In the case presented, a sixty year old Hispanic male complains of a decrease in his urinary flow. While this may be the result of a number of possible conditions, the advanced nurse must consider one of the most common causes of this complaint: prostate issues. In benign prostatic hypertrophy (BPH), an enlargement of the prostate results in a number of concerns, including decreased urinary flow. However, a nurse must first work to establish a solid physical assessment and history on the patient. A physical exam and history are required to determine a list of possible differential diagnoses.
A physical examination should focus on the abdominal region. This includes palpating the abdomen to determine if the patient has any signs or symptoms of urinary retention, another possible cause of decreased urinary flow. In addition, there are a number of diagnostic tests that should be performed on the patient. These tests include an ultrasound of the bladder, as well as laboratory testing, such as BUN, creatinine levels and a PSA. Obviously, a urinalysis should also be conducted (Marshall, Haber, & Josephson, 2014, p. 1).
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The American Urological Association has developed a detailed algorithm to assist health care providers in the diagnosis of patients with lower urinary tract symptoms. It should be noted that nearly 80% of men over the age of sixty develop some level of enlargement in the prostate (Deters, 2015). Once a patient has been diagnosed with this condition, it is important to relieve the signs and the symptoms associated with, and also to reduce the incidence of urinary tract infections in the patient. The management of the patient depends upon the scoring system. A score less than 7 indicates mild symptoms. A score of 8 to 19 indicates moderate symptoms. A score of twenty or greater indicates severe symptoms (International Prostate Scoring System, 2014). If the patient has mild symptoms, or is not particularly troubled by the symptoms that score moderate, the patient may be monitored with watchful waiting.
However, if the patient is bothered by the symptoms or has severe symptoms, the patient may be treated with medications, such as alpha-1-receptor blockade. This patient has had problems in the past, but his symptoms have increased significantly in the past two weeks. Watchful waiting is not appropriate. The patient may be prescribed Flomax (tamsulosin hydrochloride). The correct dose is 0.4 mg daily initially. The patient should be referred to a urologist for further studies and additional treatments. The patient should return in two weeks to determine if the treatment is working. If the patient does not respond to the initial dose, the patient may be treated with an increase in the dosage of the medication. Since the patient has not been seen by a cardiologist in a significant period of time, and has high cholesterol, the patient should be referred to a cardiologist for examination. This referral reflects the patient’s medical history and his age as risk factors. An ECG should be conducted and evaluated by a cardiologist as a baseline in cardiac care.
In addition to the use of multiple disciplines to treat this patient, community resources must also be utilized. A social worker should be contacted for this patient. The social worker may assist the patient in locating methods to help pay for his treatment and assist him financially. Furthermore, the social worker may assist the patient emotionally and psychologically. The patient may benefit from support groups and possibly therapy. A chronic diagnosis that impacts a basic life function has life-changing implications. This must be recognized and the patient should be referred to the appropriate resources. While this patient does have a strong support system, the patient may still benefit from additional resources.
The patient’s follow-up plan includes a visit two weeks after beginning medication. If the patient shows improvement of the symptoms, the patient may continue on the dosage. However, if the patient does not show any improvement, the dosage should be doubled. The patient should see a urologist within one month of his initial treatment. If the dosage must be increased, the patient’s consult with the urologist should be expedited.
