Case study - Benign prostatic hyperplasia: Nursing

Nurse, Solina works on a surgical step down unit and is caring for Pedro, a 55 year old male with a history of benign prostatic hyperplasia or BPH who was admitted two days ago following a transurethral resection of the prostate or terp.

Nurse, Alina goes through the steps of the clinical judgment measurement model to make clinical decisions about Pedro's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions taking action and evaluating outcomes.

First, ursula recognizes important cues including vital signs which are temperature 98.0 °F or 36.7 °C BP, 140/90 millimeters of mercury, heart rate, 88 BPM, respirations, 20 breaths per minute and oxygen saturation.

95% on room air. She also notices Pedro grimacing and shifting uncomfortably in bed when examining the collection bag for Pedro's continuous bladder irrigation or CBI nurse.

Suina notices large blood clots and amber colored drainage. Next, nurse Elina analyzes these cues.

She knows that the CBI output should be light pink and that blood clots and amber colored urine in the CBI drainage bag can indicate that the irrigation rate likely needs to be increased.

Also, Pedro's nonverbal cues and vital signs indicate he's experiencing discomfort, which is also likely due to his ineffective urinary drainage.

She also recognizes that bladder spasms resulting from his terp procedure can cause additional pain. Then she reviews the electronic health record or EHR and notes that Pedros last dose of pain medication was four hours ago.

Pedro, how are you feeling after your procedure? I'm fine.

Isn't there a male nurse on this floor? I understand that having a female nurse care for you after your terp procedure can be unfamiliar.

There are no male nurses available today, but I'm going to do my best to take care of you and make you comfortable. Is there anything I can do to help you?

I feel like I need to go to the bathroom a lot. I don't like having the catheter.

I can imagine its uncomfortable but the catheter is meant to help your prostate heal. How would you rate your pain from 0 to 10?

Seven? It really hurts and feels like pressure.

Ok. I'm going to perform an assessment now to make sure your catheter is working correctly when I'm done.

I'll check to see what medications the healthcare provider has ordered for your pain. Now, using the information shes gathered along with Pedros.

Medical history nurse, Elina chooses a priority hypothesis of impaired urinary elimination. Then she generates solutions to address Pedro's urinary elimination that will include pharmacologic and nonpharmacologic interventions.

And she establishes the expected outcome that after intervening Pedro will experience effective urinary elimination within one hour of treatment.

Nurse Elina then takes action to implement these solutions. First.

She checks the patency of his catheter and flushes it to clear the existing blood clots. Since the catheter appears to be working well, she increases the rate of the irrigation per her facility's protocol and ensures the fluid is draining properly.

Your catheter is working well. So I increased the rate of irrigation.

I'm also going to give you an anti spasmodic medication that'll help keep your bladder from spasming to help with your pain.

I can't wait to feel better. Thank you for helping me while continuing to monitor Pedro CBI nurse, Elina administers the prescribed anti spasmodic using safe medication administration principles.

She then dims the lights in his room, provides a warm blanket and encourages him to choose soothing music to play from his electronic device.

An hour later, nurse, Elina evaluates the outcome of her interventions. Pedro's vital signs are temperature 98.4 °F or 36.8 °C BP, 128/84 millimeters of mercury, heart rate, 75 BPM, respirations, 14 breaths per minute and oxygen saturation.

100% on room air. Ursula assesses Pedro's catheter bag and sees its draining clear light pink urine and is free of clots.

Also, Pedro rates his pain as three out of 10. All right.

As a quick recap, nurse, Elina recognized and analyzed cues related to Pedro's urinary elimination and pain prioritized hypotheses and generated solutions to address this problem.

She then took action to implement pharmacologic and non pharmacologic measures to address Pedro's impaired urinary elimination and evaluated outcomes comparing them to the expected outcome.

Since Pedro's urinary elimination was improved. Nurse, Elina determined the plan of care was successful.