NRSG258 – Case Study 2: Peter Harris Sample

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The current essay focuses on the case study of Peter Harris. The essay includes a discussion of the patients’ present condition and aetiology. The patient is suffering from Benign Prostatic hyperplasia. The essay also includes the pathophysiology of the patient’s present condition. The essay focuses on the pathophysiology of the post-operative deterioration of the patient.  The justification of the appropriate nursing management for the concerned situation of the patients will also be highlighted in the essay. Lastly, the interdisciplinary team will also be included in the essay.

Question :

NRSG258 National Unit Outline 201860

Peter Harris was being admitted to the hospital for surgery has revealed that the man has benign prostatic hyperplasia. Benign Prostatic hyperplasia occurs in a man with the second growth phase of the man. Peter Harris previously had the issue of Type 2 diabetes and COPD (Diamond et al. 2014). This is also one of the causes for developing benign prostatic hyperplasia. As stated by Peng et al. (2017), COPD and BPH shares common pathophysiology. Thus, in Peter Harris, both C reactive protein and higher levels of interleukin are observed. 

As, Peter Harris have COPD, thus, it is obvious that patients become physically inactive. Thus, the level of physical activity in Peter was being negatively associated with the increased risk of BPH. This evidences that physical inactivity among the older male patient contributes to factors for BPH development (Peng et al. 2017). Another major cause that has led Peter to such a condition is a change in the sex hormones that come with ageing. As commented by Breyer & Sarma (2014), diabetes mellitus is being associated with the BPH. This is due to the reason that diabetes mellitus is associated with insulin resistance to abnormal fat, carbohydrate and protein metabolism. As asserted by Wang et al. (2017), metformin helps in inhibiting the proliferation of benign prosthetic epithelial cells. It has been estimated that more than 45% of the patients with diabetes have been diagnosed with diabetic crystallography (Hill et al. 2018). As it is known that hyperinsulinemia is being related to increased sympathetic nerve activity. This leads to the increase of nerve activity that contributes to the increase in smooth muscle tone and obstruction in the bladder (Christina & Fabiana Oliveira dos, 2015). This can also be the cause of the detection of BPH in Peter Harris. 

In Peter Harris bladder outlet obstruction in men has been attributed to both the static as well as dynamic factors. In Peter, the static obstruction is due to the enlargement of the prostate upon the prostatic urethra and the outlet of the bladder. In the case of dynamic obstructing, the BPH is related to the tension of the prostate smooth muscle (Deco et al. 2015). It has been evidence that path physiology of LUTS among men such as in Peter results in the bladder outlet obstruction that is associated with prostatic enlargement. 

The bladder of Mr. Peter has become irritated due to the reason that urine is backing up rather than it is being released. Mr. Peter also feels a burning or pain when he is peeing. Sometimes, he has also noticed blood in the urine; however, he and his doctor were aware of BPH. AS per the direction of his doctor, he was being admitted to the hospital for urine surgery, where he was diagnosed with BPH. Mr. Peter was facing issues in urinating due to the reason that the enlarged prostate gland comprises the urethra that courses through the centre of the prostate, this has impeded the move of urine from the bladder through the urethra (Wang et al. 2017). This has caused the urine back into the bladder, which has led Mr., Peter to increase the frequency of peeing in the day as well as at night.

After the diagnosis of BPH, Peter was undertaken into the transurethral resection of the prostate. However, postoperative, Mr, Peter has evidencing some complications when he was being presented toward one hour from PARU. The breathing rate of Peter was being recorded as 30 breaths per minute which are abnormal. He must have a breathing rate of 15 -20 breaths per minute. The blood pressure of Mr. Peter is also decreased which is 100/60 Hr. however, the normal is 120/80 Hg. 

Mr. Peter is showing 28 beats more than the normal beats of the pulse which is 100 beats per minute. The post-operation condition of Mr. Peter is worse in every aspect. The body temperature of the patient was a little low that is 35°C; however normal is 37°C (Gawron et al. 2016). The worse situation that Mr., Peter is going through is the continuous bladder irrigation through the three-lumen urethral catheter, along with that the urine of patients also contains large blood clots. As stated by Ozge et al. (2017), continuous bladder irritation after TURBT enhances the removal of floating cancer cells and prevents those cells from attaching in the walls of the bladder. This helps in reducing tumour recurrence. Thus, continuous saline bladder irrigation is significant post-surgery of TURBT. 

As commented by Onishi et al. (2017), the initial peak of tumour recurrence after the Turbidity of the blood cancer was being detected after 100- 2000 days post operations. Peter was given the IV therapy through a peripheral line at the rate of 8b hours. This has decreased the experience of pain and irritation of the patients. In addition to, it also helps in reducing the blockage of the arteries and increase in efficiency of the blood circulation (Lazos et al. 2017). The blood clots in the urine of Mr, Peter can be removed by this IV therapy. However, it can have side effects due to the drug interference as many more drugs are being supplied to Peter for his betterment. 

The nurse plays a significant role in ensuring the continuity of care after the operation for patients. The nurse can primarily opt for the respiratory assessment. The nurse has assessed the respiratory rate which has been evidence more than that of the normal inpatient (Ciemins et al. 2016). The nurse should also encourage his adult son to foster the issues in Peter and will develop the assessment skills. The nursing management that should be applied to the patient is Tracheostomy. 

It is required that the nurse should timely change the Tracheostomy tube. This is due to the reason that it can reduce or minimise the infection and granulation of the tissue formation. The nurse who is been given responsibility for Mr. Peter post operations involves the family as well the patient that is Mr. Peter in this process. The nurse always gives emphasis on placing and securing the tubes independently (Jiji et al. 2015). The nursing management for Peter is also based on the adequate humidification. 

The humidification in the concerned situation is significant in reducing the thickness of build-up crusty formation and secretions. In this situation, the nurse cans also are a room humidifier or room vaporizer that will help to moisten the thin secretions and the tracheal tissues of Mr, Peter (Kim, Jackson & Keiller, 2016). Mr. Peter should also be evaluated for nutritional and wound healing; the nurses stress the relationship between the meticulous care for skin and prevention of the wounds and good nutrition (Pannick et al. 2015). As Mr. Peter is provided worth the tracheotomy, he might be at the risk of a deficiency of nutrition. This is due to the reason that altered anatomy and smell sensations of Peter, in order to address these problems, Mr. Peter is being encouraged by the nurses to maintain good oral hygiene and calorie snacks

Three members of the interdisciplinary team that would be appropriate for the situation are therapists and rehabilitation specialists, emotional, spiritual and social providers and lastly the support staff. Therapists are of various types that may include physical, occupational and respiratory therapists. As commented by Pannick et al. (2015) interdisciplinary team helps in improving the quality of healthcare and receives less scrutiny than management of BPH surgery. Thus it is necessary the Mr, Peter hires some of the members of the interdisciplinary team who will help in to recover better. 

Respiratory therapists are needed for Mr, Peter because, post-surgery, he was being dealt with the respiratory issue. The respiratory therapist can be suitable for treating Mr, Peter for his breathing problems. It is important that the respiratory therapist that is being selected for Mr, Peter should have the appropriate license (Trujillo et al. 2017). As reported by Peter’s adult son that he likes beer a lot and can drink up to 6 stubbiest in a single night, thus, it is not appropriate for Peter to drink so much alcohol post-surgery. Thus, a rehabilitation specialist is being hired for him so that he can lessen his thirst for the beer. Proper dieticians and nutritionists are also required so that they can evaluate the nutritional needs of Mr. Peter and supervise the preparation of serving the means. This will promote healthy eating habits in Peter.

Secondly, the social workers will also be hired in the hospital setting so that they can help Mr. Peter and his son to cope with this situation. In case there are some financial issues with them, then it can be managed by the social and emotional supporters. Depending upon the need of Mr. Peter, the social worker can help to coordinate services such as meals, long-term care, transportation, and finance. Thirdly, the support and administrative staff for Peter Harris is hired because the support team can provide the support in healing him in a better way. The administrative team will take care of the overall expenditures for Mr, Peter and will convey the issue to the social worker in case any kind of external support are needed.

Based on the discussion, it can be concluded that the history of COPD and Type 2diabetes has increased the risk of gaining a benign tumour.  The members who are appropriate for Peter are respiratory therapists and rehabilitation specialists and the support staff. The respiratory therapist will help Mr. Peter to overcome the problems in breathing and a rehabilitation specialist will help me to get rid of his alcohol drinking habit. The support team will help Peter and his family to get any in of support such as financial support for the family. 

Reference list 

Journals 

Breyer, B. N., & Sarma, A. V. (2014). Hyperglycemia and insulin resistance and the risk of BPH/LUTS: an update of the recent literature. Current urology reports15(12), 462.

Christina, A. P., & Fabiana Oliveira dos, S. G. (2015). The role of phosphodiesterase-5 inhibitors in prostatic inflammation: A review. Journal of Inflammation, 12 Retrieved from https://search.proquest.com/docview/1780101492?accountid=188056

Ciemins, E. L., Brant, J., Kersten, D., Mullette, E., & Dickerson, D. (2016). Why the interdisciplinary team approach works: Insights from complexity science. Journal of palliative medicine19(7), 767-770.

Deco, H., Wang, J., Huang, Y., Liang Liu, R., Junlei, H., Gao, L., . . . (2015). Comparison between thulium laser resection of prostate and transurethral plasmakinetic resection of prostate or transurethral resection of prostate. Scientific Reports (Nature Publisher Group), 5, 14542. Retrieved from doi:http://dx.doi.org/10.1038/srep14542

Diamond, R., Greene, M., Adelman, R., Hottensen, D., Bruell, L., & Ansell, P. (2014). Educational Digital Case Studies: Enhancing Palliative Care Communication and Interdisciplinary Team Interaction in the Hospital Setting (FR431-D). Journal of Pain and Symptom Management47(2), 437-438.

Gawron, K., Iazarz-Bartyzel, K., Potempa, J., & Chomyszyn-Gajewska, M. (2016). Gingival fibromatosis: Clinical, molecular and therapeutic issues. Orphanet Journal of Rare Diseases, 11 Retrieved from https://search.proquest.com/docview/1779518705?accountid=188056

Hill, D. L., Walter, J. K., Casas, J. A., DiDomenico, C., Szymczak, J. E., & Feudtner, C. (2018). The codesign of an interdisciplinary team-based intervention regarding initiating palliative care in pediatric oncology. Supportive Care in Cancer, 1-8.

Jiji, L. M., Schonfeld, I. S., & Smith, G. A. (2015). Capstone interdisciplinary team project: a requirement for the MS in sustainability degree. International Journal of Sustainability in Higher Education16(2), 187-199.

Kim, C., Jackson, D., & Keiller, P. (2016). Interdisciplinary Team-Teaching Experience for a Computer and Nuclear Energy Course for Electrical and Computer Engineering Students. American Journal of Engineering Education7(1), 1-8.

Lazos, J. P., Piemonte, E. D., Lanfranchi, H. E., & Brunotto, M. N. (2017). Characterization of chronic mechanical irritation in oral cancer. International Journal of Dentistry, Retrieved from doi:http://dx.doi.org/10.1155/2017/6784526

Onishi, T., Sugino, Y., Shibahara, T., Masui, S., Yabana, T., & Sasaki, T. (2017). A randomized controlled study of the efficacy and safety of continuous saline bladder irrigation after transurethral resection for the treatment of nonmuscleinvasive bladder cancer. BJU international, 119(2), 276-282.

Ozge, C., Bozlu, M., Ozgur, E. S., Tek, M., Tunckiran, A., Muslu, N., & Ilvan, A. (2015). The impact of hypoxemia on serum total and free prostate-specific antigen levels in patients with chronic obstructive pulmonary diseaseMedical Oncology, 32(5), 1-4. Retrieved from doi:http://dx.doi.org/10.1007/s12032-015-0602-2

Trujillo, J. A., Fernandez, Y., Ghafoori, L., Lok, K., & Valencia, A. (2017). Interdisciplinary family conferences to improve patient experience in the Neonatal Intensive Care Unit. Health & social work42(4), 241-246.

Pannick, S., Davis, R., Ashrafian, H., Byrne, B. E., Beveridge, I., Athanasiou, T., … & Sevdalis, N. (2015). Effects of interdisciplinary team care interventions on general medical wards: a systematic review. JAMA internal medicine, 175(8), 1288-1298.

Peng, Y., Huang, C., Liao, W., Chen, H., Yin, M., Huang, Y., . . . Ho, W. (2017). Association between chronic obstructive pulmonary disease and increased risk of benign prostatic hyperplasia: A retrospective nationwide cohort study.BMJ Open, 7(6) Retrieved from doi:http://dx.doi.org/10.1136/bmjopen-2016-015581

Wang, Z., Xiao, X., Ge, R., Li, J., Johnson, C. W., Rassoulian, C., & Olumi, A. F. (2017). Metformin inhibits the proliferation of benign prostatic epithelial cells. PLoS One, 12(3) Retrieved from DOI: http://dx.doi.org/10.1371/journal.pone.0173335

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