A patient with a history of BPH presents with nocturia, daytime fatigue, and a distended bladder. His blood pressure is elevated, and he exhibits a post-void residual volume of 150 mL. Given these findings, which nursing intervention is most appropriate to address the patient's nocturia and its related symptoms?

C) Recommend the patient void every 2 hours during the day to decrease bladder distention.

A) Encourage the patient to limit fluid intake to 1 liter per day to reduce nocturia.

B) Educate the patient on the importance of taking Tamsulosin at bedtime to improve urine flow overnight.

C) Recommend the patient void every 2 hours during the day to decrease bladder distention.

D) Advise the patient to increase sodium intake to manage nocturia-related dehydration.

A 65-year-old male patient with a history of Benign Prostatic Hyperplasia (BPH) presents with a distended bladder, nocturia, and elevated blood pressure. Despite taking Tamsulosin, he reports increased nocturia and daytime fatigue. Given the findings of a post-void residual volume of 150 mL and microscopic hematuria, which nursing intervention should be prioritized to address the patient's current symptoms and prevent potential complications?

B) Instruct the patient on double voiding techniques to decrease residual urine.

A) Educate the patient on fluid restriction in the evening to reduce nocturia.

B) Instruct the patient on double voiding techniques to decrease residual urine.

C) Advise the patient to increase physical activity to manage blood pressure.

D) Recommend the patient use a bladder diary to track symptoms and voiding patterns.

A patient with worsening urinary symptoms and increased nocturia despite adherence to medication has a distended bladder and elevated post-void residual volume. The healthcare team is considering adding a 5-alpha-reductase inhibitor and possibly a TURP. Which nursing action is most important in managing this patient's care?

B) Instruct the patient to maintain a bladder diary

A) Educate the patient on potential side effects of a 5-alpha-reductase inhibitor

B) Instruct the patient to maintain a bladder diary

C) Monitor the patient's blood pressure and adjust antihypertensive therapy as needed

D) Schedule regular follow-ups to reassess urinary symptoms and bladder ultrasound findings

A patient with a history of bladder outlet obstruction is experiencing worsening urinary symptoms, including increased nocturia, lower abdominal pain, and a sense of incomplete voiding. Despite adherence to medication, a follow-up ultrasound shows increased post-void residual volume. Which nursing intervention is the most appropriate to address the patient's current symptoms and prevent further complications?

B) Educate the patient on the importance of reducing caffeine and alcohol intake to minimize bladder irritation.

A) Encourage the patient to increase fluid intake to flush the urinary system.

B) Educate the patient on the importance of reducing caffeine and alcohol intake to minimize bladder irritation.

C) Suggest the patient increase physical activity to improve overall circulation and reduce symptoms.

D) Advise the patient to perform bladder retraining exercises to strengthen the detrusor muscle.

A patient with a history of benign prostatic hyperplasia (BPH) presents with acute urinary retention, nocturia, and a weak urinary stream. A post-void residual volume of 400 mL and elevated serum creatinine levels are noted. The healthcare team plans to catheterize the patient to relieve obstruction and considers surgical intervention. As the nurse, what is the primary goal of the initial catheterization?

C) To decompress the bladder and prevent renal damage

A) To prevent urinary tract infection

B) To assess urine color and consistency

C) To decompress the bladder and prevent renal damage

D) To measure accurate urine output for fluid balance

A patient presents with acute urinary retention and an elevated post-void residual volume, indicating bladder outlet obstruction. After catheterization to relieve obstruction, what is the priority nursing intervention to prevent potential renal compromise?

A) Encourage increased oral fluid intake to promote renal perfusion.

B) Monitor for signs of infection and educate the patient on proper catheter care.

C) Assess serum electrolyte levels to detect any imbalances.

D) Reinforce the importance of adhering to antihypertensive medication.

A patient who underwent catheterization for urinary retention is now exhibiting signs of systemic infection, including fever and elevated heart rate. The healthcare team suspects a catheter-associated urinary tract infection (CAUTI). Which nursing intervention is most appropriate to prevent further complications while awaiting culture results?

B) Administer prescribed broad-spectrum antibiotics and monitor the patient's response

A) Encourage the patient to increase oral fluid intake to 3 liters per day

B) Administer prescribed broad-spectrum antibiotics and monitor the patient's response

C) Remove the urinary catheter and reinsert a new sterile catheter

D) Apply warm compresses to the lower abdomen to alleviate discomfort

A patient who recently underwent catheterization for urinary retention is now exhibiting signs of a systemic infection and has been diagnosed with a catheter-associated urinary tract infection (CAUTI). While awaiting culture and sensitivity results, the healthcare team has initiated broad-spectrum antibiotics. Despite treatment, the patient reports worsening fatigue and a persistent fever. What is the most appropriate nursing intervention to prioritize at this time?

A) Discontinue the broad-spectrum antibiotics and await culture results.

C) Encourage the patient to increase oral fluid intake and apply warm compresses to relieve fever.

D) Request an immediate urology consultation to expedite the transurethral resection of the prostate (TURP).

A patient with a confirmed Escherichia coli bacteremia is being monitored closely for signs of sepsis. Which nursing assessment finding would most likely indicate a progression towards septic shock?

B) Reduced urine output despite fluid resuscitation

A) Stable blood pressure with tachycardia

B) Reduced urine output despite fluid resuscitation

C) Decreased white blood cell count

D) Absence of fever with normal heart rate

A patient with a confirmed Escherichia coli bacteremia and worsening renal function is being prepared for a TURP procedure. Which nursing intervention is most critical in the preoperative period to prevent further complications?

D) Monitor fluid balance and adjust intravenous fluids as needed

A) Administer prescribed antibiotics and monitor for adverse reactions

B) Educate the patient about postoperative expectations and recovery process

C) Ensure the patient remains NPO for at least 8 hours before surgery

D) Monitor fluid balance and adjust intravenous fluids as needed

BPH - Nursing Case Study

Pathophysiology

• Primary mechanism: Hormonal imbalance, particularly an increase in dihydrotestosterone (DHT), leads to prostate gland hypertrophy. DHT, derived from testosterone, binds to androgen receptors and stimulates prostate cell proliferation.

• Secondary mechanism: Age-related changes increase the sensitivity of prostate tissue to growth factors and DHT, further promoting glandular and stromal hyperplasia, particularly in the periurethral region of the prostate.

• Key complication: Urethral compression due to prostate enlargement results in bladder outlet obstruction, causing lower urinary tract symptoms (LUTS) such as urinary frequency, urgency, and weak stream, significantly impacting quality of life.

Patient Profile

Demographics:

68-year-old male, retired accountant

History:

• Key past medical history: Benign Prostatic Hyperplasia (BPH) diagnosed 5 years ago, history of hypertension

• Current medications: Tamsulosin, Lisinopril

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Increased difficulty in urination and lower abdominal discomfort

• Key symptoms: Nocturia, weak urine stream, sensation of incomplete bladder emptying, urinary urgency, occasional lower back pain

• Vital signs: Blood pressure 150/92 mmHg, heart rate 88 bpm, respiratory rate 18 breaths per minute, temperature 98.9°F

Section 1

During the initial assessment, the healthcare team conducted a thorough evaluation to better understand the patient's current condition and potential complications arising from his BPH. Physical examination revealed a distended bladder upon palpation, suggesting significant post-void residual urine due to bladder outlet obstruction. The patient reported increased nocturia, now waking up 4-5 times per night, which has disrupted his sleep pattern and contributed to daytime fatigue. A digital rectal examination (DRE) confirmed an enlarged prostate, consistent with his BPH history. The team also noted the patient's blood pressure was elevated at 150/92 mmHg, indicating suboptimal control of his hypertension.

To further investigate, a bladder ultrasound was performed, revealing a post-void residual volume of 150 mL, confirming incomplete bladder emptying. Additionally, a urinalysis was conducted, which showed no signs of infection, ruling out a urinary tract infection as a cause for his urinary symptoms. However, the urinalysis did show microscopic hematuria, prompting consideration of potential bladder irritation or other urological issues. Blood tests were ordered, including a Prostate-Specific Antigen (PSA) level, to assess for any changes that might suggest further prostate pathology.

Given these findings, the healthcare team discussed the possibility of progressive bladder dysfunction due to chronic obstruction, which could lead to detrusor muscle weakening over time. The patient's current medication regimen, including Tamsulosin, was reviewed for effectiveness, and there was consideration of adding or adjusting medications to better manage his symptoms and blood pressure. The potential need for surgical intervention, such as transurethral resection of the prostate (TURP), was also introduced as a future possibility if conservative management proves insufficient. The patient was advised to monitor his symptoms closely and report any new developments, such as increased back pain or hematuria, which could indicate worsening or new complications.

Section 2

Two weeks after the initial assessment, the patient returned for a follow-up appointment. Despite adherence to his medication regimen, including Tamsulosin, he reported a worsening of his urinary symptoms. The nocturia had increased to 6-7 times per night, further exacerbating his daytime fatigue. Additionally, he began experiencing intermittent lower abdominal pain and a sense of incomplete voiding. Upon physical examination, the bladder was again found to be distended, and a follow-up bladder ultrasound demonstrated an increased post-void residual volume of 250 mL. These findings suggested a progression of bladder outlet obstruction, raising concerns about the potential for detrusor muscle decompensation.

The patient's blood pressure remained elevated at 152/94 mmHg, despite his antihypertensive therapy, indicating the need for a review of his current regimen. Additionally, the repeat urinalysis revealed persistent microscopic hematuria, and the PSA level showed a slight increase, although still within normal range. Given these findings, the healthcare team considered a more aggressive approach to manage his symptoms and prevent further complications. The possibility of adding a 5-alpha-reductase inhibitor to reduce prostate size was discussed, alongside revisiting the option of surgical intervention such as TURP to alleviate the obstruction.

The patient was also educated on potential signs of acute urinary retention or renal impairment, which may necessitate immediate medical attention. He was advised to maintain a bladder diary to better track his symptoms and fluid intake, providing valuable data for ongoing management. The team emphasized the importance of regular monitoring and follow-up appointments to assess his response to any changes in treatment and to ensure timely intervention should his condition deteriorate further.

Section 3

Two weeks later, the patient presented to the clinic with new concerns. He reported experiencing acute episodes of urinary retention, most recently that morning, which resolved temporarily after some straining and discomfort. His nocturia persisted, and he now described a constant sense of urgency coupled with a weak urinary stream. The patient's daytime fatigue had worsened, and he appeared visibly distressed. On examination, his vital signs revealed a blood pressure of 160/98 mmHg, despite adjustments made to his antihypertensive medications. His heart rate was 88 bpm, and he was afebrile. A focused abdominal examination revealed a palpable and tender distended bladder, suggesting significant urinary retention.

A repeat bladder ultrasound showed a post-void residual volume of 400 mL, indicating a further decline in bladder function. Additionally, renal function tests revealed a slight elevation in serum creatinine to 1.4 mg/dL, up from 1.1 mg/dL, raising concerns about potential renal compromise secondary to obstructive uropathy. The persistent microscopic hematuria noted previously was still present on urinalysis, but no signs of infection were detected. Given these findings, the healthcare team prioritized immediate intervention to relieve the obstruction and prevent further renal deterioration. The decision was made to proceed with catheterization to decompress the bladder, followed by a more urgent consideration of surgical intervention, possibly a transurethral resection of the prostate (TURP), to address the underlying obstruction.

In this context, the patient was counseled about the risks and benefits of surgical intervention, including potential improvements in urinary symptoms and prevention of further complications. He was also educated on the signs of acute renal impairment and advised to report any worsening symptoms immediately. The healthcare team planned for close postoperative monitoring and follow-up to assess renal function and ensure adequate recovery of bladder function. This comprehensive approach aimed not only to alleviate the acute symptoms but also to prevent long-term sequelae associated with chronic bladder outlet obstruction.

Section 4

Following the catheterization, the patient experienced immediate relief from his urinary retention symptoms, and his bladder was successfully decompressed. However, over the next few days, his clinical status evolved with new developments. The patient began to exhibit signs of systemic infection, including low-grade fever, malaise, and chills. His blood pressure remained elevated at 158/96 mmHg, and his heart rate increased to 100 bpm. Concerned about potential catheter-associated urinary tract infection (CAUTI), the healthcare team conducted a thorough assessment and initiated a series of diagnostic tests.

A repeat urinalysis showed the presence of white blood cells and bacteria, confirming a urinary tract infection. Blood cultures were taken to rule out bacteremia, and the patient was started on broad-spectrum antibiotics while awaiting culture and sensitivity results. Despite the antibiotics, the patient reported worsening fatigue and a persistent fever of 101°F (38.3°C), prompting further evaluation. Renal function tests showed a slight increase in serum creatinine to 1.5 mg/dL, indicating ongoing renal stress.

The healthcare team recognized the importance of addressing both the infection and the underlying urinary obstruction. The patient's case was urgently reviewed by the urology team, who prioritized scheduling the transurethral resection of the prostate (TURP) as soon as the infection was controlled. Meanwhile, supportive care measures were intensified, including intravenous fluids to prevent dehydration and monitoring for hypotension. The patient's condition required close observation to anticipate and manage potential complications, such as sepsis or acute renal failure, underscoring the need for a coordinated, multidisciplinary approach to his care.

Section 5

In the days following the initiation of antibiotics, the patient’s clinical status showed mixed responses, prompting further evaluation. Despite initial hopes for improvement, his low-grade fever persisted, and his white blood cell count remained elevated at 14,000/mm^3, suggesting ongoing infection. The healthcare team noted that the patient’s blood pressure had become more labile, with readings fluctuating between 140/90 mmHg and 160/100 mmHg, and his heart rate occasionally spiking to 110 bpm. Additionally, the patient began to experience mild confusion and disorientation, raising concerns about potential systemic complications.

A repeat urinalysis revealed persistent pyuria and bacteriuria, while blood cultures returned positive for Escherichia coli, confirming bacteremia. The patient's renal function tests showed further deterioration, with serum creatinine rising to 1.8 mg/dL, indicating worsening renal involvement. Recognizing the risk of progression to sepsis, the healthcare team adjusted the antibiotic regimen based on culture sensitivities and initiated aggressive fluid resuscitation to stabilize hemodynamics and support renal perfusion.

The multidisciplinary team, including infectious disease specialists and nephrologists, collaborated to refine the management plan. The urology team emphasized the need to expedite the TURP procedure, as resolving the urinary obstruction was crucial to preventing further complications. The patient was closely monitored for signs of acute kidney injury and septic shock, with strict input and output monitoring and frequent reassessments of mental status. This proactive approach was vital to navigating the complexities of the patient's condition and setting the stage for a successful surgical intervention once the infection was adequately controlled.