- You should respond to your peers by extending, refuting/correcting, or adding additional nuance to their posts.
- All replies must be constructive and use literature where possible.
Roodelyne Petit-Homme
Urinary urgency
As I go into the fourth week of my clinical orientation, some of the patients and their chief complaints are becoming repetitive and I can anticipate the plan of care and treatment. However, today I met a seventy-four-year-old African American gentleman who came into the clinic complaining of urinary urgency and decrease urine flow for the past two weeks. He explains that it could be quite painful, since he feels that he must go all the time but is unable to empty his bladder completely. He has a history of hypertension, diabetes, hyperlipidemia, glaucoma, impaired vision, rheumatoid arthritis, bilateral knee replacement, neuropathy, and anemia.
Did you face any challenges, any success? If so, what were they?
The biggest challenge I met was my inability to ask my patient the appropriate questions so that I can gather good data to determine a possible diagnosis. My preceptor understood that and stepped in. She asks this gentleman about previous symptoms, when did they start. She also asked about the patient’s sleep cycle, urgency of urination, straining and how is the stream of urine during urination.
Describe the assessment of a patient, detailing the signs and symptoms (S&S), assessment, plan of care, and possible differential diagnosis.
A complete head to toe assessment was conducted by me. The patient’s bladder was not noted to be distended but he complained of discomfort and pain with touch. Patient also complained of occasional incontinence, urgency, and a weak strain upon urination. Due to the clinical presentation of the patient and the non-modifiable factors such as his medical history and age, my preceptor agreed that the patient is exhibiting sign and symptoms of an enlarged prostate/BPH. Benign prostatic enlargement (BPE) is common among men, affecting about 50% of those in their 50s and more than 70% of those in their 70s. Saadat and Elterman (2019). The differential diagnosis is possible urinary tract infection, and urinary incontinence. The patient was referred to a urologist for further testing. However, the patient was prescribed antibiotic and Flomax to assist in bladder emptying. Moderate to severe lower urinary tract symptoms resulting from BPH affect around 30% of men over 50 years old. The traditional treatment options for male lower urinary tract symptoms due to benign prostatic hyperplasia (BPH) include the watchful waiting with lifestyle management, the medical therapy, and the interventional procedures. (Bertolo et al., 2018)
What did you learn from this week’s clinical experience that can beneficial for you as an advanced practice nurse?
This week, I learned that as a new practitioner it is ok not to know everything and we must ask for help and know how to conduct a quick and reliable research of symptoms. My preceptor uses uptodate.com as a reliable healthcare database that offers information about diagnosis and treatment as well.
Support your plan of care with the current peer-reviewed research guide.
The conventional approach for the management of lower urinary tract symptoms arising from benign prostatic hyperplasia (BPH) has been to start with oral pharmacological options; however, due to the limited efficacy and significant side effects of these medications, many patients proceed to surgical options. TURP is still suggested as the gold-standard surgery for prostates smaller than 80 ml; however, the risks including ejaculatory and erectile dysfunction following a TURP, even velocity saline jet under robotic control, guided by real-time TRUS mapping, which is performed by the surgeon. (Saadat & Elterman, 2019)
References
Bertolo, R., Fiori, C., Amparore, D., & Porpiglia, F. (2018). Follow-up of Temporary Implantable Nitinol Device (TIND) Implantation for the Treatment of BPH: a Systematic Review. Current Urology Reports, 19(6). https://doi.org/10.1007/s11934-018-0793-0
Saadat, H., & Elterman, D. S. (2019). The Role of Aquablation for the Surgical Treatment of LUTS/BPH. Current Urology Reports, 20(8). https://doi.org/10.1007/s11934-019-0905-5
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