NRSG258 Acute care Nursing1; A Case Study on BPH

This case study focuses on providing the best care post- surgery for BPH, taking considerations of pathophysiology and deterioration of health after operation. The aetiology of the disorder together with three members of the interdisciplinary healthcare team who can be involved in the care for Peter will also be discussed.

Running Head: BPH 1
NRSG258 Acute care Nursing1; A Case Study
Student’s Name
Institutional Affiliation

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Introduction
“Benign prostatic hyperplasia is a noncancerous enlargement of the prostate gland
characterized by stromal and epithelial cell hyperplasia,” (Drucker, 2012, 1st Paragraph
Introduction). BPH is a histological condition that may or may not be linked to any symptoms.
For a diagnosis of BPH, there must be evidence of benign prostatic enlargement (BPE) and lower
urinary tract symptoms (LUTS) (Chapple & Tubaro, 2013). Transurethral Resection of the
Prostrate (TURP) is the most recommended treatment for BPH. Peter Harris takes a transurethral
resection under anesthesia after he is confirmed to have BPH via urinary symptoms. Peter is an
elderly man (72 years) and is alcoholic. He has a health history involving Types 2 Diabetes and
Chronic Obstructive Pulmonary Disease (COPD). The nurse is obliged to provide care after the
surgery before Peter’s discharge from the hospital in two days. This piece of study is going to
focus on providing the best care post- surgery, taking considerations of pathophysiology and
deterioration of his health after operation. The aetiology of the disorder together with three
members of the interdisciplinary healthcare team who can be involved in the care for Peter will
also be discussed.
LUTS are highly presented in an elderly age with men being the worst affected. It is
estimated that one out of four of men older than forty years are affected by LUTS. The irritating
symptoms of the disorder lead to a low quality life for its subjects. It was initially thought that
the enlargement of the prostrate was the only factor for LUTS. However, with the present
research there have been factors identified that are believed to be the factors for development of
benign prostate enlargement (hyperplasia). These factors include, age, hormones, growth factors,

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swelling as well as lifestyle. Many men show storage and voiding symptoms with the latter being
more common and the former being more frequent.
As already stated, BPH is a histological condition that may or may not be linked to any
symptoms. The pathogenesis of the disorder is not precise. The disease affects specifically
human in a whole clinical appearance (Roosen et al., 2013). A variety of possible factors that
interrelate with the pathogenesis of the disease include, androgens and estrogens disproportion,
hyperinsulinemia and hypercholesterolemia which promote the glandular development and
autosomal dominant inheritance. The bladder developing diminished submission leads to voiding
difficulties. The storage symptoms are because of electric unpredictability of the hypertrophied
detrusor muscle plus the amplified recruitment of the mute afferent fibers (Roosen et al., 2013).
Age is the increased factor for LUTS and aging. 50 % of all men above the age of 60
show histological BHP. There are two growth cycles of prostate gland in a man’s life. The first
cycle is at puberty where the prostate grows double its size while the other one at the age of 25
which goes on growing as age advances. BPH is common in the second cycle of growth (above
age 25) (NIDDK, 2018). What happens is that due to the increased growth with age, the prostate
gland squeezes the urethra. Walls of the bladder become thicker and that ultimately leads into a
weak bladder with diminished ability to empty. In that case, urine is left in the bladder. For Peter
who has T2DM, the retention is more pronounced. BPH results from the narrowed urethra and
retention of urine ensuing from incapability to empty the bladder (McVary & Welliver, 2016).
BPH is not manifested in men whose testicles have been removed. That leads to the
assumption by scientists that testicles is among the factors for BPH (NIDDK, 2018).
Again, hormonal imbalances is another factor. BHP is thought to be as a result of
increased amount of estrogen in the blood (a female hormone) with decreased testosterone that

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comes with age. High levels of estrogen within the prostate upsurges the activity of substances
that endorse growth of cells. Moreover, dihydrotestosterone (DHT) is a male hormone that
serves the purpose of promoting development of the prostate gland. When the testosterone
production goes down, older men continue to produce and accumulate DHT in high levels. This
results in uncontrolled enlargement of the gland from increased growth of prostate cells
(NIDDK, 2018).
Lower urinary tract symptoms that show because BPH include increased frequency in the
rates of urination, the inability to hold urine, problems to start a urine stream, weakened stream
of urine, urination with dribbling, urinating while asleep, retaining urine, inconsistency in urine,
a painful ejaculation or urination, and unfamiliar color and smell of the urine. Because of the
blocked urethra, the bladder becomes overworked when trying to pass urine through blockage
(Kaplan & McVary, 2014). Other factors include T2DM because it causes retention of urine in
the bladder
After TURP, there are various deterioration symptoms that show in all patients. Harris
has types 2 diabetes Mellitus and it has been established that DM require longer medication and
closer check after the TURP surgery. It also leads to poor treatment outcomes (Lin et al., 2017).
Peter Harris manifests several abnormal vital signs after TURP surgery as discussed below;
The normal respiration rate for an adult at rest is 12-20 breaths per every 60 seconds
(Cleveland Clinic, 2018). Peter, however, shows an abnormal and very high respiration rate of 30
breaths per minute (respiratory distress) (Chughtai, Te & Kaplan, 2014). This is without doubt as

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a result of the TURP operation that was performed under anesthesia and the fact that Peter has
COPD. COPD is already a factor because of its shortness of breath symptoms (Mahler, 2017).
The endotracheal suctioning, endotracheal tube and desflurane that occur at the end of anesthesia
impacts respiratory resistance leads to increased breathing rates (Dorsch, 2012). The priority of
care during the management phase of this condition post operation, can be by guiding Peter to
breathe through pursed lips, breath unhurriedly into a capped bag or hands, and holding
breath10-15 seconds per minute. That way Peter will relax and slowly lower the high breathing
rate.
A normal resting pulse rate for any adult is estimated to be between 60-100 beats every
sixty seconds (Agin & Perkins, 2013). Peter shows a 128 bpm per minute to mean that he has an
extremely high pulse rate. The pulse rate could be as a result of the COPD and her low BP. This
is a delicate situation for Peter as blood may not be pumped effectively and considering that he
has low level of oxygen in the body from COPD, the condition is worsened. A quick
management plan involves promoting a convenient environment that is comfortable for him and
facilitating slow breathing since the emotional distress from the surgery can lead to increased
heart rate.
The optimum body temperature for a normal and healthy human being is normally 370C
(Asthana, Sharma, Lal & Singh, 2014). This condition of hypothermia is a common observation
in elderly males that undergo TURP under spinal anesthesia like Peter (Asthana, et al, 2014). It
results from the use of irrigation fluids at room temperature. The priority of care for this matter
should be making sure that the irrigating fluid of the bladder via the three lumen urethral catheter
is warm enough (Asthana, et. Al, 2014). That according to study promotes heat loss.

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Peter’s normal vital signs include a pain score of 0/10. That means that he suffers no pain
after assessment. The pain scale tale runs from 0-10. O means no pain; 10 means extreme pain
(Pain Scale Chart, 2018). That could be because of the spinal anesthesia used during the surgery.
Peter’s safe care involves ensuring the bladder is irrigated properly using warm irrigating
fluid (Asthana, et al, 2014). Also the IV therapy should be checked to ensure it runs at the
appropriate hourly rate of 8. Another safe care 1 hour after operation, is helping ensuring that
Peter urination is running well and no retention.
Peter needs a cardiologist as part of the MDT team Peter Harris has Chronic Obstructive
Pulmonary Disease (COPD). The disorder makes it hard to breathe when at rest or when doing
normal activities (Mahler, 2017). The disease leaves the patient short of breath. It has been
confirmed that it is closely related to heart disease because of its weakening effects on the lungs.
That eventually lowers the oxygen amount in the body (hypoxia) resulting from weakened lungs
and muscle. This puts the patient at a risk position of getting a heart attack or a mild or severe
heart failure. Performing such an operation (TURP) on an old man like Peter without an expert
of the heart and heart related disorders could put Peter at a risk of death. Involving a cardiologist
can minimize the risk as he will ensure he can offer advice and treatment support or in case of an
emergency heart failure or heart attack.
He also need a nutritional advisor and a counsellor. It has been mentioned that Peter is
alcoholic. Introducing a counseling expert will help him stop the overdrinking behavior and
develop a good eating pattern, through professional advice. The nutritionist should follow Peter
closely post discharge. Peter’s drinking behavior cannot make BPH worse. Indeed it is advised

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that a patient should consume a lot of fluids. Alcohol can also help in containing the type 2
diabetes when taken in moderate levels (Domino, 2015). However, eating well is advised for any
patient to enhance a quick recovery and Peter is not doing that. Nutritional advise is therefore of
great importance for Peter’s health in general. He should be made aware of the best diet and the
moderate amount of alcohol to take so that his health cannot deteriorate beyond the current.
A DM expert is an important referral for Peter because of his T2DM condition. This
study noted that a DM patients stay for long before recovery, with higher urine retention rates
and poor results of treatment (Lin et al., 2017). The normal urine output per day is 2L that means
per hour is 167 ml per hour (Linton & Maebius, 2015). Including a DM expert for the recovery
plan of Peter before discharge would be for prevention for prevention of the reoccurrence of the
disorder. A DM expert should introduce Peter to the correct medication that will treat the
disorder thus eliminating chances of urine retention in future. He can also be of help on advising
Peter on how to optimize his alcoholic behavior.
Conclusion
BPH disorder still remain a puzzle regarding its aetiology. Peter could have been
predisposed to it because of the T2DM condition. Peter require the best safe care post operation
to ensure that he recovers from the current condition of BPH. The care plan for Peter should
involve treating or controlling his two conditions of COPD and T2DM as well as alcoholism and
poor nutrition. This requires referrals for the post discharge follow up.

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References
Agin, B., & Perkins, S. (2013). Healthy aging for dummies (p. 58). Hoboken, N.J.: John Wiley &
Sons.
Asthana, V., Sharma, J., Lal, S., & Singh, R. (2014). Effect of irrigation fluid temperature on core
temperature and hemodynamic changes in transurethral resection of prostate under spinal
anesthesia. Anesthesia: Essays And Researches, 8(2), 209. doi: 10.4103/0259-1162.134508
Chapple, C., & Tubaro, A. (2013). Male LUTS/BPH made easy (eBook, 2014) [WorldCat.org].
Retrieved 30 Aug. 2018 from
http://www.worldcat.org/title/male-lutsbph-made-easy/oclc/865476125
Chughtai, B., Te, A., & Kaplan, S. (2014). Treatment of Benign Prostatic Hyperplasia: Modern
Alternative to Transurethral Resection of the Prostate (p. 13). New York, NY: Springer New
York.
Cleveland Clinic. (2018). Vital Signs | Cleveland Clinic. Retrieved 30 Aug. 2018 from
https://my.clevelandclinic.org/health/articles/10881-vital-signs
Domino, F. (2015). The 5-minute clinical consult, 2015 (p. 976). Philadelphia, PA: Lippincott
Williams & Wilkins.
Dorsch, J. (2012). Understanding anesthesia equipment (pp. 133-401). Lippincott Williams &
Wilkins.
Drucker, P. (2012). Treatment of benign prostatic hyperplasia. [Place of publication not identified]:
Springer.
Kaplan, S., & McVary, K. (2014). Male Lower Urinary Tract Symptoms and Benign Prostatic
Hyperplasia (pp. 51-52). Hoboken: Wiley.
Lin, Y., Hou, C., Chen, T., Juang, H., Chang, P., & Yang, P., … Tsui K., (2017). Is diabetes mellitus
associated with clinical outcomes in aging males treated with transurethral resection of prostate
for bladder outlet obstruction: implications from Taiwan Nationwide Population-Based Cohort
Study. Clinical Interventions In Aging, Volume 12, 535-541. doi: 10.2147/cia.s126207
Linton, A., & Maebius, N. (2015). Introduction to Medical-Surgical Nursing (p. 917). Saint Louis:
Elsevier Health Sciences.
Mahler, D. (2017). Breathe Easy (p. 68). Lebanon, NH: University Press of New England.

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McVary, K., & Welliver, C. (2016). Treatment of lower urinary tract symptoms and benign prostatic
hyperplasia (pp. 300-416). Philadelphia, Pennsylvania: Elsevier.
NIDDK. (2018). Prostate Enlargement (Benign Prostatic Hyperplasia) | NIDDK. Retrieved 30 Aug.
2018 from https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/
prostate-enlargement-benign-prostatic-hyperplasia
Pain Scale Chart. (2018). Pain Scale Chart - 1 to 10 Levels. Retrieved 31. Aug, 2018 from
https://www.disabled-world.com/health/pain/scale.php
Roosen, A., Gratzke, C., Herrlemann, A., Magistro, G., Strittmatter, F., & Weinhold, P., … Stief C.
(2013). Ätiologie und Pathophysiologie der benignen Prostatahyperplasie. Der Urologe, 52(2),
186-192. doi: 10.1007/s00120-012-3083-3