Comprehensive Case Study: Acute Care Management of a BPH Patient

This case study focuses on the acute care of a 60-year-old patient, Mr. Alan Jones, who is suffering from urinary symptoms due to Benign Prostatic Hyperplasia (BPH). The report details the patient's medical history, including obesity, diabetes, and alcohol consumption, and his surgical procedure, a transurethral resection of the prostate (TURP). It explores the pathophysiology of BPH, including the role of dihydrotestosterone (DHT), estrogen, and aging, as well as the potential genetic components and the impact of adipose tissue. The study also addresses the risks associated with TURP, such as TURP syndrome, and its pathophysiology, including circulatory overload, water intoxication, and hyponatremia. Furthermore, it outlines the essential nursing management strategies, emphasizing the importance of monitoring urine output, pain levels, and potential complications. Finally, the report discusses the interdisciplinary team involved in the patient's care, including the roles of the OT staff, counselor, and dietician, highlighting the need for comprehensive care to ensure a successful recovery and prevent complications.

Running head: THE ACUTE CARE OF A BPH PATIENT
The acute care of a BPH patient
Name of the student
Name of the University:
Author note:

1THE ACUTE CARE OF A BPH PATIENT
BPH or Benign Prostate hyperplasia is a disease in which the prostate of a male
enlarges in size. The growth is non cancerous and happens because of the prostate stromal
cell hyperplasia. The growth is associated with the proliferation of the smooth muscle,
connective tissue and the epithelial cells present within the transition zone in the prostate
gland.
The report is discussing a case study of a 60-year-old patient, Mr. Alan Jones who
was having urinary symptoms due to the Benign Prostatic hyperplasia (BPH). The patient is
obese and has diabetes Mellitus Type 2. Mr. Jones is also an alcoholic who drinks a bottle of
wine every night. The surgery was performed under spinal anesthesia and the process of the
surgery was transutheral resection of the prostate (TURP). The bladder of the patient is
connected to a three lumen urethral catheter. After his surgery, the patient is reported to have
large blood clots in his urine.
The purpose of the report is to discuss the pathophysiology of his condition and the
reason of the deterioration of the patient. The report also discusses the nursing management
of the patient. The report also justifies the role of the members of the healthcare team.
Albeit, the androgen hormones (testosterone and other related hormones) plays a big
role in BPH development, but it does not directly causes the hyperplasia. The studies reported
that Dihydrotestosterone (DHT), a metabolite of testosterone works as a mediator for the
growth of the prostate (Kim et al., 2013). The metabolite is synthesized within the prostate
because of the reaction of enzyme 5α-reductase as the testosterone circulates within the
prostate. DHT works in the autocrine function in the stromal cells and in the epithelial cells, it
works in the paracrine function (Bostanci et al., 2013).

2THE ACUTE CARE OF A BPH PATIENT
There is a record that estrogen might play a big role in causing BPH. It is estimated
that the estrogen converts to androgen locally in the prostate tissue and initiates the cell
proliferation.
The onset of BPH is mainly age related and it rises markedly with age. It is reported
that the volume of the prostate relatively increases with age. Some theories suggest that the
weakening of the muscular tissue and fibrosis actually causes BPH. The role of the smooth
muscle is actually prevalent in the onset of BPH as the myofibers of the muscular tissue gets
broken because of aging and loses the potential for regeneration (Patel, & Parsons, 2014).
There are some reports that suggested that the onset of BPH has some genetic
component. The study stated that 50% of men who is less than 60-year-old and underwent the
surgery of BPH have inherited the disease. The pattern of inheritance shows that the pattern
of inheritance is autosomal dominant (Haj-Ahmad, Abdalla, & Haj-Ahmad, 2014).
The increased amount of adipose tissues aids in the increase of prostate volume. The
adipose amount is directly proportional to the increase of the prostate volume. The BMI
(Basic Metabolic Index) is also proportional to the onset of BPH.
The activity of the enzymes aromatase and 5α-reductase increases as the males’ age.
These enzymes are responsible for the conversion of testosterone and the other androgen
hormones to dihydrotestosterone and estrogen (Gandaglia et al., 2013). As the testosterone
and the androgen hormone metabolizes, the level of testosterone decreases and the level of
estrogen and DHT rises (Kim et al, 2012). The raised level of estrogen causes the hyperplasia
of the cells. As the median and the lateral lobes of the prostate have glandular composition,
they are enlarged. The anterior lobe of the prostate enlarges less as it has little glandular
structure (Gandaglia et al., 2013).

3THE ACUTE CARE OF A BPH PATIENT
TURP or transurethral resection of the prostrate is the surgical removal of a
part of the prostrate. TURP syndrome is one of the most important risks associated with the
TURP (Uddin et al., 2017). The initial symptoms of the TURP syndrome include a feeling of
dizziness, headache, bradycardia or slow heartbeat and feeling sick. The initial TURP
symptoms if not treated can develop risks that are threatening to life, which may result to
seizures, breathing problem, cyanosis and may even lead to coma.
The pathophysiology of the TURP syndrome includes the circulatory overload, water
intoxication, hyponatremia, toxicity of glycine, ammonia and hypotension. The prostrate bed
that has the venous network and the endometrium are found to uptake small amounts of fluid.
This uptake in the fluid results in the significant decrease in the concentration of the serum
and sodium (Ishio et al., 2015). This in turn results in the increase in the blood volume and
the systolic and diastolic pressure following the failure of the heart. A neurological disorder
is caused due to the increase in the content of the water in brain. This water intoxication also
results in the seizures and coma and the fall in the serum sodium concentration.
The proper functioning of the excitatory cells especially the heart and brain is carried
out by sodium and the decrease in its concentration leads to hyponatremia, which involves
restlessness, confusion and coma (McGowan-Smyth, Vasdev & Gowrie-Mohan, 2015).
The glycine toxicity, which is the result of the TURP syndrome, is threatening to
retina and heart. Acute myocardial infarction may be a fatal outcome in patients who is
suffering from TURP syndrome (De Lucia et al., 2014). The patients with the TURP
syndrome are exposed to bacterimia, septicemia or toxemia where the bacteria may enter into
the circulatory system and lead to a toxic state. The patient temporarily experience severe
chills, fever and hypotension.

4THE ACUTE CARE OF A BPH PATIENT
Patients who are suffering from TURP syndrome need intensive nursing care. It is the
duty of the nurse to maintain the stability of homeostasis, providing comfort of the patient
and preventing the onset of any complication (Frede & Rassweiler, 2017). It is also the duty
of the nurse to provide the information to the patient and his family regarding the prognosis
and the treatment of the syndrome. The nurse must assess the urine output of the patient in
case of impaired urinary elimination. The nurse must also instruct the patient to assume the
normal posture during micturition and carry out a regular check up of the incision and
dressing. It is also the duty of the nurse to observe regularly the loss of excessive blood if
there is any and the initiation of any infection. The nurse must keep a record of the time, the
voiding amount, urgency and the incapability of retaining urine. The patient must encourage
the patient to void if he experiences the urge and follow the instructions that is provided by
the nurse. The nurse should provide the patient with essential information that would help the
patient to deal with his disease. This may also make the patient to return to the normal life.
The interdisciplinary team for Alan Jones who would provide care before his
discharge involves the hospital staff of the OT, a counselor and a dietician. They would play
a crucial role in providing proper care to him before being discharged so that his health
condition gets improved in less amount of time. The nurses in the OT should organize proper
planning of his discharge. Since his urine contains large amount of blood clots, they should
consult the doctor to remove the clot with the help of syringe containing sterile water
containing salt. Since his pain score was 0/10, the staff should keep a check on his pain levels
in a regular manner and provide appropriate medications if required (Heidenreich et
al.,2014). The nursing staff should keep a check and monitor if there are any abnormal signs
and symptoms. They should monitor several health parameters such as respiration rate, blood
pressure, pulse, and temperature of Alan Jones. They should make sure that his health

5THE ACUTE CARE OF A BPH PATIENT
condition is stable enough to discharge him after 2 days. The nursing staff of the OT should
advise him to follow several precautions such as reduced intake of alcohol as he has a
medical history of obesity and diabetes. They should also provide proper follow-ups to the
patient and his son after the surgery to explain the dosage of medicaments that were
prescribed to him. They should provide anti-nausea medicines if he experiences any
symptoms of nausea or vomiting after the surgery. They should be patient while dealing with
him and should follow all the moral values and ethics of nursing profession (Pannick et al.,
2015).
The counselor should interact and make him feel positive to avoid any psychological
issues of distress and anxiety that might occur after the surgery. This will make him
comfortable and improve his trust in the healthcare services provided to him. A dietician
should be appointed for him to follow a nutritious diet, exercise regularly and improve his
social interaction with his family members and friends. Alan Jones can also be provided
physiotherapy sessions and rehabilitation if advised by the doctors (Huri, Akel & Şahin,
2016).
Hence, it can be concluded that several measures after the surgery of Alan Jones that
should be taken by the clinicians and the nursing staff to avoid different types of infection,
injury or accidents .The nurses and the doctors should provide safety to the patient to reduce
the risk of complications, rate of recovery. This will help in reducing the increased stay in
the hospitals and unnecessary deaths of patients. The nursing staff, counselor and the
dietician should provide appropriate care to Alan Jones after the surgery so that he is not
attacked by any kind of infectious agent. They should also monitor his health condition and
provide proper follow-ups to prevent any other signs and symptoms that might occur after the
surgical procedure. The hospital staff should have a responsible attitude and be patient while

6THE ACUTE CARE OF A BPH PATIENT
providing care to him. The hospital management, doctors and the nurses should support him
and his family members.

7THE ACUTE CARE OF A BPH PATIENT
References:
Bostanci, Y., Kazzazi, A., Momtahen, S., Laze, J., & Djavan, B. (2013). Correlation between
benign prostatic hyperplasia and inflammation. Current opinion in urology, 23(1), 5-
10.
De Lucia, C., Femminella, G. D., Komici, K., Rengo, G., & Ferrara, N. (2014). Risk of
Myocardial Infarction in the Pathophysiology and Treatment of Prostatic
Diseases. MYOCARDIAL INFARCTIONS, 77.
Frede, T., & Rassweiler, J. J. (2017). Management of Postoperative Complications Following
TURP. In Practical Tips in Urology (pp. 493-501). Springer London.
Gandaglia, G., Briganti, A., Gontero, P., Mondaini, N., Novara, G., Salonia, A., ... &
Montorsi, F. (2013). The role of chronic prostatic inflammation in the pathogenesis
and progression of benign prostatic hyperplasia (BPH). BJU international, 112(4),
432-441.
Haj-Ahmad, T. A., Abdalla, M. A., & Haj-Ahmad, Y. (2014). Potential urinary miRNA
biomarker candidates for the accurate detection of prostate cancer among benign
prostatic hyperplasia patients. Journal of Cancer, 5(3), 182.
Heidenreich, A., Bastian, P. J., Bellmunt, J., Bolla, M., Joniau, S., van der Kwast, T., ... &
Mottet, N. (2014). EAU guidelines on prostate cancer. Part 1: screening, diagnosis,
and local treatment with curative intent—update 2013. European urology, 65(1), 124-
137.

8THE ACUTE CARE OF A BPH PATIENT
Huri, M., Akel, B. S., & Şahin, S. (2016). Rehabilitation of Patients with Prostate Cancer.
In Prostate Cancer-Leading-edge Diagnostic Procedures and Treatments. InTech.
Ishio, J., Nakahira, J., Sawai, T., Inamoto, T., Fujiwara, A., & Minami, T. (2015). Change in
serum sodium level predicts clinical manifestations of transurethral resection
syndrome: a retrospective review. BMC anesthesiology, 15(1), 52.
Kim, M. K., Zhao, C., Kim, S. D., Kim, D. G., & Park, J. K. (2012). Relationship of sex
hormones and nocturia in lower urinary tract symptoms induced by benign prostatic
hyperplasia. The Aging Male, 15(2), 90-95.
McGowan-Smyth, S., Vasdev, N., & Gowrie-Mohan, S. (2015). Spinal anesthesia facilitates
the early recognition of TUR syndrome. Current urology, 9(2), 57-61.
Pannick, S., Davis, R., Ashrafian, H., Byrne, B. E., Beveridge, I., Athanasiou, T., ... &
Sevdalis, N. (2015). Effects of interdisciplinary team care interventions on general
medical wards: a systematic review. JAMA internal medicine, 175(8), 1288-1298.
Patel, N. D., & Parsons, J. K. (2014). Epidemiology and etiology of benign prostatic
hyperplasia and bladder outlet obstruction. Indian journal of urology: IJU: journal of
the Urological Society of India, 30(2), 170.
Uddin, M. M., Amin, R., Rahman, M. M., Chowdhury, S. M., Khan, M. R., & Islam, M. R.
(2017). Retrospective Review of TURP Done in One Year and Report on
Postoperative Outcome. KYAMC Journal, 4(1), 321-325.