A

Presentation
by BS Nursing
Level IV
Case Study:
Prostate
Cancer, Stage 4

Patients Data
Name: Patient X
Sex: Male
Age: 67
Work: Ex Kagawad
Civil Status: Married
Address: P-6, Libjo, Tiwi Albay
Attending Physician: Dr. Villanueva & Dr. Alvarez
Chief Resident: Dr. Arroyo
Admission Date/Time: 08-22-16, 9:30 PM

Patients Clinical Record

Admitting Officer: Dr. Arroyo
Classification: Non-urgent
Informant: Family
Review of Systems:
whole body assessment

Name: Mr. X
Chief Complaint: chills/hiccups
Admitting Diagnoses: prostate cancer, stage 4
History of Present Illness: 1 day ptc, hiccups
Patient past medical/surgical diseases:
Family History: +HPN
Personal Social & Sexual History:
Vital Signs: BP: 130/70 HR: 103
RR: 24
Temp: 35.8

Overview

This case study was conducted in order to further

understand the distinctive characteristics of prostate
cancer and its signs and symptoms. The focus is on an
elderly patient with Stage 4 prostate cancer.

Cancer is one of the leading causes of death in the

world. There are a number of theories on how this
disease can be acquired. Prostate cancer is a common
affliction among men. With regards to this, it is
important to be able to define properly the medical
condition. Included in the study are the risk factors,
usual manifestations, different procedures to limit or
cure the disease as well as suggested nursing care
management.

 The

main purpose of the case study is to

provide an insight on how prostate
cancer afflicts the male human body. It
is aimed at helping the students
increase their knowledge and skills and
be able to handle patients suffering
from prostate cancer

PATHOPHYSI
OLOGY

DOCTORS ORDER

Gordons 11
Functional
Health Pattern

1. Health
Perception/Health
Management

2. Nutritional
Metabolic

3. Elimination

4. Activity/Exercise

5. Sleep/Rest

6. Cognitive
Perceptual

7. Self Perception

8. Role Relationship

9. Sexuality

10. Coping/Stress
Tolerance

11. Value/Belief
Pattern

Course in the Ward

Course in the Ward (Day

1)
A

67-year old male was admitted at

exactly 9:30 PM last August 23, 2016,
accompanied by his wife. With a chief
complaint of chills, hiccups and back
and hip pain. He was admitted under
the service of Dr. Arroyo and following
orders were given. ON NPO, blood
pressure, temperature, pulse rate, and
respiratory rate must be recorded every
shift.

Course in the Ward (Day

2)
At

exactly 7:00 AM, above IVF changed

microset to macroset & regulated at
20gtts/min. ON soft diet as tolerated &
advised. For creatinine & serum
electrolyte with request made. For UTZ
of lower abdomen with request made.
On the same day, metroclopramide 1
amp given through IV push as first dose.

Course in the ward (Day

2)
Skin

testing to cefuroxime done; with

negative result after 30 mins. & started.
Seen and examined by Dr. Alvarez with
orders made and carried out. Creatinine
& serum electrolyte results seen&
attached to chart.
Also on the same day, UTZ of lower
abdomen & prostate done. UTZ result in
& attached to chart.

Course in the Ward (Day

2)
Updated

Dr. Alvarez regarding patients

status though phone call. Placed
ordered continuous droplight. Hooked on
O2 inhalation via nasal canula @ 2lpm
@ 1700 lbs initial tank content.

Course in the Ward (Day

3)
On

HPR signed by patient with home

meds given. Cefixime (400 mg) BID
x6days & Mefenamic Acid (500 mg) for
pain PRN.

NURSING CARE
PLAN

ASSESSSMEN
T
Subjective
Cues;
dae na ako
nakaka lakaw
pasiring sa
banyo para mag
ihi ta makulog na
ang ang sakong
lusi, likod buda
piad.
dae na akong
kusog nag
papabuhat na
sana ako ta pag
mati ko
magabaton.

As verbalized by
the patient.

Objective
Cues;
- Inability to
restore energy,
even after sleep
or rest
-inability to
maintain usual
level of physical
activity
-restlessness
-weakness
-Feelings of guilt
for not keeping
up with
responsibilities

NURSING
DIAGNOSIS

Fatigue related
to poor physical
condition
secondary to
metastasis of
cancer cells in
the back and
pelvic bone
which causes
pain.

BACKGROUN
D STUDY

GOAL &
OBJECTIVES

NURSING
INTERVENTIO
N

An
overwhelming
sustained sense
of exhaustion
and decreased
capacity for
physical and
mental work at
usual level.

At the end of
my nursing
intervention the
Patient will be
able to
verbalize
having
sufficient
energy to
ambulate and
complete
desired
activities.

Specifically;

-Demonstrate
technique to
reduce
discomfort/ pain
and be able to
demonstrate
highest level of
mobility
possible.

- Demonstrate
Energy
management
and provide
adequate rest
and sleep.

INDEPENDENT
1.Assess for pain
before activity
and the present
treatment
regimen.

Reference;
nursingcareplan
.
blogspot.com

2.Assess
characteristics of
fatigue:
o Severity
o Changes in
severity over
time
o Aggregating
factors
o Alleviating
factors
3.Using a
quantitative
rating scale such
as 1 to 10 can
help the patient
describe the
amount of
fatigue
experienced.
4.Encourage
client to express
feelings about
fatigue.
5.Assist client
with ADLs as
necessary;
(e.g., Assist
client during
ambulation
when going to

RATIONALE

Pain restricts the

client from
achieving a
maximal activity
level and if often
exacerbated by
movement.
-This method
allows the nurse
to compare
changes in the
patients fatigue
level over time

-It is important
to determine if
the patients
level of fatigue is
constant or if it
varies over time.

-use active
listening
techniques and
help identify
sources of hope.

- Encourage
independence
without causing
exhaustion.

EVALUATION
GOAL
PARTIALLY
MET.
As evidenced by
after all the
intervention
implemented the
patient
verbalized the
amount of
fatigue is
reduced with the
used of
distruction
technique such
as (controlled
breathing,
imagery, and
use of music).
Also patient
ambulate with
the help/
assistance of the
SO esp. when
going to Comfort
Room. But
cannot
accomplish any
desired activities
because of the
pain/ discomfort.

ASSESSSMEN
T
Unable to
ambulate
-pain in the
back and pelvis
area with the
pain scale of 8.
-Guarding
behavior,
protecting body
part.

NURSING
DIAGNOSIS

BACKGROUN
D STUDY

GOAL &
OBJECTIVES

NURSING
INTERVENTIO
N
6.Evaluate the
patients sleep
patterns for quality,
quantity, time
taken to fall asleep,
and feeling upon
awakening.
7.Place client
comfortably in bed,
semi fowlers
position.

8.Assist the patient

to develop a
schedule for daily
activity and rest.

9. Teach stressreduction
techniques/
distruction such as
controlled
breathing, imagery,
and use of music.
10.Teach strategies
for energy
conservation such
as sitting instead of
standing.
11.Monitor the
patients nutritional
intake for adequate
energy sources and
metabolic
requirements.

RATIONALE

EVALUATION

- Changes in the
persons sleep
pattern may be a
contributing factor
in the development
of fatigue.
-To reduce
discomfort by
facilitating proper
positioning
decrease risk for
fall.
-A plan that
balances periods of
activity with
periods of rest can
help the patient
complete desired
activities without
adding to levels of
fatigue.
- Anxiety is
correlated with
increased fatigue.

GOAL MET.
As evidenced by
patient
demonstrate
energy
conservation
technique such
as, sitting
instead of
standing. Also
adequate rest
and sleep of the
patient help
restore energy
needed for
desired activities

-technique to
conserve energy.

-The patient will

need adequate
intake of
carbohydrates,
protein, vitamins,
and minerals to
provide energy
resources.
.

GOAL MET
As evidenced
by patient
verbalized a
complaint of
fatigue at the
moment he also
experiencing
pain. When pain
is reduced the
amount of
fatigue is also
minimized by
using
medication
(Tramadol 50
mg IV every
8hours for pain)
to help reduced
discomfort/

ASSESSSMENT

NURSING
DIAGNOSIS

BACKGROUN
D STUDY

GOAL &
OBJECTIVES

NURSING
INTERVENTIO
N

12.Encourage to
increase fluid
intake
13.Minimize
environmental
stimuli,
especially
during planned
times for rest
and sleep.

RATIONALE

-to provide
hydration
-Bright lighting,
noise, visitors,
frequent
distractions can
inhibit
relaxation,
interrupt
rest/sleep, and
contribute to
fatigue.

EVALUATION

ASSESSSMEN
T

Diagnosis:
UGIB from
stress
bleeding,
benign
prostatic
hypertrophy
probably
malignant
with bone
metastasis,
UTI
complicated

NURSING
DIAGNOSIS

BACKGROUN
D STUDY
Reference:
http://en.wikipe
dia.org/wiki/Ben
ign_prostatic_hy
pertrophy

GOAL &
OBJECTIVES

NURSING
INTERVENTIO
N
7. Provide
enough time for
bladder
emptying (10
minutes).

8. Instruct the
client in ways to
avoid
constipation or
stool impaction

9. Emphasize
the importance
of keeping the
perineal area
clean.

RATIONALE
7.In addition
to the effect of
an enlarged
prostate on
the bladder,
stress or
anxiety can
inhibit
relaxation of
the urinary
sphincter.
Sufficient time
should be
allowed for
micturition
8. Impacted
stool may
place pressure
on the bladder
outlet, causing
urinary
retention.
9. To reduce
the risk of
infection
and/or skin
breakdown.

EVALUATION

ASSESSSMEN
T
Subjective cues:

Dae n ako
nakakaihi na
maray
verbalized by
the patient

kung makaihi
man ako
makulog buda
may dugo na
verbalized by
the patient

Objective
cues:

Problem: Bone
pain, dysuria,
hematuria and
urinary
retention

NURSING
DIAGNOSIS

BACKGROUND
STUDY

GOAL &
OBJECTIVES

NURSING
INTERVENTION

RATIONALE

EVALUATIO
N

Impaired
Urinary
Eliminatio
n related
to urethra
and
bladder
neck
obstructio
n
secondary
to
enlarged

- Dysfunction in
urine elimination

Ref:
Nanda 11th edition
by Marilynn E.
Doenges et.al page
721

-Due to the
location of the
prostate, BPH
causes a number of
urinary symptoms.
The prostate is
located just below
where the bladder
empties into the
urethra (which is a
thin tube that
carries urine from
the bladder,
through the penis,
to outside the
body). The
enlarged prostate
compress the
urethral canal to
cause partial, or
sometimes virtually
complete,
obstruction of the
urethra, which
interferes the
normal flow of
urine. It leads to
symptoms of
urinary hesitancy,
frequent urination,
dysuria (painful
urination),

Goal:
At the end of my 3
days nursing
interventions, the
patient will be able
to achieve normal
elimination pattern
such as able to
start and stop
stream, empties
the bladder
completely and be
free of bladder
distention and
perceived dullness
over the
hypogastric area.

Objectives:

Specifically, At the
end of my 3 days
nursing
interventions, the
patient will be able
to:

-participate in
measures to
correct/compensat
e with the defects.
-demonstrate
behaviors/techniqu
es to prevent
urinary infection.
- free from signs of
complications like
infection and
shock

1. Monitor intake
and output.

2. Monitor vital
signs.

3. Investigate
pain, noting
location,
duration,
intensity;
presence of
bladder spasms;
or back or flank
pain.
4. Assess
bladder for
urinary retention
through
palpation and
percussion.
5.. Encourage
fluid intake up to
3000 or more ml
per day
( within cardiac
tolerance)
6. Apply
alternate hot
and ice packs
over the
hypogastric

1. Serves as an
indicator of
urinary tract
and renal
function and of
fluid balance.
2. Alterations
may indicate
serious
problems such
as infection
and shock.
3. to assist in
differentiating
between
bladder and
kidney as
cause of
dysfunction.
4. To note
degree of
impairment.
Palpation and
percussion
may induce
voiding.
5. To help
maintain renal
function and
prevent
infection and
formation of
urinary stones
6.Nonpharmac
ological

Goal partially
met as
evidenced by
the client was
able to
achieve
normal
elimination
pattern but
sometimes
still cannot
empty the
bladder
completely
and still has
slight
distention of
the bladder.

prostate

Discharge Plan
Medication:
Cefixime 400 mg BID for 6 days
Mefenamic acid 500mg for pain PRN
Exercise:
Exercise should include walking at a quick pace for 15 to
20 minutes four to five days a week, and once or twice a week
at a slower pace for 20 to 25 minutes. A quick pace was
defined as a training heart rate of 70 to 85 percent of a
persons maximum heart.
During this time you should not lift heavy objects, drive a
car or take long car rides, perform strenuous exercise, or
engage in sexual intercourse. Minimize severe straining during
bowel movements by using a laxative if necessary.

 Treatment:

You may expect frequency of urination and/or

urgency and perhaps even more getting up at night.
This will usually resolve or improve slowly over the
healing period. You may see some blood in your
urine over the first six weeks. Do not be alarmed,
even if the urine was clear for a while. Refrain from
strenuous activity and push fluids until clearing
occurs.
Pharmacological and other conservative
treatments should be observed. Anything observed
out of the usual should be reported as soon as
possible to the physician. This may indicate infection
or aggravating of the current condition.

Health Teachings:

Use aseptic technique in cleaning wounds

Observe proper diet
Follow proper schedule of medication
Educate the patient regarding changes in
sexual functions such as dry
ejaculation
and difficulty having erections within 312 mos. after surgical intervention
Eliminate vices and adapt healthy lifestyle
Advice taking of multi-vitamins with
selenium

Out-Patient Follow-up:
Advice the patient to visit a hospital or a physician
when:

patient experiences severe pain that does not

diminish
patient observes hematuria and dysuria after 5 days
of surgery
patient develops fever, swelling and purulent
discharge in the incision area

Inform the patient to take the scheduled follow up

consultations with his physician regarding his condition.

Drug
Study

ORAL MEDICATIONS

CLOPIDOGREL + ASA p.o. OD

Indications: Acute coronary syndrome, recent CV event & as

alternative to aspirin in prophylaxis of thromboembolic
events.
Drug Interactions: Prophylaxis of thromboembolic events 75
mg once daily. Management of acute coronary syndrome
300 mg loading dose, followed by 75 mg once daily.
Special Precautions: Risk of thrombotic thrombocytopenic
purpura. Prolongs bleeding time. Patients having lesions
with a propensity to bleeding eg. Ulcers; at increased risk of
bleeding from trauma, surgery or other pathological
conditions. Concomitant use w/ ASA & other NSAIDSs.
Discontinue 5 days prior to surgery in elective surgery
where antiplatelet effect is not desired. Serve hepatic &
renal impairment. Pregnancy and lactation. Children

ORAL MEDICATIONS
IRBESARTAN (IDEZAR)150 mg
tab p.o.OD
Indications: Treatment of HTN & diabetic
nephropathy
Drug Interactions: May increase serum K w/K- sparing diuretics, K
supplements/salt substitutes. Reversible increase in serum lithium conc
& toxicity. Reduced antihypertensive effect with NSAIDs ie selective
cyclooxygenase-2 inhibitors, ASA >3 g/day. Hypotensive effects may be
increased w/ other antihypertensive.
SP: Risk of fetal/neonatal morbidity or mortality; hypotension (in pts w/
intravascular vol- or Na-depletion), hyperkalemia (specially in the
presence of renal impairment, overt proteinuria due to diabetic renal
disease &or heart failure). Patients w/ aortic & mitral valve stenosis,
obstructive hypertrophic cardiomyopathy; primary aldosteronism; sever
CHF or underlying renal disease including renal artery stenosis; ischemic
cardiopathy/CV disease (excessive hypotension will result in MI or
stroke). Black patients. Pregnancy (1st trimester). Childn <6yr. Elderly

ORAL MEDICATIONS
SENOKOT

2 tab until stool is soft

Indications: Relief of functional constipation
through peristaltic stimulation. Forte tab;
Relief & control of constipation in the elderly,
during pregnancy & puerperium.
Contra Indications: Acute surgical abdomen
SP: Sudden persistent change in bowel
movement for >2 wks. Discontinue used if
rectal bleeding or failure occur. Patients on Narestricted diet. Prolonged use>1 wk.
Abdominal pain, nausea or vomiting.
Pregnancy and lactation.

MEDICATIONS
OMEPRAZOLE ( ZYOM) 40 mg IV q 12 hours
Indications: Treatment of duodenal & gastric ulcer,
gastro esophageal reflux. Prophylaxis of acid aspiration
pre-op. Cap: for the control of acid secretions in
pathological hypersecretory condition
DI: increased blood conc of diazepam, phenytoin &
warfarin. Reduced absorption w/ ketoconazole. Delayed
elimination of drugs metabolized by CYP450 enzyme
system r drugs that are highly excreted in the liver.
SP: Patients w/ hepatic impairment. Pregnancy and
lactation. Children, elderly.

LABORATORY
RESULTS

Normal findings

Hemoglobin

Hematocrit

140-180 gms/L

0.40-0.54%

Actual findings

93.1 gms/L

0.28%

Interpretation

Decreased level of
hemoglobin indicates that
there is nutritional
deficiency and also seen in
cases of iron deficiency
anemia.

Decreased hematocrit
indicates anemia, such as
that caused by iron
deficiency
Monocytes

WBC

5-10x10/L

10.4x10/L

Indicates presence of
infection

Lymphocytes

0.20-0.35%

0.28%

Normal

1.0%

High monocyte counts

usually indicate bacterial
infection

Monocytes

0.02-0.08%

Urinalysis
Interpretation
Color: yellow Normal
Transparency: clear Normal
Specific gravity: 1.005 Decreased urine specific gravity may be due to
Diabetes and renal problems
Reaction: 5.0 (acidic) Normal
Albumin: negative Normal
Sugar: trace( When you have sugar or glucose in your urine, it often means
your blood sugar is too high, and your blood stream can no longer carry that
overload of glucose, and it spills over into your urine. May be due to
diabetes.)
Pus cells: 1-3/hpf(normal)
RBC: loaded (Due to urinary tract infection, kidney and prostate disease.)
Bacteria: few (Bacteria are common in urine specimens because of the
abundant normal microbial flora of the external urethral meatus and because
of their ability to rapidly multiply in urine standing at room temperature.)

Thank You
for
listening!