As with any assessment, there are several different questions that need to be asked when taking a history. In this case, the onset and duration of the issue is important to note, as this can be indicative of the severity of the problem (Resnick et al., 2013). The characteristics of the issue are also vital – in this case, the pattern of urination issues highlights which part of the genitourinary system is affected (Resnick et al., 2013). Mr. Allen notes that it often takes him a long time to start urinating and that his stream is weak when he manages to start. This suggests that there may be some blockage of the urinary tract. All of this information needs to be documented on the medical record so that physicians and other nurses can understand when the problem started and what area of the system has been affected.
The main issue that is apparent from this assessment is blood in the urine. Blood in the urine can indicate a serious issue in the male genitourinary system, and means that there needs to be a full examination conducted. In this case, the palpation and percussion portion of the assessment do not reveal any issues with the kidneys, penis, or scrotum. There is some distension present in the bladder, and there are some non-tender nodules in the prostate. In this case, considering the age of the patient and the findings from the history and the physical assessment, PSA testing and ultrasounds are the usual protocol (Cockle-Hearne et al., 2013). The PSA for this patient was high and a biopsy was therefore conducted, which showed that the patient has a low-grade prostate cancer for which surgery is recommended (Cockle-Hearne et al., 2013). All of this information needs to be logged in the medical record, including copies of the ultrasound and biopsy results, to make comparisons after surgery to measure whether this treatment was successful.
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As with any cancer, care needs to be taken to ensure that the patient fully understands the severity of the disease and is getting the help that they need to deal with the diagnosis. This patient has a history of depression, and symptoms of depression can become more apparent in patients with cancer as they come to terms with their disease (Cockle-Hearne et al., 2013). It is also noted that Mr. Allen has not always been compliant with medication in the past – this needs to be rectified as missing any recommended treatment could allow the cancer to spread (Langston et al., 2013). The nursing diagnosis here is low-grade prostate cancer and there are several different nursing interventions. The first should be post-surgery care, which includes monitoring the site for infection and ensuring that the surgery was successful by conducting further diagnostic tests (Langston et al., 2013). The second is ensuring that the patient is aware of the severity of this diagnosis and helping with the psychological issues associated with cancer (Langston et al., 2013).
The patient needs education in order to help him deal with the diagnosis. Explaining to him the odds of survival and the success rate of similar types of surgery is one way of ensuring that the patient is aware of the changes happening in their body and making sure that they are fully informed about the diagnosis and potential treatment plans. This needs to be delivered in a calm and optimistic way without misleading the patient, which can be challenging as it is a difficult diagnosis to hear. It may be useful to refer the patient and his wife to counselling if they are having difficulty dealing with the diagnosis, as prostate cancer can be severe and have an impact on everyone in the family.
