Answer

Care Plan for Patient with Urinary Flow Impairment

Patient Initials: ______                 Age: _______________                              Sex: ___________

Subjective Data:

Client Complaints:

The chief complaint of the patient is a reduction in urine output. The symptom, that has been persistent for 10 years, has escalated for 2 weeks. There is no associated pain.

HPI (History of Present Illness):

The patient is a Hispanic male aged 60 complaining of low urine output. His urine output has been low for 10 years but there has been gradual reduction in urine output for the past two weeks. The related symptoms in the past two weeks include decreased strength of urine flow, increased nocturia, and slight terminal dysuria. His daily activities are mitigated by the low propensity to urinate and he needs to be around bathrooms always. The low urine output has a low-grade fever as a related symptom. The patient associates the urinary flow impairment with cancer. He has never sought for any medical attention. However, he seeks for medical intervention because of the increased severity of the obstructive symptoms.

PMH (Past Medical History—includes current medications, any known allergies, any history of surgery or hospitalizations):

It is apparent that there is no past medical intervention for the patient’s urinary obstructive symptoms. However, his current medications are for hypercholestolemia and hypertension. Particularly, the drugs are Cardizem 240mg daily for high blood pressure and Zocor 20mg daily for hypercholesterolemia. The patient has no known drug allergies. He was hospitalized five years ago following a chest wall syndrome. However, he has not undergone recent surgeries or hospitalizations.

Significant Family History:

Both his sister and brother are alive and in good health. However, his uncles and aunts have a remote history of cardiac disease.

Social/Personal History (occupation, lifestyle—diet, exercise, substance use)

The patient is a financially stable master’s degree holder in engineering. He has always worked as an engineer. His originality is the United States and he lives in a suburban setting. The patient has a wife who is in good health. They have two grown-up sons who stay separately in their families. The wife is responsible and does most of the cooking. He asserts that he performs sufficient physical activities and leaves a healthy lifestyle. He is quite certain that he is generally healthy following the regular medical checkups with his physician. He denies smoking, drinking, and abuse of any other substance.

Description of Client’s Support System:

The patient is financially stable and has adequate resources to cater for his medical care. His annual income of $65, 000 is backed up by an excellent health insurance coverage that includes a prescription plan. His wife and work mates are quite emotionally supportive to him. However, he is unaware of the resources available to him in community and benefits minimally from the social support networks outside his home and workplace.

Behavioral or Nonverbal Messages:

The patient lack awareness of the resources available to him. Additionally, the inadequate usage of the healthcare services despite the accessibility depicts that the patient might be experiencing a chronic health condition that has gone untreated.

Client Awareness of Abilities, Disease Process, and Health Care Needs:

The patient admits that he adequately understand the diseases affecting him and the reasons for taking his medications. He has adequate perception of self-efficacy with very low stress level due to his well-integrated family. He also understands his healthcare needs because the persistent escalation of the symptoms compelled him to seek for medical intervention. The patient also does not have cultural beliefs that bar him from seeking medical intervention.

Objective Data:

Vital Signs including BMI:

BP 140/92, T: 99 po P: 80 and regular R: 18, non-labored breathing, Weight: 200pounds Height: 71” BMI: (200/71×71) × 703 = 27.89

Physical Assessment Findings:

Lungs: Clear

Lymph nodes: None

Heart: RRR with a Grade II/VI systolic murmur heard best at right sternal border

Carotids: No carotid bruits

Abdomen: Android obesity, non-tender

Rectum: Stool light brown, heme positive, enlarged prostate, tender and boggy to palpation.

Genitourinary: Circumcised, no penal masses, lesions, or discharge. Testes are descended

bilaterally, no tenderness or masses

Extremities: 2+ pulses throughout, no edema in the lower extremities.

Neurologic: Not examined

Lab Tests and Results:

CBC: WNL

Radiological Studies: None

Chem panel: WNL

PSA: 6.0

EKG: None

Client’s Support System:

The client has a socially stable family and the wife and workmates are very supportive. He gets adequate annual earnings of $65, 000 and a health insurance coverage that includes prescriptions. Therefore, he can comfortably pay for his medications cost.

Client’s Locus of Control and Readiness to Learn:

The client has a high self-concept and lives with low stress levels following the integration of his family members. He is complaint of the current medications and this shows the low possibility of adherence to the dosage. He is ready to learn the concepts that would bring his health back to the normal life following his plan to visit the hospital.

ICD-10 Diagnoses/Client Problems:

Advanced Practice Nursing Intervention Plan (including interdisciplinary collaboration, community resources and follow-up plans):

The first and most important intervention would be to create a good rapport with the patient to show the concern for the patient’s suffering. The nurse should assess the sleeping pattern of the patient and help him create a comprehensive sleeping plan. Additionally, the nurse should teach him on how and when to use sleeping aids as well as their side effects. The nurse should also encourage the patient to stop taking much fluid before sleeping. This education is necessary because nocturia disturbs sleep and intake of less fluid would reduce the urge to urinate during sleep (Oelke, Bachmann, Descazeaud, Emberton, Gravas, Michel, & Jean, 2013). It is also appropriate to provide a quiet and dark room for the patient to sleep comfortably because the disturbed sleep pattern for the past two days might cause further complications such as headaches.

The nurse should review the community and healthcare resources available for the patient to increase his knowledge of the helpful resources. Examples of such resources would be venue for sports activities for the old and national libraries where he can study about his health conditions.  The patients should also be encouraged to urinate every 2 hours to 4 hours to minimize urinary retention (Inamoto, Tsujimura, Nonomura, Azuma, Akino, Oguchi, & Watanabe, 2012). The assessment of the frequency and force of urination would help to determine the appropriate interventions to make. The nurse can also determine the patient’s urinary residual volume by catheterizing him immediately after micturition. However, the painful nature of catheterization, it is more accurate than bladder ultrasounds in obtaining urinary measurements for clinical judgments. The nurse should refer the patient to a urologist to ensure an inter-disciplinary approach to evidence-based nursing. The collaboration can also be enhanced by administering the medications as directed by the physician. Arrangements should be made for the client to visit the theatre for a prostatectomy after confirmation of a prostate cancer or benign growths. The client had previously expressed a complaint on his medications. Therefore, the nurse should advise him on the importance of dose completion and strict adherence to follow-up plans.

The low-grade fever can be mitigated by administering medications such as ibuprofen that are anti-pyrogenic. The patient can also be taught voiding strategies such as attempting to urinate in complete privacy (Inamoto, Tsujimura, Nonomura, Azuma, Akino, Oguchi, & Watanabe, 2012). The nurse can also conduct a focused assessment for retention related to prostate cancer or Benign Prostatic Hypertrophy. Lastly, the nurse should encourage his family members to provide emotional support to the patient and remind him of his medications after discharge.