Case Scenario 1: Benign Prostatic Hyperplasia

Mang Ponso, is a 68-year-old man who is being seen at the clinic for routine health maintenance and health promotion. He reports that he has been feeling
well and has no specific complaints, except for some trouble "emptying my bladder". Vital signs at this visit are 148/88, 82, 16, 36.1 C. He had a CBC and
complete metabolic panel (CMP) completed 1 week before his visit, and the results are listed below.

While obtaining your nursing history, you record no family history of cancer or other genitourinary (GU) problems, Mang Ponso reports frequency, urgency,
and nocturia x 4; he has a weak stream and has to sit to void. These symptoms have been progressive over the past 6 months. He reports he was diagnosed
with a large prostate a number of years ago. Last month, he began taking saw palmetto capsules but had to stop taking them because they “made me sick”
Also he is taking the following medicines: 5-alpha reductase inhibitors finasteride (Proscar) and alpha-blocking drug tamsulosin (Flomax).

Mang Ponso returns in 8 months to report that his symptoms are worse than ever, he has tried several different medications, but medication management
failed, and he is told that surgical intervention is necessary. He was elected to undergo Transurethral resection of the prostate (TURP). He did well post
operatively and return to his room with continuous bladder irrigation for several days while he was admitted and eventually was discharge to home.

LABORATORY /DIAGNOSTIC RESULTS

Prepare two (2) Nursing Care Plan for Mang Ponso, 1 on his clinical manifestation (urinary elimination) and 1 on fluid balance post TURP
CUES NURSING SCIENTIFIC PLANNING IMPLEMENTATIO SCIENTIFIC EVALUATION
DIAGNOSIS EXPLANATION N RATIONALE
Subjective: Risk for Deficient TURP- performed Short term: Monitor Input & Indicator of fluid GOAL MET
The patient states fluid volume r/t by inserting a After 1 hour of Output balance and
he feels worried Vascular nature Resectoscope nursing replacement needs. Short term:
about the color of of surgical area through urethra intervention, the With bladder After 1 hour of
irrigations,
his urine patient will be nursing
monitoring is
Prostatic tissue is able to maintain essential for intervention, the
“Felt thirsty” as resected in small adequate fluid estimating blood patient was able
stated by the strips under direct volume loss and accurately to maintain
patient vision usig te assessing urine adequate fluid
Objective: diathermy loop Long term: output. volume
After 24 hours of
Continuous nursing Monitor vital signs, Dehydration or Long term:
bladder irrigation Pieces washed out intervention, the noting increased hypovolemia After 24 hours of
by and pulse and requires prompt
for several days patient will be nursing
continuously respiration, intervention to
as prescribed able to maintain intervention, the
irrigated with fluid decreased BP, prevent impending
adequate fluid diaphoresis, pallor, shock patient was able
Muscle weakness volume as delayed capillary to maintain
At the end of evidenced by refill, and dry adequate fluid
Dizziness procedure, a good skin turgor mucous membranes. volume as
thrree-lumen and balance evidenced by
Dry mouth, dry catheter is inserted intake and output Investigate May reflect good skin turgor
skin and irrigation is restlessness, decreased cerebral and balance
continued for up to confusion, changes perfusion intake and output
24 hours in behavior (hypovolemia) or
Low urine output
after operation indicate cerebral
edema from
excessive solution
absorbed into the
venous sinusoids
during TUR
procedure (TURP
syndrome)

Flushes kidneys
Encourage fluid and/or bladder of
intake to 3000 bacteria and debris
mL/day unless (clots). Note: Water
contraindicated intoxication or fluid
overload may occur
if not monitored
closely

Movement or
Anchor catheter, pulling of catheter
avoid excessive may cause bleeding
manipulation or clot formation
and plugging of the
catheter, with
bladder distension

Bleeding is not
Observe catheter unusual during first
drainage, noting 24 hr for all but the
excessive or perineal approach
continued bleeding
Usually indicates
Evaluate color, arterial
consistency of urine bleeding,clotting, or
irritation that
requires aggressive
therapy

To evaluate blood
Monitor laboratory losses or
studies as indicated replacement needs

May need
Administer IV additional fluids, if
therapy or blood oral intake
products as inadequate, or
indicated. blood products, if
losses are excessive
 Traction on the 30-
mL balloon
Maintain traction on positioned in the
indwelling catheter; prostatic urethral
tape catheter to fossa creates
inner thigh pressure on the
arterial supply of
the prostatic
capsule to help
prevent and control
bleeding

Prolonged traction
may cause
Release traction permanent trauma
within 4–5 hr. or problems with
Document period of urinary control
application and
release of traction, if
used Prevention of
constipation and/or
Administer stool straining for stool
softeners, laxatives reduces risk of
as prescribed rectal-perineal
bleeding