Case Study: Management of Benign Prostatic Hyperplasia (NRSG258, 2017)

This case study presents a comprehensive analysis of a 60-year-old patient, Mr. Jones, diagnosed with benign prostatic hyperplasia (BPH). The assignment delves into the pathophysiology of BPH, detailing how prostate enlargement leads to urinary effects and potential complications like urinary tract infections and kidney stones. It explores the etiology, linking hormonal influences and lifestyle factors like alcohol consumption and obesity to the condition's development. The case study outlines various treatment options, including medication, lifestyle changes, and surgical interventions, while also evaluating the patient's post-operative condition and quality of life. Furthermore, it emphasizes the critical role of nursing management, including active surveillance, personalized care, and interdisciplinary collaboration involving nutritionists, caregivers, and psychologists. The assignment highlights the importance of understanding the disease's progression, providing patient-centered care, and ensuring a holistic approach to improve patient outcomes and quality of life. The case study references multiple research papers supporting the various aspects of the patient's condition and management.

ACU_NRSG258_Sem2_2017
UNIVERSITY:
NAME :
STUDENT ID:
COURSE CODE
COURSE NAME
ASSIGNMENT
Case Study Assessment

ACU_NRSG258_Sem2_2017
P a g e | 2
Introduction
This is a case summary of patient Jones aged 60 years who has been admitted at the
health care hospital with symptom of urinal effects, this led to diagnosis of prostatic
hyperplasia. It is also referred to as benign enlargement of the prostate. Medically it has been
described as non cancerous however it leads to increases in the size of the prostate. The
increase of the size of the prostate is involved in the hyperplasia of the prostatic and epithelial
cells. Medically it leads to increase in cells number rather than the individual size of the cells.
When these cells are large, they push downwards and narrow itself into the urethra which
results in the increase of the resistance received by the urine when being released.
This condition commonly causes resistance to the flow of the urine in the body. This
causes the bladder to work extra function which leads to progressive increase in hypertrophy
and weakness of the muscle mass. When this condition remains at the same state untreated
for long time, it causes recurrent urinary tract infections and at times is a risks factor of
kidney stones.
Presentation of Aetiology and Path physiology of the diseases
BPH involves the stoma and epithelial cells which often arises in the section of urethral
and transition zones on the glands. The growth of hyperplasia causes the enlargement of the
growth and this offers restrictions on the flow of urine.
BHP has been presumed as part of the ageing process among men and is hormonally
reliant on testosterone hormone production in the body. Over 60 % of men have
demonstrated histopathology BHP as they reach the age of 60 years same as for the case of
Mr Jones. The insuring dysfunction of the bladder results in obstruction of the urethra
emptying; this causes lower urinary tract symptoms, (Moore & Gay,2004).
Common observable symptoms as for this patient are the frequent urinary , urgency and
nocturia experience which entails awakening at night, incomplete emptying and intermittent

ACU_NRSG258_Sem2_2017
P a g e | 3
stream force. Often complications have been observed however in fewer cases. this
complications include urinary retention , impaired bladder emptying , renal failure cases and
recurrent urinary tract infections and hematuria, (Rogers et al., 2008).
Causes
Studies have often linked hormones such as the androgens and testosterone which are
related to hormones as part of the cause of this condition. This position has been supported
through experimental trials of castrated men not developing this disease when they continue
ageing. Other linked causes include dieting among men. Studies have shown that dietary
patterns affect the development of the diseases. Studies done in countries like China have
suggests that high protein intake may play crucial role in cancer development and further men
in urban cities consuming animal protein were encountering high prevalence rate, (Lepor,
2010).
As people age benign prostatic hyperplasia tend to be more prevalence, theories such as
disrepair theory have suggests that growth of BPH results from decline of the functionality of
the fibrosis and weakening of muscular tissues of the body, (Lepor, 2011). This essence
provides the important aspect of the functionality of the prostate and excretion of fluid often
produces by the prostatic glands in men glands.
As with patient John in the case study, it is relevant that his lifestyle just reflects the
level of toxicity injected in the cells of the body promoting growth of benign cells
hyperplasia. His lifestyle is that of heavy consumption of alcohol and presence of modifiable
risks factor which is obesity.
Management of the Benign Prostatic Hyperplasia
Treatment options have been offered to manage the condition. These treatment avenues
involve lifestyle management changes which are meant to ensure that medication, self
catheterization and surgery are recommended treatment options available. Medication often

ACU_NRSG258_Sem2_2017
P a g e | 4
used to ensure that benign growth are the use of alpha1 –receptor blockers and 5aplaha
reductase inhibitors which are used to minimise pressure on the urethra and for easier access
and passage of urine. At times this conservative treatment fails; however, surgical removal is
essential for this case. Other alternative medical approaches have been used to manage this
condition such as the use of saw palmetto, however much research has not been put forward
to manage this, (Lepor, 2006).
Underlying Path Physiology of Post Operative Deterioration
Patient Jones in this case study has shown that he is not affected by post surgical
clinical distress by the symptoms. This is clearly demonstrated by the clinical observations of
normal blood pressure, pulse at the rate of 120bpm, temperature slightly below normal at
35.0 degrees Celsius and pain score at 0/10. With the patient state and lifestyle management
he is currently undertaking the disease management condition is likely to deteriorate as he is
being discharge.
The effect of quality of life has often been assed using the quality of life index which
values indicate that less than score of three have shown to illustrate bothersome. Patient’s
often showing obstruction and bothersome symptoms have been categorised into stage I of
the disease, but those with no bothersome symptoms are ranked as stage II have Quality of
Life score of more or equals to 3. Those displaying significant obstruction shave shown to
have been categorised as stage III. There are those with complications of the disease which
include retention of the urine, signs and occurrence of bladder stones, recurrent bleeding, and
infections are termed as stage IV of the diseases, (Pinto et al., 2015).
Nursing Management Skills
For low grade stage disease can be managed through active surveillance by medical
nurse, to monitor for any development of any complications. A high grade stage of the
disease would need a more invasive nursing management, which can entails readmission to

ACU_NRSG258_Sem2_2017
P a g e | 5
surgical process. However for this to take effect there is need to manage the patient age state,
co-morbidity, social economic aspects and the preference values available, (Tanguay et al.,
2009).
As a nurse proper understanding of the disease path physiology and clinical
management of BPH would ensure that better individualised care and person cantered
approach towards its management which often proves a more cost effective approach .
This nursing management technique often assess whether the diseases is life
strengthening, leads to serve obstruction which often causes hydronephrosis, infection
occurrence and immune suppression to the patient which may cause ultimate death. Care
needs to taken with management of bladder, as its damage can be drastic and swift. As a case
such as these, bladder functions can be impaired immensely, this can lead to poor voiding and
occurrence of back pressure changes happening in the kidney, which alters and disrupts other
functions.
Thus watchful modal treatment should be applied with BPH management. As nurse
there is need for watchful waiting and adequate and immediate medical attention being
offered to the patient with regards to the age, and social economic state and other parameters
which are associative to the care process, (Bradway et al., 2013). Hence having a thoughtful
experience and understanding of the path physiology of the disease state is important in
ensuring that the disease is cared through a balanced clinical approach and ensuring provision
of personalized care for the patient.
Interdisciplinary Health Care Team
Nutritionist
With regard to patient Jones state of health there is need to ensure that lifestyle
counselling needs to b e adopted before any discharge is made. The mentioned dietary
behaviour whatsoever would need to ensure that the overload of alcohol consumption and

ACU_NRSG258_Sem2_2017
P a g e | 6
body mass index currently being observed for the patient is high and needs critical
management.
Nutritional counselling needs to be undertaken in order to ensure that there is reduction
in the level of carbohydrates consumed which lowers the obesity level and reduces the
breakdown of fats in the body which are often released as ketones. There are numerous
studies conducted which has enlisted dietary factors and the risks of BPH. These aspects are
confined to how the patient will manage consumption of proteins, high energy intake such as
alcohol and promote consumption of soy products which studies have shown to lower
immensely the prevalence of prostate diseases especially among the Asian population.
Thus basic role of a nutritionist in BPH management is to provide advice on the dietary
management with regards to dietary and lifestyle management of the patients. Patient such as
Jones needs to consider lowering intake of fats and increase the amounts of therapeutic foods
upon discharge as this has shown to improve the care process among the BPH patients.
Caregivers
A care giver plays a crucial role in ensuring that disease management and care of BPH
is followed to the latter. Caregivers have acted as enablers who affect medication behaviour
among aging, (Kusljic et al., 2013). Patient Jones needs a caregiver who will always ensure
that they offer the support needed by the patient in ensuring positive recovery of the diseases.
Studies have shown that older patients with caregivers who are often assisted with medication
care had better health outcomes. Patients with adequate care management were less likely to
experience complaints with respect to medical attention, thus care givers offers the necessary
support both in ward and outpatient care in ensuring that the right medical protocol is adhered
to.
Psychologist’s services
Evidence based care process has observed that usage of useful health care

ACU_NRSG258_Sem2_2017
P a g e | 7
implementation of culturally sensitive health care linked to psychological well being of
patients is essential for care of BPH. The need in hospital psychological help is essential in
ensuring that management state of the patient is stabilized.
Often defining characteristics for this patient involves the occurrence and experience of
residual urine, lower tract infections that may occur postoperatively, anxiety and depressions
symptoms associated with transurethral resection of the prostate.
Thus providing support of these services ensures that the patient cope up with
symptoms and progress of the disease positively and learning how to cope up with it after and
before discharge at the facility.
Conclusion
Patient management care will be thus essential in ensuring care for the patient is
provided. Adequate medical history and care management after surgery is essential in
ensuring that the patients receive essential health care. Proper level of care guarantees
improved quality of life to the patients. Clearly understanding the patho physiology of patient
Jones, assessing his patho physiology and involvement of greater health care team is essential
for his recovery process and positive health improvement.

ACU_NRSG258_Sem2_2017
P a g e | 8
References
Bradway, C., Bixby, M. B., Hirschman, K. B., McCauley, K., & Naylor, M. D. (2013). Case
study: transitional care for a patient with benign prostatic hyperplasia and recurrent
urinary tract infections. Urologic nursing, 33(4), 177.
Kusljic, S., Manias, E., Tran, B., & Williams, A. (2013). Enablers and barriers affecting
medication-taking behaviour in aging men with benign prostatic hyperplasia. The Aging
Male, 16(3), 112-117.
Lepor, H. (2006). The evolution of alpha-blockers for the treatment of benign prostatic
hyperplasia. Reviews in urology, 8(Suppl 4), S3.
Lepor, H. (2011). Medical Treatment of Benign Prostatic Hyperplasia. Reviews in Urology,
13(1), 20–33.
Lepor, H., & Hill, L. A. (2010). Silodosin for the treatment of benign prostatic hyperplasia:
pharmacology and cardiovascular tolerability. Pharmacotherapy: The Journal of
Human Pharmacology and Drug Therapy, 30(12), 1303-1312.
Moore, K. N., & Gray, M. (2004). Urinary incontinence in men: current status and future
directions. Nursing research, 53(6S), S36-S41.
Pinto, J. D. O., He, H. G., Chan, S. W. C., Toh, P. C., Esuvaranathan, K., & Wang, W.
(2015). Health‐related quality of life and psychological well‐being in patients with
benign prostatic hyperplasia. Journal of clinical nursing, 24(3-4), 511-522.
Rogers, M. A., Mody, L., Kaufman, S. R., Fries, B. E., McMahon, L. F., & Saint, S. (2008).
Use of urinary collection devices in skilled nursing facilities in five states. Journal of
the American Geriatrics Society, 56(5), 854-861.

ACU_NRSG258_Sem2_2017
P a g e | 9
Tanguay, S., Awde, M., Brock, G., Casey, R., Kozak, J., Lee, J., … Saad, F. (2009).
Diagnosis and management of benign prostatic hyperplasia in primary care. Canadian
Urological Association Journal, 3(3 Suppl 2), S92–S100.