Case Study: Benign Prostate Hyperplasia Ben Gordin,

Case Study: Benign Prostate Hyperplasia Ben Gordin, a 60-year-old married black man with hypertension, COPD, and coronary artery disease, comes to the ED because of an inability to void for the past 13 hours and pain in the lower abdomen, Subjective data: Reports the urge to void Is restless, anxious, and agitated, Objective data: Has prostate enlargement on digital rectal exam Has hematuria, bacteria, and WBCs in urine Has a tender and palpable bladder above the umbilicus PSA test 8 ng/ml (normal 0-4 ng/ml) Interprofessional Care: Indwelling catheter inserted by urology resident Admitted to the hospital for observation 1. Why is Ben restless, anxious, and agitated? 2. Why might Ben’s PSA be elevated? 3. What complications of BPH is Ben experiencing? You are admitting Ben to the medical-surgical unit. Use the AUA Symptom index to assess the severity of his symptoms. He tells you: (1) more than half of the time he has the sensation of not completely emptying his bladder, (2) he almost always has to void again in less than 2 hours, (3) he almost always stops and starts several times while urinating, (4) less than half the time he finds it difficult to postpone urinating, (5) more than half the time he has a weak urinary stream, (6) less than half the time he has to push or strain to begin urinating, and (7) he typically gets up twice during the night to urinate. 4. What is his AUA Symptom score? 5. Are his symptoms mild, moderate, or severe? 6. What other diagnostic test would you expect ben to have to evaluate his BPH? 7. What are the goals of treatment for BPH? Ben tells you he thought his symptoms were just a result of aging, and something he had to learn to live with. He asks you what they can do to treat his BPH to prevent this from happening again. 8. What should you tell him? 9. Based on the severity of his symptoms, which treatment option do you feel is best for Ben? Why? After speaking with his physician, Ben is scheduled for a transurethral prostatectomy (TURP) for tomorrow morning. Ben tells you that he had a friend that had this surgery and had “sexual problems” afterwards. 10. How would you respond the Ben? The next day you are caring for Ben after his TURP. The physician has ordered continual bladder irrigation. 11. What is the purpose of continual bladder irrigation? You note that the catheter outflow is dark red with a few clots. 12. What should you do? 13. Why is Ben not encouraged to get out of bed frequently and sit in a bedside chair? Two hours later Ben tells the UAP he is having an increase in bladder spasms. The UAP reports this to you. 14. How should you respond? Ben has a good night and the next morning his catheter is removed. He voids 5 hours after it is removed, but he is having some dribbling. He is concerned about “wetting” himself after he goes home. 15. How will you respond to Ben Ben is being discharge to home with his wife. No home services are needed. 16. What will you include in discharge instructions?

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