Question

Mr. Bahr is a 59-year-old man who is undergoing an annual physical today. His past medical history includes hypertension which is well controlled with losartan (Cozaar), 50 mg taken once daily. During his last annual physical, his blood pressure was 128/78, and he had no concerns other than having to wake up to urinate once in the middle of the night. During today’s visit, his blood pressure is 126/80. He tells the nurse that he now has to get up three to four times every night to urinate.

1. What further assessment data should the nurse collect regarding Mr. Bahr’s statement about awakening more frequently to urinate?

Mr. Bahr shares with the nurse that he has difficulty starting a stream of urine, that the flow of urine feels “weak,” and that he frequently experiences dribbling at the end of urination. His primary care provider performs a physical assessment, including a digital rectal examination that reveals a large prostate. The nurse notes that the patient had a PSA blood test drawn last year with the results showing 1 ng/mL. The provider orders a new PSA blood test.

2. What is the purpose of a PSA blood test? Why would this test be ordered?

Mr. Bahr’s PSA level is 12 ng/mL. A needle biopsy that was performed confirmed a diagnosis of stage III prostate cancer. The provider discusses radical prostatectomy, radiation, and hormonal therapy as options. Mr. Bahr chooses to have the radical prostatectomy procedure.

3. What are post-operative assessments specific for this surgery?

4. Postoperatively, what complications should the nurse recognize that require immediate intervention?

5. Mr. Bahr’s condition is stable following the open radical prostatectomy procedure and is discharged. What information should be included in this patient’s discharge instructions?   Include information regarding potential long-term issues the patient may experience as a result of the surgical procedure.

Answer 1

●The further assessment needed for this patient are

• Any complaints of excessive thirst and appetite to rule or for diabetes
• As it is the water pill,assess for the timings the patient takes the medication.Taking it in morning time can reduce discomfort in night time
• Reading of drop in blood pressure
• Assess for side effects

● PSA blood test is used to rule out the presence of cancer in prostate.This test will be ordered in case if the patient has frequent urination, decrease in quantity of urine ,any pain ,hematuria to rule out inflammation of prostate

● The following post operative assessment specific to the case are

• Assess the site for any bleeding, pain
• Assess urine output regularly

The complications that needs immediate intervention are

• Bleeding
• fever
• Infection
• Decrease in urine output

●The patient education needed are

• Not to lift weight
• Take medication as ordered
• Avoid smoking and alcohol
• Drink plenty of water
• Monitor urine output and report any changes immediately