Republic of the Philippines

UNIVERSITY OF NORTHERN PHILIPPINES

Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

In Partial Fulfillment
Of the Requirement in
________________________
Related Learning Experience (RLE)

A CASE STUDY ON

OBSTRUCTIVE UROPATHY SECONDARY TO BPH URINARY

BLADDER MASS

Presented by:

Bea Flor Rapisura-Pegad

BSN III-A

Presented to:

Gerardo Joven, RN, MAN, PhD

Date:
June 15, 2020
 Republic of the Philippines
UNIVERSITY OF NORTHERN PHILIPPINES
Tamag, Vigan City
2700 Ilocos Sur
College of Nursing
Website: www.unp.edu.ph Mail: unp_nursingvc@yahoo.com
CP# 09177148749, 09175785986

PARAMETER PERCENTAGE ACTUAL

(%) GRADE

Introduction and Objectives

Personal Data 5

Nursing History of Past and Present Health Illness 5

PEARSON Assessment 15

Diagnostic Procedures
a. Ideal 5
b. Actual

Anatomy and Physiology 5

Pathophysiology
a. Algorithm 15
b. Explanation

Management
a. Medical and Surgical (Ideal and Actual) 5
b. Nursing Care Plan (NCP) 25
c. Promotive and Preventive Management 5
Drug Study 5

Discharge Plan 5

Updates 5

Organization/Documentation 2.5

Bibliography 2.5

TOTAL: 100

REMARKS:
___________________________________________________________________________
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____________________

SIGNATURE OF THE CLINICAL INSTRUCTOR:

________________________________________

TABLE OF CONTENTS
I. Introduction and Objectives ………………………………………………
II. Patient’s Profile .…………………………………………………………..
III. Nursing History of Past and Present Illness ……………………………....
IV. PEARSON Assessment …………………………………………………..
V. Diagnostic Procedures
A. Ideal…………………………………………………………………
B. Actual…………………………………………………………………
VI. Anatomy and Physiology of the Organ Involved ……………………….
VII. Pathophysiology
A. Algorithm……………………………………………………………
B. Explanation…………………………………………………………
VIII. Management
A. Medical……………………………………………………………..
a. Ideal
b. Actual
B. Surgical……………………………………………………………..
a. Ideal
b. Actual
C. Nursing Care Plan……………………………………………….…
IX. Promotive and Preventive…………………………………………
X. Drug Study……………………………………………………………..
XI. Discharge Plan …………………………………………………………
XII. Bibliography …………………………………………………………..

I. Introduction
Obstructive uropathy is structural or functional hindrance of normal urine flow,
sometimes leading to renal dysfunction (obstructive nephropathy). Symptoms, less
likely in chronic obstruction, may include pain radiating to the T11 to T12
dermatomes and abnormal voiding (eg, difficulty voiding, anuria, nocturia, and/or
polyuria). Diagnosis is based on results of bladder catheterization,
cystourethroscopy, and imaging (eg, ultrasonography, CT, pyelography), depending
on the level of obstruction. Treatment, depending on cause, may require prompt
drainage, instrumentation, surgery (eg, endoscopy, lithotripsy), hormonal therapy, or
a combination of these modalities.

Causes may be congenital (occurring before birth) or acquired. Congenital causes

include obstructions at a number of sites (like pelvi-ureteric junction, posterior
urethral valves, a tight foreskin or smaller than normal penile opening), abnormalities
of the nerves to the bladder and others.
Acquired causes include bladder or kidney stones, or scar tissue from injury or
infections obstructing urine flow.
Symptoms depend on whether the obstruction is acute or develops over time, and
whether one or both kidneys are affected. Symptoms may include mild to severe
pain on one or both sides/back, fever, nausea or vomiting, swelling (edema), weight
gain or there may be a decrease in the amount of urine, the strength of its flow (with
dribbling), a need to pass urine more often and/or blood in the urine.
Stents, tubes or catheters can help bypass the blockage and relieve urine flow.
Surgery is often needed to permanently correct the problem.

Benign prostatic hyperplasia (BPH) — also called prostate gland enlargement —

is a common condition as men get older. An enlarged prostate gland can cause
uncomfortable urinary symptoms, such as blocking the flow of urine out of the
bladder. It can also cause bladder, urinary tract or kidney problems.

There are several effective treatments for prostate gland enlargement, including
medications, minimally invasive therapies and surgery. To choose the best option,
you and your doctor will consider your symptoms, the size of your prostate, other
health conditions you might have and your preferences.

The severity of symptoms in people who have prostate gland enlargement varies,
but symptoms tend to gradually worsen over time. Common signs and symptoms of
BPH include:
  Frequent or urgent need to urinate

 Increased frequency of urination at night (nocturia)

 Difficulty starting urination

 Weak urine stream or a stream that stops and starts

 Dribbling at the end of urination

 Inability to completely empty the bladder

Less common signs and symptoms include:

 Urinary tract infection

 Inability to urinate

 Blood in the urine

The size of your prostate doesn't necessarily determine the severity of your
symptoms. Some men with only slightly enlarged prostates can have significant
symptoms, while other men with very enlarged prostates can have only minor urinary
symptoms.

In some men, symptoms eventually stabilize and might even improve over time.

The prostate gland is located beneath your bladder. The tube that transports urine
from the bladder out of your penis (urethra) passes through the center of the
prostate. When the prostate enlarges, it begins to block urine flow.

Most men have continued prostate growth throughout life. In many men, this
continued growth enlarges the prostate enough to cause urinary symptoms or to
significantly block urine flow.

It isn't entirely clear what causes the prostate to enlarge. However, it might be due to
changes in the balance of sex hormones as men grow older.

Risk factors for prostate gland enlargement include:

  Aging. Prostate gland enlargement rarely causes signs and symptoms in men
younger than age 40. About one-third of men experience moderate to severe
symptoms by age 60, and about half do so by age 80.

 Family history. Having a blood relative, such as a father or a brother, with

prostate problems means you're more likely to have problems.

 Diabetes and heart disease. Studies show that diabetes, as well as heart

disease and use of beta blockers, might increase the risk of BPH.

 Lifestyle. Obesity increases the risk of BPH, while exercise can lower your
risk.

Complications of an enlarged prostate can include:

 Sudden inability to urinate (urinary retention). You might need to have a

tube (catheter) inserted into your bladder to drain the urine. Some men with an
enlarged prostate need surgery to relieve urinary retention.

 Urinary tract infections (UTIs). Inability to fully empty the bladder can

increase the risk of infection in your urinary tract. If UTIs occur frequently, you
might need surgery to remove part of the prostate.

 Bladder stones. These are generally caused by an inability to completely

empty the bladder. Bladder stones can cause infection, bladder irritation, blood
in the urine and obstruction of urine flow.

 Bladder damage. A bladder that hasn't emptied completely can stretch and
weaken over time. As a result, the muscular wall of the bladder no longer
contracts properly, making it harder to fully empty your bladder.

 Kidney damage. Pressure in the bladder from urinary retention can directly

damage the kidneys or allow bladder infections to reach the kidneys.

Most men with an enlarged prostate don't develop these complications. However,
acute urinary retention and kidney damage can be serious health threats.

Having an enlarged prostate is not believed to increase your risk of developing

prostate cancer.
II: Patient’s Profile

Name: Patient X44

Age: 54 years old
Sex: Male
Civil Status: Single
Address: San Vicente, Magsingal,Ilocos Sur
Birthday: March 11, 1962
Nationality: Filipino
Date of admission: 01-17-2020
Date of Death: 01-28-2020

Patient x44 was admitted at Ilocos Sur Provincial Hospital-Gabriela Silang on Jan 17,

2020 . Admitting diagnosis is TIC Bladder Malignancy, patient complains of severe pain

below the abdomen. Difficulty upon urination for almost 2 days.

The patient had been experiencing difficulty of urination for almost two days, went to

hospital to seek medical attention for he is in pain on the lower part of his abdomen. And

back unbearable backpain. He was diagnosed before with bladder mass and was done taking

his medications 2 year ago as been detailed by his brother.

Upon receiving the patient on January 20,2020, three days since he was hospitalized.

He is conversant, had a Cystoclysis for two days. With blood transfusion. IVF of PNSS 41-42

gtts/min.

Patient X44 was a Carpenter , he sometimes drink alcohol and smokes.

Ultrasounds, xrays and series of laboratory exams were done with the patient due to

pain he’s been experiencing.

III: NURSING HISTORY OF PAST AND PRESENT ILLNESS

The patient has a history of Hypertension on maintenance and two years ago was

diagnosed with bladder mass and undergone medications .

He was admitted last january 17, 2020. He was under IVF of 0.9 NaCl 1000 ml, 41-42

gtts/min on his right arm. He has cystoclysis for two days. He is conversant and on a blood

transfusion.

IV: PEARSON ASSESSMENT

ASSESSMENT Hospital Hospital Hospital Home Visit
Date: 1-20-20 Date Date Date
Patient X44 is conversant. 1-20-20
Able to answer my queries
on what does he feels prior
Physiological to the admission.

1-20-20
Has excessive perspiration
because of the hot
weather. He’s on
Elimination cystoclysis,PNSS of 41-42
gtts/min

1-20-20
He is on bed. He can do
minimal movement like
turning from other
Activity and Rest side,helping in changing
 his clothes and he can rest
well.

Initial vital signs taken as 01-20-20

follows:
BT= 36.5 ‘C
Safety and PR= 131 bpm
Security RR= 21 cpm
BP= 120/90 mmHg
IV site intact and patent
Side rails are working
properly

01-20-20
No o2 supplement
RR= 21 cpm

Oxygenation

NPO for 8 hrs for the 01-20-20

ABD UTZ
conversant
Nutrition With poor appetite
With PNSS for 41-42
gtts/min

V. DIAGNOSTIC PROCEDURE
 A. IDEAL

 X-Ray- A CT scan or computed tomography scan makes use of computer-processed

combinations of many X-ray measurements taken from different angles to produce cross-
sectional images of specific areas of a scanned object, allowing the user to see inside the
object without cutting.

 Urinalysis- used to detect and manage a wide range of disorders, such as urinary
tract infections, kidney disease and diabetes. A urinalysis involves checking the
appearance, concentration and content of urine.

 ABD UTZ- Abdominal ultrasonography is a form of medical ultrasonography to visualize

abdominal anatomical structures. It uses transmission and reflection of ultrasound waves
to visualize internal organs through the abdominal wall.

 COMPLETE BLOOD COUNT with BLOOD TYPE- The complete blood count
(CBC) is one of the most commonly ordered blood tests. The complete blood count is
the calculation of the cellular (formed elements) of blood. These calculations are
generally determined by special machines that analyze the different components of
blood in less than a minute. major portion of the complete blood count is the measure
of the concentration of white blood cells, red blood cells, and platelets in the blood.

B: ACTUAL

 All Ideal Diagnostic procedures are done to the patient. The ff. are the results.

XRAY
ABD UTZ

OTHER LABORATORY RESULTS

 VI. ANATOMY AND PHYSIOLOGY

Pathologic findings consist of dilation of the collecting ducts and distal tubules and
chronic tubular atrophy with little glomerular damage. Dilation takes 3 days from the
onset of obstructive uropathy to develop; before then, the collecting system is
relatively noncompliant and less likely to dilate. Obstructive uropathy without dilation
can also occur when fibrosis or a retroperitoneal tumor encases the collecting
systems, when obstructive uropathy is mild and renal function is not impaired, and in
the presence of an intrarenal pelvis.
Anatomy of Prostate

The prostate gland is part of the male reproductive system. The prostate is located
below the bladder. It surrounds the urethra, the tube that carries urine and semen
out of the body. The function of the prostate is to produce fluid. This fluid mixes with
fluid from the seminal vesicles and sperm from the testicles to form semen. During
ejaculation, semen travels through the urethra and out of the penis. Prostate health
is closely linked to hormones, chemicals that carry messages throughout the body.
Normal levels of hormones, such as testosterone, keep the prostate working
correctly.
VII:PATHOPHYSIOLOGY

The pathophysiology of bladder outlet obstruction in men with BPH has been
attributed to both static and dynamic factors.7 The static obstruction is due to the bulk
enlargement of the prostate encroaching upon the prostatic urethra and bladder
outlet, whereas the dynamic obstruction is related to the tension of prostate smooth
muscle. The medical therapies widely used today for treatment of BPH are targeted
to diminishing bladder outlet obstruction in order to reduce prostate volume and relax
prostate smooth muscle tension.6 Clinical data demonstrate that androgen
suppression and α-blockade relieve and increase urinary flow rates in men with BPH;
these data have been used to support the hypothesis that the pathophysiology of
“prostatism” is due to bladder outlet obstruction.
VIII. MANAGEMENT
A. MEDICAL
a. Ideal

Medications should be given for pain, and to prevent patient from infection. IVF of
PNSS of 41-42 gtts/min. Cystoclysis to prevent clots. Cystoclysis is process of
flushing the bladder with normal saline continuously to prevent or treat clot formation,
allowing urine to flow freely and maintain IDC patency. Other purposes of bladder
irrigation includes relieving bladder spasms as draining urine from the bladder can
relieve spasm; wash out any residue urine or sediment; prevent formation of calcific
deposits in and around the indwelling catheter; and to drain the bladder when acute
urinary retention is present. However, like any other invasive procedure, cystoclysis
must be performed aseptically so as to prevent infection. Blood transfusion should
be done. A blood transfusion is a way of adding blood to your body after an illness or
injury. If your body is missing one or more of the components that make up healthy
blood, a transfusion can help supply what your body is missing. In the case of the
patient , he is on a cystocylsis , so we have to supply the drained blood from his
ureter.

b.Actual

The patient was given medications as per physicians order. He was still at the
Surgical ward. Already on cystoclysis for two(2) days, done with aseptic technique.
With blood transfusion.

B .SURGICAL

a. Ideal

The Patient has a bladder mass, needs to remove the mass.

b.Actual

The patient is already scheduled for operation but unlucky, he died days before.
VIII:NURSING CARE PLAN

(please see attached other file)

IX:PROMOTIVE AND PREVENTATIVE

Apply TSB if febrile.

Monitor cystoclysis if it is draining ptoperly
Reposition the patient every now and then (every 2hrs) to limit the chance of
pneumonia and skin ulcers.
Continuous medication as per physician’s order.

Apply 4 rights of safe blood transfussion:– right blood, right patient, right time and right
place.

X: DRUG STUDY

(please see attached file)

XI:DISCHARGE PLAN:

I was not able to do health teachings to the patient nor significant others because upon
visitation to the hospital 8 days after the clinical duty, unfortunately he already died.
XII:BIBLIOGRAPHY

Book:
Medical –Surgical Nursing
Brunner and Suddarth’s
Vol 1&2, 10th edition

Medical –Surgical Nursing

Brunner and Suddarth’s
Vol 1&2, 14th edition

Nursing Care Plan

Guidelines for Individualizing Client Care Across Life Span
8th edition.

Internet:
https://www.google.com/search?
q=pathophysiology+of+intracerebral+hemorrhage&sxsrf=ACYBGNQVIxQbXze8n3VegdGtoG5XBGAwI
A:1575180782615&source=lnms&tbm=isch&sa=X&ved=2ahUKEwiSzITY5ZPmAhWrGqYKHe2pAasQ_
AUoAXoECA0QAw&biw=1024&bih=499#imgrc=88Hkizef9djUDM:

https://www.yumpu.com/en/document/view/45752570/nursing-care-plan-fever-nursing-crib

https://www.msdmanuals.com/professional/neurologic-disorders/stroke/intracerebral-hemorrhage

https://www.google.com/search?
q=tranexamic+acid&oq=tranexamic+acid&aqs=chrome..69i57j0l7.6438j0j4&sourceid=chrome&ie=U
TF-8