Client Complaints: Decreased urinary flow over the past two years; the condition turned acute during the last two weeks. Over this time, the client has been increasingly experiencing excessive nighttime urination urges while the urine flow strength has reduced. During the past 24 hours, the client has been struggling to pass urine while the nighttime urination frequency increased up to 5 times. The client reports the need to urinate and the difficulties in doing so are interference with his daily activities.
HPI (History of Present Illness): The client’s past experiences (from two years ago) are consistent with his current symptoms, the only difference being the gradual exacerbation of the condition and yesterday’s acuity.
PMH (Past Medical History—include current medications, any known allergies, any history of surgery or hospitalizations): The medications include Cardizem 240mg daily and Zocor 20mg daily for hypertension and hypercholesterolemia. Five years ago the client was hospitalized with chest wall syndrome. No other hospitalizations or surgeries occurred after the client’s discharge.
Significant Family History: No similar diseases reported.
Social/Personal History (occupation, lifestyle—diet, exercise, substance use): The client is an MS in engineering and working as one, with a yearly income of $65,000. Although his perceptions of his lifestyle and habits are not entirely adequate, he mostly eats homemade foods, does not consume alcohol or smoke.
Description of Client’s Support System: The client is emotionally supported by his spouse and colleagues but the family and work are the only sources of support he gets.
Behavioral or Nonverbal Messages: The client does not show any signs of depression or severe anxiety, has no mental health issues or substance abuse-related problems. He appears optimistic and has a positive body image. His distress with his disease is understandable as he suspects cancer.
Client Awareness of Abilities, Disease Process, Health Care Needs: His perception of self-efficacy is quite accurate. He takes his medications conscientiously and knows why and what for he is treated. However, his awareness of health care resources is poor as he does not use them as he should have, especially with his education level and socioeconomic status.
Vital Signs including BMI: Blood pressure in the right arm when seated – 140/92; temperature – 99; pulse – 80 and regular; respiration – 18, non-labored; weight – 200; height – 71’’; BMI – 29.5 (overweight).
Physical Assessment Findings: HEENT – normocephalic, atraumatic, EOM intact, pupils equal and react to light, no injections, no congestion, TM intact, oropharynx within normal limits, moist mucus membranes in the mouth, neck supple, thyroid within normal limits. No lymph nodes, clear lungs, no carotid bruits. Android obesity, no tenderness. The client is circumcised, with no discharges from the penis, testes within normal limits. Pulses slightly less than normal in the extremities (2+). Light-brown stool containing heme. Enlarged prostate, spongy and tender.
Lab Tests and Results: Chemistry panel and Complete blood count within normal limits. Prostate-specific antigen 6.0, calling for other tests.
Client’s Support System: The client’s support is confined to his family (spouse but not children) and his colleagues. He lives with his wife, with whom he maintains supportive relationships, and has several close friends, which he regards as important persons in his life. Although there are no familial dysfunctions or conflicts, he does not report being close to his children. The client’s spouse has been supposedly supportive in the past assisting the client in overcoming the surgery-related crisis. Notwithstanding the limited social support, the client does not experience much stress either at home or at work.
Client’s Locus of Control and Readiness to Learn: The client’s support is confined to his family (spouse but not children) and his colleagues. He lives with his wife, with whom he maintains supportive relationships, and has several close friends, which he regards as important persons in his life. Although there are no familial dysfunctions or conflicts, he does not report being close to his children. The client’s spouse has been supposedly supportive in the past assisting the client in overcoming the surgery-related crisis. Notwithstanding the limited social support, the client does not experience much stress either at home or at work.
ICD-10 Diagnoses/Client Problems: R39.12: Poor urinary stream with benign prostatic hyperplasia (ICD-10 Version: 2016, 2016).
Advanced Practice Nursing Intervention Plan (including interdisciplinary collaboration, community resources, and follow-up plans)
|Suggested intervention steps|
|1||Obtain disease-focused records underlining the character and periodicity of the urine flow decreases in the past. Enquire about the missing information from the client.||A disease-focused history is a key to a fuller etiology and a possible clue to disease management.|
|2||Perform the neurological examination and digital rectal examination.||The client did not undergo either of these examinations, which could also be significant for disease management.|
|3||Determine the patterns of urinary discharge by completing a bladder log on the frequency of the urges, difficulty of flow strength maintenance, nocturnal eliminations, and the volume/types of urine.||The log would give a clear picture of current elimination patterns and establish a correlation between the liquid consumed and elimination type/volume (Abrams, Chapple, Khoury, Roehrborn, & de la Rosette, 2013).|
|4||Consult the physician on the potential side effects of Cardizem and Zocor and consider replacing the medications.||Urine flow weakening is reported to be one of the side effects of diltiazem hydrochloride (the active ingredient of Cardizem) and simvastatin (Zocor) in senior patients(Review: Could Cardizem Cause Urine Flow Decreased?2016; Review: Could Simvastatin Cause Urine Flow Decreased?2016). The prevalence of this particular side effect is not statistically significant, which, however, does not nullify its clinical significance and may have triggered the urination-related issues in this case.|
|5||Consult the physician on the possibility of administering alpha-adrenergic blocking agents. If the medications are approved, educate the client on self-administration, dosages, and potential adverse effects.||5-alpha reductase inhibitors are known to reduce the risk of urine retention in senior clients and alleviate the obstruction symptoms (Oelke et al., 2013).|
|6||Educate the client on the strategies to prevent frequent urination urges and inability to pass urine interfering with his daily activities: double-voiding by making short rests in the bathroom (3-5 minutes) and attempting the urination afterward, trying seated positions with feet firmly on the floor, ensuring the urination occurs in total privacy and seeking urgent medical assistance if the obtrusion lasts for more than 6 hours.||A private setting and a posture with both feet on the floor can alleviate the psychological strain from the client and help his pelvic muscles relax. Double-voiding created a double detrusor contraction, which also facilitates urine passage. Correcting the client’s health-seeking behavior is an essential part of his disease management as his current behavior is poor.|
|7||Contact the client’s social support agents (spouse and colleagues) and educate them on the client’s needs in terms of: |
The spouse could be instructed to remind the client to take the prescribed drugs, practice comfortable postures, and urinate by the clock if necessary. The colleagues should be in the know of the client’s needs during his workdays and not prevent him from eliminating even if it takes longer.
|Despite the client’s perceptions of his life and work experiences as stress-free, facing a urination-related problem can result in the exacerbation of the client’s well-being. Receiving all-around support from the family and colleagues will help this client cope with the issue. Besides, as the spouse and friends are educated on the disease-related issues, they can safeguard the client during his daily activities and help him timely manage and acuity.|
Abrams, P., Chapple, C., Khoury, S., Roehrborn, C., & de la Rosette, J. J. (2013). Evaluation and Treatment of Lower Urinary Tract Symptoms in Older Men. The Journal of Urology, 189(1), 93-101.
ICD-10 Version: 2016. (2016). Web.
Oelke, M., Bachmann, A, Descazeaud, A., Emberton, M., Gravas, S., Michel, M. C….de la Rosette, J. J. (2013). EAU Guidelines on the Treatment and Follow-up of Non-neurogenic Male Lower Urinary Tract Symptoms Including Benign Prostatic Obstruction. European Urology, 64(1), 118-140.
Review: Could Cardizem Cause Urine Flow Decreased? (2016). Web.
Review: Could Simvastatin Cause Urine Flow Decreased? (2016). Web.
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