Comprehensive Care Plan For a Patient With a Genitourinary Problem

Patient Initials: PK Age: 60 years Sex: Male

Subjective Data

Client Complaints: Patient reported to clinic complaining of decreased urinary flow, nocturia and dysuria. Patient has been experiencing these symptoms for two years but they have worsened in the past two weeks. He has not experienced any form of radiating pain.

Significant Family History: Patient was born in the United States and has one sister and one brother. He has two sons, who are both married. There was no report of a dysfunctional family.

Client’s support system: Wife and friends from work.

Behavioral or Nonverbal Messages: The patient believes he could be suffering from prostate cancer, based on recent symptoms.

Client awareness of abilities, disease process, health care needs

He is well educated and has a Master’s degree in Engineering, but he is not properly informed about the healthcare resources at his disposal. He is an over-achiever and is satisfied with his life. Patient believes he is generally healthy and that he gets adequate exercises. He sees his physician regularly.

Objective Data

Vital Signs: Blood Pressure: 140/92 right/sitting, T: 99 po; P: 80 and regular; R 18, non-labored; Wt: 200#; Ht: 71”.

History of Hypertension, Hypercholesterolemia, suspected angina, costochondritis. Denies using alcohol, drugs and cigarettes. There is a history of heart disease in his family with his aunts and uncles having suffered it before.

Current medications

  • Cardizem 240mg daily
  • Zocor 20mg daily

Physical assessment findings

The patient was anxious during the examination but no acute distress was detected.

Low grade fever:

  • Abdomen: android obesity non-tender.
  • Rectum: stool light brown, heme positive.
  • Lungs: Clear

Prostate enlarged boggy and tender to palpitation:

  • Heart: RRR with Grade II/VI murmur heard best at the right sternal border.

Neurologic not assessed:

  • Genital/Pelvic: No penial lesions, masses, or discharge.
  • Extremities: No edema in the lower legs.

Lab Tests and Results

  • PSA: 6.0
  • CBC: WNL
  • Chem panel: WNL
  • Radiological Studies: None
  • EKG: None

Client’s locus of control and readiness to learn: The patient is well educated and he is ready to learn. He has a strong support system, which will also help in the treatment process.

ICD-9 Diagnoses/Client Problems

  • Unspecified essential hypertension 401.9
  • Hypercholesterolemia 272.0
  • Elevated PSA 790.93
  • Blood in stool 578.1
  • Heart disease unspecified 429.9
  • Prostatitis 601.9
  • Prostate hypertrophy 600.01
  • Slow urine stream 788.69
  • Nocturia 788.43
  • Dysuria 788.1
  • Anxiety state unspecified 300.00
  • Insomnia state unspecified 780.52
  • Undiagnosed cardiac murmur 788.2
  • Slow of urine stream 788.69
  • Urinary frequency 788.41

Advanced practice nursing intervention plan

Clerk the patient for a complete medical history including sexual behavior.

Assess Benign Prostatic Hyperplasia, guided by the American Urological Association Symptom Index.

Review the medication being used for efficacy. Possibly add more medication to reduce the blood pressure. The later recourse, however, depends on the outcome of the BPH analysis.

Refer to cardiologist for echocardiogram.

Refer to urologist for evaluation and pelvic ultrasound.

Consider prescribing an antibiotic for suspected prostatitis.

Consider prescribing an analgesic for the pain.

Order

  • STI screen
  • U/A with c/s
  • ECG

Consider a colonoscopy to check the blood in the stool if patient.

Refer to nutritionist to manage the blood pressure and cholesterol levels.

Refer to counsellor to deal with any incidence of depression and anxiety due to the illness.

Education and Counseling

The patient needs to be properly informed of the plan and the importance of compliance. The patient needs to understand the importance of committing to all medication that is prescribed. The patient needs to be aware of the dangerous symptoms to look out for. He should also be advised to see a doctor anytime he notices something unusual.

Any kinds of foods and drinks that may worsen the situation should be discouraged among them alcohol and caffeinated drinks. The patient should be advised to stick to recommended healthy diets, which should have low salt content.

The patient should be encouraged to use protection as a way of preventing bacterial contamination between him and his partner.

The patient’s wife should also be advised to regularly monitor the patient and report any symptoms. If possible, his friends from work should also be encouraged to keep an eye on the patient. The members of the patient’s support system need to be encouraged to regularly keep him company, in order to reduce incidence of him getting stressed. Follow up should be done after one week to re-assess the symptoms.

Rationale

The patient came in complaining of nocturia, terminal dysuria and fever.

Patient presents in clinic complaining of increased symptoms of nocturia, frequency. A physical examination showed that his prostate was enlarged, boggy and tender. His PSA is 6.0.

Differential diagnosis includes obstruction, UTI, acute prostatitis, and prostate cancer.

Cancer was ruled out because although the patient presented with hesitancy and fever, hematuria and back pain, which usually present in CA diagnoses, were not reported (Buttaro, et al. 2013). In addition, no asymmetrical enlargement of the prostate gland was detected.

Acute prostatitis is detected by elevated PSA levels, enlarged and tender prostate, fever, chills, malaise, frequency nocturia, and dysuria (Buttaro, et al. 2013). An analgesic, antipyretic and antibiotic could help relieve acute prostatitis.

Chronic prostatitis comes with a tender and boggy prostate frequency nocturia, and dysuria. Patients with an elevated PSA and prostatitis should be treated with antibiotics for 4-6 weeks followed by a re-evaluation (Shoskes, 2008). Dietary changes are recommended and foods to avoid are hot spices, strong acids, coffee, alcohol, and acidic juices (Daniels and Nicoll, 2011).However, the patient needs to be assessed by a urologist to rule out cancer, calculi, obstruction and stricture (Buttaro, et al. 2013).

Assessing the patient’s sexual behavior will help to rule out any sexual transmitted infections and any form of bladder infections.

The patient should have a neurologic examination in order to rule out incidence of nerve injury that could be associated with neurogenic bladder.

A colonoscopy should be done to rule out colon cancer because there was blood in the patient’s stool.

The patient has been taking his blood pressure medication as required but his readings are still on the higher side. The increase in blood pressure could be related to the stress the patient has been experiencing in the past two weeks.

Prescribing additional BP medication should be considered. An alpha antagonist such as doxazosin can help reduce BP and treat BPH (Lehne, 2013).

Referrals

The patient should urgently see a urology specialist for prostatitis and STI tests.

The patient should see a nutritionist for guidance on proper diet.

Patient needs to see a cardiologist to check the systolic heart murmur.

The patient needs to see a gastroenterologist to find out the cause of the heme positive reading.

Reference list

Buttaro, T., Trybulski, J., Bailey, P., & Sandberg-Cook, J. (2013). Primary Care. St. Louis, Missouri: Elsevier Mosby.

Daniels, R. & Nicoll, L. (2011). Contemporary Medical-Surgical Nursing. Boston: Cengage Learning.

Lehne, R.A. (2013). Pharmacology for nursing care. St. Louis, MO: Elsevier.

Shoskes, D.A. (2008). Chronic Prostatitis/Chronic Pelvic Pain Syndrome. Berlin: Springer Science & Business Media.

Calculate the price
Make an order in advance and get the best price
Pages (550 words)
$0.00
*Price with a welcome 15% discount applied.
Pro tip: If you want to save more money and pay the lowest price, you need to set a more extended deadline.
We know how difficult it is to be a student these days. That's why our prices are one of the most affordable on the market, and there are no hidden fees.

Instead, we offer bonuses, discounts, and free services to make your experience outstanding.
How it works
Receive a 100% original paper that will pass Turnitin from a top essay writing service
step 1
Upload your instructions
Fill out the order form and provide paper details. You can even attach screenshots or add additional instructions later. If something is not clear or missing, the writer will contact you for clarification.
Pro service tips
How to get the most out of your experience with My Homework Geeks
One writer throughout the entire course
If you like the writer, you can hire them again. Just copy & paste their ID on the order form ("Preferred Writer's ID" field). This way, your vocabulary will be uniform, and the writer will be aware of your needs.
The same paper from different writers
You can order essay or any other work from two different writers to choose the best one or give another version to a friend. This can be done through the add-on "Same paper from another writer."
Copy of sources used by the writer
Our college essay writers work with ScienceDirect and other databases. They can send you articles or materials used in PDF or through screenshots. Just tick the "Copy of sources" field on the order form.
Testimonials
See why 20k+ students have chosen us as their sole writing assistance provider
Check out the latest reviews and opinions submitted by real customers worldwide and make an informed decision.
11,595
Customer reviews in total
96%
Current satisfaction rate
3 pages
Average paper length
37%
Customers referred by a friend
OUR GIFT TO YOU
15% OFF your first order
Use a coupon FIRST15 and enjoy expert help with any task at the most affordable price.
Claim my 15% OFF Order in Chat
Live ChatWhatsApp