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Obstructive Uropathy 2O

Benign Prostatic
Hyperplasia

MAIN OBJECTIVE
To gain extensive knowledge and enhance
understanding in regards to Obstructive
Uropathy and its correlation to Benign
Prostatic Hyperplasia, especially in geriatric
cases.
In order to achieve this, comprehension and
analysis were done throughout the course of this
case presentation, in adherence to the following
specific objectives:

SPECIFIC OBJECTIVES
Understanding of the basics in regards to the case; its definition,
etiologies, signs and symptoms
Presentation of the patients data, including the demographics,
pertinent patient health history,
Cognizance of the disease process at hand with regards to the
condition of the patient, identification of risks and correlation the
s/sx and intrinsic/extrinsic factors for the pathophysiology to
emerge.
Draw comparisons from the anatomy and physiology to the
pathophysiology
Analysis of the diagnostic studies and associating it to the disease
process
Identification of problems present; discussion of the treatment;
presentation of appropriate nursing care plans and discharge plans

OVERVIEW
This case study revolved around a male
geriatric patient afflicted with a disease that
is deemed common to his age group.
Senescence is a life process in which all of us
are bound to go through in our lives. In this,
our bodily and mental function tend to
deteriorate overtime.

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
(e.g., difficulty voiding, anuria, nocturia, and/or
polyuria). Obstructive uropathy is a very broad
term in itself. It has an array of causes.

Many conditions can cause obstructive


uropathy, which may be acute or chronic,
partial or complete, and unilateral or bilateral
The most common causes differ by age:
Children: Anatomic abnormalities
Young adults: Calculi
Older adults: BPH or prostate cancer,
retroperitoneal or pelvic tumors (including
metastatic cancer), and calculi

Proximal to the obstruction, effects may


include increased intraluminal pressure,
urinary stasis, UTI, or calculus formation
(which may also exacerbate or cause
obstruction). Obstruction is much more
common in males (usually due to Benign
Prostatic Hyperplasia)

Globally, benign prostatic hyperplasia affects about


210 million males as of 2010 (6% of the population).
The prostate gets larger in most men as they get
older. For a symptom-free man of 46 years, the risk
of developing BPH over the next 30 years is 45%.
Incidence rates increase from 3 cases per 1000
man-years at age 4549 years, to 38 cases per 1000
man-years by the age of 7579 years. While the
prevalence rate is 2.7% for men aged 4549, it
increases to 24% by the age of 80 year

As men get older, the prostate also becomes enlarged. This


process is called benign (non-cancerous) enlargement of the
prostate or benign prostatic hyperplasia (BPH). As such, the
prostate can cause compression of the urethra at that level,
resulting in bladder symptoms. BPH related bladder symptoms are
very common; it is estimated that about 40% of men over the age
of 65 will suffer from them. This can significantly impact on a
persons quality of life. The prevalence increases with age. Other
factors that may increase the risk of BPH are race, environment,
diet, and genetics. BPH is more common in Western societies
compared to Asian. It is less common in those who eat large
amounts of vegetables. It also seems to run in the family, and the
incidence increases if a first degree relative (father or brother) has
it.

Bladder symptoms associated with prostatic


enlargement are called lower urinary tract
symptoms. This can be divided into two main
groups voiding symptoms and storage
symptoms. The voiding symptoms are caused
by the obstruction from the enlarged
prostate. When this happens, the bladder can
become overactive secondary to the
obstruction and result in storage symptoms.

In advanced cases, BPH can also cause more complicated symptoms.


They are:
Acute urinary retention:
The patient blocks up completely and cannot pass urine. A urinary
catheter would have to be inserted to drain the bladder.
Blood in the urine (hematuria):
An enlarged prostate often has engorged vessels which can bleed into the
bladder and gets mixed in with the urine. This can be precipitated by
straining (eg. constipation) or being on blood thinning medications. This is
often scary and alarming for the patient. If severe, a patient would have
to be admitted for continuous bladder washout (a closed catheter system
which allows fluid to be trickled into the bladder and drained at the same
time this can stop further bleeding in the urine).

DEMOGRAPHIC PROFILE
NAME: Patient PP
BIRTH DATE: November 15, 1930
BIRTH PLACE: Sta. Monica, Surigao del Norte
AGE: 84 years old
SEX: Male
ADDRESS: Purok 3, Magsaysay, Sta. Monica, Surigao del Norte
CIVIL STATUS: Married
CITIZENSHIP: Filipino
RELIGION: Roman Catholic
DATE AND TIME OF ADMISSION: November 3, 2015, 8:14AM
CHIEF COMPLAINT: Scanty Urine, Unable to Defecate for 3 days
AMITTING DIAGNOSIS: Functional Constipation

PERTINENT PATIENT HISTORY


Past Health History;
Patient recalled having experienced
illnesses such as cough and colds, fever
during his younger years. He experienced
hypertension during his adult years (no other
specific details given) and he has a
maintenance medication of Metroprolol . He
has no allergies in food and medications.

PERTINENT PATIENT HISTORY


History of Present Illness
The client was admitted because of Functional
Constipation and complaints of Scanty Urine.
One week prior to admission, the patient
experienced difficulty in urination and acknowledged
a disfiguration of the abdomen. Two days prior to
admission, the patient experienced short episodes of
abdominal pain , loss of appetite, and vomiting in
small amounts, with warranting difficulty in
urination.

PERTINENT PATIENT HISTORY


Social History

(enlisted the help of the significant

other)

The patient lives in Purok 3, Magsaysay, Sta.


Monica, Surigao del Norte. He has 5 children
(3 sons, 2 daughters), all of them have their
own family. He lives with his wife, and is an
active member of the church. The patient
does not smoke, and only drinks alcohol . He
has a good relationship with his peers.

PHYSICAL EXAMINATION
Vital Signs
Blood Pressure: 140/90 mmHg
Pulse Rate: 89 bpm
Respiratory Rate: 31 cpm
Temperature: 37.1oC

PHYSICAL EXAMINATION
Overall Appearance
Patient has a skinny body build, with noted
slight distention of the lower abdominal area.
Patient has minimal body odor and slightly foul
breath odor. Patient is weak and restless.
Mental Status
Patient is responsive but incoherent in
thoughts. Is in an irritable mood, disoriented to
time and place.

PHYSICAL EXAMINATION
Head (Skull, Scalp and Hair)
Patients head is round, proportionate to the size of
the body, normocephalic and symmetrical in all
areas. No noted formation of masses, nodules and
depressions upon palpation. Patient has think and
coarse hair, receding hairline noted, and white hairs.
To signs of lice infestation observed.

Face
The face appears rough and the skin looks loose and
is symmetrical in facial movements upon inspection.
Grimace noted at times.

PHYSICAL EXAMINATION
Eyes
The eyes appeared sunken, pupils both
round and reactive to light
accommodation, slightly asymmetrical,
cloudy white sclera. Tearing is present,
conjunctiva appeared smooth yet pale in
color.
Nose
No discharges, no flaring noted.

PHYSICAL EXAMINATION
Mouth
Chapped and slightly pale lips, no sores on
mouth noted. Sometimes uses mouth to breathe.
Ears
Parallel, and symmetrical. No discharges
observed. Cartilage is firm to touch,. Skin
color is same as the surroundings.

PHYSICAL EXAMINATION
Skin
Patient has poor skin turgor, relative to aging.
Cool to touch. Has light brown skin color. Flaking
of skin noted
Nails
Pale nailbeds, convex in shape and smooth.
Has slightly poor capillary refill of 4 seconds.

PHYSICAL EXAMINATION
Lungs
Has crackles sounds upon auscultation,
productive cough, symmetrical chest expansion.
Heart
Has normal heart sounds, and regular rhythm.
Peripheries: noted weak radial pulse

PHYSICAL EXAMINATION
Abdomen
No bowel movements, with flatus. Distention of the abdomen and below
noted, pain upon palpation noted as evidenced by grimacing and nonverbal
cues.
Back and torso
Noted redness, bed creases formation, skin discoloration (bluish on some
areas), pressure wound (>4mm in size) near the spinal area, and moist
warmth were noted in assessing the back. Shoulders are hunched
Extremities
Symmetrical in size and shape, weakness noted. No presence of
deformities.

GORDONS TYPOLOGY OF HEALTH


PATTERN
Health Perception and Health Management Pattern
The patient has poor knowledge about his condition, possibly
relating to aging, he often uttered words of wanting to go home. He
was scheduled for an ultrasound on November 5, 2015. He was
transported there at 10:30AM of that day.
Nutritional and Metabolic Pattern
The wife of the patient verbalized that the patient eats 3 times a
day before occurrence of illness, he would casually eat meat and
vegetables, but mostly red meat. Prior to admission, patient only
eats about once or twice a day, in small amounts. Diet consists of
porridges and soups. Patient only drinks water for 4-5 glasses a day
before admission, and on admission, he usually drinks 2-4 glasses
(245mL/glass) a day

GORDONS TYPOLOGY OF HEALTH


PATTERN
Elimination Pattern
Patient usually defecates once everyday or five times a week, and
urinates 4-5 times a day before admission, prior to admission, patient
experienced abnormal frequencies of urination (frequent urination at
night but in small amounts) SO recalls the color of the urine having red
streaks. Upon admission, patient has not been able to defecate for 3
days, but with (+) Flatus, and has a urine output of less than 300 in a
shift (scant). Patient is attached to FBC, (+) UO.
Activity and Exercise

Patient cannot anymore perform strenuous activities due to age.


Before admission, patient is able to walk and move around. On
admission, patient is unable to move on his own and needs assistance,
usually uses mouth to breathe while trying to move extremities

GORDONS TYPOLOGY OF HEALTH


PATTERN
Sleep Pattern
Before admission, patient was able to sleep for 6-10 hours
a day, including naps. On admission, patient can only sleep
for about 3-4 hours, as he is restless
Cognitive-Perceptual Pattern
Patient used to read newspapers for leisure before
admission. On admission, patient is disoriented to time,
place and person.
Self-Perception and Self Concept Pattern
The patient is observed to be in a melancholic state, since
patient is incoherent with his thoughts and words.

GORDONS TYPOLOGY OF HEALTH


PATTERN
Role and Relationships Pattern
The wife of the patient verbalized that the
patient is a family-oriented person. Has
good ties with neighbors.
Sexuality and Reproductive Pattern
Not able to perform sexual activities due
to age.

GORDONS TYPOLOGY OF HEALTH


PATTERN
Coping Stress Pattern
The patient is being surrounded by loved
ones who always give him moral support with
his experiences, he occasionally smiles when
his wife talks to him, but oftentimes just gaze.
Values and Belief Pattern

The patient is a religious person. The wife of


the patient verbalized that their family usually
go to church every Sunday and always pray.

REVIEW OF ANATOMY AND


PHYSIOLOGY (URINARY SYSTEM)
Urine production and elimination are one of the most
important mechanisms of body homeostasis
all body systems are directly or indirectly affected by
kidney function (e.g.. composition of blood is determined
more by kidney function than by diet)
main function of kidneys is to get rid of metabolic wastes
Is responsible for the creation, storage and elimination of
urine.- allows the body to eliminate nitrogenous wastes,
such as urea and uric acid-Allows the body to adjust its
concentrations of salt by producing dilute or concentrated
urine.

REVIEW OF ANATOMY AND


PHYSIOLOGY (URINARY SYSTEM)
FUNCTIONS
Regulation of the volume of blood by excretion
or conservation of water.
Regulation of the electrolyte content of the
blood by the excretion or conservation of
minerals.
Regulation of the acid-base balance of the blood
by excretion or conservation of ions
Regulation of all of the above in tissue fluid.

REVIEW OF ANATOMY AND


PHYSIOLOGY (URINARY SYSTEM)
Kidneys
Ureter
Bladder
Urethra

REVIEW OF ANATOMY AND


PHYSIOLOGY (URINARY SYSTEM)
Kidneys
- is to separate urea, mineral salts, toxins
and other waste products from the blood.
- filtering out wastes to be excreted in the
urine.
- regulating BP
- regulating an acid-base balance
- stimulating RBC production

Viewed internally, the kidney has an outer layer of outer


cortex which surrounds the inner medulla.
The medulla consists of a number of medullary pyramids,
named because of their triangular shape. These are striped
in appearance because they contain microscopic coiled
tubes called nephrons, the functional unit of the kidney .
Urine is made by the nephrons and drains into tiny collecting
ducts within the medullary pyramids. The collecting ducts
merge at the base of the pyramids to form the renal papilla.
From the papilla, urine drains into cuplike structures called
the major and minor calyces. From the calyces the urine
drains into the wider open space of the renal pelvis. This
acts like a funnel draining the urine out of the kidney into
the ureter

Urine formed in each nephron drains down the


collecting ducts and into the renal pelvis.
Urine exits the kidneys via the right and left ureters,
which deliver urine to the bladder by peristaltic
contractions of their muscle walls, and also by
gravity.
As the bladder fills with urine, its walls expand.
When it is full, reflexes are stimulated which lead to
micturition, or going for a wee. Urine is expelled
through a small tube called the urethra which leads
to the exterior of the body.

REVIEW OF ANATOMY AND


PHYSIOLOGY (URINARY SYSTEM)
Bladder
- store urine
- expels urine into the urethra (Micturation)
Urethra
- is the passageway through which urine is
discharged from the body

REVIEW OF ANATOMY AND


PHYSIOLOGY (URINARY SYSTEM)
Other parts:
Nephrons functional unit of kidney. Each
kidney is formed of about one million nephrons.
Glomerulus filters the blood
Bowmans Capsule is a large double walled
cup. It lies in the renal cortex
Tubular Component necessary substances are
being reabsorbed

REVIEW OF ANATOMY AND


PHYSIOLOGY (URINARY SYSTEM)
Loop of Henle create a concentration gradient in the
medulla of the kidney.
- reabsorb water and important nutrients in the filtrate.
Renal Vein a blood vessel that carries deoxygenated
blood out of the kidneys
Renal Artery supply clean, oxygen-rich blood to the
kidneys
Adrenal Gland (Suprarenal Gland) located on top of the
kidneys and is essential for balancing salt and water in
the body

The prostate is a small muscular gland


located inferior to the urinary bladder in the
pelvic body cavity. It is shaped like a rounded
cone or a funnel with its base pointed
superiorly toward the urinary bladder. The
prostate surrounds the urethra as it exits the
bladder and merges with the ductus deferens
at the ejaculatory duct.

Several distinct lobes make up the structure of the prostate:


On the anterior end of the prostate are the two lateral lobes, which are
rounded and shaped like orange slices when viewed in a transverse section.
The lateral lobes are the largest lobes and meet at the midline of the
prostate.
Posterior and medial to the lateral lobes is the much smaller anterior lobe, a
triangle of fibromuscular tissue just anterior to the urethra. The fibromuscular
tissue of the anterior lobe contracts to expel semen during ejaculation.
The median lobe is found just posterior to the urethra along the midline of the
prostate. The median lobe contains the ejaculatory ducts of the prostate.
The posterior lobe forms a thin layer of tissue posterior to the median lobe
and the lateral lobes.

Several distinct lobes make up the structure of the prostate:


On the anterior end of the prostate are the two lateral lobes, which are
rounded and shaped like orange slices when viewed in a transverse section.
The lateral lobes are the largest lobes and meet at the midline of the
prostate.
Posterior and medial to the lateral lobes is the much smaller anterior lobe, a
triangle of fibromuscular tissue just anterior to the urethra. The fibromuscular
tissue of the anterior lobe contracts to expel semen during ejaculation.
The median lobe is found just posterior to the urethra along the midline of the
prostate. The median lobe contains the ejaculatory ducts of the prostate.
The posterior lobe forms a thin layer of tissue posterior to the median lobe
and the lateral lobes.

Urine released from the urinary bladder is carried by the


urethra to the bodys exterior. Under normal conditions,
urine in the urethra passes through the prostate with no
complications whatsoever. The prostate enlarges slowly
throughout a mans lifetime, potentially leading to the
restriction or blockage of the urethra by the time a man
reaches his fifties or sixties. An enlarged prostate can
lead to difficulty urinating or eventually even an inability
to urinate. There are many treatments for an enlarged
prostate including medications, lifestyle changes, and
prostatectomy, the surgical removal of the prostate.

PATHOPHYSIOLOGY
As the prostate enlarges, the surrounding capsule prevents
it from radially expanding, potentially resulting in urethral
compression. However, obstruction-induced bladder
dysfunction contributes significantly to Obstructive
Uropathy. The bladder wall becomes thickened and
irritable when it is forced to hypertrophy and increase its
own contractile force. In the physiological point of view, as
the prostate enlarges, it compresses the urethra,
preventing the outflow of urine and contributing to the
common lower urinary tract
symptoms.

PATHOPHYSIOLOGY

COURSE IN THE WARD


Upon admission patient was unable to
defecate for 3 days, during last encounter,
patient was unable to defecate for 5 days.
Patient is not able to move due to
weakness
Patient oftentimes gaze into the ceiling
Patient seems disconnected to his
surroundings at times

LABORATORY RESULTS
Hematology: 11/3/15; 9:09
Component

Result

Normal Values

Indication

Hemoglobin

15.1

12.0-18.0g/dL

Normal

Hematocrit

44.4

27-54%

Normal

RBC

4.60

4.0-6.0x1012/L

Normal

WBC

12.8

4.5-10.0x109/L

Indicative of Infection

Platelet

154

150-450x109/L

Normal

Lymphocyte

11.0

17-57%

low on infection
resistance

LABORATORY RESULTS
Blood Chemistry: 11/4/15; 11:24
Component

Result

Normal Values

Indication

Glucose (FBS)

79.8

70-105mg/dL

Normal

Uric Acid

6.04

3.5-7.2mg/dL

Normal

Cholesterol

103

140-220mg/dL

Ketoacidosis

Triglyceride

59

40-200mg/dL

Normal

HDL - Cholesterol

41

30-75mg/dL

Normal

LDL - Cholesterol

50.2

0-130mg/dL

Normal

LABORATORY RESULTS
Blood Chemistry: 11/3/15; 11:05
Test

Result

Normal Values

Indication

Renal Insufficiency
Creatinine

1.68mg/dL

0.73-1.36mg/dL

LABORATORY RESULTS
Blood Chemistry: 11/5/15; 12:05
Test

Result

Normal Values

Indication

Renal Insufficiency
Creatinine

1.92mg/dL

0.73-1.36mg/dL

LABORATORY RESULTS
Urinalysis: 11/3/15; 11:05
COLOR: Yellow

WBC: 0-2

TRANSPARENCY: Cloudy

RBC: 20-25 hpf isomorphic, Positive of


blood.

pH: 6.0
SPECIFIC GRAVITY: 1.015

EPITHELIAL CELLS: Moderate


BACTERIA: None

LABORATORY RESULTS
Ultrasound: 11/5/15; 10:30

Drug Study

NAME
Generic Name:
Ranitidine (500mg
IVTT q8)
Classification:
Anti-ulcer agents

MECHANISM OF
ACION

INDICATION/CON
TRAINDICATION

SIDE EFFECTS

NURSING
RESPONSIBILITY

Inhibits the action


of histamine at the
H2 receptor site
located primarily in
gastric parietal
cells, resulting in
inhibition of gastric
acid secretion. In
addition, ranitidine
bismuth citrate has
some antibacterial
action against H.
pylori.

Indication:
Treatment and
prevention of
heartburn, acid
indigestion, and sour
stomach.

CNS:
Confusion,
dizziness,
drowsiness,
hallucinations,
headache
CV:
Arrhythmias
GI:
Altered taste, black
tongue,
constipation, dark
stools, diarrhea,
drug-induced
hepatitis, nausea
GU:
Decreased sperm
count, impotence
ENDO:
Gynecomastia
HEMAT:
Agranulocytosis,
Aplastic Anemia,

Assess patient
for epigastric or
abdominal pain
and frank or
occult blood in
the stool,
emesis, or
gastric aspirate.
Inform patient
that it may cause
drowsiness or
dizziness.
Inform patient
that increased
fluid and fiber
intake may
minimize
constipation.
Inform patient
that medication
may temporarily
cause stools and
tongue to

Contraindicated:
Hypersensitivity,
Cross-sensitivity
may occur; some
oral liquids contain
alcohol and should
be avoided in
patients with
known intolerance

NAME
Generic Name:
Domperidone
(10mg tab TID)
Classification:
Antidopaminergic
Antiemetic

MECHANISM OF
ACION

INDICATION/CON
TRAINDICATION

Inhibits the action


of histamine at the
H2 receptor site
located primarily in
gastric parietal
cells, resulting in
inhibition of gastric
acid secretion. In
addition, ranitidine
bismuth citrate has
some antibacterial
action against H.
pylori.

Symptomatic
management of upper
gastrointestinal
motility disorders
associated with
chronic and subacute
gastritis and diabetic
gastroparesis.

Contraindicated in
patients with
known sensitivity
orintolerance to
the drug.
Domperidone
should not be used
whenever
gastrointestinal
stimulation might
be dangerous, i.e.,
gastrointestinal
hemorrhage,
mechanical
obstruction or

SIDE EFFECTS

NURSING
RESPONSIBILITY

Serum prolactin
Obtaining
level may increase
medical
resulting in
attention if
galactorrhoea in
fainting,
females(increasing
dizziness,
of milk production,
irregular
probably by
heartbeat or
increasing prolactin
pulse, or other
production by the
unusual
pituitary gland) &
symptoms occur
less frequently
gynaecomastia in
males.

Gastrointestinal
(2.4%):abdominal
cramps, diarrhea,
regurgitation,
changes
inappetite, nausea,

NAME
Generic Name:
Lactulose (30CC
q12)
Classification:
gastrointestinal
agent;
hyperosmotic
laxative

MECHANISM OF
ACION

INDICATION/CON
TRAINDICATION

Potent central
dopamine receptor
antagonist.
Structurally related
to procainamide
but has little
antiarrhythmic or
anesthetic activity.
Exact mechanism
of action not clear
but appears to
sensitize GI smooth
muscle to effects
of acetylcholine by
direct action.

Osmotic effect of
organic acids causes
laxative action, which
moves water from
plasma to intestines,
softens stools, and
stimulates peristalsis
by pressure from
water content of stool.
CI:
Diabetes mellitus;
concomitant use with
electrocautery
procedures
(proctoscopy,
colonoscopy); older
adult and debilitated
patients; pediatric
use.

SIDE EFFECTS

NURSING
RESPONSIBILITY

GI:Flatulence,borbo In children if the


rygmi,belching,abd
initial dose
ominal
causes diarrhea,
cramps,pain,and
dosage is
distention (initial
reduced
dose);diarrhea
immediately.
(excessive dose);
Discontinue if
nausea, vomiting,
diarrhea
colon accumulation
persists.
of hydrogen gas;
Promote fluid
hypernatremia.
intake (>=1500
2000 mL/d)
during drug
therapy for
constipation;
older adults
often self-limit
liquids.
Lactuloseinduced osmotic
changes in the
bowel support
intestinal water

NAME

MECHANISM OF
ACION

INDICATION/CON
TRAINDICATION

Generic Name:
Metoclopramide (1
amp IVTT q8)

Potent central
dopamine receptor
antagonist.
Structurally related
to procainamide
but has little
antiarrhythmic or
anesthetic activity.
Exact mechanism
of action not clear
but appears to
sensitize GI smooth
muscle to effects
of acetylcholine by
direct action.

Increases resting tone


of esophageal
sphincter, and tone
and amplitude of
upper GI contractions.
As a result, gastric
emptying and
intestinal transit are
accelerated with little
effect, if any, on
gastric, biliary, or
pancreatic secretions.
Antiemetic action
results from druginduced elevation of
CTZ threshold and
enhanced gastric
emptying.

Classification:
gastrointestinal
agent; prokinetic
agent (GI
stimulant)

Contraindicatons
Sensitivity or
intolerance to
metoclopramide;
allergy to sulfiting
agents; history of
seizure disorders;;

SIDE EFFECTS

NURSING
RESPONSIBILITY

Report
Serum prolactin
level may increase
immediately the
resulting in
onset of
galactorrhoea in
restlessness,
females(increasing
involuntary
of milk production,
movements,
probably by
facial grimacing,
increasing prolactin
rigidity, or
production by the
tremors.
pituitary gland) &
Extrapyramidal
less frequently
symptoms are
gynaecomastia in
most likely to
males.
occur in

children, young
Gastrointestinal
adults, and the
(2.4%):abdominal
older adult and
cramps, diarrhea,
with high-dose
regurgitation,
treatment of
changes in
vomiting
appetite, nausea,
associated with
cancer
chemotherapy.
Symptoms can

NAME
Generic Name:
Cefuroxime (250
mg IVTT q6)
Classification:
Antibiotic

MECHANISM OF
ACION

INDICATION/CON
TRAINDICATION

SIDE EFFECTS

NURSING
RESPONSIBILITY

Second-generation
cephalosporin that
inhibits cell-wall
synthesis,
promoting osmotic
instability; usually
bactericidal.

Indication:
infections of the
urinary and lower
respiratory tracts,
Streptococcus
pneumoniae and S.
pyogenes,
Haemophillus
influenzae,
Staphylococcus
aureus, Escherichia
coli.
Contraindicated:
Contraindicated in
patients
hypersensitive to
drug.
Use cautiously in
patients
hypersensitive to
penicillin because
of possibility of
cross-sensitivity
with other betalactam antibiotics.
Use with caution
inbreast-feeding

Body as a Whole:
Thrombophlebitis
(IV site);

Determine
history
ofhypersensitivi
ty reactions to
cephalosporin,
penicillin and
history of
allergies
particularly to
drugs before
therapy is
initiated.
Absorption
ofcefuroxime is
enhanced by
food.

Notify prescriber
about rashes

GI:
Diarrhea, nausea,
antibioticassociated colitis.
Skin:
Rash, pruritus,
urticaria.

NURSING CARE PLAN

ASSESSMENT
Objective:
- Distended
abdomen noted
- Scanty amounts
of urine upon
checking FBC
patency
Subjective
- Difficulty in
urination as
verbalized by SO

DIAGNOSIS
Urinary Retention
r/t prostate
enlargement
secondary to
bladder distention

DESIRED
OUTCOME

INTERVENTIONS

Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient will void in
sufficient amounts
with less palpable
bladder distension.

Encourage patient
to void every 24
hr and when urge
is noted.
Percuss and
palpate
suprapubic area.
Encourage oral
fluids up to 1000
mL daily, within
cardiac tolerance,
if indicated.
Monitor vital signs
closely. Observe
for hypertension,
peripheral/depend
ent edema,
changes in
mentation. Weigh
daily. Maintain
accurate I&O (250300cc)
Monitor lab

EVALUATION
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient was able
to void but still in
scant amount
(300cc) and
bladder
distention was
still present

ASSESSMENT

DIAGNOSIS

DESIRED
OUTCOME

INTERVENTIONS
Provide catheter
care, note an any
accumulations on
the tube. Note
quality of flow
Administer
medications as
indicated:
Antibiotics and
antibacterials.
Irrigate catheter
as indicated, if
there is noted
obstruction in
tube. Check
catheter often
(every 2 to 3
hours).

EVALUATION

ASSESSMENT
Objective:
Facial grimacing
and restlessness
noted
Abdominal and
suprapubic
distention present
Subjective:
Nonverbal cues of
pain

DIAGNOSIS
Acute Pain r/t
bladder distention
as evidenced by
restlessness and
grimacing

DESIRED
OUTCOME

INTERVENTIONS

Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to show signs of
relief from pain, is
able to fully rest.

Assess pain,
noting location,
intensity (scale of
010), duration.
Recommend
bedrest if pain
recurs as
indicated.
Provide comfort
measures, e.g.,
back tapping,
helping patient
turn to sides or
assume position of
comfort.
Suggest use of
relaxation/deepbreathing
exercises,
diversional
activities, enlisting
the help of the SO.
Provide

EVALUATION
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient was able
to rest for a short
period of time
and appear
relaxed.

ASSESSMENT

DIAGNOSIS

- Impaired Skin
Objective:
- Inability to move
Integrity r/t
whole body
physical
- Breathing
immobilization
through mouth
2o disease
while attempting
process as
to move
manifested by
extremities
general body
- General body
weakness,
weakness
pressure wound,
- Poor skin turgor
and poor skin
relative to aging
turgor
- Noted redness,
bed creases
formation, skin
discoloration
(bluish on some
areas), pressure
wound (>4mm in
size) and moist
warmth at his back

DESIRED
OUTCOME

INTERVENTIONS

Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to participate in
prevention
measures for the
timely healing of
wounds without
getting
complications

Identify underlying
conditions for
appropriate
interventions to
follow
Note general
debilitation,
reduced extent of
mobility, changes
in skin and mass,
problems with selfcare and impaired
cognition
Note skin color,
texture and turgor.
Palpate for lesions,
its size,
temperature and
hydration.
Perform turning to
sides every 2 hours
Maintain
appropriate

EVALUATION
Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient
participated in
some preventive
measures
(turning to sides,
backtapping)

ASSESSMENT

DIAGNOSIS

- Impaired Skin
Objective:
- Inability to move
Integrity r/t
whole body
physical
- Breathing
immobilization
through mouth
2o disease
while attempting
process as
to move
manifested by
extremities
general body
- General body
weakness,
weakness
pressure wound,
- Poor skin turgor
and poor skin
relative to aging
turgor
- Noted redness,
bed creases
formation, skin
discoloration
(bluish on some
areas), pressure
wound (>4mm in
size) and moist
warmth at his back

DESIRED
OUTCOME

INTERVENTIONS

Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to participate in
prevention
measures for the
timely healing of
wounds without
getting
complications

Identify underlying
conditions for
appropriate
interventions to
follow
Note general
debilitation,
reduced extent of
mobility, changes
in skin and mass,
problems with selfcare and impaired
cognition
Note skin color,
texture and turgor.
Palpate for lesions,
its size,
temperature and
hydration.
Perform turning to
sides every 2 hours
Maintain
appropriate

EVALUATION
Within 6 hours of
rendering
appropriate
nursing
interventions, the
patient
participated in
some preventive
measures
(turning to sides,
backtapping)

ASSESSMENT

DIAGNOSIS

DESIRED
OUTCOME

INTERVENTIONS

Objective:
Lab results
- Cloudy urine
- Hematuria
(blood in the
urine)
- Increased
creatinine levels
(1.92)

- Risk for Fluid


Volume
Deficiency r/t
renal
dysfunction as
manifested by
laboratory
findings of
cloudy urine,
hematuria, and
increased
creatinine levels
(1.92)

Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient is expected
to maintain
adequate
hydration as
evidenced by
stable vital signs,
palpable peripheral
pulses, good
capillary refill

Monitor input and


especially output
carefully, take
note of amounts
and notify if .
Monitor BP, pulse.
Evaluate capillary
refill
Promote bedrest
with head
elevated, to
facilitate proper
circulation
Encourage
increased oral
intake based on
individual needs.

Flaky skin, weak


radial pulse,
slightly poor
capillary refill (4
secs.)

Administer IV fluids
as ordered,
regulating it to
ordered rate. Check
patency for
assurance of fluids
passing

EVALUATION
Within 4 hours of
rendering
appropriate
nursing
interventions, the
patient was able
to drink 3 glasses
of water and has
stable vital signs
(BP 130/80, PR
94). Capillary
beds still looked
pale

Discharge Plan
MEDICATION
Advice patient to adhere to the medications
given by the doctor.

Discharge Plan
ENVIRONMENT
Teach importance of environmental
cleanliness to the significant other, since
patient has impaired skin integrity, it is
important to avoid occurrence of
complications and infections since
Obstructive Uropathy in itself is

Discharge Plan
TREATMENT
[If no surgical procedures were done and only
noninvasive/pharmacologic interventions were
made] Teach SO catheterization once difficulty
of urination persists/recurs. Present the steps
clearly, the materials needed and highlight the
importance of sterility. If condition worsens,
advise to seek hospitalization and reconsider
surgical procedures.

Discharge Plan
Health Teachings
Teach patient the importance of
maintaining adequate hydration to prevent
recurrence of constipation and urination
problems
Minimize long hours of sitting as it may
affect the voiding process

Discharge Plan
Out-Patient Follow Up Care
Instruct the patient to seek or return upon
experiencing any signs and symptoms like
severe abdominal pain, hematuria, difficulty
in urination

Discharge Plan
DIET
Moderating the consumption of alcohol
and caffeine-containing products
Less intake of fluids before bedtime