TABLE OF CONTENTS

A. Introduction
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B. Objective of the Study
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C. Assessment
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• Biographic Data

• Chief Complaint

• History of Present Illness

• Past medical and Nursing History

• Personal, Social-Economic History

D. Patient Need Assessment-
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E. General Survey-
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F. Course in the ward-
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G. Laboratories and Diagnostic Examinations-
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H. Review of Anatomy and Physiology-
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I. Symptomatology
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J. Etiology of the disease
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K. Pathophysiology
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• Written Pathophysiology
• Diagram
L. Synthesis of clients conditioned status from
admission to present-
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M. Evaluation of the Objective of the study
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N. Nursing Care Plan-
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O. Bibliography
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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 35–44 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 3–4 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 25–54 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 HealthOne 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 2002- 2004,

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 (age- specific 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:
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Study the patient’s history of past and present illness

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Conduct a synoptic physical assessment of patients with Hypertensive Urgency,

HCVD, CAD, LVH, SR, NIF; Prostate CA Stage III
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Be able to review the anatomy and physiology of the affected organs and
systems
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Distinguish the affected system

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Trace and analyze the pathophysiology of the infirmity

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Classify the ordered drugs and associate its action or effects to the patient
Consider laboratory results and relate it to patient’s condition
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Construct nursing care plan for patients with Hypertensive Urgency, HCVD, CAD,
LVH, SR, NIF; Prostate CA Stage III
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Identify prognosis of the patient

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Evaluate the client’s condition from the time of admission up to the present
C. ASSESSMENT
A. Biographical Data

Name:Megatron

Age: 78 years old

Gender:Mal e

Civil Status:Married

Birthdate: November 11, 1930

Birth Place: Dumangas, Iloilo

Nationality:Fi l ipi no

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
PR – 89 bpm
RR – 32 cpm
BP – 170/110 mmhg
Weight – 77 kgs.
Height: 5 feet 4inches
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

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
 D

ate: 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__

FROM_Emergency

Room

ACCOMPANIED BY___wife_and children __

ADMITTING WT/VS: 77 kls. T- 37.3oC; RR-32cpm; PR-89bpm; BP- 170/110mmHg __

CLIENT’s PERCEPTION OF REASON FOR ADMISSION: -Client unable to verbalize-

HOW 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
 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
•
CAPILLARY REFILL good capillary refill of less than 3
seconds_
•
SKIN CHARACTER AND COLOR_skin is brown, dry, flaky
and wrinkled.
•
LIFE SUPPORTING APPARATUS: with O2 @ 3LPM via
nasal cannula
•
OTHER OBSERVATIONS (related) Patient shows
discomfort with the nasal cannula by removing it.
II. TEMPERATURE MAINTENANCE

TEMPERATURE: 37.2oC
_

SKIN CHARACTER_Skin is dry, flaky, wrinkled and
not warm to touch_

OTHER OBSERVATION (related)_patient did not
experience fever anymore_
III NUTRITIONAL FLUID
 HEIGHT/WT 5”4’/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 -can’t able to verbalize-

OTHER OBSERVATION (related)_Patient can easily be distracted, thus, having difficulty in
sleeping back again
VI PAIN AVOIDANCE
 RATE PAIN_-can’t 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 can’t able to describe, can’t able to verbalize

 OTHER observation (related) Patient has difficulty in sleeping due to pain felt
VII SEXUALITY REPRODUCTIVE
 LMP__N/A__
AOG__N/A__
 GRAVIDA/PARITY__N/A__
PRENATAL__N/A__
 MENSTRUAL CYCLE__N/A__
GYNECOLOGIC PROBLEM__N/A__
 EDC__N/A__

 FMILY PLANNING METHOD USE: calendar method

 CHILDREN (no.) __9

__
MENARCHE__N/A__
VIII STIMULATION ACTIVITY

 WORK: Before: farmer & pastor During: needs assistance in performing activities of

 RECREATION/PAST TIME: daily living, can’t 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_________
__Evie Luz Docena, RN, MN__
SN-SMC
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
Shift
Time
T
BP
RR
PR
7/28/09
7-3
9:35
37.8
160/100
32
92
10:50
37.5
150/90
25
89
11-7
12:10
37.1
140/80
18
83
4:30
36.9
130/90
20
82
7/29/09
7-3
8:45
37.3
170/100
23
84
12:00
37.7
160/90
26
89
3-11
4:00
38.1
140/90
26
78
8:00
37.2
150/90
24
81
11-7
12:30
37.3
130/90
17
83
4:00
37.1
120/80
19
85
7/30/09
7-3
8:00
37
140/80
20
82
12:20
37.4
150/100
20
80
3-11
4:00
37.2
160/100
26
97
5:00
37.1
150/90
25
94
6:00
37.3
140/80
27
89
7:00
37.3
140/80
25
88
8:00
37.4
150/90
30
81
9:00
37
140/80
28
85
10:00
36.9
140/80
29
77
C. Nutritional Status
Megatron stands 5”4’ 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

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. Can’t 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.

DATE
SHIFT
NURSE’S NOTES
DOCTOR’S ORDER
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.
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
stretcher,
awake
and 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.
Tramadol 50mg for pain
q8 PO
117
11:00
pm
Received
conscious
and
responsive
with
IVF
of D5NSS @ 120cc/o – on. L.S.L.F. diet. Vital signs
checked- followed up labs, needs attended to, watched and cared for.
07/29/
09
73
9:20a
m
Soft diet
IVF D5NSS 1L @ 120cc/hr
G. LABORATORIES AND DIAGNOSTIC EXAMS
ARTERIAL BLOOD GAS
7-30-09
9:00am
Ph (7.35-
7.45)
pCO2 (35-
45mmHg)
PO2 (80-
100mmHg)
HCO3 (22-
26mmol/L)
BE (2
mmol/L)
O2 sat%
(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
7-29-09TIME
RESULT
MED GIVEN
REFERRED
2:30pm
27mmol
10units IVTT HR
given
Dr. Edgar
10:30pm
32.7
HR 15units IVTT
Dr. Espina
2:00pm
470mg/dl
HR 2units IVTT
Dr. Edar
5:00pm
30.1mmol/l
11:00pm
33.3
7-30-09TIME
RESULT
MED GIVEN
REFERRED
5:00pm
21.5
10units HR
Dr. Edar
7:00pm
310.9
8units HR
cSS
9:00pm
13.8
4units HR
cSS
11:00pm
286
6units HR
cSS
2:00pm
26.2
10:00am
32.7
HEMATOLOGY
7-28-09
EXAM NAME
RESULT
NORMAL
VALUE
INTEPRETATION
ANALYSIS
Hemoglobin
Mass
Concentration
116
M: 140-
170g/L
F: 120-
140g/L
Decreased
Blood loss,
hemolytic anemia,
bone marrow
suppression, sickle
cell anemia
Leukocyte No.
Concentration
9.9
5,0-
10,0x109/L
Normal
Segmenters
0,73
0,55-0,65
Eosinophils
0,03
0,02-0,04
Normal
Lymphocytes
0,24
0,25-0,35
Decreased
Adrenal
corticosteroids and
other
immunosuppressive
drugs, autoimmune
diseases
Thrombocyte
Number
Concentration
257
150-
400x109/L
Normal
Erythrocyte
Volume
Fraction
0,34
M: 0,40-0,50
F: 0,37-0,43
Decreased
Iron deficiency
anemia
Blood Group
B(+)
7-30-09
EXAM NAME
RESULT
NORMAL
VALUE
INTEPRETATION
ANALYSIS
Hemoglobin
87
M: 140-
Decreased
Blood loss,
Mass
Concentration
170g/L F: 120- 140g/L
hemolytic anemia,
bone marrow
suppression, sickle
cell anemia
Leukocyte No.
Concentration
14.1
5,0-
10,0x109/L
Increased
Acute infection,
circulatory disease,
hemorrhage,
trauma, malignant
disease
Neutrophils
0,79
0,55-0,65
Increased
Stress and acute
infection
Eosinophils
0,01
0,02-0,04
Decreased
Associated with
congestive heart
failure, infectious
mononucleosis, and
aplastic and
pernicious anemia
Lymphocytes
0,20
0,25-0,35
Decreased
Adrenal
corticosteroids and
other
immunosuppressive
drugs, autoimmune
diseases
Erythrocyte
Volume
Fraction
0,25
M: 0,40-0,50
F: 0,37-0,43
Decreased
iron deficiency
anemia
ELECTROLYTES
7-30-09
EXAM NAME
RESULT
NORMAL VALUE INTEPRETATION
ANALYSIS
Creatinine
240.2
M: 53.3-
115.0umol/L
F: 44.0-
96.0umol/L
Increased
Associated
primarily with
renal disease
and obstructive
urinary tract
disease.
Sodium
156.6
135-148mmol/L
Increased
Hypernatremia
Potassium
3.25
3.5-5.0mmol/L
Decreased
Hypokalemia
Calcium
1.27
1.13-1.32mmol/L
Normal
URINALYSIS
RESULT
Color
Light yellow
Transparency
Clear
pH
5.0
SG
10.20
Pus cells
0-2
Epithelial cells
occasional
ULTRASOUND
Name: Megatron
Age: 78 years old
Address: Sto. Tomas, Dvo del Norte
Date: 07-30-09
File No.: 09-1382
Department: Medicine
Exam: Abdomen and prostate
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 cortico- medullary
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.
AtriumThere 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 de- oxygenated

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
seminal vesicles. Together these glands secrete the fluids that make up
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.
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 LOCATION & DESCRIPTION
FUNCTION
Bulbourethral
glands (2)
Pea sized organs posterior to
the prostate on either side of
the urethra.
Secretion of gelatinous seminal fluid called pre-
ejaculate. This fluid helps to lubricate the urethra
for spermatozoa to pass through, and to help
flush out any residual urine or foreign matter. (<
1% of semen)
Cells of Leydig
(Interstitial cells
of Leydig)
Adjacent to the seminiferous
tubules in the testicle.
Responsible for production of testosterone.
Closely related to nerves.
Cremaster
muscle
Covers the testes.
Raises and lowers scrotum to help regulate temperature and promote spermatogenesis. Voluntary and involuntary
contraction.
Dartos muscle
Layer of smooth muscular fiber
outside the external spermatic
fascia but below the skin
Contraction by wrinkling to decrease surface
area available for heat loss to testicles, or
expansion to increase surface area available to
promote heat loss; also helps raise and lower
scrotum to help regulate temperature
Efferent ductules
Part of the testes and connect
the rete testis with the
epididymis
Ducts for sperm to get to epididymis
Ejaculatory ducts
(2)
Begins at the vas deferens,
passes through the prostate,
and empties into the urethra at
the Colliculus seminalis.
Causes reflex for ejaculation. During ejaculation,
semen passes through the ducts and exits the
body via the penis.
Epididymis
Tightly coiled duct lying just
outside each testis connecting
efferent ducts to vas deferens.

Storage and maturation of sperm.

Penis

Three columns of erectile

tissue: two corpora cavernosa
and one corpus spongiosum.
Urethra passes through penis.

Male reproductive organ and also male organ of

urination.
Prostate gland

Surrounds the urethra just

below the urinary bladder and
can be felt during a rectal exam.

Stores and secretes a clear, slightly alkaline fluid

constituting up to one-third of the volume of
semen. Raise vaginal pH.(25-30% of semen)

Scrotum
Pouch of skin and muscle that
holds testicles.
Regulates temperature at slightly below body
temperature.
Semen

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.

Components are sperm, and "seminal plasma".

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

Seminal vesicles
(2)

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

Seminiferous
tubules (2)

Long coiled structure contained

in the chambers of the testis;
joins with vas deferens.

Meiosis takes place here, creation of gametes

(sperm).
Sertoli cells

Junctions of the Sertoli cells

form the blood-testis barrier, a
structure that partitions the
interstitial blood compartment of
the testis from the adluminal
compartment of the
seminiferous tubules.

Cells responsible for nurturing and development

of sperm cells , provides both secretory and
structural support; activated by FSH. Also called
"mother cells" or "nurse cells".

Testes
Inside scrotum, outside of body.

Gonads that produce sperm and male sex

hormones.Production of testosterone by cells of
Leydig in the testicles.

Testicular
arteries
(Gonadal
arteries)
Branch of the abdominal aorta.
It is a paired artery. Each
passes obliquely downward and
laterally behind the peritoneum.
Supplies blood to the testes.
Urethra
Connects bladder to outside
body, about 8 inches long.
Tubular structure that receives urine from bladder
and carries it to outside of the body. Also
passage for sperm.
Vas deferens
Muscular tubes connecting the
left and right epididymis to the
ejaculatory ducts to move
sperm. Each tube is about 30
cm long.
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

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 30–50 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 5–10 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
ACTUAL
SYMPTOMS
IMPLICATION
•

Difficulty starting
urination

•

Interrupted flow of urine


Due to the presence of
tumor in the prostate
gland
•

Difficulty in having an
erection

•

Painful ejaculation

•

Pain when passing

urine

•

Feeling that your


bladder is not emptying
completely when you
urinate
•

Nocturia

•

Dysuria

Painful urination due to
narrowing, obstruction
and trauma to the
passageway of the urine.
•

Hematuria

The presence of red
blood cells (erythrocytes)
in the urine due to tumor.
CORONARY ARTERY DISEASE
CLINICAL MANIFESTATION
ACTUAL
SYMPTOMS
IMPLICATION
•

Profuse sweating

•

Restlessness

Inability to relax or calm oneself due to improper oxygenation.
•

Cold and clammy skin


•

Shortness of breath

Breathing difficulty in due
to compensatory
mechanism of the body.
•

Dizziness

Impairment in spatial
perception and stability
due to poor oxygenation.
•

Nausea

•

Vomiting

•

A loss of consciousness

•

Abnormal heartbeat

•

Angina

•

Heart murmur

•

Heart attack

HYPERTENSIVE CARDIOVASCULAR DISEASE
CLINICAL MANIFESTATION
ACTUAL
SYMPTOMS
IMPLICATION
•

Chest pain

•

Confusion

•

Irregular heartbeat

•

Weakness

Inability to exert force
with one's muscles to the
degree that would be
expected given the
individual's general
physical fitness due to
poor oxygenation in the
body.
•

Dizziness

Impairment in spatial
perception and stability
due to poor oxygenation.
•

Nausea

•

Fatigue

Physical and/or mental
exhaustion that can be
triggered by stress,
medication, overwork, or
mental and physical
illness or disease such as
Hypertension.
•

Shortness of breath

Breathing difficulty in due
to compensatory
mechanism of the body.
•

Nausea

•

Anxiety

•

Nose bleeds

•

Vomiting

•

Heart palpitations

LEFT VENTRICULAR HYPERTROPHY
CLINICAL MANIFESTATION
ACTUAL
SYMPTOMS
IMPLICATION
•

Chest pain

•

Palpitations

•

Dizziness

Impairment in spatial
perception and stability
due to poor oxygenation.
•

Fainting

•

Dyspnea

Breathing difficulty in due
to compensatory
mechanism of the body.
•

Angina

•

Abdominal discomfort

•

Swelling (edema)

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 first- generation

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.

It’s 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 ω-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 ω-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 medium-

sized coronary arteries (atherosclerosis—see 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 CLIENT’S 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. Patient’s 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 patient’s 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.

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 patient’s biographical data, cephalo- caudal physical

assessment as well as pertinent medical information with regards to the client’s health

condition. Apart from that, we were also able to have a clearer view on how the disease
affects the patient’s 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 patient’s 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 patient’s early recovery.