ST.

MARY'S COLLEGE NURSING PROGRAM Tagum City A CASE STUDY on HYPERTENSIVE URGENCY, HYERTENSIVE CARIOVASCULAR DISEASE, CORONARY ARTERY DISEASE, LEFT VENTRICULAR HYPERTROPHY, SINUS RHYTHM, NOT IN FAILURE; PROSTATE CANCER STAGE III ___________________________ Presented to: EVIE LUZ S. DOCENA, RN, MN Clinical Instructor In Partial Fulfillment of the Requirements In Related Learning Experience (RLE) __________________________ By: Castillo, Kent John N. Rodriguez, Michael Roy B. Cinco, Romruth C. Sedico, Quenny Lou A. Presores, Gerlie Mae

August 2009

TABLE OF CONTENTS
A. Introduction -

B. Objective of the Study C. Assessment -

Biographic Data Chief Complaint History of Present Illness Past medical and Nursing History Personal, Social-Economic History D. Patient Need Assessment E. General Survey F. Course in the ward -

G. Laboratories and Diagnostic Examinations H. Review of Anatomy and Physiology I. Symptomatology -

J. Etiology of the disease K. Pathophysiology -

 Written Pathophysiology Diagram L. Synthesis of clients conditioned status from admission to present -

M.Evaluation of the Objective of the study N. Nursing Care Plan O. Bibliography -

A. INTRODUCTION Heart disease is the leading cause of death for all people in the US, and stroke is the third leading cause of death. Heart disease and stroke are also major causes of disability and significant contributors to increasing health care costs in the US. The mortality rate for cardiovascular disease (heart disease, stroke, and chronic obstructive pulmonary disease) is greater than the combined rate for all leading causes of death (cancer, unintentional injuries, pneumonia/influenza, diabetes, suicide, kidney disease, chronic lever disease and cirrhosis). (US DHHS, 2000). The major risk factors for cardiovascular disease are hypertension, smoking, hypercholesterolemia, high alcohol consumption, and lack of physical activity. (Tamir and Cachola, 1994). In 2001 there were approximately 460,000 indigenous people in Australia, accounting for 2.4% of the population. However persons greater than 40 years old account for proportionately fewer indigenous people, reflecting the fact that indigenous people are much more likely to die before they are old than the general Australian public: men at 56 years; women at 63 years. In addition, death rates are estimated to be four times higher in indigenous than in non-indigenous Australians. In 2002 the leading cause of death in indigenous people was cardiovascular disease (CVD), responsible for 1/3 of all deaths, followed by ischemic heart disease (16%) and stroke (9%). Of indigenous Australians aged 3544 years, 16% reported a

cardiovascular condition, with the rate increasing to 31% for those aged 45 to 54 years, and to 47% for those aged 55 years and over. The prevalence of cardiovascular disease is greater in remote areas. Coronary heart disease is 34 times higher for males and females than in non-indigenous people. Indigenous people are much more likely to die of CVD than non-indigenous people at any age, especially in younger age groups the death rate among 2554 year olds was 10 times higher than other Australians. Every hour, nine Filipinos die of cardiovascular or heart diseases. In fact, cardiovascular diseases (CVD) remain the No. 1 cause of death in the Philippines. About one out of four deaths in the country are traced to cardiovascular diseases, according to the Department of Health One out of 20 adults (40 years and older) suffers from coronary/ischemic heart disease. And one out of 10 adults (15 years and older) suffers from hypertension, or high blood pressure. Five out of 100 adults suffer from coronary artery disease. Surveys made by the DOH show that Central Luzon had the highest cases of cardiovascular diseases (225 per 100,000 population). Metro Manila registered the highest mortality rate (99 per 100,000) while the lowest was in Central Mindanao (16 per 100,000). During the past three years, eight of the ten leading causes of morbidity in Davao Region were communicable but highly preventable diseases. In 2002, the illnesses registered were the upper and lower respiratory tract infections, pneumonia, diarrhea, influenza, tuberculosis, malaria and dengue. The non-communicable leading causes of morbidity were hypertensive diseases and genitourinary system diseases. In 20022004, cerebrovascular diseases topped the leading causes of mortality, indicating the need to examine closely the lifestyle of the at-risk population in the region. In 2002, heart diseases ranked second to cerebrovascular diseases. Other leading causes of death among all ages include pneumonia, accidents, malignant neoplasms, tuberculosis, hypertensive diseases, diabetes mellitus, lower respiratory infections and septicemia. Cumulative risk and trends in prostate cancer incidence in Mumbai, India. Information relating to cancer incidence trends in a community forms the scientific basis for the planning and organization of prevention, diagnosis and treatment of cancer. We here estimated the cumulative risk and trends in incidence of prostate cancer in Mumbai, India, using data collected by the Bombay Population-based Cancer Registry

from the year 1986 to 2000. Methods;

During the 15 year period, a total of 2864

prostate cancer cases (4.7% of all male cancers and 2.4% of all cancers) were registered by the Bombay Population-based Cancer Registry. Results; Analysis of the trends in age-adjusted incidence rates of prostate cancer during the period 1986 to 2000 showed no statistically significant increase or decrease and the rates proved stable across the various age groups (00-49, 50-69 and 70+) also. The probability estimates indicated that one out of every 59 men will contract a prostate cancer at some time in his whole life and 99% of the chance is after he reaches the age of 50. Department of Urology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan. Although Asian people have the lowest incidence and mortality rates of prostate cancer in the world, these rates have risen rapidly in the past two decades in most Asian countries. Prostate cancer has become one of the leading male cancers in some Asian countries. In 2000, the age-adjusted incidence was over 10 per 100000 men in Japan, Taiwan, Singapore, Malaysia, the Philippines and Israel. Although some of the increases may result from enhanced detection, much of the increased incidence may be associated with westernization of the lifestyle, with increasing obesity and increased consumption of fat. The differences in incidences between native Americans and Asian immigrants are getting smaller, reflecting a possible improvement of diagnostic efforts and changes of environmental risk factors in Asian immigrants. Nevertheless, the huge variations in incidences among ethnic groups imply that there are important genetic risk factors. The stage distributions of prostate cancer in Asian populations are still unfavorable compared to those of Western developed countries. However, a trend towards diagnosing cancer with more favorable prognosis is seen in most Asian countries. Both genetic and environmental risk factors responsible for elevated risks in Asian people are being identified, which may help to reduce prostate cancer incidence in a chemopreventive setting. The incidence of prostate cancer has risen by 5-118% in the indexed Asian countries (agespecific and age-standardized) based on incidence and mortality rates data for prostate cancer in Asian countries for 1978-1997. Incidence at centers in Japan rose as much as 102% (Miyagi 6.3-12.7 per 100,000 person-years) while the incidence in Singaporean Chinese increased 118% from 6.6 to 14.4 per 100,000 person-years. The lowest incidence rate recorded was in Shanghai, China and the highest rates were in Rizal

Province in the Philippines, although still much lower than those in the United States of America (USA) and many European countries. Prostate Cancer is the fourth most common male malignancy worldwide. Incidence and death rates vary tremendously among countries, however in the Philippines, more and more cases are being seen every year. Local interest in Prostate Cancer has also been in the spotlight since the last Presidential Elections when Presidential Candidate Raul Roco revealed that he was diagnosed to have advanced disease. In the 1990s, Quijano did a research in Guihing, Davao Del Sur, where he attributed the high incidence of prostate and breast Cancer and other illness there to the patients prolonged exposure to pesticide in the nearby banana plantations. Although other factors such as malnutrition and the lack of sufficient housing also contribute, long pesticide exposure was largely to blame for those diseases, he said, citing similar symptoms among people living near banana and pineapple plantations in South Cotabato and different parts of Davao city. According to Local Studies Related to Aerial Spraying regarding Health and Environmental Conditions of People Living in Three Communities of Davao City Where Aerial Spraying of Pesticides is a Common Practice. September 2006. Of the 22 cases of cancer: 6 cases (27.3%) prostate cancer, 4 cases (18.2%) breast cancer, 2 cases each (9.1%) brain, uterine, bone cancer, 1case each (4.5%) liver, colon, leukemia, throat, thyroid, lung cancer.

B. OBJECTIVES General: After apprehensive case study, students will be able to extend and improve their knowledge and understanding with regards to the causes, effects, complications, signs and symptoms and nursing implementation for Hypertensive Urgency, HCVD, CAD, LVH, SR, NIF; Prostate CA Stage III for them to be able to attain a comprehensive and thorough learning experience with regards to their study that would benefit not only them but also for their readers and for the patients that they will be catering in the future with such kind of disease. Specific: Study the patients history of past and present illness Conduct a synoptic physical assessment of patients with Hypertensive Urgency, HCVD, CAD, LVH, SR, NIF; Prostate CA Stage III Be able to review the anatomy and physiology of the affected organs and systems Distinguish the affected system Trace and analyze the pathophysiology of the infirmity Classify the ordered drugs and associate its action or effects to the patient

Consider laboratory results and relate it to patients condition Construct nursing care plan for patients with Hypertensive Urgency, HCVD, CAD, LVH, SR, NIF; Prostate CA Stage III Identify prognosis of the patient Evaluate the clients condition from the time of admission up to the present

C. ASSESSMENT A. Biographical Data Name: Megatron Age: 78 years old Gender: Male Civil Status: Married Birthdate: November 11, 1930 Birth Place: Dumangas, Iloilo Nationality: Filipino Religion: Protestant Occupation: Pastor Name of Spouse: Starscream Admitting Diagnosis: Hypertensive Urgency, HCVD, CAD, LVH, SR, NIF; Prostate CA Stage III Admitting Physician: Precy Gem T, Sanchez, M.D. B. Chief Complaint Admitted due to dizziness, inability to walk and loss of appetite

VS upon admission: T 37.3oC RR 32 cpm Weight 77 kgs. C. History of Present Illness Megatron experienced dizziness, loss of appetite and inability to walk prior to admission. Patient was admitted last July 28, 2009 & was diagnosed with Hypertensive urgency, HCVD, CAD, LVH, SR, NIF, PROSTATE CA STAGE III. Since then, patient experienced difficulty and painful urination. Progressive lower extremity weakness noted after the patient complained of lumbosacral pain. Two days after his admission, result of UXD of prostate released & revealed a Grade 3 prostatic enlargement where patient was suggested for PSA correlation. He has FBC attached to urobag draining a bloody urine. Abdominal distention and bipedal edema noted. He is hypertensive, has Diabetes Mellitus & is a cigarette smoker and alcoholic drinker during adolescent stage up to adulthood stage. D. Past Medical History Megatron had undergone surgical operation of the Right eye as out-patient last July 2002 due to cataract. Four months after his operation, last November 2002, he was admitted due to hematemesis & was diagnosed with gastric ulcer. Patient underwent surgical operation of the prostate twice; last January & October 2004 at Davao Regional Hospital, where he has diagnosed with Hypertension and prostate CA stage III. He had never undergone chemotherapy. Since then, patient underwent PSA testing quarterly for 5 years, inconstantly and inconsecutively. Antineoplastic medications and antihypertensive medications were prescribed to him as home medications. E. Personal, Family History Megatron belongs to nuclear family and youngest among 9 siblings. By the age 18-32 y/o, patient was fun of smoking everyday and drinking alcoholic beverages almost 4x a week. After a year until 70 y/o, patient gradually minimized his vices into moderate amount and occasionally. Patient was fun of eating meaty products, salty and sweet PR 89 bpm BP 170/110 mmhg Height: 5 feet 4inches

foods before. Patient has no family history of any type of cancer and diabetes mellitus. His father has history of hypertension as well as his siblings. F. Socio-Economic History Megatron belongs to middle class family. For 15 years of being a farmer way back 1964-1979, he earned P50.00 P100.00 monthly as usual income. Immediately after being a farmer, he became then a pastor and receives an honorarium monthly of about P2,000-3,000 monthly. Her wife is a plain housewife while most of his children now has stable job.

D. PATIENT NEED ASSESSMENT Date: July 30, 2009 NAME OF PATIENT: Megatron _AGE__78___SEX_M__STATUS_Married___ ADMISSION; Date/Time____July 28, 09 8: 00 pm___ ADMITTING MEDICAL DIAGNOSIS: Hypertensive urgency, HCVD, CAD, LVH, SR, NIF, PROSTATE CA STAGE III ARRIVED ON UNIT BY___per stretcher__ ACCOMPANIED BY___wife_and children__ ADMITTING WT/VS: 77 kls. T- 37.3oC; RR-32cpm; PR-89bpm; BP- 170/110mmHg __ CLIENTs PERCEPTION OF REASON FOR ADMISSION: -Client unable to verbalizeHOW WAS PROBLEM BEEN MANAGED BY CLIENT AT HOME: Naga-inom ra man siya sa iyang maintenance as verbalized by the child of the patient ALLERGIES_____no known allergies______ MEDICINE (at home) Casodex (antineoplastic agent) PHYSIOLOGIC NEEDS I. OXYGENATION FROM_Emergency Room

BP__140/80__ RR 25 cpm____CR___88bpm

(CHARACTER) tachypneic___

LUNGS (per auscultation: character, lung sound, symmetry of chest expansion,

breathing character and pattern):crackles sounds heard upon auscultation, w/ symmetrical chest expansion, intercostals retraction noted, use of accessory muscles noted. CARDIAC STATUS (per auscultation) sounds, character, chest pain. __Lub-dubb sound heard with increased intensity per auscultation, chest pain not noted

seconds_

CAPILLARY REFILL good capillary refill of less than 3

and wrinkled.

SKIN CHARACTER AND COLOR_skin is brown, dry, flaky

nasal cannula

LIFE SUPPORTING APPARATUS: with O2 @ 3LPM via

OTHER OBSERVATIONS (related) Patient shows

discomfort with the nasal cannula by removing it. II. TEMPERATURE MAINTENANCE TEMPERATURE: 37.2 oC_ SKIN CHARACTER_Skin is dry, flaky, wrinkled and

not warm to touch_

experience fever anymore_ III NUTRITIONAL FLUID

OTHER OBSERVATION (related)_patient did not

HEIGHT/WT 54/77 kg _ AMT. FOOD CONSUMED: w/ good appetite, able to

consumed the OF served

PRESCRIBED DIET: LSLF, OF of 1.8kcal/day PROBLEM (nausea, vomiting, no. of times and frequency, amount and character) not
noted

EATING PATTERN: 3x a day_ INTAKE (IVF; FLUID/WATER: with IVF of PNSS 1L@300cc/hr, water = 300cc Other OBSERVATION (related)\: Skin is dry, has poor skin turgor
IV ELIMINATION

Last BOWEL MOVEMENT(frequency, amount, character)__defecated Last June 28, 09

on small amount, in brown color soft stool.

 NORMAL PATTERN 1- 2x a day, URINATION(Frequency, character, sensation)_able to urinate last July 30, 2009, with
FBC attached to urobag, draining a bloody urine @100 cc level

OTHER OBSERVATION (Related)_Bladder is distended per palpation

V REST-SLEEP

BED TIME _6-7 pm_WAKING UP__5:30 am_ SLEEP (pattern, amount of sleep)_10-11 hours_ PROBLEM AS VERBALIZED -cant able to verbalizeOTHER OBSERVATION (related)_Patient can easily be distracted, thus, having difficulty in sleeping back again VI PAIN AVOIDANCE

RATE PAIN_-cant able to verbalize- TIME STARTED__7:30 PM_ LOCATION _genital area__BEHAVIOR (restlessness, facial expression, irritable,
diaphoretic)frequent change of position noted, grimace face and guarding behavior noted on genital area

FREQUENCY_continuos_ CHARACTER cant able to describe, cant able to verbalize OTHER observation (related) Patient has difficulty in sleeping due to pain felt
VII SEXUALITY REPRODUCTIVE

LMP__N/A__ GRAVIDA/PARITY__N/A__ MENSTRUAL CYCLE__N/A__ EDC__N/A__

AOG__N/A__ PRENATAL__N/A__ GYNECOLOGIC PROBLEM__N/A__

FMILY PLANNING METHOD USE: calendar method CHILDREN (no.) __9__

VIII STIMULATION ACTIVITY MENARCHE__N/A__

WORK: Before: farmer & pastor During: needs assistance in performing activities of RECREATION/PAST TIME: daily living, cant able to sit, episodes of napping & HOBBIES/VICES: sleeping, a moderate smoker and drinker before
SAFETY AND SECURITY

NEURO VS____GCS of 10/15, eye opening to verbal command, motor response to

localized pain, and verbal response makes incomprehensible sounds _____

 MENTAL STATUS (Coherent, Responsive, conscious, unconscious) conscious, able to

respond by making incomprehensible sounds

EMOTIONAL PROBLEM (diaphoretic, trembling, restless)_restlessness: frequent

change of position due to pain felt________ LOVE BELONGING NEED

CHILDREN (living with?) Patient is loving and supportive as verbalized by her child and HUSBAND (living with) wife. Due respect and care was given to him
SELF ESTEEM NEED He is a good person and a loving father, husband and pastor. He has a moderate self esteem, also because he is a friendly type of person and being loved by family members. SELF ACTUALIZATION NEED According to one of his children, the ultimate goal of his father is to see his children succeed and become better persons. For now, his children have stable jobs. Assessed by: ______A4_________ SN-SMC __Evie Luz Docena, RN, MN__ CI

E. GENERAL SURVEY Date of Assessment: July 30, 2009 On bed, awake, unresponsive and tachypneic. With isocoric pupils of 2mm less briskly reactive to light and accommodation. Pale conjunctiva of the eye noted. With O2 @ 3LPM via nasal cannula, with NGT @ Right nostril patent and intact, with distal end close. (+) use of accessory muscles; (+) intercostal retraction; crackles sound heard per auscultation on both lung fields. With symmetrical chest expansion. With IVF of # 5

PNSS 1L @ 300cc/hr @ 200 cc level infusing well @ Left metacarpal vein. Pale nailbeds noted with capillary refill returns within 3 seconds. Bladder distention noted. With FBC attached to urobag draining a bloody urine @ 100 cc level. Bipedal edema noted. B. Vital Signs upon admission and present VITAL SIGNS Date 7/28/09 Shift 7-3 Time 9:35 10:50 11-7 12:10 4:30 7/29/09 7-3 8:45 12:00 3-11 4:00 8:00 11-7 12:30 4:00 7/30/09 7-3 8:00 12:20 3-11 4:00 5:00 6:00 7:00 8:00 9:00 10:00 C. Nutritional Status Megatron stands 54 and weighs 77 kilos. On low salt, low fat diet. With NGT at Right nostril patent and intact, with distal end close. On osteorized feeding of 1.8 T 37.8 37.5 37.1 36.9 37.3 37.7 38.1 37.2 37.3 37.1 37 37.4 37.2 37.1 37.3 37.3 37.4 37 36.9 BP 160/100 150/90 140/80 130/90 170/100 160/90 140/90 150/90 130/90 120/80 140/80 150/100 160/100 150/90 140/80 140/80 150/90 140/80 140/80 RR 32 25 18 20 23 26 26 24 17 19 20 20 26 25 27 25 30 28 29 PR 92 89 83 82 84 89 78 81 83 85 82 80 97 94 89 88 81 85 77

kcal/day. With IVF of #5 PNSS 1L @ 300cc/hr infusing well at Left metacarpal vein. With poor skin turgor. Denies malnutrition during childhood. Weight loss noted from 85 kg to 77 kg. D. Neurologic Status Glasgow Coma Scale of 10/15; eye opening to verbal command, motor response to localized pain & verbal makes incomprehensible sounds, unclear. Restlessness: frequent change of position noted. Cant able to speak out clearly to express feelings and ideas. E. Integumentary System Skin is dry, flaky and wrinkled. Flat tan to brown-colored macules noted as large as 1-2 cm on exposed body area such as face, neck, arms, hands and legs. Skin loses its elasticity, appears thin and translucent. The skin takes longer to return to its natural shape after being tented between the thumb and finger. Hair is gray in color, thin and loss of scalp noted. Presence of parasites not noted. Bristle-like hairs of the eyebrows noted. Fingernails slightly long in length, pale and thick. Capillary refill returns within 3 seconds. F. HEEN Head is symmetrically rounded. Dry lips noted. Neck symmetrical without masses and scars. Lymph nodes non palpable. Eyes. Eyeballs appear sunken. Skin folds of the upper lids is more prominent & lower lids sag. The eyes appear dry and lusterless. A thin, grayish white arc or ring appears around the part of the cornea. Pupil reaction to light and accommodation is normally symmetrically equal but less brisk. Pale conjunctiva of the eyes noted. Visual acuity is decrease. Ears of equal size and similar appearance noted. Pinna aligned with corner of eye, smooth without nodules. Bilateral on auditory canals noted. Contain moderate amount of waxy secretion. Difficulty of hearing sounds noted. Nose is symmetrical & straight, uniform in color, non-tender & without lesions. The sense of smell markedly diminish. G. Pulmonary System Respiratory rate is above normal range, with an RR of 32 cpm. Shortness of breath & dyspnea as well as use of accessory muscles upon breathing is observed,

crackles sounds heard per auscultation on both lung fields. Use of intercostals retraction upon breathing. With O2 @ 3LPM via nasal cannula. H. Cardiovascular System Cardiac rate plays around 80-90 bpm. Lubb-dubb sound heard with increased intensity per auscultation. Chest pain not noted. The anteroposterior diameter of the chest widens, with symmetrical chest expansion. Blood pressure dramatically changes from the lowest taken BP of 140/80 & the highest was 150/100mmHg. Clubbing of fingers not noted. Pallor is observed. Has history of hypertension. I. Gastrointestinal System Abdomen is round. Enlarged border on Right side of abdomen noted upon palpation as well as distention of bladder. With surgical scar noted on left iliac region. Bowel movements usually experienced 1-2 times a day with soft and brown color stool on small amount as described by watcher. Denies presence of hemorrhoids. J. Musculoskeletal System Needs assistance in performing activities of daily living. Progressive lower extremity weakness noted after the patient complained of lumbosacral pain. Presence of bipedal edema noted. K. Genito-Urinary System No bulging or masses that can be palpated in inguinal area. Scanty amount of pubic hair noted. With FBC attached to urobag draining a bloody urine @ 100 cc level within the shift. Prior to the insertion of the foley catheter, watcher verbalized that client has scanty amount of urine about 30-50cc of urine per urination with the absence of blood and bloody urine was noticed after the insertion of the foley catheter. Urinary elimination normally once a day. Bladder is distended. Unable to verbalize pain upon urination. No presence of lesions in the genital area.

F. COURSE IN THE WARD DATE SHIFT NURSES NOTES 07/28/ 09 311 8:00p m Admitted this 78 years old male patient awake, conscious, and coherent in due to increase BP and body weakness, vital signs taken and recorded. Seen and examined by Dr. Sanchez with new orders made, started with IVF of D5NSS 1L @ 120cc/o regulated and infusing well, lab exams requested, ECG and CXN done. Watched out for signs of unusualities, endorsed to NOD.

DOCTORS ORDER Admit under reverse isolation ward under onco/cardio v/s q4 Labs: CBC, pH, BT, U/A, ECG 12 leads, Serum elec., Creatinine, RBS, CXR-PA, PSA Start IVF with D5NSS 1L @ 120cc/hr Meds: Captopril 50g now q6hrs if BP > 140/90 Amlodipine 10g 1tab now OD 6am Metoprolol 100g 1tab BID PO Atorvastatin 80g 1tab OD @ HS Moriamin S2 1tab TID Refer for persistent elevated BP LSLF diet Refer accordingly

9:50p m

Received form ER per Tramadol 50mg for pain stretcher, awake and q8 PO conscious, with IVF of D5NSS 1L @ 120cc/o; regulated; placed comfortably on bed, lab exams and medications followed up; vital signs checked and recorded, watched out for any unusualities, needs attended to.

07/29/ 09

117 Received conscious and 11:00p responsive with IVF of D5NSS m @ 120cc/o on. L.S.L.F. diet. Vital signs checked- followed up labs, needs attended to, watched and cared for. 73 Soft diet 9:20a IVF D5NSS 1L @ 120cc/hr m RBS start Follow-up PSA

G. LABORATORIES AND DIAGNOSTIC EXAMS ARTERIAL BLOOD GAS 7-30-09 9:00am Ph (7.35pCO2 (35PO2 (80HCO3 (22BE (2 O2 sat% 7.45) 45mmHg) 100mmHg) 26mmol/L) mmol/L) (95-100%) 7.43 17.8 88.3 16.9 -9.7 97.2 Interpretation: partially compensated respiratory alkalosis Analysis: When a respiratory acid-base imbalance is present, it is compensated for by a physiologically induced-metabolic disturbance. In primary respiratory alkalosis, compensation occurs by metabolic means. Bicarbonate reabsorption by kidneys is reduced and bicarbonate is excreted through the urine. Occasionally, the hyperventilation that causes respiratory alkalosis is followed by an increase in lactate and pyruvate in the blood, which aids in compensation by producing a base deficit. RBS 7-29-09 TIME RESULT MED GIVEN REFERRED

2:30pm 10:30pm 2:00pm 5:00pm 11:00pm 7-30-09 TIME 5:00pm 7:00pm 9:00pm 11:00pm 2:00pm 10:00am 7-28-09 EXAM NAME Hemoglobin Mass Concentration

27mmol 32.7 470mg/dl 30.1mmol/l 33.3 RESULT 21.5 310.9 13.8 286 26.2 32.7

10units IVTT HR given HR 15units IVTT HR 2units IVTT

Dr. Edgar Dr. Espina Dr. Edar

MED GIVEN 10units HR 8units HR 4units HR 6units HR

REFERRED Dr. Edar cSS cSS cSS

HEMATOLOGY RESULT 116 NORMAL VALUE M: 140170g/L F: 120140g/L 5,010,0x109/L 0,55-0,65 0,02-0,04 0,25-0,35 INTEPRETATION Decreased ANALYSIS Blood loss, hemolytic anemia, bone marrow suppression, sickle cell anemia

Leukocyte No. Concentration Segmenters Eosinophils Lymphocytes

9.9 0,73 0,03 0,24

Normal Normal Decreased

Adrenal corticosteroids and other immunosuppressive drugs, autoimmune diseases

Thrombocyte Number Concentration Erythrocyte Volume Fraction Blood Group 7-30-09 EXAM NAME

257 0,34 B(+) RESULT

150400x109/L M: 0,40-0,50 F: 0,37-0,43

Normal Decreased Iron deficiency anemia

NORMAL VALUE

INTEPRETATION

ANALYSIS

Hemoglobin Mass Concentration Leukocyte No. Concentration

87

M: 140170g/L F: 120140g/L

Decreased

Increased 14.1 5,010,0x109/L 0,55-0,65 0,02-0,04 Increased Decreased

Neutrophils Eosinophils

0,79 0,01

Lymphocytes

0,20

0,25-0,35

Decreased

Erythrocyte Volume Fraction

0,25

M: 0,40-0,50 F: 0,37-0,43

Decreased

Blood loss, hemolytic anemia, bone marrow suppression, sickle cell anemia Acute infection, circulatory disease, hemorrhage, trauma, malignant disease Stress and acute infection Associated with congestive heart failure, infectious mononucleosis, and aplastic and pernicious anemia Adrenal corticosteroids and other immunosuppressive drugs, autoimmune diseases iron deficiency anemia

ELECTROLYTES 7-30-09 EXAM NAME Creatinine RESULT NORMAL VALUE M: 53.3115.0umol/L F: 44.096.0umol/L 135-148mmol/L 3.5-5.0mmol/L 1.13-1.32mmol/L INTEPRETATION ANALYSIS Increased Associated primarily with renal disease and obstructive urinary tract disease. Increased Hypernatremia Decreased Hypokalemia Normal

240.2

Sodium Potassium Calcium

156.6 3.25 1.27

Color Transparency pH SG

URINALYSIS RESULT Light yellow Clear 5.0 10.20

Pus cells Epithelial cells

0-2 occasional

ULTRASOUND Name: Megatron Address: Sto. Tomas, Dvo del Norte File No.: 09-1382 Exam: Abdomen and prostate

Age: 78 years old Date: 07-30-09 Department: Medicine Service of: Dr. Cuarte

Abdominal UXD: A physiologically distended gallbladder is noted with no calcification within. Wall is not thickened. The liver shows an echogenic but homogenous echotexture with no mass nor defects seen. Intrahepatic ducts & CBD are not dilated. Hepatic vessels are normal. Spleen and pancreas are unremarkable. The right kidney measures 9.1 x 4.85cm. with a cortical thickness of 1.85cm. while the left 9.05 x 4.25cm. With a cortical thickness of 1.7cm. Both show normal corticomedullary parenchymal echotexture. Both central echo complexes show mild (Grade1) dilatation with no calcification seen. Urinary bladder is normal. Prostate is enlarged measuring 4.6 x 5.1 x 4.55cm (53gms) and shows irregular borders. Impression: Fatty liver Grade 3 prostatic enlargement suggest PSA correlation Grade 1 hydronephrosis. Bilateral.

H. ANATOMY AND PHYSIOLOGY CARDIOVASCULAR SYSTEM

A. Heart Chambers The heart has four chambers, two atria and two ventricles. The atria are smaller with thin walls, while the ventricles are larger and much stronger. Atrium There are two atria on either side of the heart. On the right side is the atrium that contains blood which is poor in oxygen. The left atrium contains blood which has been oxygenated and is ready to be sent to the body. The right atrium receives deoxygenated blood from the superior vena cava and inferior vena cava. The left atrium receives oxygenated blood from the left and right pulmonary veins. Ventricles The ventricle is a heart chamber which collects blood from an atrium and pumps it out of the heart. There are two ventricles: the right ventricle pumps blood into the pulmonary circulation for the lungs, and the left ventricle pumps blood into the systemic circulation for the rest of the body. Ventricles have thicker walls than the atria, and thus can create the higher blood pressure. Comparing the left and right ventricle, the left ventricle has thicker walls because it needs to pump blood to the whole body. This leads to the common misconception that the heart lies on the left side of the body. Septum The interventricular septum (ventricular septum, or during development septum inferius) is the thick wall separating the lower chambers (the ventricles) of the heart from one another. The ventricular septum is directed backward and to the right, and is curved toward the right ventricle. The greater portion of it is thick and muscular and constitutes the muscular ventricular septum. Its upper and posterior part, which separates the aortic vestibule from the lower part of the right atrium and upper part of the right ventricle, is thin and fibrous, and is termed the membranous ventricular septum.

B. Coronary Artery The coronary circulation consists of the blood vessels that supply blood to, and remove blood from, the heart muscle itself. Although blood fills the chambers of the heart, the muscle tissue of the heart, or myocardium, is so thick that it requires coronary blood vessels to deliver blood deep into the myocardium. The vessels that supply blood high in oxygen to the myocardium are known as coronary arteries. The vessels that remove the deoxygenated blood from the heart muscle are known as cardiac veins. The coronary arteries that run on the surface of the heart are called epicardial coronary arteries. These arteries, when healthy, are capable of auto regulation to maintain coronary blood flow at levels appropriate to the needs of the heart muscle. These relatively narrow vessels are commonly affected by atherosclerosis and can become blocked, causing angina or a heart attack. The coronary arteries are classified as "end circulation", since they represent the only source of blood supply to the myocardium: there is very little redundant blood supply, which is why blockage of these vessels can be so critical. In general there are two main coronary arteries, the left and right. Right coronary artery. Left coronary artery Both of these arteries originate from the beginning (root) of the aorta, immediately above the aortic valve. As discussed below, the left coronary artery originates from the left aortic sinus, while the right coronary artery originates from the right aortic sinus. PROSTATE GLAND The prostate is one of the male sex glands. The other major sex glands are the testicles and semen. The normal prostate is about the size of a walnut. It lies just below the bladder and surrounds the beginning of the urethra. The urethra is the tube that runs through the penis. It carries urine from the bladder and semen from the sex glands. seminal vesicles. Together these glands secrete the fluids that make up

As the prostate is a sex gland, its growth is influenced by male sex hormones. The chief male hormone is testosterone, which is produced mostly by the testicles.

Overview of Male Reproductive System Structure and Function

STRUCTURE Bulbourethral glands (2) Cells of Leydig (Interstitial cells of Leydig) Cremaster muscle FUNCTION Secretion of gelatinous seminal fluid called prePea sized organs posterior to ejaculate. This fluid helps to lubricate the urethra the prostate on either side of the for spermatozoa to pass through, and to help flush urethra. out any residual urine or foreign matter. (< 1% of semen) Adjacent to the seminiferous tubules in the testicle. Covers the testes. Responsible for production of testosterone. Closely related to nerves. LOCATION & DESCRIPTION

Raises and lowers scrotum to help regulate temperature and promote spermatogenesis. Voluntary and involuntary contraction. Contraction by wrinkling to decrease surface area Layer of smooth muscular fiber available for heat loss to testicles, or expansion to Dartos muscle outside the external spermatic increase surface area available to promote heat fascia but below the skin loss; also helps raise and lower scrotum to help regulate temperature Part of the testes and connect Efferent ductules the rete testis with the Ducts for sperm to get to epididymis epididymis Begins at the vas deferens, Causes reflex for ejaculation. During ejaculation, Ejaculatory ducts passes through the prostate, semen passes through the ducts and exits the (2) and empties into the urethra at body via the penis. the Colliculus seminalis.

Epididymis

Penis

Tightly coiled duct lying just outside each testis connecting Storage and maturation of sperm. efferent ducts to vas deferens. Three columns of erectile tissue: two corpora cavernosa and one Male reproductive organ and also male organ of corpus spongiosum. Urethra urination. passes through penis. Surrounds the urethra just below Stores and secretes a clear, slightly alkaline fluid the urinary bladder and can be constituting up to one-third of the volume of felt during a rectal exam. semen. Raise vaginal pH.(25-30% of semen) Pouch of skin and muscle that holds testicles. Usually white but can be yellow, gray or pink (blood stained). After ejaculation, semen first goes through a clotting process and then becomes more liquid. Regulates temperature at slightly below body temperature.

Prostate gland

Scrotum

Semen

Components are sperm, and "seminal plasma". Seminal plasma is produced by contributions from the seminal vesicle, prostate, and bulbourethral glands.

About 65-75% of the seminal fluid in humans originates from the seminal vesicles. Contain Convoluted structure attached to proteins, enzymes, fructose, mucus, vitamin C, Seminal vesicles vas deferens near the base of flavins, phosphorylcholine and prostaglandins. (2) the urinary bladder. High fructose concentrations provide nutrient energy for the spermatozoa as they travel through the female reproductive system.

Seminiferous tubules (2)

Long coiled structure contained Meiosis takes place here, creation of gametes in the chambers of the testis; (sperm). joins with vas deferens.

Sertoli cells

Junctions of the Sertoli cells form the blood-testis barrier, a Cells responsible for nurturing and development of structure that partitions the sperm cells , provides both secretory and interstitial blood compartment of structural support; activated by FSH. Also called the testis from the adluminal "mother cells" or "nurse cells". compartment of the seminiferous tubules.

Testes

Gonads that produce sperm and male sex Inside scrotum, outside of body. hormones.Production of testosterone by cells of Leydig in the testicles.

Branch of the abdominal aorta. It Testicular is a paired artery. Each passes arteries (Gonadal Supplies blood to the testes. obliquely downward and laterally arteries) behind the peritoneum. Connects bladder to outside body, about 8 inches long. Muscular tubes connecting the left and right epididymis to the ejaculatory ducts to move sperm. Each tube is about 30 cm long. Tubular structure that receives urine from bladder and carries it to outside of the body. Also passage for sperm. During ejaculation the smooth muscle in the vas deferens wall contracts, propelling sperm forward. Sperm are transferred from the vas deferens into the urethra, collecting fluids from accessory sex glands en route

Urethra

Vas deferens

The prostate is a glandular structure that weighs approximately 20 grams, and is bounded superiorly by the bladder, inferiorly by the urogenital diaphragm (containing the membranous urethra), anteriorly by the pubic symphysis, laterally by the puborectalis muscle, and posteriorly by the rectum.

The prostate can be roughly divided into three different zones of tissue that include the 1) peripheral zone, 2) transition zone, and 3) central/periurethral zone.

The male reproductive system. The prostate gland is comprised of 3050 glands arranged in acini, which empty the prostatic secretion into the prostatic urethra.

The function of these different zones is not clear; however, in the prostate gland of the young adult the peripheral zone is composed of glandular tissue (65%), the transition zone (10%), and the central zone (25%). The central or periurethral zone appears to be most sensitive to estrogen, and is the site where benign prostatic hyperplasia tends to occur. Most prostatic carcinomas develop in the peripheral zone, which is particularly sensitive to androgens. The hypothalamic-pituitary-testicular axis

In response to the hormones secreted by the hypothalamus, the pituitary gland secretes luteinizing hormone (LH), follicle-stimulating hormone (FSH) and drenocorticotrophin (ACTH). These hormones enter the circulation, and subsequently exert their effects on the testes and adrenal glands. The final target organs in the hypothalamic-pituitary-testicular axis are the male gonads, or testes. Each testis contains a network of seminiferous tubules, which produce sperm. Between these tubules there is a system of testosterone-producing Leydig cells. FSH acts on the seminiferous tubules to promote sperm production, while LH acts on the Leydig cells to stimulate production of testosterone. The testes produce about 510 mg of testosterone each day. The growth and maintenance of the prostate gland is critically dependent upon testosterone. About 5% of total plasma testosterone is also produced by the adrenal glands. ACTH stimulates the adrenal glands to produce the adrenal androgens androstenedione and dehydroepiandrosterone, which are converted into testosterone in peripheral tissues and in the prostate gland. Negative feedback control

Testosterone controls its own release via a negative feedback effect it exerts on the hypothalamic-pituitary-testicular axis. When testosterone levels in the bloodstream are raised, the hypothalamus reduces the secretion of LHRH, which inhibits the secretion of LH from the pituitary gland. The overall effect is to reduce the amount of LH acting on the Leydig cells, therefore reducing testosterone secretion. Prostatic cell function Most testosterone (97%) circulates in the bloodstream, and is bound to one of two proteins, either sex hormone binding globulin (SHBG) or albumin. The remaining 2 3% of testosterone remains unbound, and is thought to affect the glandular cells of the prostate gland. Free testosterone passes through the prostate cell membrane, where it is metabolized to dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase. DHT is 2.5 times more potent as a male sex hormone than testosterone, and binds to androgen receptors (AR) within the glandular cells. This complex of AR with DHT then targets DNA sequences, known as androgen response elements, that activate various cell functions, including growth and proliferation.

I. SYMPTOMATOLOGY Prostate Cancer CLINICAL MANIFESTATION Difficulty starting urination Interrupted flow of urine Difficulty in having an erection Painful ejaculation Pain when passing urine Feeling that your ACTUAL SYMPTOMS Due to the presence of tumor in the prostate gland IMPLICATION

bladder is not emptying completely when you urinate Nocturia Dysuria

Painful urination due to narrowing, obstruction and trauma to the passageway of the urine. The presence of red blood cells (erythrocytes) in the urine due to tumor.

Hematuria

CORONARY ARTERY DISEASE CLINICAL MANIFESTATION Profuse sweating Restlessness Cold and clammy skin Shortness of breath Dizziness Nausea Vomiting A loss of consciousness Abnormal heartbeat Angina Heart murmur Heart attack ACTUAL SYMPTOMS IMPLICATION Inability to relax or calm oneself due to improper oxygenation. Breathing difficulty in due to compensatory mechanism of the body. Impairment in spatial perception and stability due to poor oxygenation.

HYPERTENSIVE CARDIOVASCULAR DISEASE CLINICAL MANIFESTATION Chest pain Confusion Irregular heartbeat Weakness ACTUAL SYMPTOMS IMPLICATION

Inability to exert force with one's muscles to the degree that would be

Dizziness Nausea

expected given the individual's general physical fitness due to poor oxygenation in the body. Impairment in spatial perception and stability due to poor oxygenation. Physical and/or mental exhaustion that can be triggered by stress, medication, overwork, or mental and physical illness or disease such as Hypertension. Breathing difficulty in due to compensatory mechanism of the body.

Fatigue

Shortness of breath Nausea Anxiety Nose bleeds Vomiting Heart palpitations

LEFT VENTRICULAR HYPERTROPHY CLINICAL MANIFESTATION

Chest pain Palpitations Dizziness Fainting Dyspnea Angina Abdominal discomfort Swelling (edema)

ACTUAL SYMPTOMS

IMPLICATION

Impairment in spatial perception and stability due to poor oxygenation. Breathing difficulty in due to compensatory mechanism of the body.

Abnormal accumulation of fluid beneath the skin, or in one or more cavities of the body.

J. ETIOLOGY Prostate Cancer The exact cause of Prostate Cancer is unknown. What is known, however, is that Prostate Cancer, like other cancers, is an uncontrolled growth of abnormal cells, and that the growth of Prostate Cancer is related to the male hormones, called androgens, the most prevalent being testosterone. These abnormal cells can form a malignant (cancerous) tumor. In some cases, the cancer can spread (metastasize) to other organs of the body. This occurs when cancer cells break away from a cancerous tumor and move through the blood and lymph nodes to other areas of the body. While the exact reasons why one man gets Prostate Cancer and another man does not are unknown. There are risk factors that have been associated with the incidence of Prostate Cancer in certain populations:

The incidence of Prostate Cancer increases with age more rapidly than any other cancer. More than 75% of all cases of Prostate Cancer are in men over 65 years of age. The average age of men newly diagnosed with Prostate Cancer is 70.

The risk of Prostate Cancer is twice as high for men of African descent as it is for Caucasian men. Family history: a man is more likely to develop Prostate Cancer if he has firstgeneration relatives (such as father or brother) who have been diagnosed with Prostate Cancer.

Early Prostate Cancer is often asymptomatic. That is, there are no symptoms caused by the cancer. However, more advanced Prostate Cancer can cause symptoms including urination problems: a more frequent need to urinate, especially at night; difficulty starting or stopping urination, blood in urine or ejaculate, and painful urination or ejaculation. Its important to note that these symptoms are not limited to Prostate Cancer, and may be indicative of another, non-cancerous, condition, such as an infection. If you experience any of the above symptoms, call your doctor. (http://www.suite101.com/lesson.cfm/17126/1004/2) The specific causes of prostate cancer remain unknown. A man's risk of developing prostate cancer is related to his age, genetics, race, diet, lifestyle, medications, and other factors. The primary risk factor is age. Prostate cancer is uncommon in men less than 45, but becomes more common with advancing age. The average age at the time of diagnosis is 70. However, many men never know they have prostate cancer. Autopsy studies of Chinese, German, Israeli, Jamaican, Swedish, and Ugandan men who died of other causes have found prostate cancer in thirty percent of men in their 50s, and in eighty percent of men in their 70s. In the year 2005 in the United States, there were an estimated 230,000 new cases of prostate cancer and 30,000 deaths due to prostate cancer. Dietary amounts of certain foods, vitamins, and minerals can contribute to prostate cancer risk. Men with higher serum levels of the short-chain -6 fatty acid linoleic acid have higher rates of prostate cancer. However, the same series of studies showed that men with elevated levels of long-chain -3 (EPA and DHA) had lowered incidence. A long-term study reports that "blood levels of trans fatty acids, in particular trans fats resulting from the hydrogenation of vegetable oils, are associated with an increased prostate cancer risk." Other dietary factors that may increase prostate cancer risk include low intake of vitamin E (Vitamin E is found in green, leafy vegetables), omega-3 fatty acids (found in fatty fishes like salmon), and the mineral selenium. A study in 2007 cast doubt on the effectiveness of lycopene (found in tomatoes) in reducing the risk of prostate cancer. Lower blood levels of vitamin D also may increase the risk of developing prostate cancer. This may be linked to lower exposure to ultraviolet (UV) light, since UV light exposure can increase vitamin D in the body. There are also some links between prostate cancer and medications, medical procedures, and medical conditions. Daily use of anti-inflammatory medicines such as

aspirin, ibuprofen, or naproxen may decrease prostate cancer risk. Use of the cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk. More frequent ejaculation also may decrease a man's risk of prostate cancer. One study showed that men who ejaculated five times a week in their 20s had a decreased rate of prostate cancer, though others have shown no benefit. Infection or inflammation of the prostate (prostatitis) may increase the chance for prostate cancer. In particular, infection with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to increase risk. Finally, obesity and elevated blood levels of testosterone may increase the risk for prostate cancer. Prostate cancer risk can be decreased by modifying known risk factors for prostate cancer, such as decreasing intake of animal fat. (http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html) Coronary Artery Disease Usually, CAD is due to subintimal deposition of atheromas in large and mediumsized coronary arteries (atherosclerosissee Arteriosclerosis). Less often, CAD is due to coronary spasm. Rare causes include coronary artery embolism, dissection, aneurysm (eg, in Kawasaki disease), and vasculitis (eg, in SLE, syphilis). (http://www.merck.com/mmpe/sec07/ch073/ch073a.html)

K. PATHOPHYSIOLOGY Written (Prostate Cancer) When normal cells are damaged beyond repair, they are eliminated by apoptosis. Cancer cells avoid apoptosis and continue to multiply in an unregulated manner. Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins when normal semen-secreting prostate gland cells mutate into cancer cells. The region of prostate gland where the adenocarcinoma is most common is the peripheral zone. Initially, small clumps of cancer cells remain confined to otherwise normal prostate glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia (PIN). Over time these cancer cells begin to multiply and spread to the surrounding prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large enough to invade nearby organs such as the seminal vesicles or the rectum, or the tumor cells may develop the ability to travel in the bloodstream and lymphatic system. Prostate cancer is considered a malignant tumor because it is a mass of cells which can invade other parts of the body. This invasion of other organs is called metastasis. Prostate cancer most commonly metastasizes to the bones, lymph nodes, rectum, and bladder. (http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html) Coronary Artery Disease

Coronary atherosclerosis is often irregularly distributed in different vessels but typically occurs at points of turbulence (eg, vessel bifurcations). As the atheromatous plaque grows, the arterial lumen progressively narrows, resulting in ischemia (often causing angina pectoris). The degree of stenosis required to produce ischemia varies with O2 demand. Occasionally, an atheromatous plaque ruptures or splits. Reasons are unclear but probably relate to plaque morphology, plaque Ca content, and plaque softening due to an inflammatory process. Rupture exposes collagen and other thrombogenic material, which activates platelets and the coagulation cascade, resulting in an acute thrombus, which interrupts coronary blood flow and causes some degree of myocardial ischemia. The consequences of acute ischemia, collectively referred to as acute coronary syndromes (ACS), depend on the location and degree of obstruction and range from unstable angina to transmural infarction. It can cause mesenteric ischemia; and in the renal arteries, it can cause stenosis leading to hypertension. L. SYNTHESIS OF THE CLIENTS CONDITION/STATUS FROM ADMISSION TO PRESENT A. Conclusion We therefore conclude that the study portrayed its importance and helped us know all about Hypertensive Urgency, HCVD, CAD, LVH, SR, NIF; Prostate CA Stage III. It also helped us understood the causes and effects of the diseases that enabled us to determine the predisposing and precipitating factors and traced the pathophysiology of these disorders. This also had given us the knowledge to identify where and when it had started and how the disease progressed and we had also interpreted the laboratory and diagnostic exam results of the client and recognized the implication of it. We also identified the different pharmacologic treatments indicated to the condition, considering the effects, actions and different nursing considerations with regards to the administration of the medications. We have also identified and formulated the nursing interventions that we could render to the patient that will help us attain our goal of care to our patient basing from the nursing care plan we have formulated. B. Patients Prognosis After some point in time, as the medical and the nursing management of the patient is constantly done, a development of her present health status is anticipated. Continuous administration of medications will result to termination of the signs and

symptoms that was caused by the patients disease such as fatigue, weakness, weight loss, high blood pressure, bipedal edema, dyspnic, and palpitations. Furthermore, vital signs are expected to stabilize. However, prostate cancer, like all other types of cancer, is an incurable type of disease, and the form of therapy is only palliative which only alleviates the signs and symptoms of this disease. And most probably after 3-7 days from the day of our interaction with him, he is expected to be discharged. C. Recommendations On the basis of the findings of this study, the following measures are recommended: 1. Client should take his prescribed medications religiously. He must create a schedule in order for him to be guided as when to take the medicines and for him not to be able to forget in doing so. 2. Follow the prescribed diet. His prescribed diet is a low-salt, low-fat diet, therefore client should avoid salty and fatty foods and client must take note that all canned goods are high in sodium even if it says that it is good for the heart. 3. Have an oral fluid intake with in cardiac tolerance. 4. Lifestyle modification is also important in order to prevent the severity of the condition that will further contribute complications such as cessation of smoking and drinking alcoholic beverages. 5. Visit his doctor regularly for constant check-ups and to continuously monitor his condition. D. Discharge Plan Medicine - Keep a written list of the medicines you take, the amounts, and when and why you take them. Bring the list of your medicines or the pill bottles when you see your caregivers. Learn why you take each medicine. Ask your caregiver for information about your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or food supplements without consultation. Always take your medicine as directed by caregivers. Call your caregiver if you think your medicines are not helping or if you feel you are having side effects. Do not quit taking your medicines until you discuss it with your caregiver. If you are taking medicine that makes you drowsy, do not drive or use heavy equipment. Take the medications directly as prescribed. Do not skip doses or double up on missed doses.

Exercise - Talk to your caregiver before you start exercising. Together you can plan the best exercise program for you. It is best to start slowly and do more as you get stronger. Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy. Stay active. Exercise helps keep your bones stronger. If pain keeps you from being active, ask your doctor about ways to lessen the pain. It is also important to mobilize the client in order to prevent activity intolerance and prevent constipation. Active range of motion exercises are taught to the patient to avoid joint stiffness and promote proper circulation. Few steps and mobilization will help as well. Diaphragmatic breathing and coughing exercises will be demonstrated to lessen feeling of pain sensation and prevent atelectasis. Treatment - You may be given medicine to take at home to take away or decrease pain. Your caregiver will tell you how much to take and how often to take it. Take the medicine exactly as directed by your caregiver. Avoid taking non-steroidal antiinflammatory medicines (NSAIDs). Do not wait until the pain is too bad before taking your medicine. The medicine may not work as well at controlling your pain if you wait too long to take it. Tell caregivers if the pain medicine does not help or if your pain comes back too soon. Hygiene - Good oral hygiene and proper dental care apply to all age groups but the needs of the elderly population can be slightly different than the needs of younger people. Client should also observe regular hand and body hygiene to decrease the risk of acquiring infection. Daily bath is recommended as well as frequent hand hygiene, not only for the client but also for the clients significant others. Diet - It is important that you get good nutrition when you have cancer. Eat a variety of healthy foods from all the food groups. The food groups include breads, vegetables, fruits, milk and milk products, and protein (beans, eggs, poultry, meat and fish). Eating healthy foods may help you feel better and have more energy. You may need to make diet changes depending on your tolerance, the location of your cancer, or treatment side effects. But you have hypertensive problems due to presence of a Coronary Artery Disease, thus you should watch out with your diet and have a low sodium and low fat diet. Furthermore, if you have trouble swallowing, try eating foods that are soft or in liquid form, ask your caregiver if you should add special drinks or vitamins to your diet. Tell your caregiver if you are nauseated, vomiting, or have other problems eating or digesting your food. Men 19 years old and older should drink about 3.0 Liters of liquid

each day (close to 13 eight-ounce cups). Women 19 years old and older should drink about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). If you are used to drinking liquids that contain caffeine, such as coffee, these can also be counted in your daily liquid amount. Drink even more liquids if you will be outdoors in the sun for a long time. You should also drink more liquids if you are exercising. Try to drink enough liquid each day, and not just when you feel thirsty. The best liquids to drink have water, sugar, and salt in them. These liquids help your body hold in fluid and help prevent dehydration. Ask your caregiver what liquids are best to drink if you are on a low salt or low sugar diet.

M. EVALUATION OF THE OBJECTIVE OF THE STUDY After few days of conducting thorough study about the case of Megatron, we were able to trace the history of her disease locally, nationally and globally. We have come up with a comprehensive assessment of the patients biographical data, cephalocaudal physical assessment as well as pertinent medical information with regards to the clients health condition. Apart from that, we were also able to have a clearer view on how the disease affects the patients body by tracing the pathophysiology of the disease process and identifying the different organs involved by reviewing its anatomy and physiology. By understanding fully the mechanism and effects of the disease to the patient, we have interpreted different laboratory results related to her condition. We have also identified and traced some medications and how these drugs affect the patients physiological functioning. Appropriate therapeutic care was well planned and provided to the client. And lastly, we have come up with a discharge plan pertaining to the patients early recovery.

N. BIBLIOGRAPHY Book 1. Smeltzer, Suzanne C., et. al. Brunner & Suddarths Textbook of Medical-Surgical Nursing. 11th Edition. Volume 1 and 2. Lippincott Williams and Wilkins. 2008. 2. Nurses Pocket Guide. 11th Edition 3. Davis Drug Guide. 10th Edition Internet 1. Source: Asian Pacific Journal of Cancer Prevention: Apjcp. 5(4):401-5, 2004 OctDec. 2. Changing trends of prostate cancer in Asia. Source: Aging Male. 7(2):120-32, 2004 Jun. 3. http://www.prostateline.com/prostate-cancer/anatomy-and-physiology? itemId=2617452&nav=yes. 4. http://davaotoday.com/2006/04/24/in-many-davao-villages-poison-pours-fromthe-sky/. 5. http://www.dirtybananas.org/pdf/local_studies_on_aerial_spraying.pdf 6. http://www.cancerline.com/2682687/2682690/2682696/2746539/ 7. http://www.texasheartinstitute.org/HIC/Anatomy/anatomy2.cfm

8. http://74.125.153.132/search? q=cache:3MIOUR5r0KAJ:www.dlshsi.edu.ph/forms/research/Regional/Mindanao/ Region11-Agenda.pdf+incidence+report+of+cardiovascular+disease+in+Tagum, +Davao+Del+Norte&cd=5&hl=tl&ct=clnk&gl=ph 9. http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html) 10. (http://www.suite101.com/lesson.cfm/17126/1004/2) 11. (http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html)