Question

Case Study 5 Date Name Class/Group Group Members INSTRUCTIONS: All questions apply to this case study. Your responses should be brief and to the point. Adequate space has been provided for answers. When asked to provide several answers, they should be listed in order of priority or significance. Do not asume information that is not provided. Please print or write clearly. If your response is not legible, it will be marked as ? and you will need to rewrite it. Scenario S.M. is a 68-year-old man who is being seen at your clinic for routine health maintenance and health promotion. He reports that he has been feeling well and has no specific complaints except for some trouble "emptying his bladder." He had a CBC and CMP completed 1 week before his visit, and the results are as follows: Na 140 mmol/L, K 4.2 mmol/L, CI 100 mmolL, HCO, 26 mmol/L, BUN 22 mg/dL, creatinine 0.8 mg/dL, glucose 94 mg/dL, RBC 5.2 million/mm2. WBC 7.400/mm Hgb 15.2 g/dL, Hct 46%, platelets 348,000/mm. PSA (prostate-specific antigen) 0.23 ng/mL, and UA was WNL. VS at this visit are 148/88, 82, 16, 96.9' F. 1. What can you tell S.M. about his lab work? While obtaining your nursing history. you record no family history of cancer or other genitourinary problems. S.M. reports frequency, urgency, nocturia x 4; he has a weak stream and has to sit to void. These symptoms have been progressive over the past 6 months. He reports he was diagnosed with a large prostate a number of years ago. 2. S.M. is curious why his BPH would affect his urination. He is concerned he has prostate cancer. What would you teach him? 3. The PCP asked for a PVR (postvolding residual urine). You document that S.M. volds 60 mL and his PVR is 110 mL. What is the significance of his PVR?

Answer 1

1)Lab report indicates that all parameters are within normal levels.

2)BPH or benign prostatic hyperplasia is the enlargement of prostate gland.it occurs when cells of prostate gland begin to multiply.These additional cells cause your prostate gland to swell which squeezes the urethra and limit the flow of urine.The main difference between BPH and prostate cancer is that even though the prostate gland is enlarged in both in BPH it is a benign or noncancerous condition.BPH is very common especially as a man ages and his prostate begins to grow.

3)The postvoiding residual urine measurement is a basic evaluation for urinary incontinence.PVR of less than 50ml considered normal and volumes greater than 100ml is generally considered abnormal.

4)Doxazosin relaxes the muscles in prostate and thus improves urination.Terazosin belongs to class of drugs called alpha blockers.it relieves the symptoms of BPH by relaxing muscles of bladder and prostate.Tamsulosin is a alphablocker muscles of bladder and prostate neck making it easier to urinate.

5)Take this medicine orally at night 30 minutes after a meal.Try to take this medicine same time each day.

6)Retrograde ejaculation is a condition in which semen is ejaculated backwards in to bladder rather than out through the penis.Retrograde ejaculation decreases the amount of semen ejaculated ou of penis.

7)in retrograde ejaculation muscle fails to contract.As the muscle stays relaxed the ejaculation endsup in bladder.The result is what that is called dry orgasm.Despite the lack of ejaculation it feels like normal orgasm and doesnot affect sexual life.

8)S.M should report that he is recovered and he is able to urinate normally.

9) Transurethral resection of prostate(TURP),Trans urethral incision of prostate (TUIP),prostatic stent,laser prostatectomy are the surgical options for S.M