CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55 6.The primary care provider (PCP) asked for a postvoiding residual (PVR) urine test. You use a bedside bladder scanner and document that S.M. voided 60 mL and his PVR is 110 mL. You report the PVR to the PCP. What is the significance of his PVR? The significance of his post voiding residual is the retention that the Patient still has in his bladder. The normal residual urine ranges from 0 to 15 ml; however, for patients with enlarged prostates 50 ml is acceptable Lewis, et. al (2014).7.Commonly used medications for BPH are 5-alpha reductase inhibitors, such as finasteride (Proscar) and alpha-blocking drugs, such as tamsulosin (Flomax). Howdo these drugs differ? 5-alpha reductase inhibitors- those drugs work to reduces the size of the prostate gland. Finasteride blocks the 5-alpha reductase enzyme that converts testosterone which surpresses androgen (Lewis et. Al, 2014, p. 1416,) Alpha-blocking drugs- this drug promotes smooth muscle relaxation in the prostate gland and facilitates urinary flow through the urethra. (Lewis et. Al, 2014, p.1417).8.The PCP ordered tamsulosin (Flomax) 0.4 mg/day PO. You enter S.M.'s room to teach him about this medication. What side effects will you tell S.M. about? (Select all that apply.)A, C, D, F9.S.M. asks, “Will this condition affect my relationship with my wife?” What
CHAPTER 5 GENITOURINARY DISORDERS CASE STUDY 55
1.What can you tell S.M. about his lab work? I would tell SM that his vitals are normal. S.M.’s Sodium Potassium ,Chloride Bicarbonate, BUN ,Creatinine , Glucose, RBC, WBC, Hgb-HctPlatelets, and Urinalysis all cam back within normal ranges for his age and demographic. However,Prostate-specific antigen (PSA) is low.2.What is the significance of the PSA result? Prostate-specific antigen (PSA) is 0.23 mg/mL this is low the normal range is (2.4- 4.0) up to 7.0 in older men. The prostate specific antigen assay was initially developed as a tumor marker (Lewis et. Al, 2014).3. What other specific examination will S.M. need to have along with the PSA? CAS A significant exam that tests for
Prostate-specific antigen is a digital rectal exam this tests for the size, symmetry and consistency of the prostate gland (Lewis et. Al, 2014). 4.Why did S.M. try taking the saw palmetto, and why do you think he stopped taking it? Palmetto is best known for its use in decreasing symptoms of an enlarged prostate. According to Lewis, side effects may include: nausea, vomiting, and stomach pain. (Lewis et. Al, 2014). 5.S.M. is curious why his enlarged prostate would affect his urination. He is concerned that he has prostate cancer. What would you teach him? I would teach S.M. that he dose not have cancer because of his enlarged prostate. All his labs came back normal except for PSA.