Client Concept Map Presentation

Fei Cheng
NUR 120, Fall 2019
Introduction

 Mr. AJ is a 92 years old Caucasian man

 A father of 6 (4 girls and 2 boys)
 Master degree in engineering, “used to build houses”
 Date of admission was 12/27/2018
 AJ is under both Brightview staffs and hospice care.
 Primary diagnoses are CVD, CAD, AMD, BPH, dementia, hyperlipidemia, A. fib., and
vitamins B12 and D deficiency.
 Past surgical procedures included urethral dilation and circumcision.
Pathophysiology of BPH

 Benign Prostatic Hyperplasia (BPH) is the enlargement of the

prostatic gland from the multiplication of both epithelial and
stromal cells.

(Lippincott Advisor for Education, 2019)

  Advanced age (Lippincott Advisor for Education, 2019)​

 Lack of physical exercise (Lippincott Advisor for Education, 2019)​

 Intact testes (Lippincott Advisor for Education, 2019)​

Etiology  Family history of BPH (Lippincott Advisor for Education, 2019)​

 Diabetes (Lippincott Advisor for Education, 2019)​

 Heart disease (Mayo Clinic, 2019)

  Prostatic growth happens in 2 stages- first during
puberty and the second around the age of 25. It is
during the second stage of growth when BPH usually
develops (Urology Care Foundation [UCF], 2019).
The Disease  The enlargement occurs when prostatic epithelial and
Process stromal cells multiply, in addition to delayed apoptosis
leading to accumulations of prostatic cells (Lippincott,
2019).
  The enlarged prostate push pressures against the
prostatic urethra (Lippincott Advisor for Education
[Lippincott], 2019).
The Disease  The pressure compresses and distorts the prostatic
urethra causing obstruction (Lippincott, 2019).
process (cont.)  The enlarged prostate could also cause the bladder
wall to become thick and weak, which will lead to its
inability to fully empty its content (UCF, 2019).
Common Clinical Manifestations

Recurrent UTIs Urinary retention Bladder calculi Renal insufficiency

BUN/creatinine elevated Bacteria in urine PSA may be elevated

(Lippincott Advisor for Education, 2019)

Treatments

Minimally invasive or surgical therapy

Medications Transurethral resection of the prostate (PUL)

Alpha blockers, 5-alpha reductase inhibitors, and
Tadalafil
Transurethral incision of the prostate (TUIP)
Transurethral microwave thermotherapy (TUMT)
Transurethral needle ablation (TUNA)
Laser therapy

(Mayo Clinic, 2019)

 #3

Nursing
diagnosis
Impaired physical mobility R/T decrease in
muscle mass, strength, endurance, and sedentary
lifestyle AEB decrease in fine motor skills,
decrease in gross motor, and slowed movement.

(Lippincott Advisor for Education, 2019)

 #2

Nursing
Diagnosis Risk for fall R/T difficulty with gait,
impaired mobility and balance, history
of fall, and alteration in cognitive
functioning

(Gulanick & Myers, 2017)

 #1

Nursing
Diagnosis
Risk for infection R/T stasis of
body fluid secondary to BPH

(Lippincott Advisor for Education, 2019)

Goal and Outcomes

 Client will remain free of infection for 30 days.

1. Client will demonstrate good hand and perineal hygiene by end of
clinical week.
2. Client will demonstrate the use of urinal every 4 hours by 15th of
December.
3. Client will verbalize signs and symptoms of infection after
teaching.
Interventions

 Assess
1. Access client’s current hand and perineal hygiene
2. Access client’s voiding habits, characteristic and amount of urine output and
residual.
3. Access client’s knowledge about UTIs.
4. Access client’s vital signs and lab values, and bladder fullness every 4 hours.
Interventions (cont.)

 Do
1. Administer BPH medications as prescribed.
2. Encourage urination at regular interval such as every 4 hours or whenever the urge
first come and re-urinate after the initial
3. Encourage client to increase intake of water during the daytime and limit fluid intake
3 hours before bedtime.
Interventions (cont.)

 Teach
1. Teach the importance of good hygiene and the proper way of hand and perineal
hygiene.
2. Teach client Kegel exercises to strengthen pelvic muscle to help with voiding.
3. Teach signs and symptoms of UTI.
Goal Met?
Modifications?

Change outcomes for all

teachings to be able to verbalize Must do teaching every other day
Evaluate each teaching session
or demonstrate at the end of each due to AJ’s dementia
teaching session

Continue with all other Assess at the end of 30 days to

interventions see if goal is met.
References

Gulanick, M. & Myers, J.L. (2017). Nursing care plans: diagnoses, interventions, &outcomes (9th ed.) St. Louis, MO: Mosby,
an imprint of Elsevier Inc.
Hinkle, J.L., & Cheever, K.H. (2018). Brunner & Suddarth’s textbook of medical-surgical nursing (14th ed.) [E-book]
Philadelphia, PA : Wolters Kluwer. Retrieved
from https://coursepoint.vitalsource.com/#/books/9781496379054/cfi/6/6!/4/2/2/4/2@0:0
Mayo Clinic. (2019). Retrieved November 24, 2019, from https://www.mayoclinic.org/diseases-conditions/benign-prostatic-
hyperplasia/symptoms-causes/syc-20370087 
National Institute of Diabetes and Digestive and Kidney Diseases. (2014). Retrieved December 4,
2019, from https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostate-enlargement-
benign-prostatic-hyperplasia
Lippincott Advisor for Education. (2019). Retrieved November 24, 2019, from  https://advisor-edu.lww.com/lna/home.do?
m=selection&selectedBookId=4
UC Davis Health. (2019). Retrieved December 4, 2019,
from https://health.ucdavis.edu/vascular/diseases/renal_insufficiency.html
Urology Care Foundation. (2019). Retrieved November 24, 2019, from https://www.urologyhealth.org/urologic-
conditions/benign-prostatic-hyperplasia-(bph)
Image references

http://www.clipartsuggest.com/nurse-symbol-clip-art-logo-rainbow-clip-art-hss0PO-clipart/
Mayo Clinic. (2019). Retrieved November 24, 2019, from
https://www.mayoclinic.org/-/media/kcms/gbs/patient-
consumer/images/2013/08/26/10/09/ds00027_im00954_hdg7_prostatecomparisonthu_jp
g.png