I.

Introduction
The prostate is the genital organ most commonly affected by benign and malignant

neoplasm. Benign enlargement of the prostate gland is an extremely common process that
occurs in nearly all men with functioning testes. Hyperplasia is a general medical term referring
to excess cell replication. Benign prostatic hyperplasia (BPH) is a noncancerous growth of the
prostate gland. It is the most common noncancerous form of cell growth in men and usually
begins with microscopic nodules in younger men. It should be noted that BPH is not a
precancerous condition.
Some studies have suggested that African American men are at higher risk and Asian men
at lower risk for BPH than Caucasians, a 2000 study found no greater risk for African Americans
and only a slightly lower risk for Asians. Among Caucasians in the study, men of southern
European heritage were at greater risk while men of Scandinavian ancestry had a lower chance
of developing BPH.
Histologic evidence of prostate enlargement begins about the third decade of life and
increases proportionally with aging. Specifically, about 43% of men in their 40s will have
evidence of BPH, as will 50% of men in their 50s, 75% to 88% in their 80s, and nearly 100% of
men reaching the ninth decade of life.
Some evidence has reported a higher incidence of benign prostatic hyperplasia -particularly fast-growing BPH -- in men with obesity, heart and circulatory diseases, and type 2
diabetes. Diabetes and hypertension, in any case, worsens urinary tract symptoms in men with
BPH. In one study, flow rates were adversely affected by diabetes, although residual urine
volumes were not significantly greater.
The exact cause of BPH is unknown. Potential risk factors include age, family history,
race, ethnicity, and hormonal factors. Androgens (male hormones) most likely play a role in
prostate growth. The most important androgen is testosterone, which is produced throughout a
man's lifetime. The prostate converts testosterone to a more powerful androgen,
dihydrotestosterone (DHT). DHT stimulates cell growth in the tissue that lines the prostate gland
(the glandular epithelium) and is the major cause of the rapid prostate enlargement that occurs
between puberty and young adulthood. DHT is a prime suspect in prostate enlargement in later
adulthood. Additional factors also include a defective cell death in which cells naturally self-

destruct, goes awry and results in cell proliferation a process called as apoptosis.
As BPH progresses, overgrowth occurs in the central area of the
prostate called the transition zone, which wraps around the urethra (the tube
that carries urine through the penis). This pressure on the urethra can cause
lower urinary symptoms that have been the basis for diagnosing BPH. It
should be noted that BPH is not always the cause of these symptoms. An
enlarged prostate may be accompanied by few symptoms, while severe LUTS
may be present with normal or even small prostates and are most likely due
to other conditions. Symptoms of BPH may include; Difficulty in starting to pass
urine (hesitancy), a weak stream of urine, dribbling after urinating, the need to strain to pass
urine, incomplete emptying of bladder, difficulty to control the urination urge, having to get up
several times in the night to pass urine, feeling a burning sensation when passing urine.
Sometimes a man is unaware of an obstruction until he suddenly cannot urinate at all.
This condition is called acute urinary retention. It is a dangerous complication that can damage
the kidneys and may require emergency surgery. In general, BPH progresses very slowly and
acute urinary retention is very uncommon. Men with BPH at highest risk for this complication
tend to be elderly and to have moderate to severe lower voiding symptoms. Taking antihypertensive drugs (except for diuretics) or antiarrhythmic drugs may also increase the risk.
Bladder obstruction can also cause bladder stones, blood in the urine, urinary tract infection, and
incontinence. Unfortunately, no current tests can accurately predict which men are at higher risk
for complications, although men with a weak urine stream and larger prostates are at higher risk
for urinary retention.
Diagnostic tests used to confirm Benign Prostatic Hyperplasia include Digital Rectal
Exam, Urinalysis, Serum Creatinine, Postvoid Residual Urine, Ultrasound, Urethrocystoscopy.

II.

NURSING ASSESSMENT

A. Personal History
Mr. Ruben Juco is a 82 years old male, who resides at Purok 4 Jesus St. Pulung Bulo,
Angeles City. His religious affiliation is Roman Catholic and is married to Mrs. Rita Juco. Mr.
Juco had previously worked at Clark-air based Pampanga. He loss his job when the American
soldier leave Pampanga. Since then, he never had a job and just stays in their home. Mr. Juco
usually sleeps at 10 in the evening and wakes up at around 4 in the morning. Mr. Juco usually
spends time watching TV, dawdle in front of their house, chatting with his neighbors and going
to a market via bicycle. Mr. Juco usual viand includes chicken, fish or meat and rice. He also
loves eating bread and drinking milk. Before, he used to love eating tinapa, sardines, tocino and
bagoong. He also smokes before and is able to consume 1 pack of cigarette a day. He drinks
alcohol beverages occasionally.

Regarding the finances about health he is using his

PHILHEALTH card to compensate the finances needed.

B. Family Health and Illness History
According to Mr. Juco, the familial disease that they have in the family is Diabetes
Mellitus. His mother has DM and died of natural cause while his father died of stroke. He has
seven siblings and one died due to stroke. He also added that he is the only member in the
family who has BPH.
C. History of Past and Present Illness
It is the first time of Mr. Juco to be confined in a hospital. But he always goes to Angeles
Medical Center for his routine check-up. Last 3 years ago he was diagnosed by Dr. Guzman for
having a problem in his prostate. He was advised by the doctor to stop eating foods high in salt
and rich in preservatives.
As for his present condition, he was admitted to AMC with a chief complaint of blood in
the urine and black stool and was diagnosed for having BPH or Benign Prostatic Hyperplasia
based of the diagnostic procedure he had underwent. One week prior to his admission he
experiences pain during urination and find a tinge of blood in his urine. Last Sunday, June 18,
2006 he was brought in the hospital at around 10 in the evening due to black stool and hematuria.

Upon admission he had undergone some laboratory examination such as CBC, CREA, BUN,
HGT, NA+ K+, FBS, UA, FA, 12-LEAD ECG, CBG and Chest X-ray. His initial medication is
Kepox.
D. Physical Examination
Physical Assessment done by the attending physician reveals that patient is;

Conscious and coherent

Pink palpebral conjuctiva, anisteric sclera

(-) cyanosis

(+) pain

afebrile

(+) NABS

non tender abdomen

Vital Signs upon admission (June 18, 2006)

BP- 110/70 mmHg
RR-21 bpm
PR-80 bpm
Temp-36.7 oC
Physical Assessment done by the student reveals that patient is;

Pink palpebral conjuctiva

(+) dry lips

(+) dry skin

decreased skin turgor

(+) paleness

(+) edema of hands and feet

Vital Signs upon admission (June 22, 2006)

BP- 110/60 mmHg
RR-21 bpm
PR-80 bpm
Temp-36.5 oC

III.

ANATOMY AND PHYSIOLOGY

The prostate gland is located under the urinary bladder, in front of the rectum and wraps
around the urethra (the tube that carries urine through the penis). It is basically composed of
three different cell types the glandular cells, smooth muscle cells and stromal cells
The central area of the prostate that wraps around the urethra is called the transition zone.
The entire prostate gland is surrounded by a dense, fibrous capsule.
The prostate gland provides the following functions: (1) the glandular cells produce a
milky fluid, and during sex the smooth muscles contract and squeeze this fluid into the urethra.
Here, it mixes with sperm and other fluids to make semen. (2) the prostate also secretes another
substance that may have antibacterial properties. (3) the prostate gland also contains an enzyme
called 5 alpha-reductase that converts testosterone to dihydrotestosterone, another male hormone
that has a major impact on the prostate.
The prostate gland undergoes many changes during the course of a man's life. At birth,
the prostate is about the size of a pea. It grows only slightly until puberty, when it begins to
enlarge rapidly, attaining normal adult size and shape, about that of a walnut, when a man
reaches his early 20s. The gland generally remains stable until about the mid-forties, when, in
most men, the prostate begins to enlarge again through a process of cell multiplication.
Hormonal changes also occur in the prostate gland; testosterone levels fall while
dihydrotestosterone remain at normal levels.

Neurophysiology of Continence and Micturition:

The parasympathetic and sympathetic maintains an important role in urinary continence.
During bladder filling, sensory nerve endings detect progressive stretching of the bladder wall
and convey information via the parasympathetic to the spinal cord and brain which produces
reflex contractions in the bladder neck and prostatic urethra as well as in the external urethral
sphincter thereby maintaining continence.
As volume of urine increases, starting from 300-500 ml., awareness of the need to void
develops. Voluntary voiding is accomplished by stimulation of the parasympathetic nerve fibers
causing coordinated contraction of the detrusor muscle and the bladder body. Nerve impulses
passing down the sympathetic and pudental motor fibers cease momentarily, allowing relaxation
of normally tonically contracted bladder neck, prostatic urethra and external thus allowing urine
to flow.

V. DIAGNOSTIC AND LABORATORY PROCEDURE

1. Complete Blood Count (CBC)
This is to determine blood components and the response to inflammatory process
or if there is a presence of infection.
Date Ordered: 06/21/06
Date Result In: 06/21/06
Results:
Hct- 20.3 %
Platelet- 22.6
WBC- 24.4 g/l
Granulocytes- 3
Lympho/Mono- 17
Hgb- 67
Conclusion: WBC is elevated based on the normal value of 4.3-10 g/l which
confirms the presence of infection
2. Fasting Blood Sugar
This is to measure the blood glucose levels
Date Ordered: 06/19/06
Date Result In: 06/19/06
Results:
107 mg/dl
Conclusion: the result is within normal range based on the normal value of < 126
mg/dl.
3. BUN
This is an indicator of renal function and perfusion, dietary intake of CHON and
the level of protein metabolism.
Date Ordered: 06/19/06
Date Result In: 06/19/06
Results:
17.4 mg/dl

Conclusion: the result is within normal range based on the normal value of 7-21
mg/dl.
4. Creatinine
In men with symptoms, blood tests are performed to measure a substance called
serum creatinine, which is a marker for kidney trouble. Kidney problems exist in an average of
13.6% of BPH patients. Studies have reported rates as high as 30% and as low as 0.3%.
Date Ordered: 06/22/06
Date Result In: 06/22/06
Results:
1.0 mg/dl
Conclusions:
The result is within normal range based on the normal value of 0.60-1.7 mg/dl.
5. Urinalysis
A urinalysis may be performed to detect signs of bleeding or infection. A
urinalysis involves a physical and chemical examination of urine. In addition, the urine is
spun in a centrifuge to allow sediments containing blood cells, bacteria, and other
particles to collect. This sediment is then examined under a microscope. Although urinary
infection is uncommon in younger men, it occurs more frequently in older men,
particularly those with BPH. A urinalysis also helps rule out bladder cancer.
Date Ordered: 06/22/06
Date Result In: 06/22/06
Results:
Color- yellow
Specific Gravity- 0.010
pH- 7.5
Appearance- turbid
Pus cells- 1-3 hpf
Red cells- 15-25 hpf

Conclusions:
The results are almost normal but there is a presence of pus cells in the urine
which indicates the presence of infection and presence of red cells that indicates the
presence of blood in the urine.
6. Fecalysis
Aids in the evaluation of the digestive efficiency and the integrity of the stomach
and intestines.
Date Ordered: 06/19/06
Date Result In: 06/19/06
Results:
Color- dark brown
Consistency- soft
Conclusions:
The results are normal.
7. Transcortin, also called corticosteroid binding protein or CBG
Is an alpha-globulin that has high affinity for binding cortisol. Measures urinary cortisol
and is performed in clients suspected of hyperfunction or hypofunction of adrenal gland.
8. Chest X-ray
This is to rule out respiratory cause of referred pain.

May be obtained to detect

pulmonary disease and the status of respiratory problems or trauma.

9. Electrocardiogram/ECG
Is an essential tool in evaluating cardiac rhythm.

Electrocardiography detects and

amplifies the very small electrical potential changes between different points on the surface of
the body as a myocardial cell depolarize to repolarize, causing the heart to contract.

10. Colonoscopy
Is the endoscopic visualization of the large intestine from rectum to cecum. It is the
visual examination of the lining of the entire colon with a flexible fiber optic endoscope.
Other diagnostic procedure that can be used to diagnosed Benign Prostatic Hyperplasia
a. Rectal examination
Palpation of the prostate through the rectum may reveal a markedly enlarged prostate. It
is dependent on the skills of the doctor. It has to be borne in mind that rectal examination can
increase PSA levels in patients without malignancy. The test helps rule out prostate cancer or
problems with the muscles in the rectum that might be causing symptoms, but it generally
underestimates the prostate's size. It is not accurate for diagnosing prostate cancer, and is never
the primary diagnostic tool for either BPH or cancer.
b. Uroflowmetry
To determine whether the bladder is obstructed, the speed of urine flow is measured
electronically using a test called uroflowmetry. The test cannot determine the cause of
obstruction, which can be due not only to BPH, but possibly also to abnormalities in the urethra,
weak bladder muscles, or other causes.
c. Urethrocystoscopy
A urethrocystoscopy, also called cystourethroscopy, may be performed in men diagnosed
with BPH, particularly if they are surgical candidates or if other urinary tract problems are
suspected. Such problems include blood in the urine, infection, interstitial cystitis, bladder
cancer, or prior surgery or injury. The physician can determine the presence of a number of
structural problems, including enlargement of the prostate, obstruction of the urethra or neck of
the bladder, anatomical abnormalities, or the presence of stones.
d. Postvoid Residual Urine
One of the important tests for urinary incontinence is the postvoid residual urine volume

(PVR), the amount of urine left after urination. Normally, about 50 mL or less of urine is left;
more than 200 mL is a definite sign of abnormalities. Measurements in between require further
tests. The most common method for measuring PVR is with a catheter, a soft tube that is inserted
into the urethra within a few minutes of urination. PVR can also be measured using
transabdominal ultrasonography.
e.

Ultrasound
Ultrasound of the prostate does not require a catheter and gives an accurate picture of the

size and shape of the prostate gland. Ultrasound is very beneficial when planning surgery and
determining treatment options and gauging their effectiveness. Ultrasound may also be used for
detecting kidney damage, tumors, and bladder stones.

VI.

PATIENTS CARE

a. Nursing Care Plan

1. Impaired urinary elimination related to increase urethral occlusion
Cues
S
The patient may
verbalized
difficulty in
urinating.
O
Patient may
manifest one or
more of the
following:
- (+) nocturia
- (+)
incontinence
- (+) dysuria
- (+) facial
grimaces
upon
urination
- (+) edema
- pt may also be
seen with an
indwelling
catheter

Nursing
Diagnosis
Impaired
urinary
elimination
related to
increase
urethral
occlusion

Scientific
Explanations
Due to
hyperplasia of
the prostate
gland the
urethra is being
blocked causing
obstruction in
the flow of urine
that leads to
bothersome
LUTS, thus an
impairment in
the urinary
elimination.

Objectives
After 3 hours of
nursing
intervention the
patient will be
able to manage
the
manifestation of
the disease.

Nursing
Interventions
1. Monitor vital
signs closely.
Observe for
hypertension,
peripheral/dependent
edema, changes in
mentation. Maintain
accurate I&O.

2. Encourage oral
fluids up to 3000 mL
daily, within cardiac
tolerance, if
indicated.

Rationale

Evaluation

- Loss of kidney
function results
in decreased
fluid elimination
and
accumulation of
toxic wastes
may progress to
complete renal
shutdown.

-Does the
patient able to
manage the
manifestations
of the disease;
a. nocturia
b. dysuria
c.
incontinence
d. hesitancy
to urinate?

- *Increased
circulating
fluid
maintains
renal
perfusion and
flushes
kidneys,
bladder, and
ureters of
sediment
and bacteria.
Note:
Initially,

connected with
the urine bag

fluids may be
restricted to
prevent
bladder
distension
until adequate
urinary flow
is
reestablished.
3. Encourage
patient to void every
2-4 hours and when
urge is noted.

- may minimize
over distension
of the bladder.

4. Encourage
meticulous catheter
and perineal care

- reduces risk of
ascending
infection

2. Activity intolerance related to body malaise

Cues
S
The patient may
verbalize body
malaise.
O
Patient may
manifest one or
more of the
following:
- (+) body
malaise
- (+) facial
grimaces
upon moving
- (+) edema

Nursing
Diagnosis
Activity
intolerance
related to body
malaise

Scientific
Explanations
Activity is a
natural process
and a vigorous
motion of action.
When one
manifested
insufficient
physiologic and
psychologic
functional
changes he
endure a simple
task this resulted
to activity
intolerance

Objectives
After 3 hours of
nursing
intervention the
patient will be
able to verbalize
understanding of
the health
teachings given
to increase
muscle strength

Nursing
Interventions
1. Monitor vital
signs.

Rationale

Evaluation

- to know the
present status of
the patient

a. Does the pt
able to
understand
the health
teachings
given?
b. Does he able
to increase
muscle
strength?

2. Encourage to
increase fluid
intake

- to optimize
hydration status

3. Encourage to
eat foods rich in
vitamin C and
intake of
nutritious food

- increase body
resistance

4. Encourage pt
to perform
PROM as
tolerated

- to promote
proper blood
circulation

5. Encourage pt
to change
position every 2
hours

- to optimize
circulation to all
tissues and to
relieve pressure

6. Encourage pt
to use
appropriate
assistive devices

- to prevent
injury.

3. Risk for infection related to periodic catheterization

Cues

Nursing
Diagnosis
S
Risk
for
The patient may infection related
verbalize body to
periodic
malaise.
catheterization
O
Pt. may be seen
with
an
indwelling
catheter
connected with
the urine bag
- (+) nocturia
- (+)body
malaise
- (+) hematuria
- (+) febrile

Scientific
Explanations
The pts disease
condition causes
some obstruction
in the flow of
urine enabling
him to need
catheterization to
empty
this
bladder.
Through this it
enable bacteria
contained within
the
prostatic
acini to reach the
bladder
thus
increase the risk
of
urinary
infection

Objectives

Nursing
Interventions
After an hour of 1. Monitor vital
nurse
patient signs for fever.
interaction the
patient will be
able to verbalize
understanding on
the
health 2. Encourage
teachings given. increase fluid
intake

Rationale
- Indicators of
sepsis requiring
prompt
evaluation and
intervention.
- to maintain
renal function
and prevent
development of
infection

3. Emphasize
good hand
washing
technique for all
individuals
coming in
contact with
patient.

- Prevents crosscontamination;
reduces risk of
acquired
infection.

4. Encourage
meticulous
catheter and
perineal care

- reduces risk of
ascending
infection

5. Provide
sterile or freshly
laundered bed

- Prevents
exposure to
infectious

Evaluation
a. Does the
patient
understand
individual
causative/
risk factors?
b. Does the
patient able
to identify
interventions
to reduce/
prevent risk
of infection.

linens/gowns

organisms.

6. Monitor/limit
visitors, if
necessary.

- Prevents crosscontamination
from visitors.

7. Administer
antibacterial as
ordered.

-Reduces
bacteria present
in urinary tract
and those
introduced by
drainage system.

4. Sleep pattern disturbance related to urinary incontinence

Cues
S
The patient may
verbalize
frequency in
urination at
night.

O
Patient may
manifest one or
more of the
following:
- (+) dark circles
around the
eyes
- Appears weak
and irritable
- Restless
- Noted frequent
yawning
- (+) nocturia

Nursing
Diagnosis
Sleep pattern
disturbance
related to urinary
incontinence

Scientific
Explanations
Patients
with
BPH
often
experience
excessive
urination
at
night.
This
symptom often
indicates that the
bladder outlet is
obstructed. And
due to this the
patient sleep is
being
affected
because he is
often
disturb
with the urge to
urinate at night.

Objectives

Nursing
Interventions
After 3 hours of 1. Determine
nursing
clients SOs
intervention the expectations of
patient will be adequate sleep
able to verbalize
understanding of 2. Encourage
individual
mid morning nap
appropriate
if one is required
intervention to
promote sleep.
3. Provide quiet
and comfortable
environment

Rationale
- address
opportunity to
address
misconceptions
- napping in
afternoon can
disrupt normal
sleep patterns
- in preparation
for sleep

4. Limit fluid
- to reduce
intake in evening nighttime
if nocturia is a
elimination
problem

Evaluation
a. Does the pt
able to relax and
gain enough
sleep?
b. Does he still
experience
nocturia?

5. Ineffective therapeutic regimen related to lack of understanding of disease, manifestations, and medical treatments
Cues
S
The patient may
verbalize
concerns
regarding his
condition.
O
Patient may
manifest one or
more of the
following:
- Frequently
asking
question about
his condition,
treatment and
diet
- With worried
gaze
- Minimal
response upon
assessment and
questioning

Nursing
Diagnosis
Ineffective
therapeutic
regimen related
to lack of
understanding of
disease,
manifestations,
and medical
treatments

Scientific
Explanations
There is some
information
about the disease
of the patient
that he does not
understand that
leads to
ineffective
follow-up with
the course of
therapy.

Objectives
After an hour of
nurse patient
interaction the
patient will be
able to
understand the
course of his
disease,
manifestations
and medical
treatments.

Nursing
Interventions
1. Provide
teachings about
BPH regarding
the disease
process, how to
prevent and
alleviate its
complications.

2. Encourage
fluid intake.

3. Explain
medications;
how it works, its
side effects and
precautions.

Rationale
- to diminish
clients anxiety
regarding the
process of his
disease, the
effects of this
disease to his
lifestyle, and the
complications
that the disease
could develop.

Evaluation
- Does the
patient able to
understand all
the information
given?

- Is there a
significant
changes that
occur on the
patients
knowledge
- pt with BPH
regarding;
tend to limit
c. disease
their fluids
condition
intake to combat d. diet
its manifestation e. treatment
needless did they f. medication
know that a
g. self-care
concentrated
needs
urine exacerbate
LUTS and
- Does the
increase risk of
patient able to
UTI.
comply with the
- to provide
entire therapeutic
knowledge about regimen given?
the medications
being given to
the patient

b. Drug Study
Name of Drug

Date
Ordered

GN:
Cefuroxime
BN:
Kepox

06-18-06

GN:
FeSO4
BN:
Iberet

06-19-06

Route/
Action
Dosage and
Frequency
IV
- Cephalosporin
o
750 mg, Q8

PO
500 mg,
cap, OD

- Hematinics

Indication

Adverse
Reaction

Nursing Consideration

- for UTI
- serious
infections of
lower respiratory
and urinary tracts

- phlebitis,
nausea and
vomiting,
diarrhea,
anorexia,
hypersensitivi
ty reactions

1. Check for doctors order

2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Advise patient to report any
discomfort on the IV insertion
site

- for excessive
bleeding

- Nausea and
vomiting,
black stools,
epigastric
pain

1. Check for doctors order

2. not to be given in patients with
hemosiderosis
3. Inform the patient about the
possible side effect of the drug
4. Instruct patient to take drug
with food
5. Advise patient to report
abdominal pain or blood in
stools or is vomiting.
6. monitor hemoglobin,
hematocrit, and retuculocyte
count during therapy.

Name of Drug
GN:
Digoxin
BN:
Lanoxin

Date
Ordered
06-19-06

Route/
Action
Dosage and
Frequency
PO
- Inotropic
0.25 mg,
tab, OD

Indication

Adverse
Reaction

Nursing Consideration

- for heart failure

- for proxysmal
ventricular
tachcardia

- fatigue,
headache,
weakness,
yellow vision,
nausea and
vomiting

1. Check for doctors order

2. not to be given in patients
hypersensitive to drugs
3. Inform the patient about the
possible side effect of the drug
4. Monitor apical pulse for1 full
minute before administering
5. Monitor intake and output
ratios. Assess for peripheral
edema, and auscultate lungs for
rales/crackles throughout therapy
6. Observe client for toxicity,
including symptoms of
headache, visual disturbances,
nausea and vomiting, anorexia,
or disorientation.
7. Monitor potassium levels and
encourage intake of potassium
rich foods
8. Taking digoxin with meals
may decrease gastric irritation
9. Hypothyroid clients are
particularly sensitive to these
drugs

Name of Drug

Date
Ordered

GN:
trimetazidine
diHCL
BN:
Vastarel MR

06-19-06

GN:
Tranexamic
acid
BN:
Hemostan

06-19-06

Route/
Action
Dosage and
Frequency
PO
-Anti-anginal
Tab, BID

IV
500 mg,
Q6 o

-antifibrinolytic

Indication

Adverse
Reaction

Nursing Consideration

- acute anginal
attacks
- prevent situation
that may cause
anginal attacks

- Nausea and
Vomiting,
headache,
edema

1. Check for doctors order

2. Monitor blood pressure and
pulse rate before and after giving
the meds.
3. Notify prescribing signs of
heart failure such as swelling of
hands and feet or SOB.
4. Advise patient of the side
effects of the drug.

- prevent
excessive
bleeding

- Nausea,
vomiti
vision
changes,
dizziness
diarrhea,

1. Check for doctors order

2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Advise patient to report any
discomfort on the IV insertion
site
7. Provide safety

Name of Drug
GN:
Vitamin K
BN:

Date
Ordered
06-19-06

Route/
Action
Dosage and
Frequency
IV
-Antihemorrhagic
o
10 mg, Q8

Indication

Adverse
Reaction

- prevent
hypoprothrombi
nemia related to
vitamin k
deficiency in
long term
parenteral
nutrition

- Dizziness,
flushing,
transient
hypotension
after IV
administration
, rapid and
weak pulse,
pain and
hematoma

Nursing Consideration
1. Check for doctors order
2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Monitor BP, PR, and RR
before and after administration.
7. Advise patient to report any
discomfort on the IV insertion
site
8. Provide safety
9. teach patient that foods that
provide vitamin K include
cabbage, cauliflower, eggs, fish
and dairy products

Name of Drug
GN:
Metronidazole
BN:
Flagyl

Date
Ordered
06-19-06

Route/
Action
Dosage and
Frequency
IV
-antiprotozoal
500 mg,
Q6 o

Indication

Adverse
Reaction

- for bacterial
infection caused
by anaerobic
microorganisms

- fever,
vertigo,
syncope,
weakness,
N/V, darkened
urine, metallic
taste

Nursing Consideration
1. Check for doctors order
2. Perform ANST prior to
admission
3. Should not be given if
positive skin test
4. Slow IV push
5. Inform the patient about the
possible side effect of the drug
6. Monitor liver function test
results carefully in elderly
patients.
7. Observe for edema.
8. Tell patient that metallic taste
and dark or red-brown urine may
occur.
9. Advise patient to report any
discomfort on the IV insertion
site
10. Provide safety

Name of Drug
GN:
Isosorbide
Dinitrate
BN:
Isordil

Date
Ordered
06-19-06

Route/
Action
Dosage and
Frequency
PO
-Anti-anginal
5 mg, Tab,
TID

Indication
- acute anginal
attacks
- prevent
situation that
may cause
anginal attacks

Adverse
Reaction
- Nausea and
Vomiting,
headache,

Nursing Consideration
1. Check for doctors order
2. Monitor blood pressure and
pulse rate before and after giving
the meds.
3. Notify prescribing signs of
heart failure such as swelling of
hands and feet or SOB.
4. Advise patient of the side
effects of the drug.

Name of Drug
GN:
Alfuzosin HCL
BN:
Xatral

Date
Ordered
06-20-06

Route/
Action
Dosage and
Frequency
PO
-alpha-blockers
10 mg, OD

Indication
- for enlarged
prostate gland

Adverse
Reaction

Nursing Consideration

Headache
Dry mouth
postural
hypotension
Drowsiness
palpitations
Flushing
edema
asthenia
Chest pain
tachycardia
syncope
Rash or
itching
nausea,
vomiting,
diarrhea or
abdominal
pain
vertigo
Dizziness

1. Check for doctors order

2. Assess pt for signs of BPH
(Urinary hesistancy, feeling of
incomplete bladder emptying,
interruption of urinary stream,
impairement of sixe and force
of urinary stream, terminal
urinary bleeding, dysuria,
urgency) before and
periodically during therapy
3. Monitor blood pressure and
pulse rate before and after
giving the meds.
4. Assess patient for
orthostatic reaction and
syncope.
5. Caution patient to avoid
sudden changes in position to
decrease orthostatic
hypotension
6. Instruct patient to take
medicine with the same meal
each day.
7. Instruct patient of the side
effect of the drug.

c. Medical/ Surgical Management

a. Intravenous Rehydration
When the fluid loss is severe or life threatening, IV fluids are used for
replacement.
b. Blood Transfusion
It may be necessary for replacement of RBC to WBC, platelets or blood
proteins
c. Folley Catheter
To facilitate accurate measurement of urinary output for critically ill
clients whose output need to be monitored hourly. It is also used to manage
incontinence when other measures have failed.
d.

Lavage
The process of washing out an organ, usually the bladder, bowel, paranasal
sinuses, or stomach for therapeutic purposes.

e. Watchful Waiting.
Watchful waiting involves lifestyle changes and an annual examination. It
should be noted that even when choosing watchful waiting, an initial examination
is critical to rule out other disorders.
f. Transurethral resection of the prostate (TURP)
Involves surgical removal of the inner portion of the prostate where BPH
develops. It is the most common surgical procedure for BPH

VII.

Clients Daily Progress

DAYS
Nursing Problem:
Impaired urinary elimination
Activity intolerance
Risk for infection
Sleep pattern disturbance
Ineffective therapeutic regimen
Vital Signs:

Dx & Lab Procedures

CBC
CREA
BUN
HGT
NA+, K+
FBS
UA
FA
12-Lead ECG
CBG
CX-RAY
Colonoscopy

Admission
06-18-06

Day 2
06-19-06

Day3
06-20-06

*
*
*
*
*
BP- 110/70
mmHg
PR- 80 bpm
RR- 21 bpm
Temp- 36.7 oC

*
*
*
*
*
BP- 110/70
mmHg
PR- 80 bpm
RR- 20 bpm
Temp- 36.1 oC

*
*
*
*
*
BP- 130/70
mmHg
PR- 60 bpm
RR- 21 bpm
Temp- 37.7 oC

*
*
*
*
*
*
*
*
*

*
*

Day 4
06-21-06
*
*
*
*
*
BP- 100/60
mmHg
PR- 80 bpm
RR- 19 bpm
Temp- 36.8oC

Discharge
06-22-06
*
*
*
*
*
BP- 110/60
mmHg
PR- 80 bpm
RR- 21 bpm
Temp- 36.5 oC

Medical & Surgical Management

Garlic Lavage
BT
Folley catheter
Pnss, 1L x 20 gtts/min
D5LRS, 1L x 30 gtts/min
D5050
Drugs
Kepox
Iberet
Lanoxin
Vastarel MR
Hemostan
Vitamin K
Metronidazole
Isordil Dinitrate
Xatral
Diet
DAT
NPO
Soft Diet
Activity & Exercise
CBR without BRP
PROM

*
*
*

*
*
*

*
*

*
*
*
*
*
*

*
*
*
*
*
*

*
*
*
*
*
*

*
*
*
*
*
*

*
*

*
*
*

*
*
*

*
*
*

VIII.
M -

DISCHARGE PLANNING

Instructed the patient to continue medication as ordered

1. Iberet 500 mg cap once a day (8am)
2. Lanoxin 0.25 mg tab once a day (8am)
3. Vastarel MR tab 2 x day (8am-1pm)
4. Isordil 3mg tab 3 x day (8am-1pm-8pm)
5. Xatral 10 mg tab once a day (8am)

E -

Instructed the patient to do exercise as tolerated such as walking

T -

Instructed the patient to continue the medication

H -

1. Encouraged patient to increase fluid intake

2. Encouraged patient to eat foods rich in Vitamin C and Nutritious foods
3. Encourage patient to avoid salty and fatty foods
4. Encourage patient to have enough rest

O -

Instructed to come back for follow-up check-up on June 22, 2006

Wednesday.

D -

Advised the patient to a diet as tolerated but preferably avoiding salty and
fatty foods.

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