Nursing Practice: Comprehensive Care for Prostate Cancer

This report details the nursing care provided to Mr. X, a patient with end-stage prostate cancer experiencing urinary retention, hematuria, and a urinary tract infection. The report outlines the initial management of urinary retention through catheterization, including considerations for potential complications and evidence-based guidelines for bladder irrigation. It discusses the evaluation of hematuria, including the use of urinalysis and imaging techniques, while also considering the patient's advanced stage of illness. The report emphasizes the importance of bladder drainage and safe discharge planning, providing clear instructions for managing hematuria and preventing complications. It highlights the collaborative, multidisciplinary approach to care, emphasizing the need for integrated treatments and interventions to address the patient's complex needs. The report provides valuable insights for newly graduated nurses and offers a comprehensive understanding of the clinical priorities and interventions involved in caring for patients with advanced prostate cancer.

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Nursing Practise
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Introduction
Prostate cancer is known to develop when there is an abnormal growth of the cells in the
prostate gland that is a rapid division of the cells than compared in a normal prostate which
results in the formation of a malignant tumor. In Australia, prostate cancer has been diagnosed to
be the most common cancer. Most of the people dying of cancer have been found to be the cause
of prostate cancer which is surveyed to be third most common. By the age of 85, one out 5 men
will be diagnosed to have prostate cancer (Day-Calder, 2016). In older men, it has been found to
be the most common one in which 63 percent of the cases in men were diagnosed over the age of
65 years. In the current study, the case is regarding Mr. X who is suffering from prostate cancer
and is diagnosed to be the in the last stage associated with multiple complications. To get
relieved from urinary retention he is being treated with the indwelling catheter.
Mr. X understanding towards the treatment is very poor so he tries to pull out the catheter
frequently. This is the best for the new GRNs for whom it might be interesting on how to provide
the nursing care effectively for such kind of patients and the type of treatment to be given who is
suffering from end-stage of prostate cancer associated with multiple complications. Multiple
radiations and chemotherapy treatment are given to the patient because Mr. X has been admitted
many times as he is suffering from metastatic prostate cancer (Fordham-Barnes, 2014). But this
time he is admitted with other complications like urinary retention, hematuria, and UTI. For
treating this, they have to alleviate the secondary urinary retention to the fibrotic prostate so he
was inserted with IDC.
This is the primary treatment which was started in treating him as the patient was
complaining of the pain in the lower abdomen because of the urinary retention, loss of appetite
due to multiple chemotherapy treatments and radiations, feeling of nausea, and lethargies. Here
the condition of the patient has been identified and accordingly multidisciplinary collaboration of
specialists is required for combining all the expertise so that high-quality integrated treatment
can be achieved. As the choice, of clinical priority collaborative care is the method of treatment
which can focus on meeting these requirements (Gillen, 2014). It would be the great opportunity
for newly graduated nursing students to get knowledge about these integrated treatments and
collaborative interventions. Also, the can know the clinical priorities given to the patient and
their responses along with the alternatives that are focused in this case.

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Critical analysis of the nursing and/or collaborative interventions
The patient Mr. X has been currently admitted for the treatment of Urinary retention and
Hematuria on a priority basis as this is the major problem that is giving pain to the patient
(Haycock-Stuart, et al., 2015). So a number of collaboratively integrated treatments along with
the nursing have been proposed for treating this patient and to get relieved from the pain such as
catheterization, urinalysis, bladder drainage, urinary discharge, and safe discharge.
Initial management of urinary retention
Mr. X has been admitted for urinary retention so as a part of the initial management of
the treatment acute urinary retention has to be managed by carrying out immediate and complete
decompression of the bladder through the process of catheterization. The readily available
standard transurethral catheters have been used which can be inserted easily. The patient has to
be referred to the physician who is trained in the advanced techniques of catheterization
immediately if urethral catheterization is unsuccessful. The other alternative nursing and
collaborative techniques which have to be known by the newly graduated nurses are using of
angulated coude catheter or placement of a firm (Jones-Berry, 2016). While treating, it has to be
noted that some of the potential complications if rapid decompressions arise such as hematuria,
hypertension, and post-obstructive diuresis. However, these complications cannot just be reduced
by gradual bladder decompression and there is no evidence for that.
Hence Mr. X was further recommended for rapid and complete emptying of the bladder.
For patients who are hospitalized will be requiring catheterization for a period of 14 days or less
so nurses should take care and maintain the records of treatment of Mr. X. It is because urethral
catheters impregnated with silver alloy is found to be associated with reduced rates if UTI versus
the standard catheters. By doing catheterization for14 days the patient has shown less discomfort
and bacteriuria. Currently, guidelines that are evidence-based are not available for bladder
irrigation strategies and nurses have to consult the institution on CBI for standard operating
procedures (Lavoie, et al., 2016). Due to the condition of Mr. X, he was advised with the bladder
normal saline irrigation continuously through gravity alone for achieving the pink or clear urine.
The nurse has to meanwhile monitor the color of the urine, patency, any presence of clots, and

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lack of leaking around the catheter and bowel function so that irrigation effectiveness can be
assessed.
Urinalysis
Mr. X has also been diagnosed with gross hematuria along with urinary retention. So he
was initially evaluated by aiming at the outlining of the anatomic origin of the hematuria and
also the genitourinary tract. However, it would be lengthy to go for differential diagnosis since
he was in the setting of illness that is advanced so for uncovering the probable sources it is
necessary for the nurses to go through the history of the patient carefully and has to focus on the
physical examination (MacLaren, et al., 2016). In most of the clinical circumstances, the
hematuria might be progressive and recurrent so it might require quick urologic consultation and
evaluation with the imaging studies subsequently as seen in case of Mr. X. In doing further
treatment, the options such as cystoscopy, retrograde or intravenous pyelography, magnetic
resonance imaging, ultrasonography and or urography and the conventional tomography imaging
that is computed can be carried out.
At present, there are no guidelines that are evidence-based and state that any one of these
suggested tests would be an idea in knowing the treatment. As there are no optimal imaging
modalities all mentioned tests are done for Mr. X. A combination of cystoscopy and CT
urography has been recommended to the patient by many experts for completely evaluating the
entire GU tract (Nuutinen & Rannos, 2013). It has been suggested to the patient by HPM and
urological clinicians that instillation of lidocaine gel intraurethral will improve the control of
pain from moderate to severe by undergoing cystoscopy that is flexible but the comfort does not
improve if there is a delay before the scope of insertion.
In this case the patient is advanced with his illness so as a part of the collaborative
integrated treatment methods it is important to take into consideration the more extensive way of
imaging or the invasive workup which has to be balanced with the goals of patient closely in
terms of care, burden of symptoms, and prognosis overall. The severity of the bleeding and the
facilitate patency of the outflow of the urinary has been assessed immediately by the clinicians as
it is associated with the initial workup. In case of hematuria, the major potential emergency is the
urethral obstruction (Oftedal, et al., 2017). Hence, in this case, the patient is held with the

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therapies of aspirin, drugs related to non-steroidal anti-inflammation, anticoagulation and
antiplatelet conditions. These are the used temporarily for stabilizing the patient. The patient has
been monitored for hemodynamic instability with the fluid infusion intravenously as it is was
indicated to be necessary.
Bladder drainage
The fairly straightforward treatment that is appropriate for the patient Mr. X is the
management of POUR. For avoiding the long-term damage to the integrity and functioning of
bladder it is aimed at decompressing the bladder. The first step is always to go for the immediate
catheterization. Either with the placement of indwelling Foley catheter or within and out
catheterization this treatment can be carried out (Osborne, 2014). However, it is easy to pace the
indwelling Foley catheter but prolonged used of this method is not encouraged as it is associated
with many drawbacks. When compared with intermittent catheterization it is better to go for
indwelling catheters in this patient as it leads to increased rates of UTI.
Urinary discharge
It is very important to make sure that there is a free drainage of urine so that urinary
retention is avoided and ultimately leading to obstructive uropathy. Hence the patient here is
suffering from hematuria so he has been carefully examined for making sure that there is not
retention of urine after the treatment due to the formation of the clot. If the patient is able to pass
the urine comfortably then he should be questioned about the presence of any clots in the flow of
urine and if it is so then he should be asked about the clot size, and the difficulty he faced while
passing through it. Clot retention has been noticed in the patient of Mr. X so the further treatment
is recommended where it required the insertion of three-way Foley catheter which is similar to
that of the standard two-way catheter (Page, et al., 2015). The presence of additional channels
will be allowing the irrigation of the fluid to be passed through the bladder by clearing all the
clots from the bleeding site.
Safe discharge
If the patient is not suffering from any kind of cardiovascular disorders than there is no
reason to be an inpatient that is there would be no evidence of acute renal failure, retention of

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clots, sepsis, not able to take more amount of oral fluids, or social circumstances. After deciding
that now it is safe for the patient to get discharged as he is treated for urinary retention and
hematuria it is very much important in advising the patient with clear instructions on how to
manage the hematuria in occurring again (Parisotto, et al., 2016). So Mr. X was suggested
appropriately and was asked to seek further medical attention if he faces any complications
He has been advised to take a lot of clear fluids so that plenty of urine can be flushed out
through the urinary tract. This would be the best solution in treating hematuria and clear it off
and prevent the formation of any type of clots and problem of urinary retention. In addition to
this, the patient has been advised that if the accumulation of urine in permitted in the bladder
after some point of time due to, for instance, insufficient intake of fluids then he can notice the
darkening of hematuria or passage of small clots (Scanlon, 2014). Then it should be considered
as the sign of worry and has to clear it off in few voidings if he starts taking an adequate intake
of fluids.
Disposition
The catheterization was found to be successful for this patient so he has been discharged
home after being examined with the urology follow up which was noticed to fit into the closed
leg-bag foley system and he was educated in the management of catheter at home. After catheter
therapy for preventing infection, the integrity of the catheter system that is closed is maintained
and it has to be removed as soon as possible (Sinclair, Bowen & Donkin, 2013). It is not required
to use the routine prophylactic antibiotics because its use might promote the resistance and might
lead to further complications.
However, before discharge, a dose of oral antibiotic has been recommended as it was
found to be appropriate for this patient X as the urinary catheters manipulation was excessive in
this patient. If the patient is facing a systemic illness like hypertension, fever, or multiple
comorbid medical conditions then he might require getting hospitalized again as he was facing
multiple complications earlier too so it might lead to decompression (Sprinks, 2014). It is not
necessary that by limiting the urine-emptying and gradual drainage the occurrence of hematuria
after complete bladder emptying is most likely of little clinical significance.
Reflection on future implications

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The current case study is regarding Mr. X who has been suffering from metastatic
prostate cancer and is also associated with multiple complications. The patient has been admitted
with urinary retention and hematuria who has been suffering from severe pain out of these
complications. So here usually I found that diagnosis is self-evident (Van der Berg & Daniels,
2013). The patient was found to be very much uncomfortable in passing the urine and he was
facing difficulty in doing so. However, diagnosing is such conditions are necessary. The history
of the patient is closely examined and the cause of such complications has been identified.
The patient is treated with multiple treatments available such as catheterization, bladder
drainage, urinary discharge, etc. and finally he was relieved from the pain and was discharged.
While discharging he was given necessary advice and suggestions of proper intake of fluids so
that the reoccurrence of this problem will be low in future. It has been found that medications
will play a significant role in treating the patients with urinary retention and hematuria (Vincent,
et al., 2014). Research has been carried out extensively and many of the clinical studies have
supported that as a part of the first line of medical therapy pharmacological agents will play a
role.
Within the staff of nursing, the catheterization of the urinary bladder is found to be an
exclusive procedure of the nurse which will be requiring enough practice and scientific
knowledge has to be performed. It can be explained as the drainage of the urine by introducing
the catheter into the urethra so that it reaches the interior of the urinary bladder. It has to be
handled carefully by the nurses as the improper handling might be a discomfort to the patient.
Accordingly, in the urethra, the length of the stay and the intervals between the process the
urinary catheterization can be labeled as relieving (West, et al., 2017). It has been reported that
among the key complications of the procedure is the urinary tract infection. So, the nursing
practice should be appropriate not to make patients fall into such cases.
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