Case Presentation

In

@BPH
INTRODUCTION
 Benign prostatic hyperplasia (BPH) also known as
benign prostatic hypertrophy, benign enlargement of
the prostate (BEP), and adenofibromyomatous
hyperplasia, refers to the increase in size of the
prostate in middle-aged and elderly men.
 To be accurate, the process is one of hyperplasia
rather than hypertrophy, but the nomenclature is often
interchangeable. The prostate is the genital organ most
commonly affected by benign and malignant
neoplasm.
 Benign enlargement of the prostate gland is extremely
common process that occurs in nearly all men with
functioning testes. BPH is a noncancerous form of cell
growth in men and usually begins with microscopic
nodules in younger men. It should be noted that BPH is
not a precancerous condition.
 BPH is characterized by hyperplasia of prostatic
stromal and epithelial cells, resulting in the formation
of large, fairly discrete nodules in the periurethral
region of the prostate. When sufficiently large, the
nodules compress the urethral canal to cause partial,
or sometimes virtually complete, obstruction of the
urethra, which interferes the normal flow of urine.
 It leads to symptoms of urinary hesitancy, frequent urination,
dysuria (painful urination), increased risk of urinary tract
infections, and urinary retention. Although prostate specific
antigen levels may be elevated in these patients because of
increased organ volume and inflammation due to urinary tract
infections, BPH is not considered to be a premalignant lesion.
PROSTATE CANCER
 Prostate cancer is a form of cancer that develops in the
prostate a gland in the male reproductive system. Most prostate
cancers are slow growing; however, there are cases of
aggressive prostate cancers.
 The cancer cells may metastasize (spread) from the prostate to
other parts of the body, particularly the bones and lymph
nodes. Prostate cancer may cause pain, difficulty in urinating,
problems during sexual intercourse, or erectile dysfunction.
Other symptoms can potentially develop during later stages of
the disease.
 Sometimes, however, prostate cancer does cause symptoms,
often similar to those of diseases such as benign prostatic
hyperplasia. These include frequent urination, increased
urination at night, difficulty starting and maintaining a steady
stream of urine, blood in the urine, and painful urination.
NURSING HEALTH HISTORY
A. Personal Data
Name: Mr. X
Address: Brgy. San Andres Catbalogan Samar
Age: 59 y.o
Sex: male
Civil Status: Married
Religion: Roman Catholic
Birthplace: Catbalogan Samar
Occupation: Butcher
Case no.: With old #
Date of admission: August 28, 2010
Time of admission: 3:00 pm
Tentative diagnosis: Benign Prostatic Hypertrophy probably malignant with
bone metastasis and UTI.
Attending physician: Dr. Navales
B.Chief Complaint:
A 59 y.o, male, came in per ambulatory, has been
admitted to SPH with the chief complaint of bone pain
on the lumbosacral area and presence of blood in the
urine 3 months prior to admission.

C. Family Health and Illness History

According to Mr. X, the familial disease that they have
in the family is Diabetes Mellitus and hypertension.
His father is hypertensive and has diabetes. He has 5
siblings and one has hypertension also. He also added
that he is the only member in the family who has BPH.
D. History of Past Hospitalization
According to Mr. X, he has been admitted to St. Paul’s Hospital at
Tacloban City last May 2010 with a diagnosis of Urinary tract
infection and was discharged after 3 days. After a month, he has been
admitted again at Samar Provincial Hospital and was diagnosed with
Benign Prostatic Hypertrophy with UTI by Dr. Navales.

E. History of Present Illness

Mr. X was admitted to SPH with a chief complaint of blood in the
urine and pain over the lumbosacral area was diagnosed for having
BPH or benign prostatic hypertrophy. According to the patient, 3
months prior to his admission he experiences pain during urination
and find a tinge of blood in his urine. Last Saturday, August 28, 2010
he was brought in the hospital at around 3 in the afternoon due to
severe bone pain, body weakness and hematuria.
F. Lifestyle
The patient’s occupation was a butcher. He states that he used to
eat foods rich in cholesterol, vegetables and fruits. He drinks
occasionally and used to be a smoker since age 20 and consumes
about 1 to 2 packs of cigarette per day. The patient stops smoking
and drinking alcoholic beverages after his first hospitalization at
St. Paul’s Hospital. He also stated that after his hospitalization he
experience loss of appetite causing for him to loss his weight.
Physical
Assessment
 AREAc TECHNIQUE NORMS FINDINGS ANALYSIS and
INTERPRETATIO
N
A. SKULL
1. Size, shape and Inspection Rounded (normocephalic Rounded(normocephalic) Normal
symmetry of the skull Palpation and symmetrical, with ; smooth skull contour
frontal, parietal, and
occipital prominences);
Smooth skull contour
2. Presence of nodules, Palpation Smooth, uniform Has no tenderness; no Normal
masses, and depressions Inspection consistence; absence of masses nor nodules
nodules or masses
4. Presence of edema and Inspection No edema and Has Hollowness Abnormal, Volume
hollowness in the eye. hollowness deficiency of fat within
the orbit (the space inside
of the bony eye socket).
This condition of the
patient is related to his
nutritional status, he is
malnourished because of
loss of appetite..
-because of blood loss
C. FACE
Facial features, Inspection Symmetric or slightly Symmetrical facial Normal
symmetry of facial asymmetric facial features while talking or
movements features; palpebral elevating the eyebrow.
fissures equal in size;
symmetric nasolabial
folds
D. EYES
 EYEBROWS
Hair distribution, Inspection Symmetrical and in line Symmetrical and aligned Normal
alignment, skin quality with each other; maybe with each other; black;
and movement black, brown or blond evenly distributed.
depending on race; Movements are
evenly distributed symmetrical.
 CONJUNCTIVA
1. Color, texture, and the Inspection Pinkish or red in color; Pale color; smooth in Abnormal, pale
presence of lesions in the Palapation with presence of small texture conjunctiva may be
bulbar conjunctiva capillaries; moist; no related to the low RBC
foreign bodies; no ulcers level of the patient.
(UGIB and Hematuria)

-Hgb (93.1 gms/L)

-Hct (0.28gms/L)
Hair distribution, Inspection Symmetrical and in line Symmetrical and aligned Normal
alignment, skin quality with each other; maybe with each other; black;
and movement black, brown or blond evenly distributed.
depending on race; Movements are
evenly distributed symmetrical.
2. Color, texture, and Inspection Pinkish or red in color; Pale Abnormal, pale
the presence of lesions Palpation with presence of small conjunctiva may be
in the palpebral capillaries; moist; no related to the low RBC
conjunctiva foreign bodies; no level of the patient.
ulcers (UGIB and Hematuria)

-Hgb (93.1 gms/L)

-Hct (0.28gms/L)
 SCLERA
Color and clarity Inspection White in color; clear; no White sclera with some Normal
yellowish discoloration; visible capillaries,
some capillaries maybe anicteric sclera.
visible
 VISUAL ACUITY
1. Near vision Inspection Able to read newsprint Nearsightedness Abnormal, it is a
(Myopia) refractive defect f the eye
in which collimated light
produces image focus in
front of the retina when
accommodation is
relaxed. It is caused by
an eyeball that is longer
than normal, which may
be a familial trait.
 LACRIMAL
GLAND
Palpability and Palpation No edema or tenderness No tenderness and edema Normal
tenderness of the lacrimal over lacrimal gland noted.
gland

 VISUAL FIELDS

Peripheral visual fields Inspection When looking straight Can see objects in the Normal
ahead, client can see periphery.
objects in the periphery

E. EARS

 AURICLES

1. Color, symmetry of Inspection Color same as facial Same color as the facial Normal
size, and position skin; symmetrical; skin; tip of auricle
auricle aligned with outer aligned at the outer
canthus of eye, about 10 canthus of the eye.
degrees from vertical

2. Texture, elasticity and Palpation Mobile, firm, and not Smooth in texture, Normal.
areas of tenderness tender; pinna recoils after flexible and elastic pinna;
it is folded no tenderness and pain
when palpated
 HEARING
ACUITY TESTS

1. Client’s response to Inspection Normal voice tones Can no longer hear Deviation from normal.
normal voice tones audible normal volume tones or
words. Due to aging.

Lean forward to the

person when listening

F. NOSE

1.Any deviations in Inspection Symmetric and straight; Symmetric and straight; Normal
shape, size, or color and no discharge or flaring; Uniform color
flaring or discharge from Uniform color
the nares

2. Nasal septum Inspection Nasal septum intact and Nasal septum intact and Normal
(between the nasal Palpation in midline in midline
chambers)
3. Patency of both nasal Inspection Air moves freely as the Both nares are patent Normal
cavities client breathes through
the nares
4. Tenderness, masses, Palpation Not tender; no lesions Nor tenderness nor Normal
and displacements of lesions.
bone and cartilage
G. MOUTH

 LIPS

Symmetry of contour, Inspection Palpation Uniform pink color; soft, Pink in color, dry and Abnormal, May suggest
color and texture moist, smooth texture; cracked lips cellular dehydration.
symmetry of contour;
ability to purse lips

 BUCCAL
MUCOSA

Color, moisture, texture, Inspection Uniform pink color; Pink color and dry. Abnormal, May suggests
and the presence of moist, smooth, soft, dehydration.
lesions glistening, and elastic
texture
 TEETH

Color, number and Inspection 32 adult teeth; smooth, The patient has yellowish
condition and presence of white, shiny tooth teeth and no foul odor.
dentures enamel; smooth, intact
dentures
 GUMS
Color and condition Inspection Pink gums; no retraction Pink gums; has no visible Normal
retractions
 TONGUE/FLOO
R OF THE
MOUTH
1. Color and texture of Inspection pink color; moist; pink color; moist; Normal
the mouth floor and slightly rough; thin slightly rough; thin
frenulum. whitish coating; moves whitish coating; moves
freely; no tenderness freely; no tenderness
2. Position, color and Inspection Central position; pink Located and positioned Normal
texture, movement and color; smooth tongue in the center.
base of the tongue base with prominent
veins
2. Position of the uvula Inspection Positioned in midline of Positioned at the center Normal
and mobility (while soft palate of the oropharynx
examining the palates)
H. Neck
Inspection Muscles equal in size, (+) enlargement of the Deviation from normal
head centered; head cervical lymph nodes
movement coordinated, Swollen lymph nodes in
smooth and no neck is due to infection.
discomfort; lymph nodes
not palpable; central
placement of trachea in
midline of neck; ascends
during swallowing but
not visible; lobes may
not be palpable; absence
of bruit.
I. THORAX

 ANTERIOR
THORAX

1. Breathing patterns Inspection Quiet, rhythmic, and Rapid shallow breathing. Deviation from normal.
effortless respirations
May due to pain.

RR: 27 CPM

2. Temperature, Palpation Skin intact; uniform Has an intact skin; has Normal
tenderness, masses temperature; chest wall equal warmth on both
intact; no tenderness; no sides. No masses.
masses

3. Anterior thorax Auscultation Bronchovesicular and No crackles found Normal

auscultation vesicular breath sounds

 POSTERIOR
THORAX

1. Shape, symmetry, and Inspection Palpation Anteroposterior to Has a anteroposterior to Normal

comparison of transverse diameter in transverse diameter ratio
anteroposterior thorax to ratio 1:2; Chest of 1:2, elliptical in shape
transverse diameter symmetric and symmetrical chest

2. Posterior thorax Auscultation Vesicular and No crackles. Normal

auscultation bronchovesicular breath
sounds
J.
CARDIOVASCULAR
 APICAL AREA Auscultation Pulsations visible in 50% Has full pulsation Normal
of adults and palpable in
most PMI in fifth LICS
at or medial to MCL
 CARDIOVASCUL Auscultation S1: Usually heard at all Has full and rapid Normal
AR AREAS sites pulsation. 90
AUSCULTATION bpm/minute. Normal
Usually louder at the Sounds on the aortic and
apical area Deviation from normal.
pulmonic areas; has a lub
S2: Usually heard at all sound on the apex and The patient is
sites dub sounds on the hypertensive.
tricuspid area.
Usually louder at the Blood pressure is
base of heart 170/100 mm Hg.

Systole: silent interval;

slightly shorter duration
than diastole at normal
heart rate (60 to 90
beats/min)

Diastole: silent interval;

slightly longer duration
than systole at normal
heart rates

S3: in children and

young adults

S4: in many older adults

K. AXILLAE
1. Axillary, subclavicular,
and supraclavicular
lymph nodes
L. ABDOMEN
1. Skin integrity
2. Abdominal contour
Inspection No tenderness, masses, Have no masses and Abnormal,
or nodules nodules.
Maybe due to infection
Enlarged axillary lymph and disease process.
nodes.
Inspection Unblemished skin; Uniform color and has no Normal
uniform color blemishes
Inspection and palapation Flat, rounded(convex), or Enlarged bladder Deviation from normal
scaphoid(concave)
-mass like upon palpation A bladder with larger
of the lower abdomen amount of urine maybe
visible on inspection.
An enlarged bladder may
be palpated as a mass in
the lower abdomen.
This is because of the
enlargement of the
prostate gland that
narrows the prostatic
urethral channel. This
obstructs the bladder
neck or the prostatic
urethra, causing urinary
retention or incomplete
bladder emptying.
3. Abdominal Inspection Symmetric movements Abdominal movements Normal
movements associated caused by respiration; noted when inhaling.
with respirations, visible peristalsis in
peristalsis or aortic very lean people; aortic
pulsations pulsations in thin
persons at epigastric
area

M.
MUSCULOSKELETA
L SYSTEM
 MUSCLES
1. Muscle size and Inspection Proportionate to the Proportionate to the Normal
comparison on the other body; even in both sides body; even in both sides
side

2. Fasciculation and Inspection No fasciculation and Has no fasciculation and Normal

tremors in the muscles tremors tremors

3. Muscle tonicity Palpation Even and firm muscle Weak muscle tone Abnormal, possibly
tone related to the amount of
food that patient is
eating.
He has loss of appetite
and weakness because of
metastasis of cancer cells
in the bone.
 JOINTS

1. Joint swelling Inspection No swelling, no warmth, No swelling, no warmth, Normal

no redness, no pain, no no redness, no pain, no
crepitus crepitus
N. EXTREMETIES Inspection, Palpation No swelling, no warmth, No edema, but has pain. Deviation from Normal
no redness, no pain. Bone pain is a symptom of
(+) bone pain, in, pelvis a more advanced stage of
down to the lower prostate cancer. The client
extremities. who has symptoms of
urinary obstruction and
bone pain is likely to have
metastatic disease at
diagnosis.

O. Skin Inspection, palpation Color varies from light to Pale, dry and poor skin Deviation from normal.
deep brown; from ruddy turgor. Due to blood loss and
pink to light pink; from imbalance nutrition.
yellow overtones to
olive; generally uniform
except in areas exposed
to the sun; no edema; no
abrasions or other
lesions; moisture in skin
folds and axillae; temp.
uniform w/n normal
range; good skin turgor.
 FUNCTIONAL
HEALTH PATTERNS
 USUAL
FUNCTIONAL
PATTERN
I. PERCEPTION-
HEALTh
MANAGEMENT
PATTERN
- For him, being healthy is
important. A person is
healthy when he is strong,
he can do what he wants
and does not experience
any diseases.
-he does not have any
regular medical and
dental check-ups.
- he does not have a
regular exercise, instead
he works as butcher
-He has complete
immunization.
-He has been hospitalized
in St. Paul’s Hospital in
May 2010 because of
UTI.
-Has been diagnosed with
DM type 2, 1 year ago.
-Has been already
hypertensive 3 years PTA.
INITIAL ON-GOING ON-GOING ON-GOING
APPRAISAL APPRAISAL APPRAISAL APPRAISAL
(31 August 2010) (01 September (02 September 2010) (03 September 2010)
7am-3pm 2010) 7am-3pm 7am-3pm
7am-3pm
-Admitted on August 28 -Received lying on bed -Received lying on bed on Received lying on bed,
2010, 3:00 pm awake, conscious, supine position, awake, awake, conscious,
-Conscious and coherent, responsive and coherent conscious and coherent coherent with FBC in
able to follow doctor’s with #3 D5LR 1 L at 600 with #4 D5LR 1L place attached to urobag,
order and prescribed ml regulated @ regulated @ 40gtts/min patent, with 80 ml urine.
regimen 40gtts/min flowing well flowing well @ left -able to follow doctor’s
-T=37.9 ⁰C per axilla, @ left metacarpal vein. metacarpal vein order and prescribed
P=84 bpm, regular and -able to follow doctor’s -able to follow doctor’s regimen
bounding, R=27 cpm, order and prescribed order and prescribed  Vital signs
regular and unlabored, regimen regimen (10:00am)
BP=170/100 mmHg  Vital signs  Vital signs T= 37.0 ⁰C per axilla
-Problem: UGIB from (10:00am) (10:00am) P= 80 bpm, regular and
stress bleeding, T= 37.6 ⁰C per axilla bounding
nephrolithiasis, benign T= 37.8 ⁰C per axilla P= 57 bpm, regular and R= 21 cpm, regular and
prostatic hypertrophy P= 80 bpm, regular and bounding shallow
probably malignant with bounding R= 25 cpm, regular and BP=170/1000 mmHg
bone metastasis, UTI, R= 28 cpm, rapid shallow shallow breaths - Vital signs (2:00pm)
complicated breaths BP=160/90 mmHg T= 37.4 ⁰C per axilla
-Three months PTA, BP=160/100 mm Vital signs ( 2:00pm) P=88 bpm, regular and
numbness on his right  Vital signs T= 36.5 ⁰C per axilla bounding
buttocks with weakness (2:00pm) P=60 bpm, regular and R= 22 cpm, regular and
noted. bounding shallow breaths
T= 37.5 ⁰C per axilla R= 20 cpm, regular and BP= 170/1000 mmHg
P=84 bpm, regular and unlabored
bounding BP= 100/70 mmHg
R= 25 cpm, regular and
shallow breaths
BP= 160/100 mmhg
-Has been experiencing -Laboratory results:
Hematuria since May August 28, 2010 Limited ROM
2010. U/A
-has ben experiencing Urine color: yellow
Bone pain in the pelvis Transparency: Clear
down to the lower Specific gravity: 1.005
extremities since june Reaction: 5.0
2010. Albumin: negative
-After confinement in Sugar: Trace
St, Paul’s Hospital, he Pus cells: 1-3/hpf
already stopped RBC: loaded
working because of the August 28, 2010
symptoms and feel CBC
depressed because he Hemoglobin: 93.1
could no longer gms/L
support his family Hematocrit: 0.28
financially and felt that gms/L
he is already a burden WBC: 10.4
to his family. Segmenters: 0.72
- No known allergies to Lymphocyte: 0.28
any foods and drugs. Monocyte: 1.0%
She can eat fish, oyster -Medications:
and others. Cefotaxime 1g IV every
-Does not experience 8h
any accidents. - Tranexamic acid
-When he is 500mg IV every 8
experiencing something hours
wrong in his body, he - Tramadol 50mg IV
does not tell it every 8h PRN for pain
promptly because - Metoclopramide 1
according to him it is amp IVTT PRN every
tolerable. 4h for vomiting
- he takes a bath once a - paracetamol 300 mg
day and brushes his IVTT every 4h PRN
teeth once a day. for temp greater than
- he washes his hands 38C
regularly but not - Losartan 50 mg 1 tab
always using soap. OD
- hydroxyzine 25 mg 1
tab OD at HS
-When he feels - sucralfate 1g
discomfort in his body pulverized and mixed
he also goes to the in 20 cc water QID
manghihilot because it  IVF=
is available on their
area and it is more # 3 D5LR 1L @40
approachable. gtts/min at left
- A person has a disease metacarpal vein
when he eats little -Chief complaints:
amount of food, when increased urination at
he is weak. night, dysuria, urinary
-Health for him is retention, difficulty
important for proper starting and
functioning. maintaining a steady
- he wears slippers stream of urine, blood
while inside their in the urine and
house. he feels that his painful urination and
hygienic practices are bone pain
adequate, and she feels -ambulatory
clean and neat.
-The patient is a
smoker (2packs a day)
and drinks alcoholic
beverages.
-he denies the use any
illicit drugs.
-Heredofamilial
disease: DM and
Hypertension
No food supplements
on diet
Does not perform
testicular self-
examination
Use herbal medicines
such as guava leaves for
minor illneses.
Childhood illnesses:
chicken pox, measles,
mumps
11. NUTRITIONAL- -“tikang han -Full diet at lunch -Full diet: served and -Full diet: served and
METABOLIC nagkasakit ako ngan time: served and consumed half of the consumed half of the
PATTERN umabat na a khan mga consumed half of the plate with poor plate with poor
-Generally has good simptomas, waray na plate with poor appetite appetite
appetite gud aku gaganahi appetite -Skin warm to touch, -Skin warm to touch,
-he loves to eat pork, pagkaon asya na adto -Skin warm to touch, no edema, D5LR at 40 no edema,
fish and vegetables. nga nagtikang na an no edema, gtts/min
akon paggasa” D5LR at 40 gtts/min
-he is not choosy when D5LR at 40
it comes to any cook -DAT gtts/min
and kind of food. -With # 3 D5LR 1 L
-he eats 3x a day running at 40 gtts/min
-he does not eat any
junk foods. -has problem with
-No food or eating ability to eat but has
discomfort poor appetite
-No food supplement -Skin is warm to touch,
no edema.
-Dental caries visible
-(+) pain on the pelvis
“mahilig ako
magkinaon baboy ug Fluid intake:
tambok kay siyempre 7-3
amu man gud tak
pakabuhi, pag inihaw Water= 300 cc
babaoy pero parakaon IVF= 320 cc
gyap ako utan ngan
isda”
-Usual food intake
Breakfast: 2 cup of
rice, fish
Lunch: 2 cups of rice,
adobong baboy
vegetables
Dinner: 2 cups of rice,
prito nga baboy,
vegetables, banana
he drinks 8 glasses of
water a day.
-For him, the amount
of food she consumes is
adequate.
-During snack time, he
usually eats banana
because it is affordable
and readily available in
their place.
Usual fluid intake:
1 cup of coffee, not
fond of drinking milk,
8 glasses of water
-when symptoms
started after
confinement in St.
Paul’s Hospital 3
months PTA, he no
longer eats
appropriate amount of
food.
“tikang han baga
naabat na ako hin
malain ha ak lawas
mga 3 kabulan antis ak
maconfine nganhi,
baga dire na ako gin
gaganahan pag kaon,
didto nagtikang an
akun pag ginasa ngada
yana”
- According to him, she
usually eats 4 spoons of
rice with sabaw. It is
due to her illness
III. ELIMINATION -Previous
PATTERN hospitalization May -Bladder still distended; -Bladder still distended; -Bladder still distended;
- he defecates once a 2010 ( St.Paul’s presence of percussed presence of percussed presence of percussed
day and sometimes he Hospital-Tacloban abdominal dullness abdominal dullness abdominal dullness
feels pain and City- Urinary tract Total urine Total urine Total urine
difficulty. Infection) output: output: output:
- according to him the -“nagtikasakit na pag
characteristic of her 7-3= 350 ml 7-3= 450 ml 7-3= 4000 ml
naihi ako tas pirme pa
stool is hard, dry and gud ako naihi hi gab.e -Urine: yellow, clear -Urine: yellow, clear -Urine: yellow, clear
colored dark brown. pero talagudti la.”
-She feels pain at her -defecated once, dark -has not defecated -defecated once, dark
abdomen on the -“danay naman pirme brown stool brown stool
prme aku naihi pero -perspires moderately.
hypogastric and
umbilical area. talagudti la” -perspires moderately. -Bowel sounds: 6 bowel -perspires moderately.
She urinates 7x a day -“tapos danay dire na -Bowel sounds: 7 bowel sounds per minute -Bowel sounds: 7 bowel
and feel pain and gud ak nakakakihi” sounds per minute sounds per minute
difficulty urinating,
has frequent urinating -“didan mga katapusan
at night, reduced force nah an May, napansin
and size of urinary ko na nga mayda na
stream and a sensation dugo pag iihi ko, didto
of incomplete bladder na nagtikang, tas
emptying and postvoid ngada yana”
dribbling 3 mos PTA -“ Chief complaints:
-He observed blood in dysuria, oliguria and
the urine (hematuria) hypogastric pain,
when starting the urine Abdominal distention,
stream 3 mos PTA.. bone pain, hematuria
-Previously her
defecation pattern is
daily, but when her
condition exacerbated,
it is also affected.
Last urination: patient
no longer remember
Last BM: 2 days PTA
-Percussed abdominal
dullness.
-did not defecate
-charged nurse has
done procedures to
induce voiding, i.e,
alternate hot and cold
application over the
hypogastric area
 U/A
Urine color: yellow
Transparency: Clear
Specific gravity: 1.005
Reaction: 5.0
Albumin: negative
Sugar: Trace
Pus cells: 1-3/hpf
RBC: loaded
 Perspires
moderately
 IV. ACTIVITY- - Problem: bone - Received lying - Received lying - Received lying on
EXERCISE pain (lower supine on bed, supine on bed, awake,
PATTERN extremities), conscious conscious conscious
 Occupation: weakness - No progress noted - No progress noted - Needs assistance
butcher (parag - About 3 months on condition on condition in performing
ihaw baboy- PTA, patient noted ADLS
- needs assistance - Needs assistance
 He does not have pain on the pelvis when going to the in performing - Entertains himself
routine exercise radiating bathroom ADLS by talking with
except his work downward to the significant others
lower extremities. - Perceived ability - Loves chatting
 “dire man ako for: with other people and visitors
mahilig mag - 1 month PTA, the and with - Weakness and
exercise, nag iihaw pt noted weakness - “Binhod gihapon
siya (knees)” significant others. bone pain is still
gudla ak baboy tas on his extremeties present
kun waray ngani, making him - ambulatory - Vital signs
adi la ako ha balay unable to walk (10:00am) - Vital signs
- Frequent - T= 37.6 ⁰C per (10:00am)
napahuway pero without
talking/chatting axilla - T= 37.0 ⁰C per
danay naglilimpyo assistance..
with significant - P= 57 bpm, axilla
aku ngan ako an - Persistence of others and other regular and - P= 80 bpm,
naglulutlo ha condition medical bounding regular and
balay ngan prompted this personnels. - R= 25 cpm, bounding
mahilig ako admission
magkinita tv.” - Vital signs regular and - R= 21 cpm,
- Needs assistance (10:00am) shallow breaths regular and
 he loves to watch
in performing - T= 37.8 ⁰C per - BP=160/90 mmHg shallow
Tv programs
usually in the ADLS axilla - BP=170/1000
afternoon. - ambulatory - P= 80 bpm, mmHg
 Sometimes he likes regular and
to converse with bounding
his friends and - R= 28 cpm, rapid
neighborhood.
shallow breaths
- BP=160/100 mm
- When he cleans, - Vital signs: - Vital signs - Vital signs - Vital signs
it is usually for 1 (2:00pm) - ( 2:00pm) (2:00pm)
hour because he - -T=37.9 ⁰C per
axilla, P=84 bpm, - T= 37.5 ⁰C per - T= 36.5 ⁰C per - T= 37.4 ⁰C per
gets easily tired.
- -When after the regular and axilla axilla axilla
chores are done bounding, R=27 - P=84 bpm, - P=60 bpm, - P=88 bpm,
he will rest and cpm, regular and regular and regular and regular and
watch television. bounding bounding bounding
unlabored,
- -However, he is - R= 25 cpm, - R= 20 cpm, - R= 22 cpm,
aware that his BP=170/100
mmHg regular and regular and regular and
activity is not
shallow breaths unlabored shallow breaths
enough, and he
recognizes the - BP= 160/100 - BP= 100/70 - BP= 170/1000
importance of mmhg mmHg mmHg
having regular - -Limited ROM
exercise.
- -After
confinement in
St, Paul’s
Hospital, he
already stopped
working because
of the symptoms
and feel
depressed
because he could
no longer support
his family
financially and
felt that he is
already a burden
to his family.
 V. SLEEP- REST - he is experiencing - he is experiencing - he is experiencing - he is experiencing
PATTERN intermittent sleep intermittent sleep intermittent sleep intermittent sleep
disturbance 3 disturbance 3 disturbance 3 disturbance 3
- Sleeps about 6-8
mos PTA because mos PTA because mos PTA because mos PTA because
hours a day (9pm
according to him, according to him, according to him, according to him,
to 5am), claims to
he started he started he started he started
have tight sleep
experiencing the experiencing the experiencing the experiencing the
with dreams
symptoms symptoms symptoms symptoms
- Usually naps 30 (frequent (frequent (frequent (frequent
minutes to 1 hour urination at urination at urination at urination at
every afternoon night) and bone night) and bone night) and bone night) and bone
pain pain pain pain
- The patient
regularly sleeps - After that he - After that he - After that he - After that he
at 8:00pm and feels that his feels that his feels that his feels that his
wakes up at sleep and rest is sleep and rest is sleep and rest is sleep and rest is
5;00am pm. inadequate inadequate inadequate inadequate
- Generally rested already. already. already. already.
after sleep as
claimed
- No sleep onset
problems
- No sleeping aid
used.
- Usually no
nightmares
- Somnolence: (-)
- No bedtime
rituals
- They have a
separate room
from their
children.
- he is experiencing
intermittent sleep
disturbance 3
mos PTA because
according to him,
he started
experiencing the
symptoms
(frequent
urination at
night) and bone
pain
- After that he
feels that his
sleep and rest is
inadequate
already.
 VI. COGNITIVE-
PERCEPTUAL - has slight difficulty - has slight difficulty
PATTERN - has slight difficulty - has slight difficulty hearing but no hearing but no
- The patient is an hearing but no hearing but no hearing aids used. hearing aids used.
highschol hearing aids used. hearing aids used.
- Responsive to - Responsive to
graduate - Responsive to - Responsive to verbal stimuli verbal stimuli
- he can read and verbal stimuli verbal stimuli
write properly. - lean towards the - lean towards the
- he is aware to - lean towards the - lean towards the speaker when speaker when
different people speaker when speaker when listening listening
or happening listening listening
- Does not wear - Does not wear
around him. - Does not wear - Does not wear eyeglasses. eyeglasses.
- he can talk eyeglasses. eyeglasses.
properly. - Still able to - Still able to
- During the - Still able to - Still able to remember things remember things
interview his remember things remember things easily easily
voice is weak. easily easily
- Speaks clearly, - Speaks clearly,
- has slight - Speaks clearly, - Speaks clearly, words are coherent words are coherent
difficulty hearing words are coherent words are coherent and responses are and responses are
- leans forward to and responses are and responses are relevant to relevant to
the speaker when relevant to relevant to questions asked questions asked
listening questions asked questions asked
- Oriented to time, - Oriented to time,
- Responsive to - Oriented to time, - Oriented to time, date and place date and place
verbal stimuli date and place date and place
- Problem: dysuria - Problem: dysuria
- Does not wear - Problem: bone - Problem: bone
eyeglasses pain and weakness pain and weakness
and dysuria
- Still able to
remember things
easily
- Speaks clearly
and with
relevance
- Oriented to time
and place
- According to him
he is sensitive to
the feelings of the
people around
him.
- There are no any
blockages of
communication
noted except
slight hearing
problem.
- he is not always
reading any
books like pocket
books.
- he can express his
feelings
appropriately.
 VII. SELF-
PERCEPTION- “malipayon nala ak yana - Entertains himself - Entertains himself
Verbalize goal as
SELF- nga atleast adi tak by talking to by talking with
“nabibidu gud ako yana
CONCEPT pamilya para akon per significant others bantays
kay dire na ako
PATTERN okay danay nadire ako
nakakatrabaho, dire na - sometimes he is - Shares about his
- Sees himself as a nga maging pabigat para
ako nakakabulig tak depressed and sad personal experiences
good husband and ha ira kay siyempre ako
pamilya, waray na ako and feelings
father to his family. gud an padre de pamilya” - irritable.”
gamit yana, nag iinampo
He attends to the
na la ako nga unta gad
problems of her
maupay na ako, nahadlok
wife and children.
ako ura ura kun anu an
- Claims that his mahihitabu akonm, kun
focus is in his mauupay pa ba ako o dire
family, that he will na, kairu man tak
able to provide his pamilya”
family a good life.
- Claims to be praying
- Describes self as at all times, thanking
simple, he gets God for all the
happy with simple circumstances he
things and thank experience
God for all the
- Thankful that as his
blessings as well as
family members are
the obstacles he
there to attend to his
face.
needs.
- Verbalized health
goal as staying
healthy all the time
including all family
members, “ gusto
ko hadto nga permi
la ak makusog para
makatrabaho pa ak
hin maupay ngan
matagan ko
maupai nga
kinabuhi tak
pamilya”
- Has no problem about
self
- Religious affiliation:
Roman Catholic and
an active member of a
Catholic organization
- he is contented with
his family life now
- Does not get angry
easily
- Close to his family
- According to him
there is something
wrong in his health
and body when he
began experiencing
symptoms.
- As a father, he
sometimes feels sad
because he cannot do
the previous things
like working and
bonding with his
family.
- According to his wife
he is a good father
and a good husband.
- His strength is his
family, when there are
any circumstances
that involving any
family member he is
concerned and make
some moves.
 VII. ROLE-
RELATIONSHIP
PATTERN - Claimed that family - Family stays at the - Family stays at the - Family stays at the
- he was the third child is supportive to him bedside attending to bedside to attend to bedside to attend to
in his family. his needs his needs his needs
- he is married to rita - Significant others
- Visitors from their
and they have 3 stay the bedside - Is cooperative in all - Is cooperative in all
place came to check
children. attending to his him nursing procedures nursing procedures
- he is performing the needs
typical responsibilities - His eledest son - Interacts with Dr. - Interacts with Dr.
of a husband - Entertains himself attend to his needs Navales every Navales every
- His children have a by talking to his except for his rounds. rounds.
good relationship to wife youngest daughter
her. who is studying in
- he is being cared by - Thankful that all catarman
his children who are family members are - “nagpapasalamat
very supportive to there. gud ako kay adi tak
him. asawa pati anak
- He is a good husband, pero nasasayang
he is a provider who ako kay dire ako
does everything for makakakadto ha
the family to have Catarman kay
food. capping han akon
- -Language used: anak fa sabado.”
waray
- Claimed to have a
good relationship with
wife and children.
- Decisions are made
collaboratively
- he has a harmonious
relationship with his
brothers and sisters.
Whenever there are
any problems, they
are helping each
other.
- he can form a healthy
relationship with
others.
- he is the person who
chooses his friends.
- he does not have any
enemies.
- Claims to have much
stronger relationship
with God and with his
family as time goes by.
- Close to his neighbors,
has a lot of friends as
claimed.
 IX. SEXUAL-
REPRODUCTIVE
PATTERN - wife attends to his - wife attends to his - wife attends to his - wife attends to his
- he engaged in sexual needs needs needs needs
activity to his wife - wife sits right next - wife sits right next - complained of pain - complained of
only. to her and held his to her and held his on the pelvis and hematuria
- he dresses hands in the room hands in the room lower extremities
appropriately, based on
his gender. - problem: bone - problem: bone
- Claimed sexual pain, weakness, pain, weakness,
relationship with wife dysuria, hematuria dysuria, hematuria
was better during their - -bladder distention - -bladder distention
younger years
noted noted
- Claimed to have been
satisfied with married
life.
- TSE: (-)
- Has 3children
 X.COPING-
STRESS
TOLERANCE - Talks with his wife - Family members - “danay baga’t - family members
PATTERN for concerns stay at bedside to nanluluya lugod ak staying at bedside
- Whenever he has regarding attend to his needs. pagdugang dinhe to attend to his
problem, he asks hospitalization hospital pero kay needs.
- Patient showed
guidance from our kinahanglan man - Lifts up all
- Son and wife are strong will and
Lord para maupay” problems to God.
there at the bedside determination.
- he watches television attending to his - Entertains himself
and drinks alcoholic needs by talking with
beverages and smoke significant others.
(2packs a day) as his - Significant others
stress management. involve actively in - wife is very
- When he gets mad, he the nursing supportive and
shows it and express procedures. caring
it. - “bahala na hi Lord
- Decisions are made ha akon, pero unta
collaborative with gad buligan pa ak
family members niya para
problem makabulig pa ak
- Not taking any tak mga ank, an usa
medication when ko nga anak wa pa
problematic mag graduate”
- Takes time to rest and
eat when under stress
- Verbalized feeling
safety when in
hospital
- Manage pain by
ignoring and sleeping
- Contented with
himself and family
 XI. VALUE-
BELIEF PATTERN
- he is a Roman - Believes that God - “hi lord nala bahala - Claimed to be - Believes that God
Catholic loves him akon.” praying at all loves him
- he attends mass time to thank
- Believes that - Believes that
occasionally. God for all the
religion is religion is
- he always ask the blessings.
important and that important and that
guidance of our Lord - claimed that his
one must hold one’s one must hold one’s
- Whenever there are wife prays the
faith faith
Christian events, like rosary every
Holy week, he - Prayed before afternoon - Prayed before
participates in the eating eating
activities like fasting. - Always mentions - Always mentions
- he believes in ghosts, God in some of God in some of
and elementals. responses responses
- he seldom reads the
bible.
- Does not always pray
the rosary.
- he respects and obeys
his wife
- Considers his family
and God as the most
important in his life
- Roman Catholic
- Goes to church every
Sundays
- Believes that God in
his Provider and
draws strength from
God in all His
problems.
Anatomy and
Physiology
 The Male Reproductive System
 The purpose of the organs of the male reproductive system is to
perform the following functions:
 To produce, maintain, and transport sperm (the male
reproductive cells) and protective fluid (semen)
 To discharge sperm within the female reproductive tract during
sex
 To produce and secrete male sex hormones responsible for
maintaining the male reproductive system.
 How Does the Male Reproductive System
Function?
 The entire male reproductive system is dependent on
hormones, which are chemicals that regulate the activity of
many different types of cells or organs. The primary
hormones involved in the male reproductive system are
follicle-stimulating hormone, luteinizing hormone, and
testosterone.
 Follicle-stimulating hormone is necessary for sperm
production (spermatogenesis) and luteinizing hormone
stimulates the production of testosterone, which is also
needed to make sperm. Testosterone is responsible for the
development of male characteristics, including muscle mass
and strength, fat distribution, bone mass, facial hair growth,
voice change, and sex drive.
 These external structures include the;
 Penis,
 Scrotum, and;
 testicles.

The internal organs of the male reproductive system, also called

accessory organs;
 Epididymis
 Vas deferens
 Ejaculatory ducts
 Urethra
 Seminal vesicles
 Bulbourethral glands
 Prostate gland
 
Anatomy of the Prostate Gland 
 The prostate gland
 The prostate gland is about the size of a walnut and surrounds the neck
of a man’s bladder and urethra - the tube that carries urine from the
bladder.
 It is partly muscular and partly glandular, with ducts opening into the
prostatic portion of the urethra. It is made up of three lobes: a center
lobe with one lobe on each side.
Function of the prostate gland:
 As part of the male reproductive system, the prostate gland’s primary
function is to secrete a slightly alkaline fluid that forms part of the
seminal fluid, a fluid that carries sperm.
 During male climax (orgasm), the muscular glands of the prostate help
to propel the prostate fluid, in addition to sperm that was produced in
the testicles, into the urethra.
 The semen then leaves the body out through the tip of the penis during
ejaculation.
 URINARY SYSTEM
 The principal function of the urinary system is to maintain the
volume and composition of body fluids within normal limits.
 One aspect of this function is to rid the body of waste products
that accumulate as a result of cellular metabolism.
 Other aspects of its function include regulating the
concentrations of various electrolytes in the body fluids and
maintaining normal pH of the blood.
 The urinary system consists of the kidneys, ureters, urinary
bladder, and urethra.

 The kidneys form the urine and account for the other functions
attributed to the urinary system.

 The ureters carry the urine away from kidneys to the urinary
bladder, which is a temporary reservoir for the urine.

 The urethra is a tubular structure that carries the urine from the
urinary bladder to the outside.
 Kidneys
 The kidneys are the primary organs of the urinary system.

 The kidneys are the organs that filter the blood, remove the
wastes, and excrete the wastes in the urine.

 They are the organs that perform the functions of the urinary
system.

 The other components are accessory structures to eliminate the

urine from the body.
 Ureter

Each ureter is a small

tube, about 25 cm long,
that carries urine from the
renal pelvis to the urinary
bladder.
It descends from the renal
pelvis, along the posterior
abdominal wall, behind the
parietal peritoneum, and
enters the urinary bladder
on the posterior inferior
surface.
 Urinary Bladder
The urinary bladder is a
temporary storage reservoir
for urine.
 It is located in the pelvic
cavity, posterior to the
symphysis pubis, and
below the parietal
peritoneum.
The size and shape of the
urinary bladder varies with
the amount of urine it
contains and with pressure
it receives from
surrounding organs.
Laboratory
Analysis
 Normal findings Actual findings Interpretation

Decreased level of hemoglobin

indicates that there is
nutritional deficiency and also
Hemoglobin 140-180 gms/L 93.1 gms/L
seen in cases of iron deficiency
anemia.

Decreased hematocrit indicates

anemia, such as that caused by
Hematocrit 0.40-0.54% 0.28%
iron deficiency
Monocytes

Indicates presence of infection

WBC 5-10x10/L 10.4x10/L

Lymphocytes 0.20-0.35% 0.28% Normal

High monocyte counts usually

Monocytes 0.02-0.08% 1.0%
indicate bacterial infection
 URINALYSIS
Interpretation
Color: yellow Normal

Transparency: clear Normal

Specific gravity: 1.005 Decreased urine specific gravity may be due to Diabetes and renal
problems
Reaction: 5.0 (acidic) Normal

Albumin: negative Normal

Sugar: trace( When you have sugar or glucose in your urine, it often means your blood sugar is
too high, and your blood stream can no longer carry that overload of glucose, and it spills over
into your urine. May be due to diabetes.)
Pus cells: 1-3/hpf(normal)
RBC: loaded (Due to urinary tract infection, kidney and prostate disease.)
Bacteria: few (Bacteria are common in urine specimens because of the abundant normal
microbial flora of the external urethral meatus and because of their ability to rapidly multiply in
urine standing at room temperature.)
 SONOGRAPHIC FINDINGS

Both kidneys are normal in size with bright cortical echo pattern.
No stone, nor mass seen in the right kidney. Multiple renal stones
are seen kidney with sizes ranging from 1.0-1.3 cm. moderate
ectasia is noted on both kidneys. Proximal left ureter is dilated.
Urinary bladder is adequately distended with thickened wall and
with irregular borders. Prostate glands measures about
4.3x7.3x6.2 cm. prostate gland volume of 93.4cc. No prostatic
mass seen. Intact prostate margin.

Impression:
Moderate hydronephrosis on both kidneys
Nephrolithiasis left kidney, Cystitis
Enlarged prostate gland
Bilateral renal parenchymal disease grade 1
Drug
Study
 DRUG ACTION INDICATION DOSAGE CONTRAINDI SIDE NURSING
CATION EFFECT/ CONSIDERATIO
ADVERSE N
REACTION
Paracetamol Inhibitor of the For mild pain or Paracetamol 300 -Product GI: Hepatic -Advised patient to
(acetaminophen) synthesis of Fever. mg IVTT every 4 containing necrosis take medication
prostaglandins hours for alcohol be DERM:Rash exactly as directed
(PGs). The drug temperature avoided. or urticaria and not to take
relieve fever greater than 38˚C more than the
through central -Hypersensitivity recommended
action in the or intolerance to amount
hypothalamic these compound -Advised patient to
heat regulating consult the
center. physician if
discomfort or fever
is not relieve by
routine dosage of
this drug and fever
is greater than 39.5
˚C (103 ˚F)
 DRUG ACTION INDICATION DOSAGE CONTRAINDIC SIDE NURSING
ATION EFFECT/ CONSIDERATION
ADVERSE
REACTION
Losartan It blocks the Hypertension Losartan Hypersensitivity to CNS: dizziness, -Monitor blood pressure
insomnia,
potassium vasoconstrictor potassium drug or its to evaluate drug efficacy.
headache,
and aldosterone- 50 mg 1 components asthenia, fatigue -Assess liver and kidney
secreting effects tablet once a Precautions GI: nausea, function tests and
of angiotensin II; day vomiting, electrolyte levels.
use: hypertension, Use cautiously in: diarrhea,
-Stay alert for oliguria,
• heart failure, dyspepsia,
as a single drug or abdominal pain and renal failure in
in combination renal or hepatic Musculoskeletal: patients with severe heart
with other impairment, joint pain, back failure whose renal
antihypertensives obstructive biliary pain, muscle
function depends on the
disorders cramps
Other: renin-angiotensin-
• high-dose hypersensitivity aldosterone system.
diuretic therapy reactions -Instruct patient to
• black patients including
immediately report
• pregnant or angioedema
hypersensitivity
breastfeeding reactions, especially lip
patients or eyelid swelling, throat
• children younger tightness, and difficulty
than age 18 (safety breathing.
not established).
 DRUG ACTION INDICATION DOSAGE CONTRAINDIC SIDE EFFECT/ NURSING
ATION ADVERSE CONSIDERATIO
REACTION N
Hydroxyzine Competitively Treatment of Hydroxyzine 25 Allergy to any  CNS: -Since drowsiness
blocks the effects anxiety, mg 1 tablet once a antihistamines Headache, may occur with use
of histamine at preoperative day at hours of nervousness of the drug, patients
peripheral H1 sedative, sleep , dizziness, should be warned
receptor sites; has antipruritic tremor, of this possibility
skeletal muscle seizure and cautioned
relaxing, against driving a
bronchodilator,  Respirator car or operating
antiemetic and y: dangerous
analgesic Thickening machinery while
properties. of bronchial taking Hydroxyzine
secretions pamoate. 
 General: - Patients should be
Weight gain advised against the
 Other: simultaneous use of
blurred other CNS
vision depressant drugs,
and cautioned that
the effect of alcohol
may be increased.
 DRUG ACTION INDICATION DOSAGE CONTRAINDIC SIDE EFFECT/ NURSING
ATION ADVERSE CONSIDERATIO
REACTION N
Sucralfate Probaby, adheres accelerating the Sucralfate 1 g Use cautiously in CNS:dizziness, Monitor for
to and protect healing of gastric tablet pulvorise patient with sleepiness, nausea persistent
surface of ulcer and duodenal and mixed in 200 chronic renal and vomiting constipation
by forming a ulcers. cc water QID failure GI: constipation, Tell patient to take
barrier gactrict the maedication on
discomfort, empty stomach 1
diarrhea, dry hour before meals
mouth Instruct patient to
Derm: rash, continue
pruritus prescribed regimen
to ensure complete
healing
 DRUG ACTION INDICATION DOSAGE CONTRAINDI SIDE NURSING
CATION EFFECT/ CONSIDERATION
ADVERSE
REACTIO
N
Cefotaxime Third Generation Treatment of Cefotaxime I g Hypersensitivity Dermatologi - Report immediately
Cephalosporin susceptible IV every 8 hours to cefotaxime, c: Rash, any redness, swelling,
that binds to cell infection in ASNT9(-) any component pruritus burning, or pain at
Gastrointesti
wall membrane respiratory tract, of the nal: injection/infusion site;
causing skin and skin formulation, or Diarrhea, chest pain,
synthesis, structure, bone other nausea, palpitations,
causing cell and joint, urinary cephalosporin vomiting, respiratory difficulty
death; has a tract, gynecologic colitis or swallowing; or
bactericidal effect as well as Local: Pain itching or hives.
at injection
septicemia, and -Maintain adequate
site
documented or hydration unless
suspected instructed to restrict
meningitis. fluid intake.
-May cause diarrhea
Report unresolved or
persistent diarrhea;
vaginal itching or
drainage, sores in
mouth, blood in stool
or urine, easy bleeding
or bruising, unusual
fever or chills); or
respiratory difficulty.
 DRUG ACTION INDICATION DOSAGE CONTRAINDIC SIDE NURSING
ATION EFFECT/ CONSIDERATIO
ADVERSE N
REACTION
Ranitidine(Zant Completely Used in the Ranitidine 500  an alcohol Minor side -Finish the full
course of tablets
ac) inhibits the action treatment of mg IV every 8 abuse effects include
prescribed by your
of histamine on peptic ulcer hours probem constipation, doctor even if you
the H2 at disease (PUD), diarrhea, feel better.
receptors site of dyspepsia, stress  kidney fatigue, -Do not self-medicate
parietal cells, ulcer prophylaxis, disease headache, with aspirin,
ibuprofen or other
decreasing gastric and  liver disease insomnia, antiinflammatory
acid secretion gastroesophageal muscle pain, medicines; these can
reflux disease  other nausea, and aggravate your ulcer
chronic and may make it
(GERD). vomiting.
bleed.
illness Major side - If you get black,
effects are rare; tarry stools or vomit
 an unusual they include: up what looks like
or allergic agitation, coffee grounds, call
reaction to your doctor at once.
anemia, You may have a
ranitidine, confusion, bleeding ulcer.
other depression,
medicines, easy bruising or
foods, dyes, bleeding,
or hallucinations,
preservative hair loss,
s irregular
heartbeat, rash,
visual changes,
and yellowing
of the skin or
eyes.
 DRUG ACTION INDICATION DOSAGE CONTRAINDI SIDE NURSING
CATION EFFECT/ CONSIDERATION
ADVERSE
REACTION
Tranexamic acid Tranexamic acid  treatment of Tranexamic -contraindicated Signs of - prolonged use
(Antifibrinolytic competitively excessive acid 500 mg in patients with potential side carries a risk of
Agents) inhibits bleeding IV every 8 disseminated effects, thrombosis in patients
activation of resulting hours intravascular especially who have an
plasminogen from coagulation blurred vision underlying
thereby reducing systemic or without or other changes prothrombotic state
conversion of local concomitant in vision, -tranexamic acid
plasminogen to hyperfibrin heparin therapy. hypotension, should be avoided in
plasmin olysis -not indicated in and thrombosis patients with acquired
(fibrinolysin), an hematuria caused or disturbances in colour
enzyme that  prophylaxis by diseases of the thromboembolis vision; ophthalmic
degrades fibrin in patients renal m. exam is recommended
clots, fibrinogen, with parenchyma before and during
and other plasma coagulopath therapy if patient is
proteins, y treated beyond several
including the undergoing days
procoagulant surgical -use with caution in
factors V and procedures patients with renal
VIII . insufficiency,
cardiovascular or
cerebrovascular
disease
 DRUG ACTION INDICATION DOSAGE CONTRAINDI SIDE EFFECT/ NURSING
CATION ADVERSE CONSIDERATION
REACTION
Tramadol It is classified as  Moderate Tramadol 50 nausea, -Advise patient not
Hydrochloride an atypical pain mg IV every Acute constipation, to wait until pain
(Opioid centrally acting 8hours for intoxication with dizziness, level is high to self-
analgesic) analgesic, and  Severe pain pain alcohol, headache, medicate; drug will
has opioid and hypnotics, drowsiness, and not be as effective.
 Most types
non-opioid centrally acting vomiting.Some -Advise patient to
of
properties. analgesics, patients who avoid using alcohol
Neuralgia,
Tramadol is a narcotics, received tramadol or other CNS
including
synthetic opioids, or have reported depressants (eg,
Trigeminal
analogue of psychotropic seizures. Abrupt sleeping pills).
Neuralgia.
codeine that has agents; withdrawal of -Advise patient that
weak opioid  Multiple hypersensitivity. tramadol may this medication may
agonist other result in anxiety, cause drowsiness and
properties. It also conditions sweating, to use caution while
inhibits the that result insomnia, rigors, driving or using
neuronal reuptake in severe pain, nausea, heavy equipment, or
of norepinephrine pain to the diarrhea, tremors, performing other
and serotonin as victim. and hallucinations. tasks requiring
do the mental alertness.
antidepressant  Post -Advise patient to
drugs. operative notify health care
pain in provider if pain is
canines. not relieved by the
medication at
prescribed dosage.
 DRUG ACTION INDICATION DOSAGE CONTRAINDICATI SIDE EFFECT/ NURSING
ON ADVERSE CONSIDERATION
REACTION
Metoclopramid Blocks  Treatment Metoclopra Metoclopramide should restlessness, -Assess nausea and
e dopamine  and mide not be used whenever drowsiness, vomiting, abdominal
(antiemetic) receptors in prevention 1 amp. stimulation of dizziness, distention and bowel
chemotherecept of nausea IVTT, then gastrointestinal motility lassitude, and/or sounds prior to and
ors and PRN might be dangerous, dystonic following
Trigger zone of vomiting. e.g., in the presence of reactions administration.
the CNS. gastrointestinal headache, -Assess patient for
Stimulate hemorrhage, extrapyramidal extrapyramidal
motility of the mechanical obstruction, effects such as effects( involuntary
upper GI tract or perforation. oculogyric crisis, movements, facial
and accelerate Metoclopramide is hypertension, grimacing, rigidity,
gastric empying contraindicated in hypotension, trembling of hands).
patients with known hyperprolactinae -Monitor for tardive
sensitivity or mia dyskinesia
intolerance to the drug. leading to (involuntary
Not be used in galactorrhoea, rhythmic movements
epileptics or patients diarrhoea, of the tongue, face,
receiving other drugs constipation, mouth or jaws, and
which are likely to and/or sometimes
cause extrapyramidal depression. extremities).
reactions
Nursing Care Plans
 ASSESSSMENT NURSING BACKGROUND GOAL & NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTION

Subjective Cues; INDEPENDENT 1. to Build trust GOAL

“ kamasakit an akon Altered Comfort; Pain is “an At the end of my 1.Establish Raport. between the patient PARTIALLY MET.
Chronic Pain related unpleasant sensory nursing intervention   and the nurse.  As evidenced by
likod ngan akon
2.pain is always patient report of pain
balakang gin to bony infiltration and emotional the patient will be at a lower intensity
kukurian ngani ako of the tumor to the experience able to verbalizes 2. Reassure patient subjective, only (from scale of 8 to 5)
that you know pain patient can feel the after intervention.
pag kiwa”. back and pelvic area associated with adequate relief of
is real and will pain. “Pero pabalikbalik la
As verbalized by the secondary to actual or potential pain and report assist him or her in   it sakit tak likod ngan
patient. metastatic spread of damage or lower intensity of dealing with it. 3.The tool used to may balakang tikang
Objective Cues; the disease described in terms pain discomfort 3. Use pain identify intensity of pa han June abot
-pain scale of 8 (enlargement of the of such damage; (from 8 to become assessment rating pain. yana nawawara
scale. 4.Comprehensive talagsa pag gin
-Guarding behavior, prostate, BPH). Pain is categorized 3 or less) after tatagan bulong”. As
according to its interventions 4. Assess and assessment of pain
protecting body part verbalized by the
record pain and its used to identify
-restlessness duration, location, implemented. patient.
characteristics: extent of pain. GOAL MET.
-change in blood and etiology. Three Specifically; location, quality,   As evidenced by
pressure (150/90) basic categories of - Demonstrates use frequency, and   patient Uses non-
- Tachycardia pain are generally of new strategies to duration. 5. The goal of these pharmacologic pain
-weakness recognized: acute relieve pain and 5. Teach patient techniques is to strategies as
pain, chronic reports their non- reduce tension, recommended such
-irritability as back rubs, slow
(nonmalignant) effectiveness. pharmacological subsequently
-unable to move breathing,
methods for reducing pain.
pain, and cancer- - Uses pain repositioning
reducing   diversional activities
related pain. medication as pain/promoting   such as music,radio,
Reference; prescribed. comfort ; such   GOAL MET.As
(International as(back rubs, slow   evidenced by patient
Association for the breathing,repositio   uses pain medication in
order to reduced pain,
Study of Pain, ning   such as Cefotaxime an
1979)
diversional activities   antibiotic and Tramadol
such as music, . that has an analgesics
radio). properties.
ASSESSSMENT NURSING BACKGROUND GOAL & NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTION
6. Re-administer pain 6.To assess if the pain
assessment scale. is reduced or need
further interventions
7. Observe or monitor
signs and symptoms 7.Vital signs are
associated with pain, usually altered in
such as BP, heart rate, patient experiencing
temperature, color and pain
moisture of skin,  
restlessness, and  
ability to focus.  
8. Participates in  
activities important to  
recovery (e.g, 8.Help in recovery of
drinking fluids, the patient, thus
coughing, ambulating) preventing
9. Provide rest periods complication
to facilitate comfort,  
sleep, and relaxation.  
  9. The patient’s
10. Monitor the experiences of pain
patient's voiding may become
pattern, watches for exaggerated as the
bladder distention and result of fatigue.
assist with
catheterization. 10.Patient has
11. Provide Warm difficulty urinating,
compresses to the aseptic technique must
pubis or sitz bath may be used in
also helpful. catheterization.
12.Stool softeners are  
provided to ease 11. this may relieve
bowel movements the spasms.
   
12. to prevent
excessive straining
during defecation;
preventing
constipation
 ASSESSSMENT NURSING BACKGROUND GOAL & NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTION

Subjective cues: Impaired - Dysfunction in urine Goal: 1. Monitor intake and 1. Serves as an Goal partially
  elimination At the end of my 3 output. indicator of urinary
Urinary  
met as evidenced
“ dire na gud ako days nursing   tract and renal
Elimination Ref: interventions, the function and of fluid by the client was
nakakakihi,  
talagudti nala an ak related to Nanda 11th edition by patient will be able to   balance. able to achieve
Marilynn E. Doenges achieve normal 2. Alterations may normal
naiihi” as urethra and et.al page 721 2. Monitor vital signs.
verbalized by the elimination pattern   indicate serious elimination
bladder neck   such as able to start problems such as
patient -Due to the location of   pattern but
  obstruction and stop stream, 3. Investigate pain, infection and shock.
the prostate, BPH sometimes still
empties the bladder 3. to assist in
“ kun makaihi man secondary to causes a number of noting location, cannot empty the
urinary symptoms. The completely and be free differentiating
ako, masakit liwat enlarged of bladder distention duration, intensity; between bladder and
prostate is located just bladder
tas may dugo na” as prostate and perceived dullness presence of bladder kidney as cause of
verbalized by the below where the spasms; or back or completely and
bladder empties into the over the hypogastric dysfunction.
patient flank pain. still has slight
urethra (which is a thin area. 4. To note degree of
  tube that carries urine   4. Assess bladder for impairment. distention of the
“ iinihi ihi ako from the bladder, Objectives: urinary retention Palpation and bladder.
talagudti, through the penis, to   through palpation and percussion may
nagsasakit nala outside the body). The Specifically, At the end percussion. induce voiding.
danay tak pus.on enlarged prostate of my 3 days nursing 5.. Encourage fluid 5. To help maintain
kay dire ku man compress the urethral interventions, the intake up to 3000 or renal function and
naiihi ngatanan” as canal to cause partial, patient will be able to: more ml per day prevent infection and
verbalized by the or sometimes virtually   ( within cardiac formation of urinary
complete, obstruction -participate in stones
patient of the urethra, which
tolerance)
  measures to 6. Apply alternate hot 6.Nonpharmacologic
interferes the normal
Objective cues: correct/compensate and ice packs over the al regimen to induce
flow of urine. It leads to
  with the defects. hypogastric area. voiding.
symptoms of urinary
Problem: Bone hesitancy, frequent -demonstrate 7. Provide enough
7.In addition to the
behaviors/techniques to effect of an enlarged
pain, dysuria, urination, dysuria time for bladder prostate on the bladder,
(painful urination), prevent urinary
hematuria and emptying (10 stress or anxiety can
increased risk of infection. inhibit relaxation of the
urinary retention - free from signs of
minutes).
  urinary tract infections,   urinary sphincter.
and urinary retention complications like Sufficient time should be
infection and shock   allowed for micturition
 ASSESSSMENT NURSING BACKGROUND GOAL & NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTION
Diagnosis: Reference: 7. Provide enough 7.In addition to
http://en.wikipedia. time for bladder the effect of an
UGIB from org/wiki/Benign_pr emptying (10 enlarged prostate
stress bleeding, ostatic_hypertrophy minutes). on the bladder,
benign prostatic   stress or anxiety
hypertrophy  
can inhibit
 
probably   relaxation of the
malignant with   urinary sphincter.
bone metastasis,   Sufficient time
UTI complicated   should be allowed
  for micturition
8. Instruct the client 8. Impacted stool
in ways to avoid may place
constipation or pressure on the
stool impaction bladder outlet,
  causing urinary
retention.
9. Emphasize the 9. To reduce the
importance of risk of infection
keeping the and/or skin
perineal area clean. breakdown.
Reference:
Nanda 11th
edition by
Marilynn E.
Doenges et.al
page 721
www.scribd.com/d
oc/12232424/Nur
singCribcom-
Nursing-Care
ASSESSSMENT NURSING BACKGROUND GOAL & NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTION

Subjective Cues; GOAL

“ Dire ako At the end of my INDEPENDENT PARTIALLY
Fatigue related to An overwhelming 1.Assess for pain
nakakalakat bisan nursing intervention Pain restricts the MET.
poor physical sustained sense of the Patient will be before activity and
pag kakadto ha client from achieving As evidenced by
condition secondary exhaustion and able to verbalize the present treatment a maximal activity after all the
banyo pag-iihe ky regimen.
masakit akon boto ha to metastasis of decreased capacity having sufficient level and if often intervention
cancer cells in the for physical and energy to ambulate   exacerbated by implemented the
likod ngan may
balakang.” back and pelvic mental work at and movement. patient verbalized
complete desired 2.Assess -This method allows the amount of fatigue
“Nanluluya ako bone which causes usual level. characteristics of
activities. the nurse to compare is reduced with the
waray ako lakas pain. fatigue:
  changes in the used of distruction
himuon it mga Reference; o Severity patient’s fatigue level technique such as
burohaton ky dara it Specifically; o Changes in
nursingcareplan.   over time (controlled
akon gin aabat.” severity over time   breathing, imagery,
  blogspot.com -Demonstrate o Aggregating
technique to reduce   and use of music).
As verbalized by the factors   Also patient
patient. discomfort/ pain o Alleviating factors   ambulate with the
  and be able to 3.Using a -It is important to help/ assistance of
Objective Cues; demonstrate highest quantitative rating determine if the the SO esp. when
- Inability to restore level of mobility scale such as 1 to 10 patient’s level of going to Comfort
energy, even after possible. can help the patient fatigue is constant or Room. But cannot
sleep or rest   describe the amount if it varies over time. accomplish any
-inability to maintain - Demonstrate of fatigue   desired activities
Energy experienced.   because of the pain/
usual level of
management and 4.Encourage client to -use active listening discomfort.
physical activity express feelings
-restlessness provide adequate techniques and help  
rest and sleep. about fatigue. identify sources of
-weakness 5.Assist client with
-Feelings of guilt for   hope.
  ADLs as necessary;  
not keeping up with (e.g., Assist client
  - Encourage
responsibilities during ambulation
  independence
- when going to
-Using pain without causing
comfort room). exhaustion.
medication
 
 
ASSESSSMENT NURSING BACKGROUND GOAL & NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTION

Unable to ambulate 6.Evaluate the patient’s - Changes in the GOAL MET.

sleep patterns for person’s sleep pattern As evidenced by
-pain in the back quality, quantity, time may be a contributing patient demonstrate
and pelvis area taken to fall asleep, and factor in the
feeling upon awakening. energy conservation
with the pain scale development of fatigue. technique such as,
7.Place client
of 8. comfortably in bed, semi  -To reduce discomfort sitting instead of
-Guarding fowler’s position. by facilitating proper standing. Also
behavior, protecting   positioning decrease adequate rest and
  risk for fall.
body part. sleep of the patient
8.Assist the patient to -A plan that balances
develop a schedule for periods of activity with help restore energy
daily activity and rest. periods of rest can help needed for desired
  the patient complete activities
 
desired activities
 
 
without adding to levels
of fatigue. GOAL MET .
9. Teach stress-reduction - Anxiety is correlated As evidenced by
techniques/ distruction with increased fatigue.
patient verbalized a
such as controlled  
breathing, imagery, and complaint of fatigue
use of music. -technique to conserve at the moment he
10.Teach strategies for energy. also experiencing
energy conservation   pain. When pain is
such as sitting instead of
standing.
  reduced the amount
11.Monitor the patient’s of fatigue is also
nutritional intake for minimized by using
adequate energy sources -The patient will need medication
and metabolic adequate intake of
(Tramadol 50 mg
requirements. carbohydrates, protein,
  vitamins, and minerals IV every 8hours for
to provide energy pain) to help
resources. reduced discomfort/
. pain.
ASSESSSMENT NURSING BACKGROUND GOAL & NURSING RATIONALE EVALUATION
DIAGNOSIS STUDY OBJECTIVES INTERVENTION
12.Encourage to -to provide
increase fluid hydration
intake
13.Minimize
environmental -Bright lighting,
stimuli, especially noise, visitors,
during planned frequent
times for rest and distractions can
sleep. inhibit relaxation,
  interrupt rest/sleep,
and contribute to
fatigue.