NR 603 Week 5 APEA Predictor Assignment Part 2
NR 603: Advanced Clinical Diagnosis and Practice Across
the Lifespan
, Week 5: APEA Predictor- Part 2
Diagnoses: BPH with LUTS (Acute urinary retention) / Stage 2: Significant obstruction with
bothersome symptoms
Diagnose of benign prostatic hyperplasia (BPH) is based on comprehensive history (personal and
family medical history), physical exam and medical testing. The initial assessment should begin
with the personal and family medical history. The personal history includes symptoms the patient
is experiencing. The patient is experiencing increased urinary frequency, urgency, hesitancy, and
sensation of incomplete voiding which are all classic signs of BHP (NIDDK, 2021). The
following step is family history. Individual with a family member, especially a brother, increase
number of family with BHP or young family member with BHP are at greater risk of BPH. The
patient has a brother with BHP, which increases risk of BHP (Salih, F.A.M, Mustafa, M., el. at,
2016 / ACS, 2021). A Symptoms Index (AUA-SI) is performed to evaluate the severity of
symptoms of lower urinary tract symptoms (LUTS). The patient scored an 8 on the AUA-SI.
Following a comprehensive history, next is a physical exam including digital rectal exam (DRE).
Performing determines the enlargement of the prostate gland, the degree of firmness, tenderness,
or detection of any nodules. The prostate enlargement or presence of nodules do not correlate
with the symptoms a man may experience.
Medical testing includes a urinalysis and PSA. Acute prostatitis (AP) and prostate cancer needs
to be rule out to aid in the diagnoses of BHP. A urinalysis can help by indicating an infection
ruling out AP due to bacteria. The patient’s urinalysis was negative for infection. A PSA and
DRE can be used to distinguish between BHP and PC (Coker TJ, Dierfeldt DM., 2026). A
diagnosis of clinical BPH can be detected by measuring the intravesical prostatic protrusion
(IPP) on a transabdominal ultrasound (TAIS) and uroflowmetry. A normal bladder neck inverted
of the prostate is less 20g or less and a flow peak rate of 20 mL/s or above. The patient had a
flow rate peak of 16 m/Ls with a prostate volume of 36g (Foo, K.T., 2017).
Treatment:
Since the patient has bothersome symptoms of LUTS, plan of care is to relieve symptoms of
LUTS and prevent compilation associated with BHP. If the treatment fails, consider re-
evaluating the treatment plan or possible referral to a specialist for assessment and treatment
(Lokeshwar, S. D., Harper, B. T., el. at, 2019).
Lifestyle modification: Is the initial step in the treatment of BPH.
• Diet and exercise- The patient needs to decrease his intake of red meat, fat, milk, dairy
products, and starch, while increasing his intake of fruits and vegetables can help
decrease the progression of BHP. Studies have demonstrated exercise and increasing
in
physical activity decreasing the risk of BHP surgery.
• Weight loss management – A BMI of 35kg/m2 or more increases the risk of prostate
enlargement, progression of LUTS and BPH surgery (Lim K. B., 2017).
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