A CASE STUDY OF A 64-YEAR-OLD MALE WITH A

FINAL DIAGNOSIS OF HYPERTENSION, DIABETES

MELITUS TYPE 2, ANEMIA, SECONDARY TO
BENIGN PROSTATE HYPERPLASIA
 INTRODUCTION

Benign prostatic hyperplasia—also called BPH—is a condition in men in which the prostate gland is enlarged and not cancerous. Benign prostatic
hyperplasia is also called benign prostatic hypertrophy or benign prostatic obstruction. The prostate goes through two main growth periods as a man
ages. The first occurs early in puberty, when the prostate doubles in size. The second phase of growth begins around age 25 and continues during
most of a man’s life. Benign prostatic hyperplasia often occurs with the second growth phase. As the prostate enlarges, the gland presses against and
pinches the urethra. The bladder wall becomes thicker. Eventually, the bladder may weaken and lose the ability to empty completely, leaving some
urine in the bladder. The narrowing of the urethra and urinary retention—the inability to empty the bladder completely—cause many of the
problems associated with benign prostatic hyperplasia. The cause of benign prostatic hyperplasia is not well understood; however, it occurs mainly
in older men. Benign prostatic hyperplasia does not develop in men whose testicles were removed before puberty. For this reason, some researchers
believe factors related to aging and the testicles may cause benign prostatic hyperplasia. Throughout their lives, men produce testosterone, a male
hormone, and small amounts of estrogen, a female hormone. As men age, the amount of active testosterone in their blood decreases, which leaves a
higher proportion of estrogen. Scientific studies have suggested that benign prostatic hyperplasia may occur because the higher proportion of
estrogen within the prostate increases the activity of substances that promote prostate cell growth. Another theory focuses on dihydrotestosterone
(DHT), a male hormone that plays a role in prostate development and growth. Some research has indicated that even with a drop in blood
testosterone levels, older men continue to produce and accumulate high levels of DHT in the prostate. This accumulation of DHT may encourage
prostate cells to continue to grow. Scientists have noted that men who do not produce DHT do not develop benign prostatic hyperplasia.
 General Objective

This study aims to broaden my knowledge regarding Benign Prostatic Hyperplasia as well as identify symptoms beforehand to prevent
further complications. and will be able to analyze all the gathered data and to create an effective nursing care plan and intervention to the
client’s condition. It also aims to develop my skills, knowledge, attitude and communication in providing the proper care to be extended.

Specific Objective

 To be able to assess the client and identify the manifestation of Benign Prostatic Hyperplasia.
 To be able to formulate and prioritize nursing diagnosis applicable for client.
 To be able to plan and set goals to meet the needs of the client.
 To provide necessary nursing intervention that can be applied for patient with BPH.
 To evaluate the effectiveness of intervention rendered to the client.
 Client R is a 64 years old male with the case of Hypertension, Diabetes Mellitus Type 2, Anemia, Secondary to
Benign Prostate Hyperplasia who was admitted last March 7, 2024 with a chief complaint of Difficulty in Urinating. It
all started from a normal urination The client was given, but his condition didn't seem to be getting better, so his wife
was worried and took him to the emergency room.

Chest X Ray was ordered by hir Attending Physician

(03/07/2024)
Impression:
Findings:
Basal Pleural Thickening vs Minimal Pleural
Heart is Enlarged Effusion, Left

Aorta is tortuous Cardiomegaly

The Left costophrenic sulcus is obscured Atheromatous Aorta

Body thorax is unremarkable

Kidney-Ureter-Bladder (KUB) - Prostate (03/07/2024)

Ultrasound Findings

Kidneys:

The right kidney measures 108.29x48.43x51.34mm while the left kidney measures 108.64x48.62x48.84mm. The kidneys are normal in size. No sign of hydronephrosis. No distinct mass
nor lithiasis. The Renal cortices show normal thickness and echogenicity

Summary: No unusual findings in both kidneys based on ultrasound examination

Ureters: The ureters are not dilated

Urinary Bladder:

No distinct mass or lithiasis. Np Border irregularities observed.

Volume measurement 93.56cc. Post void 6.15cc

Summary: Small UB Capacity, Minimal residual urine

Prostate:

The partially visualized prostate gland is slightly enlarged measuring 41.05x32.52x38.72mm. Wt. 27.06g ( Previous measurement: 41.56x31.36x39.49mm. Wt 26.96g) No distinct mass.
Calcifications noted.

Summary: Slightly Enlarged Prostate Gland with Calcifications

Theoretical Framework: Self-Care Theory

Dorothea Orem's Self-Care Deficit Theory

emphasizes the importance of individuals' ability
to perform self-care activities for maintaining
health and well-being. In the context of patients
with Benign Prostatic Hyperplasia (BPH), nurses
play a crucial role in assisting patients with self-
care tasks such as medication management and
lifestyle modifications. Nursing interventions
focus on providing therapeutic care to promote
health and recovery, while also acknowledging
the potential role of caregivers in supporting
patients who may have difficulty performing self-
care independently.
Clients Profile Patient’s Initial: Gender: Male Age: 64 Years Marital Status:
Old Married

Mr. R.B.V

Educational Occupation: Retired Religion: Roman Place of Birth:

Attainment: Company Driver Catholic

Garchitorena, Cam
Sur

Health Care Source of information:

Financing: Self Pay Patient

Usual source of medical care: Private Hospitals

Date of admission: Date of Interview: Date of Discharge:

3/7/24 3/11/2024 3/14/2024

Admitting Diagnosis: Final Diagnosis:

Benign Prostate Hyperplasia, Anemia HPN, DM Type 2, Anemia, Secondary to Benign

Prostate Hyperplasia
 B. Nursing Health History

Chief complaint: “Pag umiihi ako sobrang sakit at pakonti konti ang iniihi ko” as verbalized by the patient

C. History of Present Illness

1 Day prior to admission client experience difficulty of urinating like a burning inside of it with a pain scale of
7/10. Client said that “Sobrang konti nang naiihi ko at pabalik balik ako sa CR”.

3hrs prior to admission client kept on complaining a burning sensation when he urinates and still a slight amount of
urine. With a pain scale level of 7/10

1 hr prior to admission client experience a 9/10 pain scale when urinating, his wife and son was worried and rush
him into Olivarez General Hospital by their own vehicle
 D. Past medical
history
Childhood illness Chicken Pox

Childhood/Adult Immunization COVID-19 Vax, Flu Vaccine,

Accidents and Injuries Vehicular Accident ( 2009 )

Previous hospitalization/surgery Cataract Surgery (R)

Medication(s) prior to confinement Amlodipine 50g, Metformin 50mg,

Clopidogrel 75g, Irbesartan 150mg,

E. Family History of Illness

According to the client Mr. R, his father diagnosed with Benign Prostatic Hyperplasia, and Heart Failure and Type
2 Diabetes Mellitus and died at the age of 77 because of a cardiac arrest. His mother is died at the age of 80 from
Respiratory Arrest. His grandfather from his father died from Stroke and his grandmother died from Pneumonia. While
his grandfather on the mother side died and he cannot remember the cause of death and his grandmother from mother
side died at the age of 82 from Breast Cancer. Patient stated that he has 3 siblings. His Eldest brother aged 68 has been
diagnosed with Diabetes Mellitus type 1 and Hypertension as well. While his younger sister aged 54has been diagnosed
with Hypertension and Asthma. On the youngest sister aged 41 has No Known Illness. In addition, he doesn’t know
about their aunties and uncles because they don’t have communication with them
Family Genogram
F. Developmental History
 G. Personal/Social History

Mr. R has five sibling and he is the oldest. He was not a breadwinner of their family as his mother helped him with his education
back then and with house expenses as his father passed away when they were young. He got married at the age of 26. He had two boys,
the eldest was 30 and the youngest was 25 years old. He works in a stressful and hectic schedule as a Company Driver. The client
verbalized his work as a source of stress but an enjoyment to him as he meets new people along the way. He shares his ideas with life.

He seldom does household chores and cooks meals for his family because of his age as this was taken by his wife to do it so that
he can rest. One rule of his before is that when he is home, he does not bring work stress or work related in their home. He makes sure
that he gives time to listen to his children and wife and even on the weekends he does watching television and don’t mind the stress so
that he can spend his time with his family. He likes to read during his spare time to exercise his mind to function well each day.

His wife is the foundation of their family but he is the decision maker. He always has the last word and opinion in their family,
especially when it comes to their children. He stated that he is a fan of traveling before because if its work as driver, exploring. His wife
has Diabetes mellitus type 2 also and he stated that his wife takes maintenance as well with him. His wife is health conscious as she is in
the house and had a background in med related before which is a barangay health officer. She was the one encouraging him to go to the
hospital because of his condition.

He eats vegetables and meats but he likes to have a banana (saba) after his meals. He used to smoke back then during his teenage
days. He is still drinking alcohol sometimes together with his son.
 H. Environmental History

Mr. R and his wife lived in a subdivision in Silverio Compound, Paranaque City. The environment is clean and
peaceful. They live in a single-story type of house where he and his wife together with their children live there. The
garbage is collected thrice a week which is Tuesday, Wednesday and Saturday. Their neighborhood is defined as a civil
relationship as stated by the patient. They do the casual stuff like greeting and sometimes they talk to their neighbor.
The community is well-disciplined and they are aware of their responsibility as part of the community. They are near
mini grocery stores, small clinics, gasoline stations and small stalls for food. They are near their barangay.
 J. Gordon's Typology of 11 Functional Health Pattern

a. Health Perception/Health Management Plan

Prior to the client's hospitalization the client defines health as one of the top priorities of humans. He described a healthy person as a person who
prioritizes their mental health. “You cannot function well enough if your mind is contradicting you to move” as verbalized by the patient. He eats healthy
foods like vegetables and fruits but he prefers to with Banana (Saba) with Bagoong.

He barely does household chores. He thinks walking around the house and on their subdivision is one of his exercises.

During the hospitalization the client had changed his perspective with his definition with health that he would prioritize being healthy by exercising
and eating healthy foods and to lessen his sweet cravings. He also added he will look after his water intake. He is uncomfortable with what he feels
“Nararamdaman ko yung hilo paminsan minsan” as verbalized by the client he stated that he does want to experience this again.

Analysis: The concept of health is shaped by its definition. The World Health Organization (WHO) articulates health not merely as the absence of
illness and disability, but as a condition that includes holistic well-being, incorporating physical, mental, and social aspects. (World Health Organization,
2015)

Interpretation: The client expresses a desire to recover quickly and enhance his well-being through disciplined behavior and strict adherence to the
instructions given by his doctor.
 •Nutritional/Metabolic Pattern

Prior to hospitalization the client gets enough nutrients. He has a proper appetite to eat food. He makes sure that there are vegetables upon her meal.
Also, He loves to eat with Bananas (Saba), Sweet Potato and coffee either hot or cold. And he has no allergies in foods.

During the hospitalization patient was advised to have a low salt low fat diet as he has a Hypertension, He doesn’t want to skip a meal because of
his medications is needed to be taken with food. He always looks for bananas (Saba) or even a sweet potato to eaten while on his stay in the hospital.

Analysis: A low salt, low-fat diet is often recommended for individuals with certain health conditions such as hypertension, cardiovascular diseases,
and obesity. This dietary pattern aims to reduce the intake of sodium and unhealthy fats, which are linked to increased risk of heart disease, high blood
pressure, and other metabolic disorders. Here's a breakdown of the nutritional and metabolic implications of such a diet. (National Heart, Lung, and Blood
Institute. (n.d.). Low-Salt Diet: How to Lower Your Sodium Intake. 2018)

Interpretation: Due to his condition, the client successfully adhered to the prescribed low salt low fat diet as instructed by his doctor. This dietary
plan ensured that the client consumed an appropriate and specified quantity of essential nutrients, which played a crucial role in reducing the amount of
sodium on his body's.
 Elimination Pattern

Prior to hospitalization the client usually defecated once a day which happens during the morning before or after he takes a bath. The color of his stool is dark brown or
sometimes brown. It is semi-solid sometimes there is a strong odor and sometimes not. He urinates at 7-9 times a day with a champagne color sometimes, dark yellow and clear
white. The client does feel a pain sometimes or a discomfort with his urination and defecation.

During his hospitalization the client did not yet have her defecated though he has the feeling of discomfort that he feels defecating. He only had her urination which he
stated was a dark yellowish color or amber color. There was pain or discomfort during his urination and he can’t control when he urinates and feels like burning on his penile
part.

Analysis: Benign prostatic hyperplasia (BPH) is a condition in aging men marked by prostate gland enlargement, leading to urinary symptoms. Common symptoms
include increased frequency and urgency of urination, nocturia (nighttime urination), difficulty initiating or maintaining urination, and straining during urination. These
symptoms result from urethral obstruction caused by the enlarged prostate. If untreated, BPH can lead to complications such as urinary retention and kidney damage. Patients
should seek medical evaluation for appropriate management. (National Institute of Diabetes and Digestive and Kidney Diseases. (2019).

Interpretation: Before hospitalization, the patient experienced regular bowel movements. However, while in the hospital, their bowel movements decreased to twice
throughout the entire stay due to the doctor's directive to reduce sodium intake and consume appropriate meals for their age. Additionally, the patient reports experiencing a
burning sensation at the tip or beneath during urination, along with occasional loss of control over urination, resulting in varying amounts being released.
Activity- Exercise Pattern

Prior to hospitalization after bedtime, he does stretch like stretching his legs upward at the side of the bed and he will sit down and circulate his
arms. He also stated that his daily chores give his exercise like walking around the house or in their subdivision. The client takes supplements such as
Vitamins C.

During his hospitalization he is in bedrest with bathroom privileges where his movements will be less. The doctor’s order for the client is to have a
bedrest for his entire stay with minimal activity. He was able to walk to the bathroom without an assistant but the way he walks is slow. He was able to
move in the bed by positioning itself for physical assessment that was conducted and by sitting down on its own.

Analysis Maintaining an appropriate activity and exercise pattern is essential for the overall health and well-being of elderly patients. Regular
physical activity can help improve cardiovascular health, maintain muscle strength and flexibility, enhance mood, and reduce the risk of chronic diseases
such as heart disease, diabetes, and osteoporosis. Here's an analysis of the activity and exercise pattern for elderly patients. (National Institute on aging
and development (2020)

Interpretation: Before being hospitalized client had his walking around and consider as exercise and doing a stretching. While on his hospitalization
client has been bedrest with bathroom privileges so his only exercise that he can do is just by walking going to the bathroom
a. Sleep-Rest Pattern

Prior to hospitalization the client gets 6-7 hours of sleep. He had a difficulty in sleeping specially when taking a late coffee in the afternoon. He
sleeps at 10:00 in the evening and wakes up at 5:00 in the morning. He does not take any supplements or medication to sleep. He just lay down in the bed
and positioned herself in a comfortable position.

During his hospitalization the client slept for only 3-4 hours as he was struggling to sleep. He couldn’t get enough sleep because of the interruption
with the vital signs, and His family was calling virtually randomly to ask how he went through and the lights of the room are too bright. Also when
urinating it contributes the pain so client cant sleep easily.

Analysis: Numerous studies have consistently highlighted profound links between the duration of sleep and a myriad of health issues, including
cardiovascular events, stroke risk, artery calcification, and alterations in inflammatory markers, among others. Additionally, research suggests that
insufficient sleep often precedes adverse health outcomes, although definitive causality remains to be established (Buysse, D. J., Grunstein, R., Horne, J.,
& Lavie, P. (2016) Can enhancing sleep quality lead to better health outcomes? Insights from Sleep Medicine Reviews)

Interpretation: The client's sleep is compromised due to the presence of unfamiliar stimuli that keep him awake late at night. Additionally, he
experiences frequent awakenings for vital sign checks and follow-up medication administration as required. The pain and difficulty of urinating he
experiences during her hospitalization also contributes to the disruption of her sleep.
a. Cognitive - Perceptual Pattern

Prior to hospitalization the client has slight sensory deficits or memory lapses due to his aged. His memory is slightly intact sometimes he forgets
things to do. He can understand an instruction and can do a task that was instructed to him. He is not wearing eyeglasses or any devices to facilitate her
hearing, speaking, touching, seeing and tasting. He prefers to have medication to stop the pain he is having and he stated he likes to rubbed menthol
ointment on his forehead and in back when he feels dizzy or wants to relax.

During the hospitalization the patient had stated that his memory is still slightly intact and he is cooperative with the conducted interview. He is
clear with his responses while he feels pain after urinating.

Analysis: Sensory perception entails the conscious process of organizing and interpreting incoming data or stimuli in order to derive meaningful
information. (Goldstein, E. B. (2018). Cognitive Psychology: Connecting Mind, Research, and Everyday Experience.

Interpretation: While on his hospitalization, the client exhibited intact awareness of his surroundings. His sensory receptors and memory lapses due
to aging. And his response to stimuli, conduction of impulses, and perception were functioning. The client's cognitive-perceptual pattern remained
unchanged during his hospitalization, and he displayed cooperation and ease in answering questions.
a. Self-Perception/Self Concept

Prior to hospitalization the client described himself as a strong foundation of their family. wise, cheerful, loving dad and a caring person. He always
tries his best to see both sides of the situation before he gives his opinion and on how he can extend his help. He is beyond blessed to have his two adults
though he is strict but he makes sure his children are enjoying their adult like other adults do.

During the hospitalization the client verbalized that he is still the same in his perception of himself. Though his situation makes his wander and
anxious he makes himself strong and firm.

Analysis: Self-esteem is the subjective appraisal an individual makes regarding their own value or significance. This assessment encompasses
comparing personal standards and accomplishments to those of others and to one's own idealized self. When there exists a disparity between an
individual's self-esteem and their envisioned ideal self, it can result in a weakened self-concept or diminished self-esteem (Myers, D. G., & Twenge, J. M.
(2019). Social Psychology).

Interpretation: The client's self-esteem has been significantly impacted by his past experiences, including the diagnosis he received. specifically, his
prostate had a problem. These events have had a profound effect on his self-esteem.
a. Role Relationship Pattern

Prior to hospitalization the client and his family are in a nuclear type of family. He is the decision maker of the family; everything goes to him first
before his wife and children make a move. He and his wife has retired from their jobs the working on their family is their Eldest Son and Daughter to
sustain the needs of their family. He also helps to budgets their monthly expenses.

During his hospitalization nothing had changed with his role he is still the decision maker regardless of his hospitalization. His wife is the only
companion in the hospital. Their family reached out for support through prayers and some of their families are willing to extend help financially if they
will need it.

Analysis: Over the course of their lives, people experience numerous changes in the roles they inhabit. A role can be described as a set of
anticipations concerning how an individual occupying a specific position should behave and act. Conversely, role performance pertains to the actual
behaviors and actions demonstrated by a person within a particular role, which correspond to the expectations linked with that role (Ackley, B. J., &
Ladwig, G. B. (Nursing Diagnosis Handbook: An Evidence-Based Guide to Planning Care). Page 1287).

Interpretation: Regardless of the difficulties the client has encountered, his core role remains unchanged. He affirms that his ability to love, show
affection, and fulfill responsibilities remains constant regardless of the circumstances he faces. During his struggle with his condition, the client expresses
gratitude for the unwavering presence and support of his family, who played a vital role in helping his navigate and overcome the challenges he
experienced.
a. Sexual Reproductive Pattern

Prior to hospitalization the client stated He and his wife are not sexually active and they are both satisfied with their life as elderly. The patient
verbalized that he is the one who asks for his wife to do those things while in their younger years before

During the hospitalization they are still the same, his wife is still around to hold him during this time of toughness.

Analysis: Understanding human sexuality is a multifaceted endeavor, characterized by its complexity and intricacy, which can prove challenging to
grasp entirely. It is a deeply personal and individualized aspect of human existence, molded by the diverse array of life experiences unique to each
individual. A myriad of factors, spanning physiological, psychosocial, and cultural realms, interplay to shape one's sexuality. These influences
significantly impact attitudes and behaviors pertaining to sexuality, thus contributing to the vast spectrum of perspectives and actions witnessed among
individuals (Weber, J. R. (2011). Health Assessment in Nursing, p. 793).

Interpretation: The client states that even he and his wife had their interactions long time ago. He is satisfied what they are now. He always admires
his wife for being here and still holding with him during this situation.
a. Coping-Stress Pattern

Prior to hospitalization the client's source of stress is the problem at home. He gets phone calls each day about the concerns on their bills and other
personal matters. All the problems inside their home goes to his hands which tires him and stresses his for a full load of thoughts. He eats Saba paired
with Bagoong that is sweet to relieve his stress and if he is having a stress that he can’t managed they go to out of town with his wife or sometimes with
family.

During the hospitalization of the client, he verbalized being drowsy or tired. He verbalized that he has prepared himself for his situation. He feels
stress that his son and his daughter are working all of this for him to be treated. And he feels stressed if he sees his wife having sleepless nights by
watching him all day in hospital.

Analysis: The effects of stress can reverberate across multiple dimensions of an individual's well-being, encompassing physical, emotional,
intellectual, social, and spiritual realms. This holistic impact underscores how stress can influence the entirety of a person's being, resulting in a diverse
array of outcomes across these various dimensions (Pender, N. J. (Health Promotion in Nursing Practice).

Interpretation: The client possesses various coping mechanisms that are both efficient and effective in dealing with stress. When he experiences
stress, he is aware of how to redirect his focus and engage in activities that help his cope with those emotions. This indicates that he has developed a solid
understanding of his personal coping strategies and can effectively apply them when needed.
a. Value-Belief Pattern

Prior to hospitalization the client stated that He and his family manage to attend masses in an average of two Sundays every month. He prays to God
for blessings and above everything, he values his family most.

During the hospitalization the client still devoted in their prayers to ask for the Almighty for his faster rehabilitation. He continued to be devoted in
his religion. Though, there have been many trials that have already come to him and his family’s way. He still believes firmly and has put his faith in God

Analysis: Spiritual distress occurs when an individual encounters obstacles or challenges to their spiritual well-being or belief system, which
typically provides them with strength, hope, and a sense of purpose in life. This condition can be influenced by a variety of factors, including
physiological issues, treatment-related concerns, and situational challenges, all of which may contribute to an individual's experience of spiritual distress.

Interpretation: Despite experiencing spiritual distress caused by his condition, the client still managed to strengthen his faith in God. Despite the
challenges he faced, he remained steadfast in his belief and held onto the conviction that everything happens for a purpose and that God has greater plans
in store for him and his family.
Review of Systems
 ANATOMY AND PHYSIOLOGY

Most of the male reproductive system is on the outside of your abdominal cavity
or pelvis. The external body parts of the male reproductive system include the penis,
scrotum and testicles. Another name for these parts is genitals or genitalia.

Penis

The penis is the male organ for sexual intercourse. It contains many
sensitive nerve endings, and it has three parts:

Root. The root is the base of your penis. It attaches to the wall of your
abdomen.

Body (shaft). The body has a shape like a tube or cylinder. It consists of
three internal chambers: the two larger chambers are the corpora cavernosa, and
the third chamber is the corpus spongiosum. The corpora cavernosa run side by
side, while the corpus spongiosum surrounds your urethra. There’s a special,
sponge-like erectile tissue inside these chambers. The erectile tissue contains
thousands of spaces. During sexual arousal, the spaces fill with blood, and your
penis becomes hard and rigid (erection). An erection allows you to have
penetrative sex. The skin of the penis is loose and stretchy, which lets it change
size when you have an erection.
 Glans (head). The glans is the cone-shaped tip of the penis. A loose layer of skin (foreskin) covers the glans. Healthcare providers sometimes
surgically remove the foreskin (circumcision). In most people, the opening of the urethra is at the tip of the glans. The urethra transports pee and
semen out of your body. Semen contains sperm. You expel (ejaculate) semen through the end of your penis when you reach sexual climax (orgasm).
When your penis is erect, your corpora cavernosa press against the part of your urethra where pee flows. This blocks your pee flow so that only
semen ejaculates when you orgasm.

What is a normal size of the penis? Studies suggest that the average penis is about 3.5 inches (8.9 cm) when flaccid (soft) and a little more
than 5 inches (13 cm) when erect.

Scrotum: The scrotum is the loose, pouch-like sac of skin that hangs behind the penis. It holds the testicles (testes) as well as nerves and
blood vessels. The scrotum protects your testicles and provides a sort of “climate-control system.” For normal sperm development, the testes must
be at a temperature that’s slightly cooler than body temperature (between 97 and 99 degrees Fahrenheit or 36 and 37 degrees Celsius). Special
muscles in the wall of the scrotum let it contract (tighten) and relax. Your scrotum contracts to move your testicles closer to your body for warmth
and protection. It relaxes away from your body to cool them.

Testicles: The testicles (testes) are oval-shaped organs that lie in your scrotum. They’re about the size of two large olives. The spermatic cord
holds the testicles in place and supplies them with blood. Most people AMAB have two testicles, on the left and right side of the scrotum. The
testicles make testosterone and produce sperm. Within the testicles are coiled masses of tubes. These are the seminiferous tubules. The seminiferous
tubules produce sperm cells through spermatogenesis.

Epididymis: The epididymis is a long, coiled tube that rests on the back of each testicle. It carries and stores the sperm cells that your testicles
create. The epididymis also brings the sperm to maturity — the sperm that emerge from the testicles are immature and incapable of fertilization.
During sexual arousal, muscle contractions force the sperm into the vas deferens.
 Prostate: The function of the prostate is to store and secrete a slightly alkaline fluid, milky or white in appearance, that usually constitutes 20-30% of the volume of the
semen along with spermatozoa and seminal vesicle fluid. The alkalinity of semen helps neutralize the acidity of the vaginal tract, prolonging the lifespan of sperm. The
alkalinization of semen is primarily accomplished through secretion from the seminal vesicles. The prostatic fluid is expelled in the first ejaculate fractions, together with
most of the spermatozoa. In comparison with the few spermatozoa expelled together with mainly seminal vesicular fluid, those expelled in prostatic fluid have better motility,
longer survival and better protection of the genetic material (DNA).

The prostate also contains some smooth muscles that help expel semen during ejaculation. Secretions

Prostatic secretions vary among species. They are generally composed of simple sugars and are often slightly alkaline.

In human prostatic secretions, the protein content is less than 1% and includes proteolytic enzymes, prostatic acid phosphatase, and prostate-specific antigen. The
secretions also contain zinc with a concentration 500-1,000 times the concentration in blood.

Regulation
To work properly, the prostate needs male hormones (androgens), which are responsible for male sex characteristics.

The main male hormone is testosterone, which is produced mainly by the testicles. Some male hormones are produced in small amounts by the adrenal glands.
However, it is dihydrotestosterone that regulates the prostate.

Internal Parts

Vas deferens

The vas deferens is a long, muscular tube that travels from the epididymis into the pelvic cavity, just behind the urinary bladder. The vas deferens transports mature
sperm to the urethra in preparation for ejaculation.
 Ejaculatory ducts

Each testicle has a vas deferens that joins with seminal vesicle ducts to form ejaculatory ducts. The ejaculatory ducts move through your prostate, where they collect
fluid to add to semen. They empty into your urethra.

Urethra

The urethra is the tube that carries pee from your bladder outside of your body. If you have a penis, it also ejaculates semen when you reach orgasm.

Seminal vesicles

The seminal vesicles are sac-like pouches that attach to the vas deferens near the base of the bladder. Seminal vesicles make up to 80% of your ejaculatory fluid,
including fructose. Fructose is an energy source for sperm and helps them move (motility).

Prostate gland

The prostate is a walnut-sized gland that rests below your bladder, in front of your rectum. The prostate adds additional fluid to ejaculate, which helps nourish sperm.
The urethra runs through the center of the prostate gland.

Bulbourethral (Cowper) glands

The bulbourethral glands are pea-sized structures on the sides of your urethra, just below your prostate. They create a clear, slippery fluid that empties directly into the
urethra. This fluid lubricates the urethra and neutralizes any acids that may remain from your pee.
PATHOPHYSIOLOGY
LABORATORIES AND DIAGNOSTIC STUDY
 VII. Problem List
- Acute Pain related to bladder irritation as evidenced by verbalization of flank pain
- Activity intolerance related to generalized body weakness as evidenced by pallor.
- Disturbed sleeping pattern related to interruptions for therapeutics, monitoring, other generated awakening, and
excessive stimulation (noise and lighting)
- Impaired urinary elimination as evidenced by difficulty in urinating
- Urinary Retention related to obstruction caused by enlarged prostate gland
List of Priority Problems
NURSING CARE PLAN
NURSING CARE PLAN
NURSING CARE PLAN
Care Map
Evidence-based nursing
COURSE IN THE WARD
Discharge Plan
 Evaluation

a. Summary of the study

This is a study of a 64 years old male with a final diagnosis of a Hypertension, Diabetes Mellitus Type 2, Anemia,
Secondary to Benign Prostate Hyperplasia who was admitted last March 7, 2024 with a chief complaint of Difficulty in
Urinating. at Olivares General Hospital. The recovery is medication, supplements and appropriate management,
medical and nursing intervention that apply to the client’s case are applied during treatment. There is a gradual
recovery as the patient was clear during the interview and the patient was able to move without supervision. The Nurse
Student and Patient were able to establish the Self-care deficit theory of Dorothea Orem. The nursing and medical
treatment had helped the client to gain its strength and cope from its recovery. All the intervention for the client was
seen gradually which is a sign of progress. The assessment, diagnosis, planning, implementation and evaluation were
used to be able to improve the outcomes of the client
 Conclusion
In our conclusion, the client’s chief complaint has been treated. It is because of the proper treatment and
management. The client was able to function well and had an understanding with his condition. As a student nurse who
was exposed to the Medical Surgical Ward, we have applied from what we have learned to our lecture. The exposure at
the Medical Surgical ward is monumental with learning. We have learned and so does our client with the care we have
extended