Alan Jones Prostatic Hyperplasia Patient: A Case Study Analysis

Aetiology and Pathophysiology of Prostatic Hyperplasia

Discuss about the Alan Jones Prostatic Hyperplasia Patient.

The patient in the present case study analysis is Alan Jones, a 60-year-old man, who has been admitted to the healthcare unit for urinary symptoms after being diagnosed with being prostatic hyperplasia (BPH). The patient has a history of type 2 diabetes and obesity. The patient is a regular drinker of alcohol and lives alone. He had been taken to the hospital for surgery and underwent a transurethral resection of the prostate (TURP) with spinal anaesthesia. After remaining in the post-anaesthetic recovery room (PARU) he had been transferred to the ward where continuous bladder irrigation was done with the hep of the three-lumen urethral catheter. Blood clots are present in his urine. The present essay is divided into three main sections. First, the aetiology and pathophysiology of the patient’s presenting conditions have been described. The next section focuses on the underlying pathophysiology of the post-operative deterioration. A nursing management plan is prioritised and outlined accordingly. Lastly, a discussion is done on the inclusion of three members of the interdisciplinary healthcare team who would be involved in the care plan for Alan.

Benign prostatic hyperplasia (BPH) is the medical condition leading the patient to suffer an increase in the prostate size. This increment is non-cancerous and involves hyperplasia of epithelial and stromal cells of the prostate. The result is that the transition zone of the prostate suffers emergence of large and discreet nodules. The increase in the cell number is the distinct feature of this clinical condition (Chughtai et al., 2016).

The aetiology of the clinical condition can be conferred to three main factors; hormones, diet and degeneration. Experts point out that androgens and testosterone play a primitive role in the development of BPH. BPH is the result of a failure in the spermatic venous drainage system, giving rise to the hydrostatic pressure increase. It is to be noted that such failure occurs in men above the age of 50 years (Parnham & Haq, 2013). Studies indicate that diet of an individual has a significant role in the progress of the clinical condition. A negative association with alcohol intake is prominent. Individuals who consume alcohol on a daily basis are at higher risk of developing the condition. Epidemiological data also indicate the relationship between diabetes and obesity, and BPH. BPH can be attributed to being an age-related disease (Parsons et al., 2013).

Pathophysiology of Post-operative Deterioration

When muscular tissues of the prostate are weak due to age and fibrosis occurs in the tissues, BPH is common. The reason is that muscle tissues play a significant role in carrying out thee main functions of the prostate as it is responsible for providing the force for fluid excretion coming from the prostatic glands. With increasing age, myofibres suffer dilations and as they are injured and broken. Regeneration of these myofibres are in a low rate, and thus collagen fibres are used up for the replacement of broken myofibres. Any misrepair makes the tissues weaker, and the functioning is hampered, impairing fluid secretion (Scattoni & Maccagnano, 2017). Accumulation of the fluid is the cause of increased resistance of muscular tissue at the time of dilations and contractions. Muscular tissue fibrosis and fluid accumulation become the primary cause of prostate expansion (Vahlensieck et al., 2015). In the present case, the age of the patient is 60 years, enhancing the chances of elevated testosterone. Further, the patient is an alcohol consumer and suffers from diabetes and obesity.

The patient in the present case has undergone a transurethral resection of the prostate (TURP) with spinal anaesthesia given to him. After undergoing recovery in the post-anaesthetic recovery room (PARU) for 2 hours, he has been shifted to his ward. His urine contains large clots of blood, and a three-lumen urethral catheter is being used for continuous bladder irrigation. His observations include BP 160/90mmHg and Pulse 128bpm which are abnormal vital signs. While the normal reference range for BP is 120/80 mmHg, the normal reference range for pulse is 60-100 bpm (Butcher et al., 2013). According to Bachmann et al., (2014) TURP might lead to blood clots in the urine of the patient due to the healing of the wound suffered at the time of the surgery. If the bladder is irrigated with the help of a catheter, chances are high that urine becomes red due to blood cot and debris that is stopped once irrigation is stopped. A blood clot is a major issue since this might lead to obstruction of the urethra. A wide range of cardiopulmonary and neurologic symptoms suffered by the patient is due to intravascular absorption of hypotonic bladder-irrigating fluids at the time of transurethral resection of the prostate. Since the body absorbs an increased amount of fluid, blood pressure and pulse rate increases. Hypertension is the result of hypervolemia. In patients undergoing this surgery, reflex bradycardia is the response to the increased blood pressure. These two conditions can be noted as Transurethral resection (TUR) syndrome (Teo et al., 2017).

Nursing Management Plan

The role of the nurse in the management of patient conditions after TURP holds much value as continual care is to be ensured in such cases. Comprehensive care is to be delivered as per the needs of the patient on an individual basis. The first nursing priority would be impaired urinary elimination. This is in relation to blood clots and irritation of catheter use. At the time of bladder irrigation, assessment of drainage system and urine output is essential. The rationale is that retention chances are high due to blood clots and spasms in the bladder (Madersbacher, 2017). The patient is to be seated in a normal position for proper passage of urine. Incision and dressing are to be checked on a regular basis as the promotion of wound healing are important. The patient is to be encouraged to void when an urge is felt since voiding with urge is a preventive measure for urinary retention. The second priority would be encouraging the patient to increase fluid intake as tolerated. This is effective in renal perfusion nd adequate hydration (Butcher et al., 2013).

Monitoring vital signs is imperative as there is a need of prompt intervention if dehydration is suffered. If the patient is in a state of confusion or restlessness appropriate guidance is to be provided by the nurse. Anchoring catheter needs special mention as pulling or movement that is improper causes bleeding. Bleeding is to be observed as active bleeding is a concern. The catheter system is to be kept sterile for avoiding sepsis nd infection. Dressings are to be changed regularly for the same reason. Wet dressings are the prime cause of skin irritation as media is gained for bacterial growth (Suskind et al., 2016).

Health care delivery is comprehensive and of optimal standard when an interdisciplinary team comes forward for planning the care of the patient that is person-centred. Apart from the nursing and medical team, three members of the interdisciplinary healthcare team who are to be involved in the care of Alan are a dietician, physiotherapist and counsellor (Collins & Terris, 2016). The patient Alan has been suffering from obesity and diabetes, implying that a proper diet is essential for the patient to recover fast from his present condition. A dietician would aid in this regard. A one-to-one nutrition management would be imperative for the patient. The physiotherapist would be responsible for changing physical movement practices of the patient. A counsellor would help the patient to overcome the depression and anxiety arising due to the operation and its consequences on the emotional front (DiCenso et al., 2014).

Interdisciplinary Healthcare Team

The dietician would be responsible for carrying out an assessment of the requirement of Alan and investigate the treatment options for him after a brief consultation. Research indicates that dietary patterns influence the chronic disease such as diabetes. Patients are to follow a diet chart outlined by the dietician on a strict basis. A collaboration of the dietician with the physician is important since diet chart has a key relationship with the medical treatment process outlined for the patient (Frede & Rassweiler, 2017). A physiotherapist would be the exercise therapist who would promote body movement of alan for optimal energy expenditure required by the patient to stay fit. Physical therapy would go hand in hand with proper food intake. The activity that would be outlined for Alan would consider his BMI and mobility needs. The physiotherapist would also aid in educating Alan about the implications of obesity, as indicated by its medical complications. The patient would be encouraged not to adhere to a sedentary lifestyle (Potter et al., 2016). Counselling is a primitive part of patient care undergoing prostate surgery as negative influence occurs on the individual’s emotions and thoughts. The purpose of counselling is to resolve any doubts arising in the mind of the patient regarding his medical condition. A patient is to be given adequate information regarding the treatment procedure for enabling the patient to be well aware of the consequences they hold. The two main issues arising due to the surgery are decreased sexual function and pelvic floor impairment. Alan needs to be informed about these two concerns of sexual functioning and inconsistent urinary output for better self-management (Bowen et al., 2015).

The above essay described the nursing procedure and underlying medical principles guiding a patient care for transurethral resection of the prostate (TURP). The main causes of the pathophysiology of Bening prostatic hyperplasia are diet, age and hormones. The presenting condition might be complex, owing to a number of changes in the patient’s body. Nursing management for such patients need to focus on impaired urinary elimination, increased risk of volume deficiency, infection prevention and monitoring of vital signs. Comprehensive care for the patient demands the inclusion of other healthcare professionals, namely a dietitian, physiotherapist and counsellor. With the care plan outlined above, it is to be expected that the patient would achieve desired outcomes within the stipulated time frame prior to his discharge.

References

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Bowen, D. K., Butcher, M. J., Botchway, A., & McVary, K. T. (2015). Counseling on sexual side effects from TURP. The Canadian journal of urology, 22(6), 8063-8068.

Butcher, H. K., Bulechek, G. M., Dochterman, J. M. M., & Wagner, C. (2013). Nursing Interventions Classification (NIC)-E-Book. Elsevier Health Sciences.

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Collins, M. A., & Terris, M. (2016). Transurethral resection of the prostate. Kim ED.

DiCenso, A., Guyatt, G., & Ciliska, D. (2014). Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences.

Frede, T., & Rassweiler, J. J. (2017). Management of Postoperative Complications Following TURP. In Practical Tips in Urology (pp. 493-501). Springer London.

Madersbacher, S. (2017). Re: Functional Outcomes After Transurethral Resection of the Prostate in Nursing Home Residents. European Urology, 71(6), 989.

Parnham, A., & Haq, A. (2013). Benign prostatic hyperplasia. Journal of Clinical Urology, 6(1), 24-31.

Parsons, J. K., Sarma, A. V., McVary, K., & Wei, J. T. (2013). Obesity and benign prostatic hyperplasia: clinical connections, emerging etiological paradigms and future directions. The Journal of urology, 189(1), S102-S106.

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of Nursing-E-Book. Elsevier Health Sciences.

Scattoni, V., & Maccagnano, C. (2017). Benign Prostatic Hypertrophy. In Atlas of Ultrasonography in Urology, Andrology, and Nephrology (pp. 281-291). Springer International Publishing.

Suskind, A. M., Walter, L. C., Zhao, S., & Finlayson, E. (2016). MP35-19 baseline functional status predicts postoperative treatment failure in nursing home residents undergoing transurethral resection of the prostate (turp). The Journal of Urology, 195(4), e488.

Teo, J. S., Lee, Y. M., & Ho, S. S. H. (2017). An update on transurethral surgery for benign prostatic Obstruction. Asian Journal of Urology.

Vahlensieck, W., Theurer, C., Pfitzer, E., Patz, B., Banik, N., & Engelmann, U. (2015). Effects of pumpkin seed in men with lower urinary tract symptoms due to benign prostatic hyperplasia in the one-year, randomized, placebo-controlled GRANU study. Urologia internationalis, 94(3), 286-295.