A patient with a history of benign prostatic hyperplasia (BPH) presents with acute urinary retention, bilateral flank pain, and evidence of a urinary tract infection. After catheterization and initiation of antibiotics, which nursing intervention is most critical to prevent further renal impairment?

B) Monitor urine output closely and report any significant changes to the healthcare provider.

A) Encourage the patient to increase fluid intake to promote urine flow.

B) Monitor urine output closely and report any significant changes to the healthcare provider.

C) Educate the patient on the importance of completing the full course of antibiotics.

D) Advise the patient to avoid caffeine and alcohol to reduce bladder irritation.

A patient with benign prostatic hyperplasia (BPH) presents with acute urinary retention, bilateral flank pain, and elevated serum creatinine levels. After catheterization and initiation of antibiotics, which nursing intervention is most critical to incorporate into the patient's care plan to prevent further renal damage?

A) Monitor urinary output and color every 2 hours.

B) Schedule a follow-up ultrasound in 6 months.

C) Encourage fluid restriction to avoid bladder overdistension.

D) Advise the patient to limit physical activity to reduce stress.

A 68-year-old male patient with a history of benign prostatic hyperplasia (BPH) and recent urinary tract infection is now showing signs of systemic infection with a confirmed E. coli bacteremia. Despite broad-spectrum IV antibiotics, his condition remains unstable. Which of the following nursing interventions is most critical in preventing further complications in this patient?

B) Monitor vital signs and report any further deterioration immediately.

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

B) Monitor vital signs and report any further deterioration immediately.

C) Educate the patient about the importance of completing the full course of antibiotics.

D) Prepare the patient for potential surgical intervention, such as TURP.

A patient with benign prostatic hyperplasia (BPH) and acute urinary retention develops signs of systemic infection and is diagnosed with bacteremia secondary to a urinary tract infection. Which nursing intervention is the priority to prevent further renal impairment in this patient?

C) Administer the prescribed broad-spectrum intravenous antibiotics as scheduled.

A) Encourage increased oral fluid intake to promote urine output.

B) Monitor vital signs every 4 hours to detect changes in condition.

C) Administer the prescribed broad-spectrum intravenous antibiotics as scheduled.

D) Educate the patient about the importance of completing the full course of antibiotics.

A patient diagnosed with sepsis secondary to a urinary tract obstruction exhibits persistent fever, tachycardia, hypotension, rising serum lactate levels, and declining renal function. Which nursing intervention is the most critical to prioritize in the immediate management of this patient?

B) Increase the rate of intravenous fluid resuscitation

A) Administer antipyretics to manage fever

B) Increase the rate of intravenous fluid resuscitation

C) Prepare for urgent transurethral resection of the prostate (TURP)

D) Initiate renal replacement therapy

A 68-year-old male patient is diagnosed with sepsis secondary to a urinary tract obstruction. Despite broad-spectrum antibiotics, his fever persists, heart rate remains elevated, and blood pressure trends downward. Laboratory tests reveal an elevated serum lactate of 3.5 mmol/L and creatinine of 2.4 mg/dL. Imaging shows significant bilateral hydronephrosis and enlarged prostate with bladder outlet obstruction. Which nursing intervention is most critical to prioritize at this time to address the patient's hemodynamic instability?

A) Increase fluid resuscitation to improve renal perfusion.

B) Administer antipyretics to reduce the patient's fever.

C) Prepare the patient for immediate surgical intervention.

D) Monitor urine output hourly to assess renal function.

A patient in the ICU post-TURP is being monitored closely for potential complications. His blood pressure has improved to 105/65 mmHg, and his heart rate is 108 bpm. However, his respiratory status shows slight deterioration with an oxygen saturation of 91% on room air and a pH of 7.32. Which nursing intervention would be most appropriate to address his current respiratory compromise?

A) Administer supplemental oxygen to improve oxygen saturation levels.

B) Increase intravenous fluid rate to enhance tissue perfusion.

C) Request a chest X-ray to assess for pulmonary edema.

D) Prepare for possible intubation due to respiratory acidosis.

A patient who underwent an emergency transurethral resection of the prostate (TURP) is now in the intensive care unit. Post-operatively, the patient's blood pressure is 105/65 mmHg, heart rate is 108 bpm, and serum lactate levels have normalized to 2.8 mmol/L. Urine output has increased to 30 mL/hour. Based on these findings, which nursing intervention should be prioritized to address the patient's current condition?

B) Continue monitoring vital signs and urine output closely for signs of improvement or deterioration.

A) Increase the rate of IV fluid administration to improve urine output.

B) Continue monitoring vital signs and urine output closely for signs of improvement or deterioration.

C) Initiate diuretic therapy to manage fluid retention and improve renal function.

D) Prepare the patient for transfer to a step-down unit due to improved hemodynamic status.

A patient in the intensive care unit post-TURP exhibits mild hematuria, a low-grade fever, and a white blood cell count of 12,500/mm³. Given these findings, which nursing intervention should be prioritized to address the potential complication of infection?

C) Initiate empiric antibiotic therapy as ordered and monitor for signs of improvement.

A) Increase the rate of intravenous fluids to prevent dehydration.

B) Administer antipyretic medications to manage the fever.

C) Initiate empiric antibiotic therapy as ordered and monitor for signs of improvement.

D) Encourage deep breathing exercises to improve oxygen saturation.

A patient is in the intensive care unit post-TURP and is exhibiting mild hematuria, low-grade fever, and mild hyponatremia. Which nursing intervention is the most appropriate to prioritize in addressing the current clinical findings?

B) Administer prescribed antibiotics and monitor for signs of infection resolution.

A) Increase the rate of intravenous fluids to flush the bladder and correct hyponatremia.

B) Administer prescribed antibiotics and monitor for signs of infection resolution.

C) Administer a diuretic to address potential fluid overload contributing to hyponatremia.

D) Apply cold compresses to the surgical site to reduce bleeding and inflammation.

bph - Nursing Case Study

Pathophysiology

• Primary mechanism: Hormonal imbalances, particularly increased dihydrotestosterone (DHT) levels, lead to prostate cell proliferation. This results in the enlargement of the prostate gland, which is commonly seen in benign prostatic hyperplasia (BPH).

• Secondary mechanism: The hyperplastic prostate tissue causes compression of the urethra, leading to obstruction of urinary flow. This triggers compensatory changes in bladder function, such as detrusor muscle hypertrophy and increased bladder pressure.

• Key complication: The obstruction and increased bladder pressure can result in urinary retention, frequent urination, and increased risk for urinary tract infections. If severe, it may lead to bladder stones or renal damage due to backflow of urine.

Patient Profile

Demographics:

68-year-old male, retired accountant

History:

• Key past medical history: Benign prostatic hyperplasia (BPH) diagnosed 5 years ago, hypertension, type 2 diabetes

• Current medications: Tamsulosin, Metformin, Lisinopril

• Allergies: Penicillin

Current Presentation:

• Chief complaint: Difficulty urinating and frequent nighttime urination

• Key symptoms: Hesitancy, weak urine stream, urgency, incomplete bladder emptying, nocturia, mild lower abdominal discomfort

• Vital signs: Blood pressure 148/92 mmHg, heart rate 96 bpm, respiratory rate 18 breaths per minute, temperature 99.1°F

Section 1

The patient's condition has progressed over the past few weeks, and he presents to the clinic with new complications. He reports experiencing increased lower abdominal pain and a noticeable decrease in urine output over the past 48 hours. Upon further assessment, the nurse notes a palpable bladder distension, indicating potential acute urinary retention. The patient's vital signs show a slight increase in blood pressure at 152/94 mmHg and a heart rate of 102 bpm, suggesting possible discomfort or stress related to his current urinary issues. Additionally, the patient now complains of bilateral flank pain, raising concerns about potential upper urinary tract involvement.

Laboratory tests are ordered, revealing an elevated serum creatinine level of 1.8 mg/dL, indicating impaired renal function. Urinalysis shows the presence of leukocytes and bacteria, suggesting a urinary tract infection, likely secondary to urinary stasis and retention. An ultrasound of the kidneys and bladder is performed, revealing bilateral hydronephrosis, a concerning sign that urine is backing up into the kidneys due to the obstruction. This finding underscores the need for urgent intervention to prevent further renal damage.

The healthcare team decides to place a urinary catheter to relieve the acute urinary retention and initiate antibiotic therapy to address the infection. The patient is educated on the importance of timely intervention and the potential need for surgical options, such as transurethral resection of the prostate (TURP), if conservative management fails to resolve the obstruction. This escalation in care emphasizes the need for ongoing monitoring of renal function and urinary symptoms, as well as reassessment of his current medication regimen to optimize management of his BPH while considering his comorbid conditions.

Section 2

As the urinary catheter is successfully placed, the patient experiences immediate relief from his acute urinary retention, evidenced by the drainage of a significant volume of urine, which alleviates the palpable bladder distension. However, over the next 24 hours, the healthcare team observes a concerning development: the patient begins to exhibit signs of systemic infection. His temperature rises to 101.3°F (38.5°C), and his heart rate increases further to 112 bpm, suggesting the onset of sepsis. In addition to these symptoms, the patient reports feeling increasingly fatigued and nauseated, with continued bilateral flank pain, raising concerns about pyelonephritis or worsening upper urinary tract infection.

Subsequent laboratory tests reveal a marked increase in white blood cell count to 15,000/mm³, with a left shift indicating an acute inflammatory response. Blood cultures are drawn, and initial results identify the presence of Escherichia coli, confirming the suspicion of bacteremia secondary to his urinary tract infection. The patient's renal function continues to be a critical focus, with serum creatinine now further elevated to 2.1 mg/dL, indicating a progression of renal impairment. Given these findings, the healthcare team promptly escalates the antibiotic regimen to a broader-spectrum intravenous antibiotic in an effort to control the systemic infection and mitigate further renal damage.

Despite these interventions, the patient's condition remains precarious, and a multidisciplinary discussion is initiated to explore more definitive management options, including urgent surgical intervention. The potential need for a transurethral resection of the prostate (TURP) becomes increasingly pressing, as the obstruction continues to pose a significant risk to renal function and overall health. The team also considers the use of nephrostomy tubes as a temporary measure to relieve the pressure on the kidneys. The patient's clinical course underscores the complexity of managing BPH with concurrent infectious and obstructive complications, highlighting the critical importance of timely intervention and continuous reassessment of treatment strategies.

Section 3

As the patient's condition evolves, the healthcare team continues to monitor him closely for any changes in his status. Despite the administration of broad-spectrum intravenous antibiotics, the patient's fever persists, and his heart rate remains elevated at 110 bpm, indicating ongoing systemic inflammation. The patient's blood pressure begins to trend downward, with readings of 95/60 mmHg suggesting a potential hypovolemic or distributive component to his hemodynamic instability. The nursing team notes that the patient is increasingly lethargic and exhibiting signs of confusion, prompting a reassessment of his neurological status.

A repeat set of laboratory tests reveals that the patient's serum lactate level has risen to 3.5 mmol/L, further supporting the diagnosis of sepsis and underscoring the urgency of addressing the underlying infection. Additionally, his renal function continues to decline, with serum creatinine now elevated to 2.4 mg/dL, indicating progressive renal impairment. In light of these developments, the healthcare team intensifies their focus on optimizing fluid resuscitation and vasopressor support to stabilize the patient's hemodynamics while continuing to assess the need for surgical intervention to address the underlying prostatic obstruction.

In parallel, imaging studies, including a renal ultrasound and CT scan of the abdomen, are ordered to evaluate the extent of urinary tract obstruction and potential complications such as hydronephrosis or abscess formation. The imaging results reveal significant bilateral hydronephrosis and a notably enlarged prostate with evidence of bladder outlet obstruction. These findings reinforce the need for a more aggressive approach to relieve the obstruction, and the team schedules an urgent consultation with urology to discuss the feasibility of a transurethral resection of the prostate (TURP) as a definitive measure to resolve the obstruction and prevent further renal compromise. The patient's care plan emphasizes the importance of a collaborative, multidisciplinary approach to address the complex interplay of infectious, obstructive, and renal factors impacting his health.

Section 4

As the healthcare team continues to address the patient's multifaceted condition, they closely monitor his response to the ongoing interventions aimed at stabilizing his hemodynamics and resolving the urinary obstruction. Despite aggressive fluid resuscitation efforts, the patient's blood pressure remains borderline at 92/58 mmHg, and his heart rate has increased to 115 bpm, suggesting persistent circulatory instability. The addition of vasopressor support with norepinephrine is initiated to maintain adequate mean arterial pressure and improve organ perfusion. The patient's urine output has decreased to 20 mL/hour, further indicating worsening renal function. These observations prompt the team to reevaluate their management strategy and prioritize urgent surgical intervention.

In collaboration with the urology team, a decision is made to proceed with an emergency transurethral resection of the prostate (TURP) to relieve the obstruction and potentially reverse the renal impairment. Prior to the procedure, the patient undergoes a pre-operative assessment that reveals a slight deterioration in his respiratory status, as evidenced by an oxygen saturation of 91% on room air and increased work of breathing. Arterial blood gas analysis shows a mild respiratory acidosis with a pH of 7.32 and a PaCO2 of 48 mmHg, suggesting the onset of respiratory compromise secondary to metabolic derangements. The anesthesiology team is alerted to these findings to ensure appropriate intraoperative management and postoperative monitoring.

Post-TURP, the patient is transferred to the intensive care unit for close observation. Initial post-operative assessments indicate a gradual improvement in his hemodynamics, with blood pressure readings now trending upward to 105/65 mmHg and heart rate slightly decreasing to 108 bpm. Serum lactate levels have begun to normalize, now at 2.8 mmol/L, indicating a positive response to the surgical intervention and ongoing supportive measures. However, the patient remains at risk for further complications, necessitating vigilant monitoring for potential post-operative bleeding, infection, or electrolyte imbalances. The multidisciplinary team remains engaged, emphasizing the importance of continued collaboration to guide the patient's recovery and address any emerging challenges in his clinical course.

Section 5

As the patient settles into the intensive care unit post-TURP, the healthcare team conducts thorough initial assessments to identify any immediate post-operative complications. Notably, the patient exhibits mild hematuria, a common occurrence after TURP, but the team remains vigilant for signs of significant bleeding. His oxygen saturation has improved to 94% on 2 liters of supplemental oxygen via nasal cannula, and his work of breathing has decreased, suggesting better respiratory function following the surgical relief of obstruction. However, there is a new development of low-grade fever at 38.4°C (101.1°F), raising concerns about potential infection, given the invasive nature of the procedure and the patient's recent hemodynamic instability.

Laboratory results reveal a white blood cell count of 12,500/mm³, indicating a possible inflammatory response or early infection. The urinalysis shows cloudy urine with elevated leukocytes and a positive nitrite test, pointing towards a urinary tract infection likely exacerbated by the urinary stasis and catheterization. Considering these findings, the team initiates empiric antibiotic therapy and sends urine cultures to guide targeted treatment. Electrolyte monitoring indicates a mild hyponatremia with a serum sodium level of 132 mmol/L, likely secondary to the fluid shifts and ongoing intravenous fluid therapy. The care team adjusts the patient's fluid management to address this imbalance while closely monitoring for any additional metabolic derangements.

In response to these developments, the team emphasizes the importance of frequent monitoring and reassessment to catch any further complications early. The patient's recovery trajectory will depend on swiftly addressing the infection, correcting electrolyte imbalances, and ensuring adequate organ perfusion. The evolving clinical picture requires continuous interdisciplinary collaboration, with the nursing staff playing a crucial role in ongoing assessments and communication with the medical team. The plan includes maintaining hemodynamic support, optimizing respiratory care, and ensuring meticulous wound and catheter care to promote healing and prevent further infectious complications. The patient’s progress will be continuously evaluated, with adjustments made to his care plan as needed to support his recovery and prevent further deterioration.