can spread to several parts of your body.

The urethrathe tube that carries urine from your

stream

bladder and through your penispasses through

the middle of the prostate gland camera.gif. When
the prostate presses against the urethra, you can
have trouble passing urine. This could include
trouble getting started (urinary hesitancy),

incomplete emptying, or a weak urine stream.

Sometimes, a urinary problem is caused by a
prostate cancer tumor that is pressing on the
urethra.
Difficulty in
having

After treatment for prostate cancer you may have

erection and

difficulty getting or keeping an erection. This is

ejaculation

also known as erectile dysfunction (ED) or

impotence. Many men get problems with their
erections and this is more likely to happen as men
get older.Causes of erection problems include one
or a combination of the following: treatment for
prostate cancer, other health problems, certain
medicines and depression or anxiety.

Painful

Dysuria refers to pain during urination. Dysuria

urination
(dysuria)

can be a symptom of some types of cancer, such

as bladder cancer and prostate cancer. Dysuria is
not a symptom that is exclusive to cancer, and is
likely to be caused by a much less serious

urinate

condition, such as a urinary tract infection.

The causes of nocturia are often gender-specific;

frequently,

for men, it can be a symptom of an enlarged

especially at

prostate, which causes the flow of urine from the

night
(nocturia)

bladder to be blocked. A man suffering from this

condition may not be fully emptying his bladder
during the day. This can leave him with a partially
full bladder when he goes to bed at night, which
will trigger the wake-up call to the bathroom.

MEDICALMANAGEMENT

Complete Blood Count taken last 08/12/ 2014

The test is often used as a broad screening test to determine an individual's general health status. It can be used to
screen for a wide range of conditions and diseases, help diagnose various conditions, such as anemia, infection,
inflammation, bleeding disorder or leukemia, monitor the condition and/or effectiveness of treatment after a diagnosis is
established and monitor treatment that is known to affect blood cells, such as chemotherapy or radiation therapy.
Component

Definition

Rationale

Result

Interpretation /

Nursing

Significance

Responsibilities

-the iron-containing
oxygen-transport
Hemoglobin
{N:140-

metalloprotein

a. Explain to the
- This test is

in

the red blood cells

180g/L}

patient the

usually used to
assess for the

Aplastic

purpose of the

anemia

test and the need

presence of
-Hemoglobin is the
oxygen-carrying
pigment
RBCs.

of

anemia and
polycythemia and

the

low
80

deficienc
y anemia

to monitor
response to
treatment for
each.

Iron

Cancer

for a blood
sample to be
drawn.
b. No fasting is
required before
the test.
c. Monitor patient
for fatigue,
paleness,
tachycardia &

bleeding.
d. Check S&S of
Dehydration thirst, poor skin
turgor, dry
mucous
membranes,
tachycardia,
hypotension, low
urinary output.

-It is the average

mass of
hemoglobin per red
blood cell in a
Erythrocytes
{N: 4.5 -5.0
10^12/L}

sample of blood.
- increases the
cell's surface area
and facilitates the
diffusion of oxygen
and carbon dioxide.

- They transport

Enlarged
spleen

oxygen from the

lungs to all body
cells and
transfer carbon
dioxide from the

Porphyria

Sickle

low
2.36

cell
anemia

cells to the
organs of
excretion.

Thalasse
mia

-a calculation of the
amount of
MCH: Mean
Corpuscular

hemoglobin
contained within the
RBCs.

Hemoglobin
{N: 28 33

- the weight of the

pg}

Hgb in each RBC

MCV: Mean
Corpuscular
Volume
{N:82-98 fl}

MCHC: Mean
Corpuscular
Hemoglobin
Concentration
{N:33-36g/L}

In order to
calculate the

High
33.9

Macrocytic
anemia

amount of
hemoglobin
contained within
the RBCs

-indicates the
volume of the Hgb

High
104.2

in each RBCs
-the hemoglobin

-The MCHC is a

content relative to

valuable

the size of the cell

indicator of Hgb

(hemoglobin

deficiency and

concentration) per

of the oxygen-

RBC
-the proportion of
Hgb contained in

carrying

each RBC

capacity of the
individual
erythrocyte.

Low
32.5

-liver Cirrhosis
-Hypothyroidism
-myelofibrosis

Hypochromic
anemia

White Blood
Cells {N:4.810.8 10^g/L}

constitute the

-determines the

bodys primary

number of

defense against

leukocytes
percubic

foreignness; that
is, leukocytes
protect the body

High
13.2

-Acute
lymphocytic

millimeter of

leukemia

whole blood.

from foreign

-Certain

organisms,

bacterial

substances, and

infections

tissues.
-Certain viral
infections

-the first white

blood cells to arrive
at an area of
Neutrophil
{N:40-70 %}

inflammation. They
begin working to
clear the area of
cellular debris
through the
process of

Normal
52%

phagocytosis.

Play an integral
Lymphocyte
{N: 19-48%}

part in the antibody

Normal
34%

response to
antigens. The
lymphocytes have
a lifespan of days
or years
live months or even
Monocytes
{N: 3-9%}

years,

are

not

considered
phagocytic

cells

when they are in

the
blood.
after

circulating
However,
they

are

present in the
tissues for several
hours,

monocytes

NORM
AL
9%

mature

into

macrophages,
which

are

phagocytic
cells.
-important role in
Eosinophils
{N: 2-8 %}

the defense against

Normal
5%

parasitic infections.
-They
also
phagocytize

cell

debris.

They

are

active

in

also

infection,

allergic reactions.
-release histamine,
Basophils
{N: 0 - 0.5%}

bradykinin,

and

serotonin
whenactivated

by

injury or infection.
-Basophils are also
involved
producing
responses.

in
allergic

stress, severe

Normal
0

-the proportion of
Hematocrit
{N: 0.40
0.48%}

red blood cells to

Low
0.25

plasma within a
sample of blood

Thrombocyte
{N: 150-400
10^g/L}

-Platelets are

- provides
information

essential to

about platelet

hemostasis and

production, and

blood clotting
- They also release
phospholipids

allows

which are required

by the intrinsic
coagulation
pathway.

monitoring of
the effect of
antineoplastic
drug therapy
and radiation
therapy

Normal
367

Anemia
Hemolysis
Renal failure

Immunology Test taken last 08/12/ 2014

Component

Definition

Prostate Spec.

A prostate-

Ag ( PSA )

specific

{N: 0-4 }

antigen (PSA)
test measures

Rationale

Result

A PSA test can

help pick up
prostate cancer
before you
have any
symptoms.

>100.0

Interpretation /

Nursing

Significance

Responsibilities

ng/mL

a. Explain to the
patient the purpose
Prostate cancer

of the test and the

the amount

need for a blood

of prostate-

sample to be drawn.

specific

antigen in

b. No fasting is

the blood.

required before the

PSA is
released into
a man's blood
by
his prostate
gland .Health
y men have
low amounts
of PSA in the
blood. The
amount of
PSA in the
blood
normally
increases as
a man's
prostate
enlarges with
age. PSA may
increase

test.

because of
inflammation
of the
prostate gland
(prostatitis)
or prostate
cancer. An
injury, a
digital rectal
exam, or
sexual activity
(ejaculation)
may also
briefly raise
PSA levels.

DRUG STUDY

TRAMADOL

Date Ordered

08/13/14

Generic Name

Tramadol + Paracetamol

Brand Name
Classification

Algesia

Analgesics (centrally acting)

Physiologic Mechanism
Decreased pain.

Mode of Action

Pharmacologic Mechanism
Binds to mu-opioid receptors.
Inhibits reuptake of serotonin and norepinephrine in the CNS.

Ordered Dose
Indications
Contraindication

1 capsule / TID
Moderate to moderately severe pain
Should not be given to patients who are hypersensitive to
tramadol, paracetamol, opioids, or any component of the product.

Drug Interaction

Carbamazepine,quinidine, CYP2D6 inhibitors

(eg fluoxetine,paroxetine, amitriptyline),MAOIs, SSRIs,
digoxin,warfarin; other CNS depressants, TCAs; other

paracetamol-containing products. Alcohol.

Dizziness, nausea, somnolence. Asthenia, fatigue, hot flushes,

Side / Adverse
Effects

headache, tremor, abdominal pain, constipation, diarrhea,

dyspepsia, flatulence, dry mouth, vomiting, anorexia, anxiety,
confusion, euphoria, insomnia, nervousness, pruritus, rash,
increased sweating.

1. Assess type, location, and intensity of pain before

and 2-3 hr (peak) after administration.
2. Assess BP & RR before and periodically during
administration. Respiratory depression has not
occurred with recommended doses.
3. Assess bowel function routinely. Prevention of
constipation should be instituted with increased
intake of fluids and bulk and with laxatives to
Nursing
Responsibilities

minimize constipating effects.

4. Assess previous analgesic history. Tramadol is not
recommended for patients dependent on opioids or
who have previously received opioids for more than
1 wk; may cause opioid withdrawal symptoms.
5. Overdose may cause respiratory depression and
seizures. Naloxone (Narcan) may reverse some,
but not all, of the symptoms of overdose. Treatment
should be symptomatic and supportive. Maintain
adequate respiratory exchange.
6. Encourage patient to cough and breathe deeply
every 2 hr to prevent atelactasis and pneumonia.

ciprofloxacin

Date Ordered

08/13/14

Generic Name

ciprofloxacin

Brand Name

Classification

Mode of Action

Cipro

Antibacterial, Fluoroquinolone

Ciprofloxacin promotes breakage of double-stranded DNA in

susceptible organisms and inhibits DNA gyrase, which is
essential in reproduction of bacterial DNA.

Ordered Dose

500 mg / BID

Treatment of uncomplicated UTIs caused by E. coli, K.

pneumoniae as a one-time dose in patients at low risk of
nausea, diarrhea (Proquin XR)

Indications

Treatment of chronic bacterial prostatitis

Hypersensitivity. Not to be used concurrently with

Contraindication

tizanidine. Avoid exposure to strong sunlight or sun lamps

during treatment.

This medication can slow down the removal of other medications

from your body, which may affect how they work. Examples of
affected drugs include duloxetine, pirfenidone, tasimelteon,
tizanidine, among others.
Drug Interaction

Avoid drinking large amounts of beverages containing caffeine

(coffee, tea, colas), eating large amounts of chocolate, or taking
over-the-counter products that contain caffeine. This drug may
increase and/or prolong the effects of caffeine.

GI disturbances; headache, tremor, confusion,

convulsions; rashes; joint pain; phototoxicity. Transient
increases in serum creatinine. Hematological, hepatic and

Side / Adverse

renal disturbances. Vasculitis, pseudomembranous colitis

Effects

and tachycardia. Phototoxicity.

Potentially Fatal: Anaphylactoid reaction;

cardiopulmonary arrest.

Nursing
Responsibilities

1. Assess patient if he is Allergic to ciprofloxacin

2. Ensure that the patient swallows ER tablets whole; do not
cut, crush, or chew.
3. Ensure that patient is well hydrated.
4. Instruct patient not to take ciprofloxacin with dairy products
such as milk or yogurt, or with calcium-fortified juice. He
may eat or drink dairy products or calcium-fortified juice

with a regular meal, but do not use them alone when

taking ciprofloxacin. They could make the medication less
effective.
5. Tell patient that Ciprofloxacin can cause side effects that
may impair his thinking or reactions. Tell patient to be
careful if he plans to drive or do anything that requires him
to be awake and alert.
6. Instruct patient to take ciprofloxacin with a full glass of
water (8 ounces).
7. Instruct patient to avoid taking antacids, vitamin or mineral
supplements, sucralfate (Carafate), or didanosine (Videx)
powder or chewable tablets within 6 hours before or 2
hours after you take ciprofloxacin. These other medicines
can make ciprofloxacin much less effective when taken at
the same time.
8. Inform patient that Ciprofloxacin may cause swelling or
tearing of a tendon (the fiber that connects bones to
muscles in the body), especially in the Achilles' tendon of
the heel.
9. Instruct patient to stop taking ciprofloxacin and call the
doctor at once if he has sudden pain, swelling, tenderness,
stiffness, or movement problems in any of your joints. Also
instruct patient to rest his joint until he receive medical
care or instructions

felodipine

Date Ordered
Generic Name
Brand Name

08/13/14
felodipine

Plendil

Classification
Calcium channel-blocker, Antihypertensive
Felodipine relaxes coronary vascular smooth muscles by
inhibiting calcium ions from entering the 'slow channels' or
Mode of Action

voltage-sensitive areas of vascular smooth muscles and

myocardium during depolarisation. It also increases myocardial
O2 delivery in patients with vasospastic angina.

Ordered Dose

Indications

Contraindication
Drug Interaction

10 mg / OD - 6AM
Essential hypertension, alone or in combination with other
antihypertensives
Hypersensitivity.
Increase absorption with ethanol. Plasma levels increased by
enzyme inhibitors e.g. cimetidine.

Flushing, headache, peripheral oedema, tachycardia, palpitation,

Side / Adverse
Effects

dizziness, fatigue. Ankle swelling may occur. Hyperplasia, rash,

pruritus. Gingival enlargement, angina, angioedema, decreased
libido, insomnia, irritability in patients with pronounced gingivitis
or periodontitis.

1. Have patient swallow tablet whole; do not chew or crush.

2. Monitor patient carefully (BP, cardiac rhythm and output)
while drug is being adjusted to therapeutic dose.
3. Monitor cardiac rhythm regularly during stabilization of

Nursing
Responsibilities

dosage and periodically during long-term therapy.

4. Administer drug without regard to meals.
5. You may experience these side effects: Nausea, vomiting
(eat frequent small meals); headache (adjust lighting,
noise, and temperature; medication may be ordered if
severe).
6. Report irregular heartbeat, shortness of breath, swelling of
the hands or feet, pronounced dizziness, constipation.

NURSING MANAGEMENT

NURSING THEORY
Faye Glenn Abdellah (Twenty One Nursing Problems)
METAPARADIGM IN NURSING

PERSON
Abdellah

classifies

the

beneficiary

of

care

as

individuals. However, she does not set standard limits on the

nature and essence of human beings. The twenty one nursing
problems relate with biological, psychological and social
aspects of individuals and can be said to correspond to
concepts of importance.
HEALTH
In this theory, the concept of health is defined as the center and purpose of
nursing services. Although Abdellah does not give a definition of health, she speaks to a
total health needs and a healthy state of mind and body in her description of nursing
as a comprehensive service.
ENVIRONMENT
The idea of environment is addressed by Abdellah and is included in planning
for optimum health on local, state, national, and international levels. However, as
Abdellah elaborates her ideas, the apex of nursing service is the individual.
NURSING
The concept of nursing in this theory is generally grouped into twenty-one
problem areas for nurses to work out their judgement and appropriate care. Abdellah
considers nursing to be an all-inclusive service that is based on the disciplines of art
and science that serves individuals, sick or well, cope with their needs.

1 OVERT: which is obvious or can be-seen condition

2 COVERT: This is an unseen or masked one.

TWENTY-ONE NURSING PROBLEMS

1 To maintain good hygiene and physical comfort;
2 To promote optimal activity: exercise, sleep, rest;
3 To promote safety through prevention of accident, injury, or other trauma and
4
5
6
7
8
9

through the prevention of the spread of infection;

To maintain good body mechanics and prevent and correct deformity;
To facilitate the maintenance of a supply of oxygen to all body cells;
To facilitate the maintenance of nutrition of all body cells;
To facilitate the maintenance of elimination;
To facilitate the maintenance of fluid and electrolyte balance;
To recognize the physiological responses of the body to disease conditions-

10
11
12
13
14
15
16
17
18

pathological, physiological and compensatory;

To facilitate the maintenance of the regulatory mechanism and functions;
To facilitate the maintenance of sensory function;
To identify and accept positive and negative expressions, feelings and reactions;
To identify and accept interrelatedness of emotions and organic illness;
To facilitate the maintenance of effective verbal and non verbal communications;
To promote the development of productive interpersonal relationship;
To facilitate progress toward achievement and personal spiritual goals
To create or maintain a therapeutic environment;
To facilitate awareness of self as an individual with varying physical emotional

and developmental needs;

19 To accept the optimum possible goals in the light of limitations physical and
emotional;
20 To use community resources as an aid in resolving problems arising from illness;
and
21 To understand the role of social problems as influencing factors in the cause of
illness.
The Twenty one nursing problem of Abdellah elaborated that the core in nursing
service is the individual, the beneficiary of care. The twenty one nursing problems relate
with biological, psychological, and social aspects of individuals and can be said to
correspond to concepts of importance. Abdellahs theory generally grouped the areas
for nurses to work out twenty-one nursing problems for them to utilize their judgment
and to give their appropriate care towards the client.

We chose this nursing theory by Abdellah because its main focus which is the
total health needs is likely to be related to our patient JPH who was diagnosed with late

stage of prostate cancer. Knowing that cancer patients are prone to develop a wide
range of physical, emotional, social, cultural, and spiritual crises it is important for us
nurses to give optimum care indicative for our patients. The twenty one nursing problem
listed all of the problems that is needed to be corrected and what is to be focused.

NURSING
CARE
PLANS

Date/time

Cues

A
U
G
U
S
T

Objective:
- (+) Foley

12,

- Vital signs

Catheter
- (+) cystoclysis
- Pallor
T- 36.7 PR-100

2
0

RR-20 CR-105
BP-110/70
- Tentative

diagnosis:

cancer

Prostate

Nee
d
N
U
T
R
I
T
I
O
N
A
L

Nursing
Diagnosis
Risk for fluid
volume
deficit
related to
loss of fluid
through
abnormal
routes as
evidenced
by (+)
catheter

M
E
T
A
B
O
L
I
C

Rationale:
Fluid volume
deficit, or
hypovolemia
, occurs
from a loss
of body fluid
or the shift
of fluids into
the third
space, or
from a
reduced
fluid intake.
Common
sources for
fluid loss are
the
gastrointesti
nal tract,
polyuria,
and
increased
perspiration.
Fluid volume
deficit may
be an acute
or chronic
condition
managed in

8am
P
A
T
T
E
R
N

Objective of Care

INTERVENTIONS

After my 7 hours span of

care, my patient will be
able to maintain hydration
as evidenced by:

1.Monitor vital signs

a. Stable vital
signs
b. Palpable
peripheral
pulses
c. Good capillary
refill

For baseline data

2. Monitor intake
and output
Rapid/sustained
diuresis could cause
patients total fluid
volume to become
depleted and limits
sodium reabsorption
in renal tubules
3. Record actual
weight

Patients may be

unconscious of their
actual weight or
weight loss because
of approximation of
weight
4. Promote bedrest
with head elevated.
Decreases cardiac
workload, facilitating
circulatory
homeostasis.
5. Monitor
electrolyte levels,
especially sodium
As fluid is pulled
from extracellular
spaces, sodium may
follow the shift,
causing
hyponatremia.

Afte
car
to m
evi

the hospital
out patient
center, or
home
setting.

6. Administer IV
fluids as needed.

Replaces fluid and

sodium losses to
prevent/correct
hypovolemia
following outpatient
procedures.
7. Monitor skin
temperature,
palpate peripheral
pulses
Cool clammy skin,
weak pulses
indicate decreased
peripheral
circulation and need
for additional fluid
replacement.
8. Provide oral
hygiene
Attention to mouth
care promotes

Jay-ar Y. Gealon BSN 4A

EVALUATION

AUGUST 11, 2014

NURSING

OBJECTIVES/

INTERVENTIONS

PLAN

1.) Monitor Vital Signs

Impaired gas exchange

span of care, my

related to decreased

patient will be able

hemoglobin count

R: To have a baseline data

3pm

2.) Note skin color and feel

to demonstrate

temperature of the skin.

improved gas

R: Skin pallor or mottling, cool or cold

exchange as

skin temperature, or an absent pulse

evidenced by:

After 8 hours of
care, my patient was
able to demonstrate

can signal arterial obstruction, which

immediate intervention.
3.) Check capillary refill.

exchange as

R: Nail beds usually return to a

evidenced by:

pinkish color within 3 seconds after

nail bed compression.

a.) pinkish palpebral

conjuctiva

b.) strong peripheral

4.) Do not elevate legs above the

Rationale:

Hemoglobin is a protein in
the blood that receives

is an emergency that requires

improved gas

pulse

Within my 8 hours

"GOAL MET"

NURSING DIAGNOSIS

a.) Pinkish
palpebral
conjunctiva

oxygen from the lungs.

When hemoglobin does n

have access to the oxyge

needs, it turns blue causin

the blood to have a bluish

b.) Strong

tint.

peripheral pulse

level of the heart.

Reference:

R: With arterial insufficiency, leg

elevation decreases arterial blood

c.) Pinkish

Edmund G. Lowrie, M.D.R

supply to the legs.

nailbeds

Garth Kirkwood, M.D.Mar

R. Pollak, M.D.

5.) Change positions slowly when

getting client out of bed.
R: The elderly commonly have
postural hypotension resulting from

d.) Capillary refill

time of less then 3

c.) pinkish nailbeds

age-related losses of cardiovascular

seconds

reflexes
d.) capillary refill
time of 2 seconds

6.) Keep client warm, provide

blankets
R: Clients with arterial
insufficiency complain of being

e.) Vital Signs in

constantly cold; therefore keep

normal range

extremities warm to maintain

vasodilation and blood supply.
7.) Encourage client to walk with
support hose on and perform toe up
and point flex exercises.
R: Exercise helps increase venous
return, build up collateral circulation,
and strengthen the calf muscle
pumps
8.) Teach patient breathing exercises
R: Increases lung expansion and
opens airways to improve ventilation,
preventing respiratory failure.

e.) Vital Signs in

normal range

DISTURBED SLEEP REST PATTERN

Date
&
Time

CUES

NEED

NURSING

OBJECTIVES OF

DIAGNOSIS

CARE

NURI

INTERV

A
U
G
U

Subjective:

Disturbed sleep rest

After 1 day span of care 1. Assess the

Dili man ko

pattern related to

our client will be able to

perception of c

katarong ug tulog

discomfort

maintain a good

sleep difficulty

diri. As verbalized

sleeping habit and

relief measure

by patient.

Changes in

comfortable

treatment.

environment health

environment as

R: knowing th

Objectives :

and routine combined evidence by:

etiological fact

-sleeping hours

with hospital routines

appropriate th

decreased to 4

interferes with patient

a.)Report improvement

2. Instruct the

hours than the

normal sleep-wake

in sleep pattern.

avoid heavy m

S
T
1
2

usual 8 hours.

pattern. Weakness

2
0
1

A
M

b.) absence of frequent

yawning

R:

althoug

continue to disrupt

irritable

sleep. Other factors

that contribute to

c.) Report sense of well

stimulation fro

sleep fragmentation

being and feeling

and nicotine c

include stimuli that

rested.

sleep.

tend to awaken

3. Increase

people in the middle

daytime physi

of the night. Internal

activities as in

stimuli such as

instruct the pa

discomfort are

strenuous acti

frequent

bedtime.

-frequent yawning
9

and discomfort can

-restlessness and

4
@

retiring.

also keep one

gastric digesti

disturbances. Any
illnesses that cause

R: Activity re

physical discomfort

and promotes

can result in sleep

However, ove

problems.

may cause ins

4. Recommen
Lippincott Williams &

environment c

Wilkins., 2009;

sleep or rest (

Gulanick, 2006;

comfortable te

Kozier, et al, 2009;

ventilation, da

Black, J & Hawks, J,

closed door)

2010

R: Many pe
better in cool,

environments.

5.) provide a w

before the clie

sleep

R: vasodilatat
veins provide

effect, causing

fall right to sle

6.) position cl
comfortable p
R: to alleviate

Date/Time

Cues

Needs

Nursing Diagnosis

Objective of Care

Subjective:

Nursing Intervention

Evaluation

1. Monitor urinary elimination,

08/13/14
@ 2:00 PM

08/13/14 The patient may

Impaired Urinary

Within my 7 hours

including consistency, odor,

verbalize difficulty

Elimination related

span of care my

volume,and color.

8:00 AM

in urinating.

to bladder neck

patient will be able to

R: These parameters help

Goal Partially

obstruction by

manage the

determine adequacy of

Met

Objective:

enlarged prostate

manifestation of the

urinary tract function.

- (+) oliguria

gland as evidenced

disease such as:

2. Help the client select

Within my 7

- (+) incontinence

by dysuria , Oliguria

appropriate incontinence

hours span of

garment or pad for short-term

care my

sufficient amounts

management while more

patient able to

a. Void in

- (+) dysuria

and bladder

-(+)facial grimace

distention .

upon urination

with no palpable

definitive treatment is

managed the

-With an indwelling

bladder distension.

designed.

manifestation

R: Appropriate

of the disease

undergarments can help

such as:

catheter connected
with the urine bag

post void residuals

of less than 50 mL,

with absence of

dribbling/overflow.

E
R
N

Demonstrate

there was no
sign of urinary

diminish the embarrassing

aspects of urinary

Demonstr

incontinence.

ate post void

3. Instruct him to limit fluids

residuals of

for 2 to 3 hours before

less than 50

bedtime.

mL, with
absence of

R: decreased fluid intake

disorders (urgency,
oliguric, dysuria)

dribbling/

several hours before bedtime

will decrease the incidence of
urinary retention and overflow

overflow.

there was

incontinence, and promote

rest.
4. Instruct him to drink a
minimum of 1,500 mL (six 8-

no sign of

ounce glasses) fluids per day

urinary

R: Increased fluids during the

disorders

day will increase urinary

(urgency,

output and discourage

oliguric,

bacterial growth.

dysuria)

5. Limit ingestion of bladder

irritants (e.g., colas, coffee,
tea, and chocolate).
R: Alcohol, coffee, and tea
have a natural diuretic effect
and are bladder irritants.
6. Instruct the family member
to record urinary output.
R: Serves as an indicator of

urinary tract and renal

function and of fluid balance.
7. Catheterize for residual
urine, as appropriate.
R: an enlarged prostate
compresses the urethra so
that urine is retained.
Checking for residual urine
provides information about
bladder emptying.
8. Instruct him on which signs
and symptoms to report to
the health care provider (e.g.,
burning on urination,
hematuria, oliguria).
R: In the individual with
prostatic hypertrophy, urinary
retention and an over
distended bladder reduce
blood flow to the bladder wall,
making it more susceptible to
infection from bacterial

growth. Monitoring for these

manifestations of urinary tract
infection is essential to
prevent urosepsis.

Rebecca Leah Salada

Discharge Planning

Medications

Health Teachings
Encourage to comply with the treatment
regimen.

Explain in simple words the indication and

modes of action of each medication to the
patient as well as his significant other.

Rationale
To help lessen the risk of possible
complications and to avoid delay of
restoration of the health of the client.
Making the patient understand why a
certain drug is given and what is its action
will facilitate conformity to the treatment
regimen.

Explain the significance of taking the

medications with the right dose at the right

To prevent over dosage or under dosage.

time.
Inform and explain the possible side
effects that may occur upon taking the
prescribed medications. If symptom
persists or worsen, consult your doctor.

Some side effects are life-threatening to

the patient. Immediate consultation is
necessary to prevent untoward injuries.

Encourage to take drug with food if not

Some drugs may cause GI irritation if

contraindicated.

taken with empty stomach.

Exercise/Environment

Health Teachings

Rationale
This recharges your energy to function

Have adequate rest and sleep.

better in both physical and mental manner.

And to prevent anemia

Promote a safe environment. Make sure

This is to avoid any unexpected accidents

that accident hazards were eliminated.

that may cause death or injury

Position patient in a semi-Fowlers postion.

To promote breathing and good blood

oxygenation.

Treatment
Health Teachings

Rationale

Bed rest

To conserve energy

Return for follow-up check-up

To check any improvement in the condition.

Hygiene
Health Teachings

Rationale
To prevent the build-up of plaque, the

Encourage patient to have oral care every

after meal and especially after eating
sweet food.

sticky film of bacteria that forms on the

teeth. Bacterial plaque accumulated on
teeth because of poor oral hygiene is the
causative factor of the major dental
problems that could lead to gum disease.

Encourage personal hygiene daily.

Teach proper hand washing.
Stress importance of keeping the
environment clean
Make sure that the drinking water is not
contaminated.

This will maintain a germ-free and fresh

physical appearance.
To prevent spread of microorganisms.
To prevent acquiring diseases

Can cause more complications.

Out-patient Referral
Health Teachings

Rationale

Stress the importance of having a

This is to reassess the patient`s condition

follow-up checkup from her physician.

and progress after the interventions done.

Instruct to seek medical attention

immediately if symptoms persist again
or worsen

To prevent further complications.

Encourage them to carry out diagnostic

To evaluate condition of the patient that

exams.

needs medical attention.

Diet
Health Teachings
Eat vitamin C rich foods such as
orange.
Increase oral fluid intake.

Have a balanced diet.

Diet
To improve immune system.
Rehydration of ones body and to eliminate
infectious agents.
This facilitates coping strengths. Inadequate
diet can be a stressor.

PROGNOSIS

REFERENCES

REFERENCES

Black, J.M., Hawks, J.H. (2009). Medical-Surgical Nursing: Clinical

Management for Positive Outcomes (8th Edition). USA: Elsevier
Saunders
Daniels, R., Nosek, L., Nicoll, L. (2007). Contemporary Medical-Surgical
Nursing. USA: Delmar Cengage Learning.
Gulanick, M., Myers, J.L., et al. (2007). Nursing Care Plans, Nursing
Diagnosis and Interventions (6th Edition). Singapore: Mosby Inc.
Kee, J.L., Hayes, E.R., McCuistion, L.E. (2009). Pharmacology: A Nursing
Process Approach (6th Edition). Singapore: Saunders Elsevier Inc.
Kozier, Barbara et. al. (2007).Fundamentals of Nursing: Concepts,
Process and Practice (5th edition). Singapore: Pearson Education
Pte.Ltd.
Lemone, P., Burke, K. (2007). Medical-Surgical Nursing: Critical Thinking
in Client Care (4th Edition). New Jersey: Pearson Education Inc.
Porth, C. (2007) Essentials of Pathophysiology Concepts and Altered
Health Status (2nd Edition). USA: Lippincott Williams & Wilkins.
Roth, L. (2011). Mosby Nursing Drug Reference (24th Edition). USA:
Mosby Inc.
Smeltzer, S.C., Bare, B.G. (2009). Brunner and Suddarths Textbook of
Medical Surgical Nursing (12th Edition). Philadelphia: Lippincott
Williams and Wilkins.
Spratto, G.R., Woods, A.L. (2010). Delmar Nurses Drug Handbook. USA:
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