CASE PRESENTATION

Atienza, Anyanna Yvette

Duapa, Patricia Bianca
Silang, Jessel
Vergara, Maria Fatima
Valdez, Jolian Danna

DISEASE AND ITS DEFINITION

Benign prostatic hyperplasia—also called BPH—is a condition in men in which the

prostate gland is enlarged and not cancerous. Benign prostatic hyperplasia is also
called benign prostatic hypertrophy or benign prostatic obstruction.

The prostate goes through two main growth periods as a man ages. The first occurs
early in puberty, when the prostate doubles in size. The second phase of growth begins
around age 25 and continues during most of a man’s life. Benign prostatic hyperplasia
often occurs with the second growth phase.

● Benign prostatic hyperplasia is the most common prostate problem for men older
than age 50
● Affects about 50 percent of men between the ages of 51 and 60 and up to 90
percent of men older than 80.

ETIOLOGY

The actual cause of prostate enlargement is unknown. The etiology of BPH is

influenced by a wide variety of risk factors in addition to direct hormonal effects of
testosterone on prostate tissue. BPH arises as a result of the loss of homeostasis
between cellular proliferation and cell death, resulting in an imbalance favoring cellular
proliferation.

RISK FACTORS

Non-modifiable (age, geography and genetics)

Modifiable (sex steroid hormones, the metabolic syndrome, obesity, diabetes, physical
activity, diet, and inflammation)
PATHOGENESIS
 ASSESSMENT FINDINGS

Subjective data

“Nasakit yung tiyan ko”

Objective data

● pale and weak in appearance

● unable to walk
● with productive cough
● Pain scale-8/10 throbbing abdominal pain (RLQ)

BIOCHEMISTRY

URINALYSIS 4 PARAMETERS
HEMATOLOGY

X-RAY Result

Grade Iii Prostate Gland Enlargement With Concretions And Suggestive Intravesicular
Extension

UTZ Result

Consider Diffuse Renal Parenchymal Disease, Bilateral Correlate

RADIOLOGICAL FINDINGS

Ileus Fecal Retention Well-Defined Hyperdense Focus In The Left Hemiabdomen.

Consider Nephrolithiasis Ultrasound Correlation Is Suggested For Further Evaluation
Osteodegenerative Changes Of The Spine Cardiomegaly Atheromatous Aorta Thoracic
Spondylosis

COMPLICATION

Urinary tract infection (UTI) is a symptomatic urinary infection accompanied by

functional or structural abnormalities of the genitourinary tract. Benign prostatic
hyperplasia (BPH) is a major cause of lower urinary tract obstruction in male patients,
and bladder outlet obstruction (BOO) secondary to BPH can lead to UTIs in men.
However, no evidence has clearly shown that UTI in the aging male population is
associated with either post-void residual urine or BOO.

SURGICAL AND MEDICAL TREATMENT

SURGICAL TREATMENT

TURP is the most common surgery for benign prostatic hyperplasia and considered the gold
standard for treating blockage of the urethra due to benign prostatic hyperplasia. Laser surgery.
With this surgery, a urologist uses a high-energy laser to destroy prostate tissue.

This is the most common treatment for BPH. During this procedure, your urologist will insert a
rigid instrument called a resectoscope into the urethra. This is why it is called transurethral.
Inserting the scope this way means no cutting into the prostate.

Transurethral incision of the prostate (TUIP): This is a similar procedure to TURP. Instead of
prostate tissue being removed the bladder neck and prostate are cut to relax the bladder
opening, allowing urine to flow more freely. TUIP is most successful on men with smaller
prostates.

Simple prostatectomy: This method is a surgical procedure in which an incision is made

through the abdomen or performed laporoscopically. The inner portion of the prostate gland is
removed, leaving the outer segment intact.
MEDICATIONS

DRUG DATA
Generic Name
Sodium Bicarbonate

CLASSIFICATION
Alkalinizing Agents

MECHANISM OF ACTION
Sodium bicarbonate is a systemic alkalinising agent. It increases blood and urinary pH by
dissociation to provide bicarbonate ions, which neutralises the hydrogen ion concentration.

INDICATION
Indicated in the treatment of metabolic acidosis which may occur in severe renal disease,
uncontrolled diabetes, circulatory insufficiency due to shock or severe dehydration,
extracorporeal circulation of blood, cardiac arrest and severe primary lactic acidosis.

CONTRAINDICATION
Metabolic or respiratory alkalosis, hypocalcaemia, hypochlorhydria, severe pulmonary oedema,
unknown abdominal pain. IV: Conditions with Na intake restrictions (e.g. renal failure),
hypoventilation, history of urinary calculi, coexisting K depletion, hypernatraemia. Patient with
chloride loss due to vomiting or continuous gastrointestinal suction. IV: Concomitant use with
diuretics known to produce hypochloraemic alkalosis.

ADVERSE REACTIONS
● Aggravated congestive heart failure (CHF)
● Cerebral hemorrhage
● Swelling (edema)
● High blood sodium levels
● Low blood calcium levels
● Low blood potassium levels
● Muscle spasms (associated with low calcium levels)
● Metabolic alkalosis
● Belching
● Bloating
● Excess fluid in the lungs (pulmonary edema)
● Hyperosmolality
● Intracranial acidosis
● Milk-alkali syndrome

NURSING CONSIDERATION
● Assess the client’s fluid balance throughout the therapy. This assessment includes
intake and output, daily weight, edema and lung sounds.
● Symptoms of fluid overload should be reported such as hypertension, edema, difficulty
breathing or dyspnea, rales or crackles and frothy sputum.
● Sigs of acidosis should be assessed such as disorientation, headache, weakness,
dyspnea and hyperventilation.
● Assess for alkalosis by monitoring the client for confusion, irritability, paresthesia, tetany
and altered breathing pattern.
 ● Monitor the client’s serum calcium, sodium, potassium, bicarbonate concentrations,
serum osmolarity, acid-base balance and renal function before and throughout the
therapy.

DRUG DATA
Generic Name
Ketoanalogues, essential amino acids.

CLASSIFICATION
Nutritional or dietary supplements

MECHANISM OF ACTION
Transaminated by taking nitrogen from non-essential amino acids, thereby decreasing the
formation of urea by re-using the amino group. It follows same catabolic pathways as amino
acids and works by improving the metabolism of protein in the body, thereby improving the renal
function.

INDICATION
For prevention and therapy of damages due to faulty or deficient protein metabolism in chronic
renal insufficiency in connection with limited protein food of 40 gram per day (for adults) and
less.

CONTRAINDICATION
● Hypersensitivity to the active substances or to any of the excipients.
● Hypercalcaemia.
● Disturbed amino acid metabolism.

ADVERSE REACTIONS
Increased calcium levels, nausea, vomiting, diarrhea, and abdominal pain

NURSING CONSIDERATION
Before:

● Assess electrolyte levels

● Explain therapeutic value of drug
● Assess allergy to the drug
● Caution patient of the different side effects
● Assess vital signs
● Proper preparation of the drug

During:

● Verify patient’s identity

● Administer with food to prevent GI upset
● Administer drug at right time, route, and dosage
● Advise to swallow the tablet whole
● Monitor vital signs
After:

● Document administration of drug

● Instruct patient to report immediately if symptoms of hypercalcemia occurs like muscle
weakness, constipation
● Monitor calcium levels.
● Monitor for signs of hypercalcemia and electrolyte levels.
● Monitor vital signs especially cardiac changes.

DRUG DATA
Generic Name
Tamsulosin hydrochloride, finasteride

CLASSIFICATION
Alpha-adrenoreceptor antagonists

MECHANISM OF ACTION
Tamsulosin (alpha-blockers) and Finasteride (5-alpha reductase inhibitor), primarily used to
treat enlarged prostate gland. Tamsulosin makes it easy to pass urine by relaxing the muscles
of the prostate gland.

INDICATION
TAMSULOSIN PLUS FINASTERIDE is indicated for the treatment of symptomatic Benign
Prostatic Hyperplasia (BPH) in men with enlarged prostate; to improve symptoms, reduce the
risk of acute urinary retention, reduce the risk of the need for surgery including transurethral
resection of the prostate and prostatectomy, and reduce the risk of symptomatic progression of
BPH.

CONTRAINDICATION
Patients with a hypersensitivity to Tamsulosin hydrochloride or Finasteride, a history of
orthostatic hypotension or severe hepatic insufficiency.

ADVERSE REACTIONS
Impotence, Ejaculation disorder, Headache, Breast tenderness, Dizziness, Decreased libido,
Breast enlargement, Infection, Chest pain, back pain

NURSING CONSIDERATION
● Avoid using with other alpha-blockers. Tamsulosin is contraindicated with strong
CYP3A4 inhibitors such as ketoconazole.
● Assess and monitor blood pressure, especially after first dose because tamsulosin may
cause orthostatic hypotension.
● Monitor for severe allergic reaction (swelling of face, tongue, or throat, difficulty
breathing, and blistering of the skin. Check with your doctor immediately if this occurs.

DRUG DATA
Generic Name
Ciprofloxacin
CLASSIFICATION
Therapeutic class: Antibiotics
Pharmacologic class: Fluoroquinolones

MECHANISM OF ACTION
Inhibits bacterial DNA synthesis, mainly by blocking DNA gyrase; bactericidal.

INDICATION
● Complicated intra-abdominal infection
● Severe or complicated bone or joint infection, severe respiratory tract infection, severe
skin or skin-structure infection
● Severe or complicated UTI; mild to moderate bone or joint infection; mild to moderate
respiratory infection; mild to moderate skin or skin-structure infection; infectious diarrhea;
typhoid fever
● Complicated UTI or pyelonephritis
● Nosocomial pneumonia
● Mild to moderate UTI
● Uncomplicated UTI
● Chronic bacterial prostatitis
● Lower respiratory tract infections
● Mild to moderate acute sinusitis
● Empirical therapy in febrile neutropenic patients
● Inhalation anthrax (postexposure)
● Plague due to Yersinia pestis; plague prophylaxis as soon as possible after suspected or
● confirmed exposure

CONTRAINDICATION
● Contraindicated in patients sensitive to fluoroquinolones
● Use cautiously in patients with CNS disorders, such as severe cerebral arteriosclerosis
or seizure disorders, and in those at risk for seizures. Drug may cause CNS stimulation.

ADVERSE REACTIONS
CNS: seizures, confusion, headache, restlessness. GI: pseudomembranous colitis, diarrhea,
nausea, vomiting. GU: crystalluria, interstitial nephritis. Hematologic: leukopenia, neutropenia,
thrombocytopenia, eosinophilia. Musculoskeletal: tendon rupture. Skin: rash, SJS, toxic
epidermal necrolysis. Other: hypersensitivity reactions.

NURSING CONSIDERATION
● Monitor patient's intake and output, and observe patient for signs of crystalluria.
● Tell patient to take drug as prescribed, even after feeling better.
● Advise patient to drink plenty of fluids to reduce risk of urine crystals.
● Advise patient not to crush, split, or chew the extended-release tablets.
● Warn patient to avoid hazardous tasks that require alertness, such as driving, until
effects of drug are known.
● Instruct patient to avoid caffeine while taking drug because of potential for increased
caffeine effects.
● Advise patient that hypersensitivity reactions may occur even after first dose. If a rash or
other allergic reaction occurs, tell patient to stop drug immediately and notify prescriber.
● Tell patient that tendon rupture can occur with drug and to notify prescriber if pain or
inflammation occurs.
 ● Tell patient to avoid excessive sunlight or artificial ultraviolet light during therapy.

DRUG DATA
Generic Name
Tramadol

CLASSIFICATION
Therapeutic class: Analgesics
Pharmacologic class: Synthetic centrally active analgesics

MECHANISM OF ACTION
Unknown, Thought to bind to opioid receptors and inhibit reuptake of norepinephrine and
serotonin.
INDICATION
Moderate to moderately severe chronic pain

CONTRAINDICATIONS
● Contraindicated in patients hypersensitive to drug or opioids, in patients with severe
renal or hepatic impairment, suicidal patients, and in those with acute intoxication from
alcohol, hypnotics, centrally acting analgesics, opioids, or psychotropic drugs.
● Contraindicated in patients with GI obstruction, including paralytic ileus.
● Contraindicated with concomitant use or within 14 days of MAO inhibitor therapy.
● Contraindicated in patients with significant respiratory depression or acute or severe
bronchial asthma or hypercapnia in unmonitored settings or where resuscitative
equipment isn't available.
ADVERSE REACTIONS
 Headaches. Make sure you rest, and drink plenty of fluids
 Feeling sleepy, tired, dizzy or "spaced out" These side effects should wear off within a
week or two as your body gets used to tramadol
 Feeling or being sick (nausea or vomiting)
 Constipation
 Dry mouth
 Sweating
 Low energy

NURSING RESPONSIBILITY
● Take this medication exactly as directed by the handling physician. Adhere according to
the directions and read the medication label. Never go beyond the prescribed dosage or
immediately inform the doctor if there is a sense to take more.
● Tramadol tablets should never be broken or crushed to be inhaled or dissolved in a
liquid to be injected into a vein. The likely outcome of this practice is death.
● For the oral form, never approximate the dose; instead, use a dose measuring cup or the
accompanying syringe.
● After starting tramadol, discontinue all other opioid drugs/medications. Tramadol can be
taken with or without meals, but take it consistently within a specified time or period.
● It is possible to experience withdrawal symptoms if one abruptly discontinued tramadol
use. Consult the handling physician before discontinuing any medication.
● Misuse or overdosing can lead to death.
 ● Tramadol should not be shared with anyone, especially someone who has a history of
drug abuse. Addiction, overdosage, or death can result from misuse.

DRUG DATA
Generic Name
Mesegor Vita

CLASSIFICATION
APPETITE STIMULANTS

MECHANISM OF ACTION
Pizotifen has an appetite-stimulating action suitable for increasing body weight in underweight
anorectic patients. The compound is well tolerated, permitting treatment of anorexia both in
children and adults.

INDICATION
Preventing or treating sodium loss due to excessive sweating or dehydration.

CONTRAINDICATIONS
Hypersensitivity to the drug.
Pizotifen + Thiamine HCl + Riboflavin phosphate + Pyridoxine HCl + Nicotinamide (Mosegor
Vita) should not be given to children below 1 year of age.

ADVERSE REACTIONS
Hypernatremia, hypokalemia, acidosis. Fluid and solute overload leading to dilutionof serum
electrolyte level, CHF, over hydration, acute pulmonary edema

NURSING RESPONSIBILITY
Observe S&S of hypernatremia, flushed skin, elevated temperature, roughdry tongue, and
edema. Monitor VS and I&O

PREVENTION AND PATIENT HEALTH TEACHING

Regular exercise and maintaining a healthy weight can reduce the risk of developing BPH and
several other conditions (including those that are risk factors for BPH). If you have BPH, there
are still things you can do to manage the condition to prevent worsening symptoms.

1. Avoid delaying urination: delayed urination can aggravate symptoms of BPH and lead to
other problems like urinary tract infections
- Make a habit of going to the bathroom when they have the urge

- Practice double voiding (empty the bladder, wait a moment, then try again)
 2. Avoid use of certain over-the-counter medications: antihistamines and decongestants
may also worsen BPH symptoms
3. Watch your alcohol consumption: limiting yourself to one or two alcoholic drinks per day
is generally safe, but excess consumptions can irritate the prostate
4. Practice healthy lifestyle habits: Some habits like smoking and poor sleep hygiene can
negatively affect prostate health
5. Limit how much caffeine and alcohol you take in; they make you pee more and can
irritate your bladder

6. Practice stress management and relaxation techniques

Patients should be warned that if they become unable to urinate, they are at risk for permanent
kidney or bladder injury and need to go to a hospital emergency department.

NURSING CARE PLAN

DIAGNOSI INTERVENTIO EVALUATIO

ASSESSMENT PLANNING RATIONALE
S N N
Subjective Data: Acute After the  Established  To gain After the
“Nahihirapan urinary nursing rapport trust nursing
akong umihi” as retention intervention intervention,
verbalized by related to , the patient  Monitor vital  Observe the patient
the patient. mechanical will be able signs and for was able to
obstruction to achieve a input and hypertensi achieve a
Objective Data: of an regular output. on and regular
 Conscious enlarged voiding fever. voiding
and coherent prostate as pattern.  Weigh daily. pattern.
 Restlessness evidenced
 Facial by bladder  Increase
grimace distention. in weight
upon may
urination indicate
 Nocturia decreased
 Incontinence  Encourage fluid
 Dysuria patient to void elimination.
 Vital signs every 2-
taken as: 4hours when  May
BP – 140/80 urge is noted. minimize
PR – 75 urinary
RR – 18  Provide retention/o
O2SAT – 93% perineal care. ver
TEMPT – 35.5 distension
of the
 Percuss and bladder.
palpate
suprapubic  Reduces
 area. risk of
ascending
infection.
 Encourage to
increase oral  A
fluid intake up distended
to 2-3 L per bladder
day, within can be
cardiac felt in the
tolerance, if suprapub
indicated ic area.

 Increase
d
circulating
fluid
maintains
renal
perfusion
and
flushes the
kidneys,
bladder,
and
ureters of
“sediment
and
bacteria”.

INTERVENTIO RATIONAL EVALUATIO

ASSESSMENT DIAGNOSIS PLANNING
N E N
Subjective Data: Acute pain After the  Encourage  Soothe After the
“Sumasakit related to nursing sitz baths and perineal nursing
kapag umiihi distended intervention, warm soaks. discomfor intervention,
ako” as bladder as the patient t with a the patient
verbalized by evidenced by will be able warm sitz was able to
the patient. complaints of to verbalize bath for verbalize
bladder or relief from 20 relief from
rectal bladder or minutes bladder or
spasm. urinary tract several urinary tract
pain. times per pain.
Objective Data: day to
 Conscious relax the
and coherent prostate
 Facial grimace and
upon urinating surroundi
 Pale and weak ng
in appearance muscles.
 Restlessness
 Pain upon  Secure the  Securing
urinating with catheter. the
a scale of urinary
8/10. catheter
 Vital signs correctly
taken as: to the
BP – 140/80 client’s
PR – 75 thigh
RR – 18 prevents
O2SAT – 93% pain from
TEMPT – 35.5 an injury
in the
penile-
scrotal
 Relieve junction
bladder and
spasms pulling on
the
bladder
when
turning or
ambulatin
g.

 Administ
 Promote er
prostate antispas
massage. modics
as
prescribe
d to
minimize
bladder
spasms
brought
on by
catheter
sensitivity
.

 Prostate
 Relieve pain massage
with can
medications. relieve
excess
fluids that
build up
in the
prostate
and
 reduce
the
inflammat
ion and
pressure
causing
the pain.
The
patient
can be
instructed
on how to
do this
themselv
es.

 Narcotics
may be
given
following
surgical
procedur
es to
relieve
acute
pain.