Patient Scenario: Diagnosed with Prostate Cancer - Essay Example

? Patient Scenario: Diagnosed with Pro Cancer Institute Patient Scenario: Diagnosed with Pro Cancer What are the components of physical examination? Describe each component. The physical examination for prostate cancer has two main components, namely Digital Rectal examination (DRE) and measuring blood levels of Prostate Specific Antigen (PSA). Digital Rectal examination is undertaken as a part of annual examination to directly palpate the prostate and check for abnormal texture and presence of lumps. Prostate specific antigen is secreted by prostate into the semen, some of it normally leaks into the blood stream. However, in prostate cancer, the levels in blood rise very high which the guide further examination like prostate biopsy. (Melman & Newnham, 2011). 2. Mr. Smith’s blood pressure was 160/100 mmHg. a. How does a medical provider take or measure blood pressure? Blood pressure is measured by using sphygmomanometer. The cuff (40% of the arm circumference) is inflated and the brachial artery is auscultated to measure the blood pressure. The cuff is deflated slowly. The pressure at which the korsakoff sounds become audible is the systolic blood pressure and the pressure at which these sounds disappear are taken as diastolic blood pressure (Boon & Davidson, 2006). b. What do the top (numerator) and bottom (denominator) numbers mean in the biological sense? The numerator indicates the systolic blood pressure, which is the pressure with which heart contracts to push blood against resistance through the arteries. The denominator indicates diastolic blood pressure, which is the pressure in the peripheral circulation when the heart relaxes during consecutive beats. c. What is the significance the size of these two numbers? The measurement of the systolic and diastolic blood pressure is essential as it signifies a person’s health risks of having diseases of the cardiovascular system as well as other health problems. The systolic blood pressure above 120 mm Hg and the diastolic blood pressure above 80 mm Hg indicate hypertension, i.e. 140/90 mm Hg or higher. d. Is Mr. Smith’s blood pressure within normal range? Explain how you concluded whether Mr. Smith’s blood pressure is/is not within normal range. Mr. Smiths’ blood pressure is not in the normal range. His blood pressure was measured to be 165/100 mm Hg, which exceeds well above the normal range of 120/ 80 mm Hg. This puts him in the stage 2 hypertension (blood pressure equal to or above 160/100 mm Hg). e. Discuss the possible health issues anticipated for a person with a blood pressure of 165/100 mm Hg. The person with the blood pressure of 165/100 mm Hg is at highly increased risk of suffering from cardiovascular diseases. High blood pressure increases the workload on heart muscle. To compensate for the increasing demand, left ventricle undergoes remodeling and hypertrophy, which in turn puts the person at an increased risk of arrhythmias, sudden death and heart failure in the long run. The vessels are also damaged as a result of atherosclerosis, and the end organ effects are evident in the form of retinopathy, nephropathy and stroke (Porth, 2007). 3. Based on the data provided, what laboratory tests were performed and what samples were taken from the patient? Select one of the laboratory tests ordered for Mr. Smith and discuss why Mr. Smith’s physician might have ordered the test and the information she might have expected to obtain from that particular test. The blood samples were taken for the laboratory tests that include complete blood count, electrolyte panel, blood glucose, renin, ACTH and cortisol. Urine samples were collected to measure levels of Potassium and 24 hour urinary aldosterone. Glucose intolerance and hypokalemic alkalosis are common presentations of ectopic ACTH production in patients with prostatic carcinoma. So, the physician ordered serum ACTH and cortisol levels suspecting the Para neoplastic Cushing’s syndrome accompanying prostatic adenocarcinoma. The raised levels of ACTH and cortisol confirm the findings. 4. a. Compare Mr. Smith’s values with reference values and indicate whether Mr. Smith’s values are below, above, or within normal range (compare Mr. Smith’s values with the Reference values) for each laboratory tests in the table above from the second set of tests. Mr. Smith's hemoglobin is 7.3 g/dl, which is below the reference range of 13.8 to 18.2 g/dl. His hematocrit (20.4%) is also below the reference range (45-52%). The platelet count is very low (20x109/L) as compared to the normal 150-400x109/L. He is going through hypokalemic alkalosis as evident from the low serum potassium levels (2.6mmol/L as compared to normal 3.8-4.5mmol/L) and high bicarbonate levels (38mmol/L as compared to normal 22-26mmol/L). He is hyperglycemic as his blood sugar is raised to 460 mg/dl, when normally it should be 64.8-104.4 mg/dl. The tests showed low serum aldosterone. The levels of serum renin were normal. Also, the urinary levels of potassium and 24 hour urinary aldosterone were in normal reference ranges. The adrenocorticotrophic hormone (1082 pg/ml) and cortisol (155.5 microg/dL) were significantly elevated as compared to normal 9-46 pg/ml ACTH and 0-25 microg/dL cortisol, respectively. 4. b. Select one of the values outside of normal range from the table above and discuss possible medical concerns related to the identified change in Mr. Smith’s values. Ectopic ACTH production and resultant elevated levels of cortisol put the patient at increased risk of metabolic alkalosis, hypokalemia and hypertension (Rickman et al, 2001). The patient has increased chances of having arrhythmias and respiratory failure (Cheng et al, 2004). 5.  What imaging procedures did Mr. Smith undergo? Discuss the distinctions and similarities between the two different imaging approaches. What were the results of imaging procedures in Mr. Smith’s case? Radiographic imaging was done to identify the extent and severity of malignancy in Mr. Smith's case. The two imaging procedures done were the magnetic resonance imaging (MRI) and computed tomography scan (CT scan). Both MRI and CT scan are very helpful in assessing the extent of spread of cancer and the metastasis to different organs in the body. CT scan is helpful for soft tissue imaging as well as for bony metastasis. It is also helpful in guiding needle for biopsy. MRI is more sensitive than CT scan and helps detect earliest bone changes. It is also helpful in guiding the treatment plan (Peh, 2011). In Mr. Smith, the imaging procedures reveal extensive spread of cancer, to the bone as well as to the adrenals, which in turn have become nodular and have resulted in the obstruction of the intestine. REFERENCES 1. Boon, N. A., & Davidson, S. (2006). Davidson's principles & practice of medicine. Edinburgh: Elsevier/Churchill Livingstone. 2. Cheng, C. J., Chen, Y. H., Chau, T., & Lin, S. H. (January 01, 2004). A hidden cause of hypokalemic paralysis in a patient with prostate cancer. Supportive Care in Cancer : Official Journal of the Multinational Association of Supportive Care in Cancer, 12, 11, 810-2. 3. Melman, A., & Newnham, R. E. (2011). After prostate cancer: A what-comes-next guide to a safe and informed recovery. New York: Oxford University Press. 4. Peh, CG. “Imaging in Bone Metastases”. medicine.medscape.com. n.p. May 25, 2011. Retrieved March 03, 2012. http://emedicine.medscape.com/article/387840-overview#a01 5. Porth, C., & Porth, C. (2007). Essentials of pathophysiology: Concepts of altered health states. Philadelphia: Lippincott Williams & Wilkins. 6. Rickman, T., Garmany, R., Doherty, T., Benson, D., & Okusa, M. D. (January 01, 2001). Hypokalemia, metabolic alkalosis, and hypertension: Cushing's syndrome in a patient with metastatic prostate adenocarcinoma. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 37, 4, 838-46. Read More