ALDRIN M.

PAULINO BSN 3A

Case Scenario: Prostate Cancer

Mr. Delgado is a 64-year old Caucasian male who comes into the clinic of his family physician with complaints of back pain, blood in the semen
during intercourse and weakness and numbness in his legs and feet for 2 months. His past medical history is notable only for hypertension and
gallstones. The examination reveals a 1 cm hard nodule palpated on the right side of his prostate. His PSA was checked 2 months ago and was
found to be 4.6ng/ml. Because of the presence of palpable nodule, he was referred to a urologist for prostate needle biopsy to rule out prostate
cancer. Mr. Degado looks horrified and afraid about the explanation given by his physician. The physician explains the procedure and reassures
Mr. Delgado about the procedure, he agreed to undergo the procedure. Mr. Delgado tells the doctor that he cannot have prostate cancer
because he feels just “fine” and look great. Mr. Delgado meets the urologist who repeats the prostate examination and concurs that there is a
1.0 cm nodule contained within the right side of his prostate. He recommends that he undergo a transrectal ultrasound (TRUS) guided prostate
needle biopsy to determine if the nodule contains prostate cancer. Three days later, the prostate needle biopsy is performed. The pathology
results show that he has Gleason 3+3=6 prostate cancer in 5 of the 12 biopsy cores with all the positive cores on the right side of the prostate.
The urologist explains to Mr. Delgado that (1) his relatively low PSA of 4.6ng/dl, (2) his small localized nodule on prostate exam, and (3) the low
volume Gleason 6 cancer on the biopsies together strongly suggest that his prostate cancer has not spread and is still confined to the prostate.
Radiation therapy (external beam radiotherapy or brachytherapy), radical prostatectomy, and active surveillance are all the options given to Mr.
Delgado. Mr. Delgado decides to undergo radical prostatectomy and radiation therapy for 12 cycles. The operation and radiation therapy went
well, and Mr. Delgado has an uneventful recovery. He is pleased to learn that the pathology report indicates that all of cancer was removed. His
PSA level is checked 6 weeks after the surgery and is undetectable, consistent with complete excision of the prostate and the tumor. Mr.
Delgado prescribe dutasteride (Avodart) as his maintenance drug and was given Sipuleucel-T (Provenge) vaccine.

NCP: Focus on post radical prostatectomy.

ALDRIN M. PAULINO BSN 3A

CUES NURSING SCIENTIFIC PLANNING IMPLEMENTATIO SCIENTIFIC EVALUATION

DIAGNOSIS EXPLANATION N RATIONALE
Subjective: Risk for Deficient Surgery may be Short term: Monitor Input & Indicator of fluid GOAL MET
fluid volume r/t done through After 1 hour of Output balance and
“Felt relief and Vascular nature several small or nursing replacement Short term:
contented” as of surgical area large incisions in intervention, the needs. With After 1 hour of
the abdomen or
stated by the patient will be bladder nursing
behind the scrotum
patient able to maintain irrigations, intervention, the
adequate fluid monitoring is patient was able
“Felt thirsty” as May remove and volume essential for to maintain
stated by the check the lymph estimating blood adequate fluid
patient nodes near the Long term: loss and volume
prostate After 24 hours of accurately
nursing assessing urine Long term:
Objective: intervention, the output. After 24 hours of
Prostate, the
patient will be nursing
seminal vesicles,
Muscle weakness able to maintain Monitor vital signs, Dehydration or intervention, the
and a portion of
urethra will then be adequate fluid noting increased hypovolemia patient was able
Dizziness removed volume as pulse and requires prompt to maintain
evidenced by respiration, intervention to adequate fluid
Dry mouth, dry good skin turgor decreased BP, prevent volume as
skin Nerve-sparing and balance diaphoresis, pallor, impending shock evidenced by
methods may be intake and output delayed capillary good skin turgor
Low urine output used to try to refill, and dry and balance
preserve erectile mucous intake and output
function
membranes.

After surgery, Investigate May reflect

catheter will be restlessness, decreased
placed to drain confusion, changes cerebral
urine from bladder. in behavior perfusion
Urine will flow (hypovolemia) or
through the indicate cerebral
catheter into a edema from
sterile bag
ALDRIN M. PAULINO BSN 3A

excessive solution
absorbed into the
venous sinusoids
during TUR
procedure (TURP
syndrome)

Encourage fluid Flushes kidneys

intake to 3000 and/or bladder of
mL/day unless bacteria and
contraindicated debris (clots).
Note: Water
intoxication or
fluid overload
may occur if not
monitored closely

Movement or
Anchor catheter, pulling of
avoid excessive catheter may
manipulation cause bleeding or
clot formation
and plugging of
the catheter, with
bladder
distension

Observe catheter Bleeding is not

drainage, noting unusual during
excessive or first 24 hr for all
continued but the perineal
bleeding approach

Evaluate color, Usually indicates

ALDRIN M. PAULINO BSN 3A

consistency of arterial bleeding,

urine clotting, or
irritation that
requires
aggressive
therapy

Monitor To evaluate blood

laboratory studies losses or
as indicated replacement
needs

Administer IV May need

therapy or blood additional fluids,
products as if oral intake
indicated. inadequate, or
blood products, if
losses are
excessive

Maintain traction Traction on the

on indwelling 30-mL balloon
catheter; tape positioned in the
catheter to inner prostatic urethral
thigh fossa creates
pressure on the
arterial supply of
the prostatic
capsule to help
prevent and
control bleeding
ALDRIN M. PAULINO BSN 3A

Release traction Prolonged

within 4–5 hr. traction may
Document period cause permanent
of application and trauma or
release of traction, problems with
if used urinary control

Administer stool Prevention of

softeners, laxatives constipation
as prescribed and/or straining
for stool reduces
risk of rectal-
perineal bleeding