Clinical Scenario involving the patient Richard Rogers - Term Paper Example

Clinical Scenario involving the patient Richard Rogers Your name:   Course name:         Professors’ name: Date: Introduction Benign prostatic hyperplasia (BPH) is a non-cancerous enlargement of a person’s prostate gland, which makes urination uncomfortable and difficult (Nichol et el 2009). This illness is common among patients who are above 50 years, but most men are believed to have some degree of benign prostatic hyperplasia (BPH) (Garimella et el, 2009). The symptoms that is associates with Benign prostatic hyperplasia (BPH) are known as lower urinary tract symptoms (LUTS) (Gordon and Shaughnessy, 2008). These symptoms in older men can cause them to have trouble when passing urine. There are many invasive methods that have been developed to be used in the treatment of BHP, but Transurethral Resection of the Prostate (TURP) has remain the most effective surgical treatment to be used in the treatment of lower urinary tract symptoms (LUTS) that are related to Benign prostatic hyperplasia (BPH) (Davidson and Chutka, 2008). This is for the simple reason that more than 90 percent of patients who have been treated using the procedure reporting improved or normal voiding, after 5 years follow-up period (Newman, 2007). This report use clinical reasoning cycle to gather data about Mr. Richard Rogers who is 65 years old and is suffering from LUTS. Thereafter, the data about the patient will be used to generate a series of nursing problems statements that are related to the care of Mr. Richard Rogers. Nursing Problems Common nursing problems found in patient with BPH in order of priority are: a.) Relieve acute urinary retention; b.) promote comfort; c.) Risk for Deficient Fluid Volume; d.) prevent patients from having complications; and e.) help patients to deal with psycho-social concerns. a. Relieve acute urinary retention Urinary retention in a patient with BHP is characterized by poor urinary stream with straining, incomplete voiding, intermittent flow and hesitancy (Farrell & Dempsey, 2011). As the patient’s bladder remains full, it may lead to nocturia, incontinence, and high frequency. According to the data from the patient’s chart sheet. The patient was experiencing excruciating pain when the urine is not able to flow out (Tollefson, 2012). Moreover, the patient had developed high blood pressure, has chest pain, was anxious and was sweating. According to the patient’s chart, physical examination showed a visible midline mass that was above the symphysis pubis, this shows the patient’s bladder was incompletely emptied. Patient’s palpation has disclosed a distended bladder (Johnson, Munoz, Gottlie and Jarrard, 2007). On digital examination of the bladder reveals a rubbery enlargement of the prostate which was not consistent with the degree of urinary obstruction (Nichol et el 2009). b.) promote comfort As indicated in the patient medical chart Mr. Richard Rogers had complications which include: involuntary urination, weak stream, painful urination and in some case the patient was unable to urinate (Newman, 2006). These conditions were detrimental and very uncomfortable to the patient in maintain a proper working, healthy urinary system (Craft, Gordon & Tiziani, 2011). Generally, patient with suspected Benign prostatic hyperplasia (BPH) have a history of weak stream, straining to urinate, frequent urination, nocturia, and incomplete emptying of the bladder. A patient with BHP may complain on a group of symptoms known as prostatism: urinary hesitancy, an interrupted stream, decreased urine stream force and caliber, and feeling of incomplete voiding (Lemone et al, 2011). These symptoms discussed above in one way or another will make the patient to feel uncomfortable. c.) Risk for Deficient Fluid Volume The patient should be encouraged to take water or any other fluid every day. It is for the simple reasons that the patient with BHP may have restricted himself in taking oral fluids in order to prevent urinary symptoms. Oral fluid will maintain renal perfusion and flushes kidneys and bladder. When a patient restricts himself in taking oral fluids, this will increase the risk of dehydration/hypovolemia. d.) prevent patients from having complications Post surgery rectal examination is important to monitor the progress of the patient with BPH. The scare tissues in the patient’s rectal that were as a result of the surgery will require treatment after the patient has undergone the surgery (MacDonald and Wilt, 2007). In rare occasions, the opening of the ladder becomes shrinks and scarred, causing obstruction in the patient’s rectal. This complication can be solved during the doctor’s visit when the physicians will simple stretch the patient urethra (Johnson, Munoz, Gottlie and Jarrard, 2007). Regardless of which type of medication Mr. Richard Rogers takes, it is important that he continue to visit the hospital to ensure that any complications arising from his surgery are taken care of appropriately. e.) help patients to deal with psycho-social concerns Psychosocial issues in Benign prostatic hyperplasia (BPH) deserve attention because patients with BPH not only have the illness that requires treatment but they also often experience social and psychological problems (Wilt, Ishani and MacDonald, 2007). Various studies on the incidence of psychosocial problems in BPH patients such as post-traumatic stress and depression have been conducted in men with BPH (Keita et al, 2005). Most patients with BPH tend to distance themselves from other people closer to them and are often confronted with specific problems, such as incontinence, erectile dysfunction, gastrointestinal symptoms, and erectile dysfunction. Therefore, it is the role of a nurse to help Mr. Roger to overcome these psycho-social issues that may arise. Three (3) highest priority problem statements Creating priorities is a process that is used to determine a preferential sequencing of patient’s activities. Because nurse is responsible for various activities while attending to a patient, the nurse needs to write down the priorities while taking care of the patient. As a nurse in the case study, I used high, moderate, low or very low to classify what need to be done first and last in the post-surgery care management of Mr. Rogers. Those risks that may put the patients health in danger I classified them as high (MacDonald and Wilt, 2007), while risk that may not put the patients health in danger I classified them as low. In between there is moderate risk and low risks. I gave high risk the first priority, followed by moderate risk, then followed by low risks. Lastly, low risks were given low priority. In the post-surgery care management of Mr. Rogers, Relieve acute urinary retention was classified as high risk (Pittler, 2007). Promotion of comfort was classified as having moderate risk. Lastly, Risk for deficient fluid volume was classified as having low risks. Retentions of urine in the patient are given the first priority because urine retention in patients can cause the patient’s bladder to stretch to enormous size and cause the bladder to tear (Wilt, Ishani and MacDonald, 2007). If the patient’s bladder distends it may cause pain in the patient (Gordon & Shaughnessy, 2008). In addition, Pressure increase in the patient’s bladder can also prevent the urine from entering the ureters or even cause the patient’s urine to pass back up the ureters and into the kidney, and this may cause hydronephrosis, and possibly kidney failure, pyonephrosis, and sepsis (MacDonald and Wilt, 2007). Promotion of comfort in Mr. Roger was given the second priority because Mr. Roger had complications which included: having pain while urination, weak stream, involuntary urination, and in some case the patient had difficulties when urinating. These conditions were very uncomfortable and detrimental to Mr. Rogers in maintain a proper working and healthy urinary system. Therefore, patient’s comfort is a must for successful post surgery recovery. Risk for Deficient Fluid Volume was given third priority because a patient with BHP may restrict himself from taking oral fluids in an attempt to control urinary symptoms (Johnson, Munoz, Gottlie and Jarrard, 2007). As sodium loss increases in the patient’s body, extracellular fluid volume decreases (Wilt, Ishani and MacDonald, 2007). This intervention is necessary to prevent fluid volume deficit in patient’s body because the kidney is unable to conserve sodium (Dedhia and McVary, 2008). Post Surgery Care Management Intervention/Action Rationale Urinary Retention Care (NIC) The patient will be encouraged urinate every 3-5 hours and when urge is noted (Davidson & Chutka, 2008). The patient will be asked about stress when lifting objects, coughing, sneezing, moving, laughing, coughing (MacDonald and Wilt, 2007). Observe patient’s urinary-stream, noting force and size. Encourage oral fluids up to 0.3 litres (Dedhia and McVary, 2008). Provide/encourage meticulous catheter and perineal care ((MacDonald and Wilt, 2007). Recommend sitz bath as indicated Administer medications as prescribed by the doctor: Androgen inhibitors e.g, finasteride (Proscar); Antispasmodics, e.g., oxybutynin (Ditropan) Antibiotics and antibacterials (Dedhia and McVary, 2008). This will help to minimize overdistension/retention of the patient bladder Pressure from urethral can inhibit voiding (Pittler, 2007). Useful in evaluating degree of obstruction and choice of intervention. Increased circulating fluid maintains renal perfusion and flushes kidneys, bladder, and ureters of “sediment and bacteria.” Reduces risk of ascending infection. Enhance voiding effort because its promote relaxation of the muscle and decreases edema in a patient. Decrease symptoms This drug will relieve the patient’s bladder spasms that may be caused by irritation throught the use of the catheter. To prevent infection (Dedhia and McVary, 2008). Pain Management (NIC) Assessing the patient’s pain (scale of 0-10), and noting intensity, location, duration. Tape catheter to the abdomen and drainage tube to thigh (if traction not required) (Wilt, Ishani and MacDonald, 2007). Provide the patient’ with comfort, e.g rexation exercise, back rub, and putting the patient at the position of comfort (Davidson and Chutka, 2008). Give the patient a prostatic massage . Insert catheter and attach to straight drainage as indicated (Johnson et el, 2007). Administer medications: : Antibacterials, e.g., methen amine hippurate (Hiprex); Narcotics, e.g., meperidine (Demerol); Bladder sedatives and Antispasmodics, e.g., oxybutynin (Ditropan), flavoxate (Urispas), To help the nurse to determine appropriate medical intervention. Prevents erosion of the penile-scotal junction and pull on the bladder. Enhance patient’s coping mechanism and promote relaxation (Nichol et el 2009). Aids in evacuation of ducts of gland to relieve congestion/inflammation. This will reduce bladder irritability and tension, and at same time drain the patient’s bladder. To kill bacteria that may be present in the patient’s urinary tract system. Used to relieve severe pain the patient may experience. Relieves bladder irritability ((Wilt, Ishani and MacDonald, 2007) Fluid Management (NIC) Monitor the patient’s output. (Moyad & Lowe, 2008). Encourage the patient to take fluids. Administer hypertonic salin (Pittler, 2007). Promote bedrest with head elevated (Davidson and Chutka, 2008). Sustained/rapid dieresis may make the patient’s body fluid from getting depleted and limits the sodium re-absorpiton in the patient’s renal tubules. To reduce the risk of hypovolemia/dehydration. Replaces sodium losses and fluid to correct/prevent hypovolemia following outpatient procedures (Pittler, 2007). facilitating circulatory homeostasis and decreases cardiac workload. Assessment criteria a. Urinary retention: The assessment will use post-void residual (PVR) tools to assess the urinary retention. b. Pain: A pain scale will be used to assess the patient pain. The rating scale is numbered 0 to 10, ten being most severe pain imaginable and zero translating to no pain at all. This scaled will be supported by asking questions with regard to pain. c. Risk for Deficient Fluid Volume: decrease in urine output with increased specific gravity; assess for and report symptoms and signs of fluid volume deficit (Neal & Keister, 2009): dry mucous membranes, thirst; postural hypotension and/or low B/P; decreased skin turgor; neck veins flat when client is supine etc. Conclusion In the case study, the patient’s data or information suggested that most patients who had benign prostatic hyperplasia (BPH) would prefer treatment such as Transurethral Resection of the Prostate (TURP) that affect long-term illness progression over those therapies that offer short term relief. In most cases, this preference by many patients are ignored by medical practitioners, and this may brought discord between the views that are held by doctors and beliefs held by patients. Therefore it is important for medical practitioners to assess and understand patient’s beliefs on the treatment of the illness. References Craft, J., Gordon, C & Tiziani, A. (2011).Recommended Understanding Pathophysiology. New York: Elsevier Davidson J.H, and Chutka D.S. (2008). Benign prostatic hyperplasia: treat or wait? J Fam Pract, ;57(7):454-63. Dedhia, R; McVary, K (2008). "Phytotherapy for Lower Urinary Tract Symptoms Secondary to Benign Prostatic Hyperplasia". The Journal of Urology 179 (6): 2119–25. Friedman A.H. (2009). Tamsulosin and the intraoperative floppy iris syndrome. JAMA, 20;301(19):2044-5. Garimella PS, Fink HA, Macdonald R, Wilt TJ. (2009). Naftopidil for the treatment of lower unrinary tract symptoms compatible with benign prostatic hyperplasia. Cochrane Database Syst Rev, (4). Gordon AE, Shaughnessy AF. (2008). Saw palmetto for prostate disorders. Am Fam Physician, 67(6):1281-1283. Johnson AR, Munoz A, Gottlieb JL, Jarrard DF. (2007). High dose zinc increases hospital admissions due to genitourinary complications. J Urol, 177(2):639-43. Lemone, P., Burke, K, et al. (2011). Recommended Medical Surgical Nursing: Critical thinking in client care. London: Pearson. Keita H, Diouf E, Tubach F et al. (2005). Predictive factors of early postoperative urinary retention in the postanesthesia care unit. Anesth Analg, 101:592-596.      MacDonald, R and Wilt, T. J. (2007). "Alfuzosin for treatment of lower urinary tract symptoms compatible with benign prostatic hyperplasia: A systematic review of efficacy and adverse effects". Urology 66 (4): 780–8.     Moyad MA, Lowe FC. (2008). Educating patients about lifestyle modifications for prostate health. Am J Med, 121(8 Suppl 2):S34-42. Neal RH, Keister D. (2009). What's best for your patient with BPH? J Fam Pract, 58(5):241- 7. Newman, DK., (2006) Urinary incontinence, catheters and urinary tract infections: An overview of CMS Tag F 315. 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