HOLY ANGEL UNIVERSITY

COLLEGE OF NURSING
A.Y. 2007-2008

IN PARTIAL FULFILLMENT OF THE

REQUIREMENTS IN RELATED LEARNING EXPERIENCE

(CASE STUDY ANALYSIS)

SUBMITTED BY:
GROUP 2/N-402

David, Joseph
David, Rachel Joy
Dayrit, Apple Rose
De Leon, Charisse Hazel
Dimarucut, Anilyn Joan
Domingo, Ester
Fernando, Erin Leigh
Frasco, Kaycee Lyn
Geronimo, Avegale
Ibay, Ma. Cristelle
Joven, Katrina
Lacson, Jimver
Lansang, Cynthia Mae

SUBMITTED TO:

MS. MICAH MAUREEN SANTOS, RN

Clinical Instructor, AMC Rotation

July 12, 2007

Figure 1: Urine flow with BPH.

Figure 2: Foley catheter insertion

 I. INTRODUCTION

Benign prostatic hyperplasia (BPH), also known as Nodular hyperplasia, benign

prostatic hypertrophy or benign enlargement of the prostate (BEP) refers to the increase
in size of the prostate in middle-aged and elderly men.

It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting

in the formation of large, fairly discrete nodules in the periurethral region of the prostate.
When sufficiently large, the nodules compress the urethral canal to cause partial, or
sometimes virtually complete, obstruction of the urethra which interferes the normal flow
of urine. It leads to symptoms of urinary hesitancy, frequent urination, increased risk of
urinary tract infections and urinary retention. Depending on the size of the enlarged
prostate, the age and health of the patient, and the extent of obstruction, BPH is treated
symptomatically or surgically. BPH rarely causes symptoms before age 40, but more than
half of men in their sixties and as many as 90 percent in their seventies and eighties have
some symptoms of BPH.

More than half of the men in the United States between the ages of 60 and 70 and
as many as 90% between the ages of 70 and 90 have symptoms of BPH. For some men,
the symptoms may be severe enough to require treatment.

The likelihood of developing an enlarged prostate increases with age. A small

amount of prostate enlargement is present in many males older than age 40 and more than
90% of males older than age 80. It is estimated that by 2006, 115 million men age 50 and
older will develop BPH. Blacks, with an incidence rate of 224.3 cases per 100,000
people, are at the greatest risk, present with more advanced disease, and have a poorer
diagnosis. Whites, by comparison, have an incidence of 150.3 cases per 100,000 people
while Asians have an incidence of 82.2 cases per 100,000 people. (Wrongdiagnosis,
2000)

The following are statistics that present the severity and prevalence of Benign
Prostatic Hyperplasia:

Incidence Rate: approx 1 in 627 or 0.16% or 433,216 people in USA

Deaths from Benign Prostate Hyperplasia: 430 deaths reported in USA 1999 for
hyperplasia of prostate (NVSR Sep 2001)
Hospitalization statistics for Benign Prostate Hyperplasia: The following are
statistics from various sources about hospitalizations and Benign Prostate Hyperplasia:

 70 was the mean age of patients hospitalized for hyperplasia of prostate in

England 2002-03 (Hospital Episode Statistics, Department of Health, England,
2002-03)
 37% of hospital consultant episodes for hyperplasia of prostate occurred in people
over 75 in England 2002-03 (Hospital Episode Statistics, Department of Health,
England, 2002-03)
  Procedures for Benign Prostate Hyperplasia: 350,000 to 400,000 operations
per year in America (Kidney and Urology Foundation of America, 2002)

Clinical features and a rectal examination are usually sufficient for diagnosis.
Other findings help to confirm it such as urography, BUN and serum creatinine tests,
urinalysis and urine culture, and cystourethroscopy. Excretory urography may indicate
urinary tract obstruction, hydronephrosis, calculi or tumors, and filling and emptying
defects in the bladder. Elevated blood urea nitrogen and serum creatinine levels suggest
renal dysfunction. Urinalysis and urine culture show hematuria, pyuria and, when the
bacterial count exceeds 100,000/µl, urinary tract infection (UTI).

Finasteride (Proscar), FDA-approved in 1992, and dutasteride (Avodart), FDA-

approved in 2001, inhibit production of the hormone DHT, which is involved with
prostate enlargement. The 5α-reductase inhibitors (finasteride and dutasteride) are
another treatment option. When used together with alpha blockers a reduction of BPH
progression to acute urinary retention and surgery has been noted in patients with larger
prostates. Urine flow rates can be improved with alpha1-adrenergic blockers, which
relieve bladder outlet obstruction by preventing contractions of the prostatic capsule and
bladder neck. Finasteride lowers levels of hormones produced by the prostate, reduces the
size of the prostate gland, increases urine flow rate, and decreases symptoms of BPH. It
may take 3 to 6 months before a significant improvement in symptoms occurs. Potential
adverse effects related to finasteride include decreased sex drive and impotence.

The FDA also approved the drugs terazosin (Hytrin) in 1993, doxazosin
(Cardura), in 199, tamsulosin (Flomax) in 1997, and alfuzosin (Uroxatral) in 2003 for the
treatment of BPH. All four drugs act by relaxing the smooth muscle of the prostate and
bladder neck to improve urine flow and to reduce bladder outlet obstruction. The four
drugs belong to the class known as alpha blockers. These drugs decrease the degree of
oblockage of urine flow. These may cause retrograde ejaculation.

Conservative therapy includes prostate massages, sitz baths, fluid restriction for
bladder distention, and antimicrobials for infection. If symptoms are mild, methods for
relief may include avoiding alcohol and caffeine, especially after dinner; urinating when
the urge is initially felt; avoiding over-the-counter cold and sinus medications that
contain decongestants or antihistamines because they can increase BPH symptoms;
keeping warm and exercising regularly as cold weather and lack of physical activity may
worsen symptoms; performing pelvic strengthening exercises (Kegel exercises); reducing
stress because nervousness and tension can lead to more frequent urination. Some males
have had success taking extracts of saw palmetto berries, an herb that has been used to
ease prostate symptoms. Fat-soluble saw palmetto extract that has been standardized to
contain 85% to 95% fatty acids and sterols is more effective. Regular ejaculation may
help relieve prostatic congestion.

Severe BPH can cause serious problems over time. Urine retention and strain on
the bladder can lead to urinary tract infections, bladder or kidney damage, bladder stones,
and incontinence—the inability to control urination. If the bladder is permanently
damaged, treatment for BPH may be ineffective. When BPH is found in its earlier stages,
there is a lower risk of developing such complications. Examination may detect
secondary anemia and, possibly, renal insufficiency secondary to obstruction. One of the
complications of BPH is urinary tract infection. It is defined as presence of any infection
of any of the organs of the urinary tract.

A common source of infection is catheters, or tubes, placed in the bladder. A

person who cannot void or who is unconscious or critically ill often needs a catheter that
stays in place for a long time. Some people, especially the elderly or those with nervous
system disorders who lose bladder control, may need a catheter for life. Bacteria on the
catheter can infect the bladder, so hospital staff take special care to keep the catheter
sterile and remove it as soon as possible.

 The group chose the case because it is one of the most-common age-related
reproductive disorders experienced by males. Even though the disease condition
is a benign one, it can cause much discomforts and complications on the part of
the patient, and may even become a precipitating factor in the formation of
urinary tract infections and renal failure. The disease can affect the person’s
physical, psychological, social, and sexual functions. The group, in turn, aims to
apply medical-surgical knowledge regarding benign prostatic hyperplasia and
urinary tract infection in order to help the patient attain proper treatment, and
management of the given diseases through proper information dissemination.

Nurse-Centered Objectives:

As the case study progresses, the group aims to achieve the following objectives:
1. Provide therapeutic communication with the patient and the significant others.
2. Gather enough data and information upon assessment pertinent to the disease
condition.
3. Have a thorough understanding about the case of the patient, the medical
management and the necessary nursing interventions on client’s wellness.
4. Formulate nursing diagnoses according to the patient’s health condition
5. Devise a long-term and short-term plan of care in lieu with the diagnoses
obtained.
6. Render appropriate nursing interventions and health teachings needed by the
patient.
7. Evaluate the effectiveness of the interventions given.
8. Provide supplementary health teachings to the patient.
 II. NURSING ASSESSMENT

1. Personal History

Mr. AG is a 88 years old married man. He was born on June 9, 1919, and is
currently residing at #191 Sitio Maligaya, Pulung Maragul, Angeles City. He was
admitted at Angeles Medical Center last June 15, 2007 due to the chief complaint of
fever. He was admitted under the service of Dr. Archimedes De Guzman.
The highest educational attainment the patient was able to attain was grade 7 and
according to him, they held their classes under the tree. Reaching that level is considered
the highest educational attainment back in his days. From the year 1960s to 1990s, Mr.
AG was a building contractor. In 1963, he became a professor in different schools and
colleges like Harvardian College, St. Peter College in Apalit, and Minalin Academy. He
retired from his teaching career in 1973. According to Mrs. Teresita Yco (daughter of the
Mr. AG), the patient had vices. He started his vices at 20 years old, which included
occasional drinking of 1 bottle of alcohol and smoking 10 sticks per day. He decided to
stop his vices when he reached the age of 40 years old. The pack-years of the patient is
680.
He drinks coffee every morning and eats 3 meals and 3 snacks per day. Mr. AG
drinks 8 to 10 glasses of water per day. Sometimes he would ask for a buko juice.
Currently, he has a good appetite and has no allergies on food. However, the patient
stated that he loved to eat foods high in cholesterol such as steak, and meat.
According to Mrs. Brenda Carlos, (sister of Teresita Yco), the patient usually
sleeps at around 9:00 pm and wakes up at around 5:30 am with 1 to 2 waking times. He
naps for about 1 to 2 hours in the afternoon. Regarding his elimination pattern, the patient
is on an indwelling urinary catheter since 2000, which is usually left unreplaced for one
month. Usually, the patient’s urine output measures for about 100 to 1500 ml per day,
yellowish in color. Sometimes, hematuria is seen in his urine bag. He had constipation, of
which laxative is given in order to promote defecation. He takes a bath everyday, lasting
for 20 to 30 minutes, with the assistance of her daughter. Mr. AG’s usual exercise was
walking. His recreational activities include watching T.V. and reading newspapers.
Mr. AG and his wife are currently unemployed. They are currently followers of
the Iglesia ni Cristo. He decides to consult the doctor if the family is not able to manage
his health condition. Mr. AG’s family is very supportive when one of their family
members is sick. Their primary medium of language is Kapampangan but they can also
speak and understand Filipino and English.

3. History of Past Illness

His prostate problem started in 1945. The patient reported that he experienced
frequent urge to urinate everyday, anorexia, incomplete bladder emptying, weak urinary
stream and occasional nocturia which is accompanied by pain. He continued to
experience these myriad of symptoms until 2000. He stated that the catheters inserted on
him starting on that year relieved him of the signs and symptoms of BPH.
Mr. AG underwent several operations. His first operation was herniorraphy on both
inguinal areas of his legs in 1970 at JBLMRH, which yielded no complications. His
second operation was an open-reduction internal fixation (ORIF) of the right femur in
1994 at Arizona U.S.A. due to an accident of falling from a tree.

4. History of Present Illness

Three days prior to admission, starting at 6:00 am, Mr. AG experienced fever,
chills, loss of appetite and hypogastric pain, which persisted few hours before the actual
admission. The patient did not consult to their family doctor and the patient didn’t take
meds at all.
Few hours prior to admission, Teresita Yco decided to consult the their family
doctors regarding Mr. AG’s condition and the doctor advised them that the patient must
be admitted to the hospital for proper diagnosis of his conditions, thus his admission.
Prior to admission, Mr. AG was admitted at Angeles Medical Center emergency
room at 10:00 pm, with the chief complaint of fever and under the service of Dr.
Guzman. He was diagnosed to have benign prostatic hyperplasia and urinary tract
infection.
Some of the signs and symptoms of BPH are experienced by the patient during
his hospital stay: He experienced urinary frequency as evidenced by the following: June
25, Urine output = 1550 ml; and lastly, June 27, Urine output = 3,500 ml. He also
experienced vague symptoms such as anorexia on June 12 to June 15. He had
experiences of having a weak urinary stream, causing urine retention as evidenced by the
following: on June 19, Urine output = 450 ml; June 22, Urine output = 750 ml; and lastly,
June 23, Urine output = 430 ml. Signs of bladder distention was also noted (June 19, 22,
and 23). Hypertension was experienced secondary to decreased oncotic pressure
secondary to obstruction on the following dates: June 16, 130/80 mmHg; June 18, 130/80
mmHg; June 23, 130/80 mmHg; June 24, 130/80 mmHg; June 25, 130/80 mmHg; June
26, 140/90 mmHg; and lastly, June 27, 140/80 mmHg.
Upon admission, the doctor tried to consider the possibility of an urinary tract
infection co-existing with his benign prostatic hyperplasia, as evidenced by fever and
chills experienced at June 12, 8:00 pm; June 15, 10:00 pm, axillary temperature at
37.8oC; June 17, 8:05 am, axillary reading at 38 oC; and lastly, June 18, 2:00 pm, axillary
reading at 38.6 oC. He also experienced hematuria on June 17 and 21.
An incidental finding of anemia secondary to gastrointestinal bleeding to
consider small intestinal erosion secondary to chronic intake of NSAID intake
(Paracetamol) was discovered. It can be traced to the frequent intake of Celecoxib he had
to control pain he experienced secondary to urinary tract infection. It manifested as:
pallor (June 19), non-foul smelling blackish stool (June 19-23), presence of blood and
blood clots from colon up to terminal ileum, and multiple erosions in the 3rd part of
duodenum during colonoscopy (June 21), presence of hematuria (June 21) and fever
(June 19 – 38.6 oC; June 22 – 38.5 oC).
He also experienced constipation secondary to fecal impaction on June 15, 17, 26
and 27, respectively.
5. Physical Examination (Cephalocaudal)

Upon Admission (June 15, 2007, 10:00 pm) – Lifted from the chart
Vital signs:
Temp: 37.8 °C
PR: 79 bpm
RR: 18bpm
BP: 120/70 mmHg
Eyes: pink palpebral conjunctiva, anicteric sclera
Nose and Ears: absence of naso-aural discharge
Thorax: Symmetric chest expansion (SCE), no retractions, clear breath
sounds
AP, AB 5th intercostal space midclavicular line, no murmurs
Abdomen: Flabby, Normal abdominal bowel sounds, Soft, non-tender
abdomen
General: absence of palpable masses, cyanosis, and edema

June 16, 2007 – Lifted from the chart

Vital signs:
Temp: 36.4 °C
PR: 82 bpm
RR: 21 bpm
BP: 140/70 mmHg
General: presence of nape pain, dizziness, and headache

June 17, 2007 – Lifted from the chart

Vital signs:
Temp: 38 °C
PR: 80 bpm
RR: 20 bpm
BP: 130/70 mmHg
General: presence of chills, diaphoresis, irritability, flaring of the eyes, and
muscle weakness, presence of constipation, hematuria

June 18, 2007 – Lifted from the chart

Vital signs:
Temp: 38.6 °C
PR: 82 bpm
RR: 21 bpm
BP: 130/80 mmHg
General: presence of chills, diaphoresis, irritability, flaring of the eyes, muscle
weakness, and anorexia

June 19, 2007 – Lifted from the chart

Vital signs:
Temp: 38.6 °C
 PR: 82 bpm
RR: 21 bpm
BP: 120/80 mmHg
General: presence of chills, diaphoresis, irritability, flaring of the eyes, muscle
weakness, and anorexia; presence of pallor, passing of non-foul smelling black
stool, bounding pulses, bladder full and palpable, pain felt upon palpationUrine
output = 450 ml

June 20, 2007 – Lifted from the chart

Vital signs:
Temp: 36.9 °C
PR: 82 bpm
RR: 21 bpm
BP: 90/60 mmHg
General: presence of muscle weakness; presence of pallor, passing of non-foul
smelling black stool, weak, thready pulses, cool extremities, restlessness

June 21, 2007 – Lifted from the chart

Vital signs:
Temp: 36.8 °C
PR: 82 bpm
RR: 22 bpm
BP: 110/70 mmHg
General: presence of muscle weakness, anorexia; presence of pallor, passing of
non-foul smelling black stool, weak, thready pulses, cool extremities, restlessness,
presence of blood and blood clots from colon up to terminal ileum, and multiple
erosions in the 3rd part of duodenum during colonoscopy, hematuria

June 22, 2007 – Lifted from the chart

Vital signs:
Temp: 38.5 °C
PR: 81 bpm
RR: 23 bpm
BP: 130/80 mmHg
General: presence of pallor, non-foul smelling black stool, presence of chills,
diaphoresis, irritability, flaring of the eyes, muscle weakness, slight nape pain,
bounding pulses, bladder full and palpable, pain felt upon palpation, Urine output
= 750 ml
June 23, 2007 – Lifted from the chart
Vital signs:
Temp: 36.5 °C
PR: 80 bpm
RR: 21 bpm
BP: 130/80 mmHg
General: presence of muscle weakness, anorexia; presence of pallor, passing of
non-foul smelling black stool, bounding pulses, cool extremities, slight nape pain,
bladder full and palpable, pain felt upon palpation, Urine output = 430 ml

June 24, 2007 – Lifted from the chart

Vital signs:
Temp: 36.5 °C
PR: 78 bpm
RR: 20 bpm
BP: 130/80 mmHg
General: presence of muscle weakness, presence of pallor, passing of brownish
black stool, cool extremities, slight nape pain, weak pulses

1st Nurse-Patient Interaction (June 25, 2007, 2:00 pm)

Vital signs:
Temp: 36 oC
PR: 82 bpm
RR: 18 bpm
BP: 140/90 mmHg
HEAD: General: oblong, symmetrical
Hair: short, straight, and neatly combed, thin in distribution and grayish to
white in color
Scalp: absence of dandruff, and pediculosis
Skull: Smooth skull contour, absence of nodules or masses, symmetric
facial movements
EYES: General: no discharges noted on both eyes
Lids: skin intact, absence of periorbital edema, discoloration and lesion
Sclera: anicteric, presence of arcus senilis
Eyeballs: symmetrical in size and shape, sunken
Eyelashes: evenly distributed
Conjunctiva: pale palpebral conjunctiva
Cornea: transparent, shiny, and smooth
Pupils: pupils equally round, responds to light accommodation
Vision: absence of double vision, can clearly read newspapers
NOSE: No discharges or any lesion, damage or flaring, symmetrical in size and
shape, straight, uniform in color
EARS: General: Symmetrical aligned, with auricle aligned in the outer cantus of
the eye and color same as facial skin, pinna recoils after it is folded
External: symmetrical appearance of pinna, no abnormal discharges noted
Internal: no discharges noted
MOUTH AND THROAT:
General: Soft, dry, slightly rough in texture, Symmetrical in contour
Mouth: teeth are aligned, absence of halitosis, smooth, white, shiny tooth
enamel, pale oral mucosa, denture on the mandible part
Lips: Lips pale, dry, no infection noted
Tongue: Pale in color, moves freely, central position
NECK: Muscles equal in size, coordinated smooth movements with no
discomforts, non-palpable lymph nodes, absence of carotid
pulsations, and presence of slight nape pain
CHEST: Respirations: eupnic
Chest: symmetrical chest expansion (SCE), no abnormal breath sounds,
and no lesions, patient reports about cough
HEART: no murmurs
BREAST: no lesions and discharges, absence of tenderness, masses, nodules
ABDOMEN: General: absence of pain during urination, absence of constipation,
passing of brown stool, and yellow urine, urinary frequency – urine output of
1550 ml (lifted from chart)
REPRODUCTIVE:
Prostate: absence of pain, and tenderness, non-palpable, Urine output =
1550 ml
INTEGUMENTARY:
Skin: dry, loose skin, brown complexion, absence of cyanosis, and
jaundice, skin returns after 5 seconds when pinched
Nails: smooth texture, pale, clean and short, intact epidermis, delayed return of
color after 5 seconds
MUSKULOSKELETAL:
no deformities or tenderness, equal movement on both sides of body,
presence of straight incision at the right femur
NEUROLOGICAL:
Mental Status: awake, conscious, coherent, oriented
Memory: fresh
Language: clear and consistent
Judgment: sound and reasonable
Position: semi-Fowler’s position

2nd Nurse-Patient Interaction (June 26, 2007, 6:00 pm)

Vital Signs:
Temp: 36.4 oC
PR: 78 bpm
RR: 19 bpm
BP: 120/80 mmHg
HEAD: General: oblong, symmetrical
Hair: short, straight, and neatly combed, thin in distribution and grayish to
white in color
Scalp: no dandruff, and pediculosis
 2. Family Health History

Father of Mr. AG Mother of Mr. AG

(Died because of (Died because of
old age) old age)

2nd Eldest 3rd 4th Mrs. AG

Eldest sister Mr AG
sister Brother Brother
(HTN,
anemia, Mrs. Teresita Yco
BPH,
UTI)
2nd male

3rd male

4th male

Mrs. Brenda Carlos

6th female
Legend:
7th male
absence of hereditary and acquired
diseases
8th male
presence of acquired diseases

9th male

Youngest male
 3. History of Past Illness

His prostate problem started in 1945. The patient reported that he experienced
frequent urge to urinate everyday, anorexia, incomplete bladder emptying, weak urinary
stream and occasional nocturia which is accompanied by pain. He continued to
experience these myriad of symptoms until 2000. He stated that the catheters inserted on
him starting on that year relieved him of the signs and symptoms of BPH.
Mr. AG underwent several operations. His first operation was herniorraphy on
both inguinal areas of his legs in 1970 at JBLMRH, which yielded no complications. His
second operation was an open-reduction internal fixation (ORIF) of the right femur in
1994 at Arizona U.S.A. due to an accident of falling from a tree.

4. History of Present Illness

Three days prior to admission, starting at 6:00 am, Mr. AG experienced fever,
chills, loss of appetite and hypogastric pain, which persisted few hours before the actual
admission. The patient did not consult to their family doctor and the patient didn’t take
meds at all.
Few hours prior to admission, Teresita Yco decided to consult the their family
doctors regarding Mr. AG’s condition and the doctor advised them that the patient must
be admitted to the hospital for proper diagnosis of his conditions, thus his admission.
Prior to admission, Mr. AG was admitted at Angeles Medical Center emergency
room at 10:00 pm, with the chief complaint of fever and under the service of Dr.
Guzman. He was diagnosed to have benign prostatic hyperplasia and urinary tract
infection.
Some of the signs and symptoms of BPH are experienced by the patient during
his hospital stay: He experienced urinary frequency as evidenced by the following: June
25, Urine output = 1550 ml; and lastly, June 27, Urine output = 3,500 ml. He also
experienced vague symptoms such as anorexia on June 12 to June 15. He had
experiences of having a weak urinary stream as evidenced by the following: on June 19,
Urine output = 450 ml; June 22, Urine output = 750 ml; and lastly, June 23, Urine output
= 430 ml. Signs of bladder distention was also noted (June 19, 22, and 23). Hypertension
was experienced secondary to decreased oncotic pressure secondary to obstruction on the
following dates: June 16, 130/80 mmHg; June 18, 130/80 mmHg; June 23, 130/80
mmHg; June 24, 130/80 mmHg; June 25, 130/80 mmHg; June 26, 140/90 mmHg; and
lastly, June 27, 140/80 mmHg.
Upon admission, the doctor tried to consider the possibility of an urinary tract
infection co-existing with his benign prostatic hyperplasia, as evidenced by fever and
chills experienced at June 12, 8:00 pm; June 15, 10:00 pm, axillary temperature at
37.8oC; June 17, 8:05 am, axillary reading at 38 oC; and lastly, June 18, 2:00 pm, axillary
reading at 38.6 oC. He also experienced hematuria on June 17 and 21.
An incidental finding of anemia secondary to gastrointestinal bleeding to
consider small intestinal erosion secondary to chronic intake of NSAID intake
(Paracetamol) was discovered. It can be traced to the frequent intake of Celecoxib he had
to control pain he experienced secondary to urinary tract infection. It manifested as:
pallor (June 19), non-foul smelling blackish stool (June 19-23), presence of blood and
blood clots from colon up to terminal ileum, and multiple erosions in the 3rd part of
duodenum during colonoscopy (June 21), presence of hematuria (June 21) and fever
(June 19 – 38.6 oC; June 22 – 38.5 oC).
He also experienced constipation secondary to fecal impaction on June 15, 17, 26
and 27, respectively.

5. Physical Examination (Cephalocaudal)

Upon Admission (June 15, 2007, 10:00 pm) – Lifted from the chart
Vital signs:
Temp: 37.8 °C
PR: 79 bpm
RR: 18bpm
BP: 120/70 mmHg
Eyes: pink palpebral conjunctiva, anicteric sclera
Nose and Ears: absence of naso-aural discharge
Thorax: Symmetric chest expansion (SCE), no retractions, clear breath
sounds
AP, AB 5th intercostal space midclavicular line, no murmurs
Abdomen: Flabby, Normal abdominal bowel sounds, Soft, non-tender
abdomen
General: absence of palpable masses, cyanosis, and edema

June 16, 2007 – Lifted from the chart

Vital signs:
Temp: 36.4 °C
PR: 82 bpm
RR: 21 bpm
BP: 140/70 mmHg
General: presence of nape pain, dizziness, and headache

June 17, 2007 – Lifted from the chart

Vital signs:
Temp: 38 °C
PR: 80 bpm
RR: 20 bpm
BP: 130/70 mmHg
General: presence of chills, diaphoresis, irritability, flaring of the eyes, and
muscle weakness, presence of constipation, hematuria

June 18, 2007 – Lifted from the chart

Vital signs:
Temp: 38.6 °C
PR: 82 bpm
RR: 21 bpm
 BP: 130/80 mmHg
General: presence of chills, diaphoresis, irritability, flaring of the eyes, muscle
weakness, and anorexia

June 19, 2007 – Lifted from the chart

Vital signs:
Temp: 38.6 °C
PR: 82 bpm
RR: 21 bpm
BP: 120/80 mmHg
General: presence of chills, diaphoresis, irritability, flaring of the eyes, muscle
weakness, and anorexia; presence of pallor, passing of non-foul smelling black
stool, bounding pulses, bladder full and palpable, pain felt upon palpation

June 20, 2007 – Lifted from the chart

Vital signs:
Temp: 36.9 °C
PR: 82 bpm
RR: 21 bpm
BP: 90/60 mmHg
General: presence of muscle weakness; presence of pallor, passing of non-foul
smelling black stool, weak, thready pulses, cool extremities, restlessness

June 21, 2007 – Lifted from the chart

Vital signs:
Temp: 36.8 °C
PR: 82 bpm
RR: 22 bpm
BP: 110/70 mmHg
General: presence of muscle weakness, anorexia; presence of pallor, passing of
non-foul smelling black stool, weak, thready pulses, cool extremities, restlessness,
presence of blood and blood clots from colon up to terminal ileum, and multiple
erosions in the 3rd part of duodenum during colonoscopy, hematuria

June 22, 2007 – Lifted from the chart

Vital signs:
Temp: 38.5 °C
PR: 81 bpm
RR: 23 bpm
BP: 130/80 mmHg
General: presence of pallor, non-foul smelling black stool, presence of chills,
diaphoresis, irritability, flaring of the eyes, muscle weakness, slight nape pain,
bounding pulses, bladder full and palpable, pain felt upon palpation
June 23, 2007 – Lifted from the chart
Vital signs:
Temp: 36.5 °C
PR: 80 bpm
RR: 21 bpm
BP: 130/80 mmHg
General: presence of muscle weakness, anorexia; presence of pallor, passing of
non-foul smelling black stool, bounding pulses, cool extremities, slight nape pain,
bladder full and palpable, pain felt upon palpation

June 24, 2007 – Lifted from the chart

Vital signs:
Temp: 36.5 °C
PR: 78 bpm
RR: 20 bpm
BP: 130/80 mmHg
General: presence of muscle weakness, presence of pallor, passing of brownish
black stool, cool extremities, slight nape pain, weak pulses

1st Nurse-Patient Interaction (June 25, 2007, 2:00 pm)

Vital signs:
Temp: 36 oC
PR: 82 bpm
RR: 18 bpm
BP: 140/90 mmHg
HEAD: General: oblong, symmetrical
Hair: short, straight, and neatly combed, thin in distribution and grayish to
white in color
Scalp: absence of dandruff, and pediculosis
Skull: Smooth skull contour, absence of nodules or masses, symmetric
facial movements
EYES: General: no discharges noted on both eyes
Lids: skin intact, absence of periorbital edema, discoloration and lesion
Sclera: anicteric, presence of arcus senilis
Eyeballs: symmetrical in size and shape, sunken
Eyelashes: evenly distributed
Conjunctiva: pale palpebral conjunctiva
Cornea: transparent, shiny, and smooth
Pupils: pupils equally round, responds to light accommodation
Vision: absence of double vision, can clearly read newspapers
NOSE: No discharges or any lesion, damage or flaring, symmetrical in size and
shape, straight, uniform in color
EARS: General: Symmetrical aligned, with auricle aligned in the outer cantus of
the eye and color same as facial skin, pinna recoils after it is folded
External: symmetrical appearance of pinna, no abnormal discharges noted
Internal: no discharges noted
 MOUTH AND THROAT:
General: Soft, dry, slightly rough in texture, Symmetrical in contour
Mouth: teeth are aligned, absence of halitosis, smooth, white, shiny tooth
enamel, pale oral mucosa, denture on the mandible part
Lips: Lips pale, dry, no infection noted
Tongue: Pale in color, moves freely, central position
NECK: Muscles equal in size, coordinated smooth movements with no
discomforts, non-palpable lymph nodes, absence of carotid
pulsations, and presence of slight nape pain
CHEST: Respirations: eupnic
Chest: symmetrical chest expansion (SCE), no abnormal breath sounds,
and no lesions, patient reports about cough
HEART: no murmurs
BREAST: no lesions and discharges, absence of tenderness, masses, nodules
ABDOMEN: General: absence of pain during urination, absence of constipation,
passing of brown stool, and yellow urine, urinary frequency – urine output of
1550 ml (lifted from chart)
REPRODUCTIVE:
Prostate: absence of pain, and tenderness, non-palpable, Urine output =
1550 ml
INTEGUMENTARY:
Skin: dry, loose skin, brown complexion, absence of cyanosis, and
jaundice, skin returns after 5 seconds when pinched
Nails: smooth texture, pale, clean and short, intact epidermis, delayed return of
color after 5 seconds
MUSKULOSKELETAL:
no deformities or tenderness, equal movement on both sides of body,
presence of straight incision at the right femur
NEUROLOGICAL:
Mental Status: awake, conscious, coherent, oriented
Memory: fresh
Language: clear and consistent
Judgment: sound and reasonable
Position: semi-Fowler’s position

2nd Nurse-Patient Interaction (June 26, 2007, 6:00 pm)

Vital Signs:
Temp: 36.4 oC
PR: 78 bpm
RR: 19 bpm
BP: 120/80 mmHg
HEAD: General: oblong, symmetrical
Hair: short, straight, and neatly combed, thin in distribution and grayish to
white in color
Scalp: no dandruff, and pediculosis
 Skull: Smooth skull contour, no nodules or masses, symmetric facial
movements
EYES: General: no discharges noted on both eyes
Lids: skin intact, no periorbital edema, no discoloration and lesion
Sclera: anicteric
Eyeballs: symmetrical in size and shape, sunken
Eyelashes: evenly distributed
Conjunctiva: pale palpebral conjunctiva
Cornea: transparent, shiny, and smooth
Pupils: pupils equally round, responds to light accommodation
Vision: absence of double vision, can clearly read newspapers
NOSE: No discharges or any lesion, damage or flaring, symmetrical in size and
shape, straight, uniform in color
EARS: General: Symmetrical aligned, with auricle aligned in the outer cantus
of the eye and color same as facial skin, pinna recoils after it is folded
External: symmetrical appearance of pinna, no abnormal discharges noted
Internal: no discharges noted
MOUTH AND THROAT:
General: Soft, dry, slightly rough in texture, Symmetrical in contour
Mouth: teeth are aligned, absence of halitosis, smooth, white, shiny tooth
enamel, pale oral mucosa, denture on the mandible part
Lips: Lips pale, dry, no infection noted
Tongue: Pale in color, moves freely, central position
NECK: Muscles equal in size, coordinated smooth movements with no
discomforts, non-palpable lymph nodes, no carotid pulsations
CHEST: Respirations: eupnic
Chest: symmetrical chest expansion (SCE), no abnormal breath sounds,
and lesions, patient reports about cough
HEART: no murmurs
BREAST: no lesions and discharges, absence of tenderness, masses, nodules
ABDOMEN: General: absence of pain during urination, constipation, passing of
brown stool and yellow urine
REPRODUCTIVE: Prostate: absence of pain, and tenderness, non-palpable
INTEGUMENTARY:
Skin: dry, loose skin, brown complexion, absence of cyanosis, and
jaundice, poor skin turgor, cool extremities
Nails: smooth texture, pale, clean and short, intact epidermis, delayed
return of color after 5 seconds
MUSKULOSKELETAL:
nodeformities or tenderness, equal movement on both sides of body,
straight incision at the right femur, presence of body weakness, presence
of pain on the left femur rated as 5/10
NEUROLOGICAL:
Mental Status: awake, conscious, coherent, oriented
Memory: fresh
Language: clear and consistent
 Judgment: sound and reasonable
Position: semi-Fowler’s position

June 27, 2007 – Lifted from the chart (Before discharge)

Vital signs:
Temp: 36 °C
PR: 81 bpm
RR: 20 bpm
BP: 120/80 mmHg
General: presence of muscle weakness, presence of pallor, passing of brownish
black stool, cool extremities, weak pulses,urinary frequency-urine output of 3,500
ml

III. THE PATIENT AND HIS ILLNESS

1. Anatomy and Physiology

Figure 3: Normal urine flow. Figure 4: Location of the Prostate

Gland

The prostate is a walnut-sized gland that forms part of the male reproductive system. The gland is
made of two lobes, or regions, enclosed by an outer layer of tissue. As the diagrams show, the prostate is
located in front of the rectum and just below the bladder, where urine is stored. The prostate also surrounds
the urethra, the canal through which urine passes out of the body. The gland produces seminal fluid, which
is mixed with sperm to make semen.With age, the gland may begin to grow - this happens to most men.
The growth may eventually cause problems with urination, because the gland pinches off the urethra as it
increases its size. Scientists do not know all the prostate's functions. One of its main roles, though, is to
squeeze fluid into the urethra as sperm move through during sexual climax. This fluid, which helps make
up semen, energizes the sperm and makes the vaginal canal less acidic.
 b. Synthesis of the Disease

Benign prostatic hyperplasia (BPH) also known as Nodular hyperplasia,

Benign prostatic hypertrophy or Benign enlargement of the prostate (BEP) refers to
the increase in size of the prostate in middle-aged and elderly men. As a man matures, the
prostate goes through two main periods of growth. The first occurs early in puberty, when
the prostate doubles in size. At around age 25, the gland begins to grow again. This
second growth phase often results, years later, in BPH. Though the prostate continues to
grow during most of a man's life, the enlargement doesn't usually cause problems until
late in life. BPH rarely causes symptoms before age 40, but more than half of men in
their sixties and as many as 90 percent in their seventies and eighties have some
symptoms of BPH.

RISK FACTORS:

Predisposing Factors

The main risk factor for prostate enlargement is aging. Prostate enlargement
rarely causes signs and symptoms in men younger than 40, but approximately half the
men in their 60s experience some signs and symptoms. On a microscopic level, BPH can
be seen in the vast majority of men as they age, particularly over the age of 70 years,
around the world.
A family history of prostate enlargement can increase the odds of developing
problems from prostate enlargement.
In terms of nationality, prostate enlargement is more common in American and
European men than in Asian men. Blacks, with an incidence rate of 224.3 cases per
100,000 people, are at the greatest risk, present with more advanced disease, and have a
poorer diagnosis. Men who lead a western lifestyle have a much higher incidence of
symptomatic BPH than men who lead a traditional or rural lifestyle. This is confirmed by
research in China showing that men in rural areas have very low rates of clinical BPH,
while men living in cities adopting a western lifestyle have a skyrocketing incidence of
this condition, though it is still below rates seen in the West.
(http://en.wikipedia.org/wiki/Benign_prostatic_hyperplasia)

Precipitating Factor

Obesity (particularly an increased abdominal girth) may increase the risk for
BPH. (Black, 2005)
Frequent use of α – adrenergic agonists commonly found in the over-the-
counter cold medications or diet pills increases the severity of bothersome lower urinary
tract symptoms (LUTS) associated with BPH and the risk for acute urinary retention.
PATHOLOGIC CHANGES:

It is characterized by hyperplasia of prostatic stromal and epithelial cells, resulting

in the formation of large, fairly discrete nodules in the periurethral region of the prostate.
When sufficiently large, the nodules compress the urethral canal to cause partial, or
sometimes virtually complete, obstruction of the urethra which interferes the normal flow
of urine. As the prostate enlarges, the layer of tissue surrounding it stops it from
expanding, causing the gland to press against the urethra like a clamp on a garden hose.
The bladder wall becomes thicker and irritable. The bladder begins to contract even when
it contains small amounts of urine, causing more frequent urination. Eventually, the
bladder weakens and loses the ability to empty itself, so some of the urine remains in the
bladder. The narrowing of the urethra and partial emptying of the bladder cause many of
the problems associated with BPH.
Throughout their lives, men produce both testosterone, an important male
hormone, and small amounts of estrogen, a female hormone. As men age, the amount of
active testosterone in the blood decreases, leaving a higher proportion of estrogen. This is
based on the fact that BPH occurs when men generally have elevated estrogen levels and
relatively reduced free testosterone levels, and when prostate tissue becomes more
sensitive to estrogens and less responsive to DHT. Cells taken from the prostates of men
who have BPH have been shown to grow in response to high estradiol levels with low
androgens present. Estrogens may render cells more susceptible to the action of DHT.
Another theory focuses on dihydrotestosterone (DHT), a substance derived from
testosterone in the prostate. It is a metabolite of testosterone which is a critical mediator
of prostatic growth. DHT is synthesized in the prostate from circulating testosterone by
the action of the enzyme 5α-reductase, type 2. This enzyme is localized principally in the
stromal cells; hence, these cells are the main site for the synthesis of DHT.
DHT can act in an autocrine fashion on the stromal cells or in paracrine fashion
by diffusing into nearby epithelial cells. In both of these cell types, DHT binds to nuclear
androgen receptors and signals the transcription of growth factors that are mitogenic to
the epithelial and stromal cells. DHT is 10 times more potent than testosterone because it
dissociates from the androgen receptor more slowly. The importance of DHT in causing
nodular hyperplasia is supported by clinical observations in which an inhibitor of 5α-
reductase is given to men with this condition. Some research has indicated that even with
a drop in the blood's testosterone level, older men continue to produce and accumulate
high levels of DHT in the prostate. This accumulation of DHT may encourage the growth
of cells. Scientists have also noted that men who do not produce DHT do not develop
BPH.
Some researchers suggest that BPH may develop as a result of "instructions"
given to cells early in life. According to this theory, BPH occurs because cells in one
section of the gland follow these instructions and "reawaken" later in life. These
"reawakened" cells then deliver signals to other cells in the gland, instructing them to
grow or making them more sensitive to hormones that influence growth.
Other causes include neoplasm, arteriosclerosis, diabetes, inflammation, and
metabolic or nutritional disturbances.
.
SIGNS AND SYMPTOMS WITH RATIONALE:

• weak urinary stream – As the bladder compensates for the increased urethral
resistance due to chronic obstruction, the detrusor muscle tone becomes unstable,
producing weakened contractions. These weak contractions cause inadequate
evacuation of urine experienced as decrease in force of stream.
• urinary hesitancy – Urethral obstruction due to hyperplasia and hypertrophy
reduces the micturition reflex, causing hesitancy.
• incomplete bladder emptying – The weak contractions of the detrusor muscle
due to prolonged obstruction cause inadequate evacuation of urine experienced as
decrease in force of stream.
• daytime voiding frequency – Exacerbations of urinary obstruction increases
urethral resistance to outflow, which in turn triggers the body to amplify the
strength of detrusor muscle contraction by stimulating alpha-adrenergic agonist
action, causing overactive contractions, experienced as frequent daytime voiding.
• nocturia – As the inadequate evacuation of urine becomes chronic, the detrusor
muscle decompensates, increasing the postvoid residual volume, which when
prolonged to be excreted, gets worser throughout the end of the day and
experienced as nocturia.
• urinary urgency – It can be due to the overactive detrusor muscle contractions as
compensation for increased urethral resistance or increased residual volume
which triggers the micturition reflex, and felt by the body as the urge to urinate.
• straining upon urination – Obstruction of the urethral orifice and bladder neck
impedes urine flow and applies pressure on underlying blood vessels near them,
which is felt as straining.
• hematuria – Acute urine retention triggers interstitial fluids to go into
intravascular spaces, causing dilatation of ureters and kidney. If prolonged, it may
rupture the bladder and be perceived as hematuria.
• symmetrically enlarged prostate gland with smooth, rubbery surface upon
palpation – DHT and estradiol triggers formation of nodular hyperplasia in the
transitional zone (stromal cells near the urethra), which is felt as such upon
palpation
 b. Synthesis of the Disease

RISK FACTORS
Predisposing Factor

One of the prominent risk factors present in the patient is his age. The patient is
already 88 years old and its incidence is much more increased for men over the age of 80
years, with a probability of 90%.
The main risk factor for prostate enlargement is aging. Prostate enlargement
rarely causes signs and symptoms in men younger than 40, but approximately half the
men in their 60s experience some signs and symptoms. On a microscopic level, BPH can
be seen in the vast majority of men as they age, particularly over the age of 70 years,
around the world.

PATHOLOGIC CHANGES

The risk factors present triggers the hyperplasia of prostatic stromal and
epithelial cells, which compressed the urethral canal to cause partial, or sometimes
virtually complete, obstruction of the urethra which interfered with the normal flow of
urine of the patient. In the chronicity of the disease condition, the gland continued to
press against the urethra like a clamp. The bladder wall becomes thicker and irritable.
The bladder begins to contract even when it contains small amounts of urine, causing
more frequent urination. Eventually, the bladder weakens and loses the ability to empty
itself, so some of the urine remains in the bladder. The narrowing of the urethra and
partial emptying of the bladder cause many of the signs and symptoms experienced by
the patient.

SIGNS AND SYMPTOMS WITH RATIONALE

• weak urinary stream – As the bladder compensates for the increased urethral
resistance due to chronic obstruction, the detrusor muscle tone becomes unstable,
producing weakened contractions. These weak contractions cause inadequate
evacuation of urine experienced as decrease in force of stream.
• incomplete bladder emptying – The weak contractions of the detrusor muscle
due to prolonged obstruction cause inadequate evacuation of urine experienced as
decrease in force of stream.
• urinary urgency – It can be due to the overactive detrusor muscle contractions as
compensation for increased urethral resistance or increased residual volume
which triggers the micturition reflex, and felt by the body as the urge to urinate.
• daytime voiding frequency – Exacerbations of urinary obstruction increases
urethral resistance to outflow, which in turn triggers the body to amplify the
strength of detrusor muscle contraction by stimulating alpha-adrenergic agonist
action, causing overactive contractions, experienced as frequent daytime voiding.
 IV. DIAGNOSTIC AND LABORATORY PROCEDURES

DIAGNOSTIC/ DATE ANALYSIS AND

LABORATORY INDICATION ORDERED/DAT RESULTS NORMAL INTERPRETATION
PROCEDURES / E RESULTS VALUES OF RESULTS
PURPOSE WERE
RELEASED
CROSS- Cross- Date Ordered:
MATCHING matching 06/19/07; 06/21/07 Compatible Compatible It means that the
refers to the ; Blood type blood transfused
testing that is Date Results (-) allergic from the donor is
performed to Released: reactions compatible to the
determine the 06/19/07; 06/22/07 (fever, recipient.
compatibility rashes,
of a donated chills,
unit of blood pruritus,
for its intended etc.)
recipient.
Blood typing
is a laboratory
test done to
determine a
person’s blood
type.

Nursing Responsibilities for Crossmatching:

Before:
 Explain the procedure to the patient.
 Tell patient that no fasting is required.
 Tell patient that the test might bring a little pain to the puncture site.
During:
 Label the blood tube appropriately before sending it to the laboratory.
After:
 Apply pressure or a pressure dressing to the venipuncture site.
 Assess the venipuncture site for bleeding.
DIAGNOSTIC/ DATE ANALYSIS AND
LABORATORY INDICATION ORDERED/DAT RESULTS NORMAL INTERPRETATION
PROCEDURES / E RESULTS VALUES OF RESULTS
PURPOSE WERE
RELEASED
COMPLETE It is a basic Hgb: Decreased amounts
BLOOD protocol 1st: 06/15/07 1st: 10.7 imply presence of
COUNT/ whenever a 2nd:06/21/07 2nd: 5.9 14-18g/dl anemia secondary to
HEMATOLOGY patient is being 3rd:06/21/07 3rd: 7.8 gastrointestinal
admitted inside 4th:06/22/07 4th: 9.3 bleeding.
the hospital to
determine
presence of
blood
disorders or to
check for
manifestations
of the disease
condition. In
this case, it
was done to
determine
presence of
anemia.
The number of Hct: Decreased amounts
st st
red blood cells 1 : 06/15/07 1 : 36.3 imply presence of
determine 2nd: 06/19/07 2nd: 19.8 anemia secondary to
presence of 3rd: 06/19/07 3rd: 19.7 40.0-54.0 gastrointestinal
anemia due to 4th: 06/19/07 4th: 21.4 bleeding problem.
any sources of 5th: 06/21/07 5th: 18.1
bleeding in the 6th: 06/22/07 6th: 21.1
body. 7th: 06/22/07 7th: 26.9
It measures the WBC: Increased amounts
st st
number of 1 : 06/15/07 1 : 15.7 indicate presence of
white blood 2nd: 06/19/07 2nd: 19.8 infection in the
cells per cubic 3rd: 06/19/07 3rd: 18.3 4.3-10.0 urinary tract. It can
millimeters of 4th: 06/19/07 4th: 21.8 be due the prolonged
blood. It is 5th: 06/21/07 5th: 20.4 stay of catheters in
done to the urethral meatus
determine of the patient or due
presence of an to hypoxemia
urinary tract secondary to
infection. obstruction.

Lymphocytes Lymphocytes: The patient’s

are specialized 1st: 06/15/07 1st: 21 lymphocyte is below
WBC present 2nd: 06/19/07 2nd: 12 normal range which
in the blood 3rd: 06/19/07 3rd: 7 28.0-48.0 indicates that the
that destroys 4th: 06/19/07 4th: 12 immune response of
invading 5th: 06/21/07 5th: 13 the body is not
organisms; efficient enough to
may also combat infection,
indicate predisposing the
presence of patient to coughs. It
viral infection. may also mean that
It is also done Fluconazole is
to evaluate taking effect on the
 Nursing Responsibilities for Hematology:
Before:
 Explain to the patient the purpose of the procedure.
 Tell patient that no fasting is required.
During:
 Collect approximately 5 to 7 ml of blood in a lavender-top tube.
 List on the laboratory slip any drugs or other patient factors that can affect blood
levels.
After:
 Instruct patient not to take aspirin for fever or any drugs that is anticoagulant.
 Apply pressure or a pressure dressing to the venipuncture site.
 Observe venipuncture site for bleeding.

DIAGNOSTIC/ DATE ANALYSIS AND

LABORATORY INDICATION ORDERED/DAT RESULTS NORMAL INTERPRETATION
PROCEDURES / E RESULTS VALUES OF RESULTS
PURPOSE WERE
RELEASED
BLOOD The blood urea BUN: Increased amounts
CHEMISTRY nitrogen 06/22/07 31.2 7-21 of BUN in the blood
(BUN) test is a mg/dl indicates inadequate
measure of the excretion of urea due
amount of to obstruction seen
nitrogen in the in prostatic
blood that hyperplasia.
comes from
urea. It helps
in assessing
the excretory
function of the
kidney.
Creatinine is a Creatinine: Increased amounts
st
breakdown 1 : 06/15/07 1st: 2.28 0.5-1.69 of serum creatinine
product of 2nd: 06/22/07 2nd: 2.41 mg/dl is directly related to
creatinine, a presence of a renal
which is an disorder, which in
important part this case is benign
of muscle. The prostatic
test is hyperplasia.
performed to
evaluate
kidney
function.

The blood uric Uric acid: Increased levels in

 acid test 06/16/07 9.2 3.5- the blood may be
measures the 8.5mg/dl caused by decreased
amount of uric excretion of it in the
acid in a blood kidneys due to the
sample. It is presence of
also done to obstruction.
evaluate
kidney
function.

Nursing Responsibilities for Blood Chemistry procedures:

Before:
 Explain the procedure to the patient.
 The patient should try not to eat overnight before the test. (For Serum Uric acid)
 Inform the patient that he/she may feel moderate pain, prick or stinging sensation
or throbbing.
During:
 Collect approximately 5 ml of blood for each tests.
 Avoid hemolysis.

After:
 Apply pressure to the venipuncture site.
 For Creatinine: Tell the patient to stop taking certain drugs that may affect the
test.
 Inform the patient of the following risks:
• Excessive bleeding
• Fainting or feeling light-headed
• Hematoma (blood accumulating under the skin)
• Infection (a slight risk any time the skin is broken)
• Multiple punctures to locate veins

DIAGNOSTIC/ DATE ANALYSIS AND

LABORATORY INDICATION ORDERED/DAT RESULTS NORMAL INTERPRETATION
PROCEDURES / E RESULTS VALUES OF RESULTS
PURPOSE WERE
RELEASED
URINALYSIS This may be Date Ordered: Color: Normal The color, specific
done as a 06/18/07; 06/26/07 1st – Yellow Color: gravity, sugar
general 2nd – Light Amber content, and pH of
screening to Date Results yellow yellow the urine are within
check for early Released: the normal range,
signs of 06/18/07; 06/26/07 Specific Specific regardless of the
disease. It may gravity: gravity: existence of the
be used to 1st -1.015 1.010-1.025 disease condition.
check for a 2nd -1.010 The urine is slightly
urinary tract turbid in appearance
infection or Sugar: Sugar: which may be due to
st nd
blood in the 1 and 2 - Negative presence of bacteria
urine. negative from UTI.
There are many red
Pus cells: Pus cells: cells in the urine
1st - 35-40 Negative may be due to
nd
2 – 2-3 infection, and
traumatic bladder
Red cells: Red cells: catheterizations,
1st –many Up to two which causes
nd
2 – 0-2 erosions on the
collecting system,
Amorphous Amorphous and seen as
Urates: urates: hematuria and
1st – Few Negative increased red cells.
Hematuria can also
Appearance: Appearance: be attributed to the
1st and 2nd - Clear gastrointestinal
slightly bleeding findings on
turbid him. However, there
is improvement as
Reaction: pH: 4.6-8.0 days had passed.
1st and 2nd - Occurrence of
pH 6.0 amorphous urate
crystals in the urine
Albumin: Albumin: may be due to the
st
1 - 1+ Negative existing UTI.
2nd – negative There is albumin
present in the urine
which may be due to
Others: movement of fluids
2nd – (+) from interstitial into
fungal intravascular spaces
elements of the urethra. In the
second test, it is
negative indicating
that the disease
condition is
progressively
improving.
 However, fungal
elements are present
in the second
collection, which
may result from the
infiltration of bowel
elements into the
urinary system due
to previous fecal
impaction.

Nursing Responsibilities for Urinalysis:

Before:
 Explain the procedure to the patient.
 Tell the patient that no fasting is required.
During:
 Collect a voided specimen in a urine container.
 Have the client collect midstream specimen by:
 Having the patient begin to urinate in a bedpan, urinal, or toilet and then
stop urinating.
 Correctly position a sterile urine container, into which patient voids 3 to 4
ounces of urine.
 Capping the container.
 Allowing the patient to finish voiding.
After:
 Transport the urine specimen to the laboratory promptly.
DIAGNOSTIC/ DATE ANALYSIS AND
LABORATORY INDICATION ORDERED/DAT RESULTS NORMAL INTERPRETATION
PROCEDURES / E RESULTS VALUES OF RESULTS
PURPOSE WERE
RELEASED
CHEST X-RAY It can indicate Lung Granuloma
so much 06/15/07 Small fields are formation is one of
information granuloma, clear, heart the foremost
about heart, left lower lobe, in its usual manifestations of
lung, bony Cardiomegaly, size, with tuberculosis, which
thorax, left diaphragm, may be traced to the
mediastinum ventricular sulci, ribs, smoking history of
and great form and blood the patient. The aorta
vessels. It is Atheromatous vessels is atheromatous
important in aorta intact. which can be due to
the complete deposition of plaque
evaluation of or fat deposits
the pulmonary suggestive of a high
and cardiac cholesterol diet.
system. This Cardiomegaly in the
procedure is left ventricle may
often part of indicate obstruction.
the general
admission
screening work
up in adult
patients.

Nursing Responsibilities for Chest X-ray:

Before:
 Explain the procedure to the patient.
 Tell the patient that no fasting is required.
 Instruct the patient to remove clothing to the waist and to put on an x-ray gown.
 Instruct the patient to remove all metal objects (e.g. necklace, pins) so they do not
block visualization of the part of the chest.
 Tell the patient that he/she will be asked to take a deep breath and hold it while
the x-ray films are obtained.
 Ensure that the testicles in men and ovaries in women are covered with a lead
shield to prevent radiation-induced abnormalities.
 Inform the patient that no discomfort is associated with chest radiography.
During:
 After the patient is correctly positioned, tell him or her to take a deep breath and
hold it until the x-ray films is obtained.
 Note that x-ray films are obtained by radiologic technologist in several minutes.
After:
 No special care is required after chest radiography.