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CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55

1. WhatcanyoutellS.M.abouthislabwork?
IwouldtellSMthathisvitalsarenormal.S.M.sSodiumPotassium,Chloride
Bicarbonate,BUN,Creatinine,Glucose,RBC,WBC,HgbHctPlatelets,and
Urinalysisallcambackwithinnormalrangesforhisageanddemographic.However,
Prostatespecificantigen(PSA)islow.
2. WhatisthesignificanceofthePSAresult?
Prostatespecificantigen(PSA)is0.23mg/mLthisislowthenormalrangeis
(2.44.0)upto7.0inoldermen.Theprostatespecificantigenassaywasinitially
developedasatumormarker(Lewiset.Al,2014).
3.WhatotherspecificexaminationwillS.M.needtohavealongwiththePSA?CAS
Asignificantexamthattestsfor Prostatespecificantigenisadigitalrectalexam
thistestsforthesize,symmetryandconsistencyoftheprostategland(Lewiset.Al,
2014).
4. WhydidS.M.trytakingthesawpalmetto,andwhydoyouthinkhestopped
takingit?
Palmettoisbestknownforitsuseindecreasingsymptomsofanenlarged
prostate.AccordingtoLewis,sideeffectsmayinclude:nausea,vomiting,and
stomachpain.(Lewiset.Al,2014).
5. S.M.iscuriouswhyhisenlargedprostatewouldaffecthisurination.Heis
concernedthathehasprostatecancer.Whatwouldyouteachhim?
IwouldteachS.M.thathedosenothavecancerbecauseofhisenlarged
prostate.AllhislabscamebacknormalexceptforPSA.

CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55

6. Theprimarycareprovider(PCP)askedforapostvoidingresidual(PVR)urine
test.YouuseabedsidebladderscanneranddocumentthatS.M.voided60mL
andhisPVRis110mL.YoureportthePVRtothePCP.Whatisthesignificance
ofhisPVR?
Thesignificanceofhispostvoidingresidualistheretentionthatthe
Patientstillhasinhisbladder.Thenormalresidualurinerangesfrom0to15ml;
however,forpatientswithenlargedprostates50mlisacceptableLewis,et.al
(2014).
7. CommonlyusedmedicationsforBPHare5alphareductaseinhibitors,suchas
finasteride(Proscar)andalphablockingdrugs,suchastamsulosin(Flomax).How
dothesedrugsdiffer?
5alphareductaseinhibitorsthosedrugsworktoreducesthesizeofthe
prostategland.Finasterideblocksthe5alphareductaseenzymethatconverts
testosteronewhichsurpressesandrogen(Lewiset.Al,2014,p.1416,)
Alphablockingdrugsthisdrugpromotessmoothmusclerelaxationinthe
prostateglandandfacilitatesurinaryflowthroughtheurethra.(Lewiset.Al,
2014,p.1417).
8. ThePCPorderedtamsulosin(Flomax)0.4mg/dayPO.YouenterS.M.'sroomto
teachhimaboutthismedication.WhatsideeffectswillyoutellS.M.about?
(Selectallthatapply.)
A,C,D,F
9. S.M.asks,Willthisconditionaffectmyrelationshipwithmywife?What
shouldyoutellhim?IwouldtellS.M.thatthemedicationthatwillbeprescribed
tohavewillaffecthiserectilefunction.
10. WhatwouldyouexpectS.M.toreportifthemedicationwassuccessful?

CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55


S.M.shouldreportdecreasedsymptomsoffrequency,urgency,nocturia,and
improvedstream.Hemayalsoreporthecanvoidstandingup.
11. WhatsurgicaloptionsareavailabletoS.M.?
Transurethralneedleablation(TUNA):Aneedleisplacedintotheprostateandprostate
tissueisablated.Again,thereisnotissuetoexamineforpathologyafterthisprocedure.It
canbedoneinsituationswheresurgeryisneededbutthepersonmaynottoleratealarger
surgerylikeaTURP(Lewiset.Al,2014,P.1418).
Transurethralresectionoftheprostate(TURP):Thephysicianusesamonopolar
instrumenttoentertheurethraandcoretheprostate.Theareaisthencauterizedtostop
thebleeding.Thisprocedurerequiresinpatienthospitalizationbecauseoftheincreased
chanceofbleeding.Anindwellingcatheterisplacedovernightorlongerasneeded.
(Lewiset.Al,2014,P.1418).
GyrusTURP:AstandardTURPisperformedwithabipolarGyrusinstrumentthatboth
cutsandcauterizestheprostate(Lewiset.Al,2014,P.1418).
Openprostatectomysurgeryofchoiceformenwithlargeprostate,complete
visualizationofprostategland(Lewiset.Al,2014,P.1418).
Laserprostatectomylaserbeamtocutordestroyprostate(Lewiset.Al,2014,P.1418).
KTPlaser:KTPisatypeoflaserthatcorestheprostateandcauterizesastheprocedureis
done,therebydecreasingthechancesofbleeding.Itcanbedonewithapersontaking
warfarin(Coumadin),ifstoppinganticoagulantsisanissue.Itisanoutpatientprocedure

CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55


(Lewiset.Al,2014,P.1418).
SalineTURP:ThisissimilartoaPTCAinthataballoonispositionedinsidetheprostate
andinflatedtoopentheurethraandcompresstheprostatictissueawayfromtheurethra.
Thisproceduremayrequireanovernightstay.(Lewiset.Al,2014.Pg.1418.)
Transurethralmicrowavethermotherapy(TUMT):Intenseheatistransferredtothe
prostatethroughaurethralprobe.Thisprocedureisusuallyanoutpatientprocedure.
(Lewiset.Al,2014.Pg.1418.)

Reference

CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55


Lewis, S. L., Dirksen, S. R., Heitkemper, M. M., & Bucher, L. (2014). MedicalSurgical Nursing Assessment and Management of Clinical Problems, Single
Volume. London: Elsevier Health Sciences.