MN568 Unit 5 Discussion – benign prostate hypertrophy

MN568 Unit 5 Discussion – benign prostate hypertrophy

Unit 5 Discussion

Topic 3

Mr. E.D. is a 63-year-old retired mail carrier who presents to his primary care provider for a routine follow up for his hypertension. He complains of a 4-day history of dysuria, increased urinary frequency, and nocturia. He states that he has been having fever and chills. Denies any recent sexual activity. On examination, his temperature is 99.5 F., pulse 75 and regular, respiratory rate 16 and unlabored, and blood pressure 135/85. He does not appear acutely ill and is in no apparent distress MN568 Unit 5 Discussion – benign prostate hypertrophy. Examination of the abdomen was normal. A digital rectal exam revealed a moderately enlarged, firm, non-tender prostate gland. He states that he has severe urgency and difficulty urinating.

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Subjective Data

The use of questionnaire such as the American Urological Symptom Index is helpful to understand the severity of symptoms. The questionnaire reveals an overall score of mild, moderate and severe. Questions include asking the patient over the past month it is felt they did not fully empty the bladder, how often they have urinated in the past month within 2 hours, how often in the past month urinary flow started and stopped, how often in the past month it is difficult to urinate, how often in the past month urine flow is weak, how often in the past month staining with urination occurred, and how often in the past month they were woken in the night to urinate (Dunphy et al., 2015). MN568 Unit 5 Discussion – benign prostate hypertrophy.

Other subjective data would include questioning of when fever, chills first started and if the patient has taken anything to relieve the fever, chills. Family history of cancer and prostate cancer should be obtained from the patient. It is important to obtain history around any recent trauma to the urethral area and prostate.

 

Differential Diagnosis

1) Benign Prostate Hyperplasia

2) Urinary Tract Infection

3) Prostatitis

4) Urethral obstruction/stricture related to trauma

5) Unrelated etiologies- diabetes, neurogenic bladder.

MN568 Unit 5 Discussion – benign prostate hypertrophy

 

Physical Examination

A focused subjective data collection will assist in diagnosis of benign prostate hypertrophy. A focused physical examination on the suprapubic area with concentration on the bladder should be completed. The practitioner should assess for bladder distention and complaints of pain with palpation. A digital rectal exam (DRE) will assist in determination of nodules and size of prostate based on fingers breath during the DRE. This exam may be contraindicated in patients with neurological anal sphincter disorders (Deters & Kin, 2017). MN568 Unit 5 Discussion – benign prostate hypertrophy Measurement of the prostate gland can be assessed by fingers breath and reported in documentation. Caution should be taken when performing a digital rectal exam if infection is suspected because of the potential for sepsis by performing DRE.

Diagnostics

Diagnostic testing for this patient should include a prostate specific antigen (PSA) and consideration of a cystoscopy. A PSA level of 4.0ng/mL and lower is considered normal (National Cancer Institute, 2018). A PSA above 4.0ng/mL would be an indication for a referral to a urologist or a needle biopsy to be completed. The National Cancer Institute (2018) points out that twenty-five percent of men with an elevated PSA will not have prostate cancer (National Cancer Institute, 2018). The PSA can assist in helping a practitioner to not overtreat a patient with an enlarged prostate with medications that could affect the patients erectile function.

Laboratory diagnostics for urinalysis, urine culture, comprehensive blood panel and complete blood count are indicated to rule out infection and electrolyte imbalances.

The prostate symptom index is an eight-question test created by the American Urological Association to assist the practitioner by allowing the patient to rate how severe the symptoms can be affecting individual quality of life. An intravenous pyelogram can measure postvoid residual based on the severity of reported symptoms from the patient questionnaire. MN568 Unit 5 Discussion – benign prostate hypertrophy.

Benign Prostatic Hypertrophy

Benign Prostatic Hypertrophy is a common condition that affects men after age forty. The prostate gland begins to enlarge during puberty through around age twenty and begins to enlarge again in older years (Dunphy, Winland-Brown, Porter, & Thomas, 2015). The enlarged prostate interrupts the flow of urine and affects a male’s quality of life.  Some studies suggest a high incidence of BPH with obesity and lack of physical activity (Belaynen & Korownyki, 2016). Education for prevention of BPH from the nurse practitioner should include regular physical activity, a low fat diet, and reduction of alcohol consumption. MN568 Unit 5 Discussion – benign prostate hypertrophy.

Evidence-based Treatment Plan

Evidence-based treatment plan for mild symptoms (severity score >7) scale and for those with moderate-severe symptoms (severity score >8) that is not affecting quality of life (Deters, 2017). For patients with symptoms affecting their quality of life medication therapy such as alpha blockers, 5-alpha-reductase inhibitors are supported as best practice once prostate cancer has been ruled out.

First line therapy selective alpha₁-adrenergic receptors include silodosin 4 to 8mg daily, or terazosin 1 to 10mg daily (Dunphy et al., 2015). Long-acting alpha₁-adrenergic blockers are also useful in daily dosing and should be titrated gradually. 5-alpha-reductase inhibitors helps to reduce the size of the prostate by blocking the conversion of testosterone to DHT (Dunphy et al., 2015). Slow titration to maximum dosing is important to prevent hypotension with these medications. MN568 Unit 5 Discussion – benign prostate hypertrophy.  Saw palmetto acts similar to 5-alpha-reductase inhibitors for nonpharmacological interventions. These pharmacological and non-pharmacological interventions can improve quality of life for patients with BPH.

Patients with BPH should be reevaluated annually and screened for prostate cancer. The nurse practitioner should assess the effectiveness of pharmacological or nonpharmacological approach and severity of the symptoms affecting the patient’s quality of life. MN568 Unit 5 Discussion – benign prostate hypertrophy.

References

Belaynen, M., & Korownyki, C. (2016). Treatment of lower symptoms in benign prostatic

hypertrophy with α-blockers. Canadian Family Physician, 62, 523. MN568 Unit 5 Discussion – benign prostate hypertrophy

Deters, L. A. (2017). Benign Prostatic Hyperplasia (BPH) Treatment & Management. Medscape.

Retrieved from https://emedicine.medscape.com/article/437359-treatment#d18

Dunphy, L. M., Winland-Brown, J. E., Porter, B. O. & Thomas, D. J. (2015) Primary Care: The

Art and Science of Advanced Practice Nursing. Philadelphia, PA: F. A. Davis Company.

National Cancer Institute. (2018). Prostate-Specific-Antigen (PSA) Test. Retrieved from

https://www.cancer.gov/types/prostate/psa-fact-sheet MN568 Unit 5 Discussion – benign prostate hypertrophy

 

 

 

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