Nursing Care For End-Stage Prostate Cancer Patient With Multiple Complications

Primary Treatment Using Catheterization to Alleviate Secondary Urinary Retention

Question:

Discuss about the Precautions Transmission of Infectious Agents.

Prostate cancer is known to develop when there is an abnormal growth of the cells in the prostate gland that is a rapid division of the cells than compared in a normal prostate which results in the formation of a malignant tumor. In Australia, prostate cancer has been diagnosed to be the most common cancer. Most of the people dying of cancer have been found to be the cause of prostate cancer which is surveyed to be third most common. By the age of 85, one out 5 men will be diagnosed to have prostate cancer (Day-Calder, 2016). In older men, it has been found to be the most common one in which 63 percent of the cases in men were diagnosed over the age of 65 years. In the current study, the case is regarding Mr. X who is suffering from prostate cancer and is diagnosed to be the in the last stage associated with multiple complications. To get relieved from urinary retention he is being treated with the indwelling catheter.

Mr. X understanding towards the treatment is very poor so he tries to pull out the catheter frequently. This is the best for the new GRNs for whom it might be interesting on how to provide the nursing care effectively for such kind of patients and the type of treatment to be given who is suffering from end-stage of prostate cancer associated with multiple complications. Multiple radiations and chemotherapy treatment are given to the patient because Mr. X has been admitted many times as he is suffering from metastatic prostate cancer (Fordham-Barnes, 2014). But this time he is admitted with other complications like urinary retention, hematuria, and UTI. For treating this, they have to alleviate the secondary urinary retention to the fibrotic prostate so he was inserted with IDC.

This is the primary treatment which was started in treating him as the patient was complaining of the pain in the lower abdomen because of the urinary retention, loss of appetite due to multiple chemotherapy treatments and radiations, feeling of nausea, and lethargies. Here the condition of the patient has been identified and accordingly multidisciplinary collaboration of specialists is required for combining all the expertise so that high-quality integrated treatment can be achieved. As the choice, of clinical priority collaborative care is the method of treatment which can focus on meeting these requirements (Gillen, 2014). It would be the great opportunity for newly graduated nursing students to get knowledge about these integrated treatments and collaborative interventions. Also, the can know the clinical priorities given to the patient and their responses along with the alternatives that are focused in this case.

Collaboratively Integrated Treatments for High-Quality Integrated Treatment

The patient Mr. X has been currently admitted for the treatment of Urinary retention and Hematuria on a priority basis as this is the major problem that is giving pain to the patient (Haycock-Stuart, et al., 2015). So a number of collaboratively integrated treatments along with the nursing have been proposed for treating this patient and to get relieved from the pain such as catheterization, urinalysis, bladder drainage, urinary discharge, and safe discharge. 

Mr. X has been admitted for urinary retention so as a part of the initial management of the treatment acute urinary retention has to be managed by carrying out immediate and complete decompression of the bladder through the process of catheterization. The readily available standard transurethral catheters have been used which can be inserted easily. The patient has to be referred to the physician who is trained in the advanced techniques of catheterization immediately if urethral catheterization is unsuccessful. The other alternative nursing and collaborative techniques which have to be known by the newly graduated nurses are using of angulated coude catheter or placement of a firm (Jones-Berry, 2016). While treating, it has to be noted that some of the potential complications if rapid decompressions arise such as hematuria, hypertension, and post-obstructive diuresis. However, these complications cannot just be reduced by gradual bladder decompression and there is no evidence for that.

Hence Mr. X was further recommended for rapid and complete emptying of the bladder. For patients who are hospitalized will be requiring catheterization for a period of 14 days or less so nurses should take care and maintain the records of treatment of Mr. X. It is because urethral catheters impregnated with silver alloy is found to be associated with reduced rates if UTI versus the standard catheters. By doing catheterization for14 days the patient has shown less discomfort and bacteriuria. Currently, guidelines that are evidence-based are not available for bladder irrigation strategies and nurses have to consult the institution on CBI for standard operating procedures (Lavoie, et al., 2016). Due to the condition of Mr. X, he was advised with the bladder normal saline irrigation continuously through gravity alone for achieving the pink or clear urine. The nurse has to meanwhile monitor the color of the urine, patency, any presence of clots, and lack of leaking around the catheter and bowel function so that irrigation effectiveness can be assessed.

Mr. X has also been diagnosed with gross hematuria along with urinary retention. So he was initially evaluated by aiming at the outlining of the anatomic origin of the hematuria and also the genitourinary tract. However, it would be lengthy to go for differential diagnosis since he was in the setting of illness that is advanced so for uncovering the probable sources it is necessary for the nurses to go through the history of the patient carefully and has to focus on the physical examination (MacLaren, et al., 2016). In most of the clinical circumstances, the hematuria might be progressive and recurrent so it might require quick urologic consultation and evaluation with the imaging studies subsequently as seen in case of Mr. X. In doing further treatment, the options such as cystoscopy, retrograde or intravenous pyelography, magnetic resonance imaging, ultrasonography and or urography and the conventional tomography imaging that is computed can be carried out.

Evaluation Methods for Hematuria

At present, there are no guidelines that are evidence-based and state that any one of these suggested tests would be an idea in knowing the treatment. As there are no optimal imaging modalities all mentioned tests are done for Mr. X. A combination of cystoscopy and CT urography has been recommended to the patient by many experts for completely evaluating the entire GU tract (Nuutinen & Rannos, 2013). It has been suggested to the patient by HPM and urological clinicians that instillation of lidocaine gel intraurethral will improve the control of pain from moderate to severe by undergoing cystoscopy that is flexible but the comfort does not improve if there is a delay before the scope of insertion.

In this case the patient is advanced with his illness so as a part of the collaborative integrated treatment methods it is important to take into consideration the more extensive way of imaging or the invasive workup which has to be balanced with the goals of patient closely in terms of care, burden of symptoms, and prognosis overall. The severity of the bleeding and the facilitate patency of the outflow of the urinary has been assessed immediately by the clinicians as it is associated with the initial workup. In case of hematuria, the major potential emergency is the urethral obstruction (Oftedal, et al., 2017). Hence, in this case, the patient is held with the therapies of aspirin, drugs related to non-steroidal anti-inflammation, anticoagulation and antiplatelet conditions. These are the used temporarily for stabilizing the patient. The patient has been monitored for hemodynamic instability with the fluid infusion intravenously as it is was indicated to be necessary.

The fairly straightforward treatment that is appropriate for the patient Mr. X is the management of POUR. For avoiding the long-term damage to the integrity and functioning of bladder it is aimed at decompressing the bladder. The first step is always to go for the immediate catheterization. Either with the placement of indwelling Foley catheter or within and out catheterization this treatment can be carried out (Osborne, 2014). However, it is easy to pace the indwelling Foley catheter but prolonged used of this method is not encouraged as it is associated with many drawbacks. When compared with intermittent catheterization it is better to go for indwelling catheters in this patient as it leads to increased rates of UTI.

It is very important to make sure that there is a free drainage of urine so that urinary retention is avoided and ultimately leading to obstructive uropathy. Hence the patient here is suffering from hematuria so he has been carefully examined for making sure that there is not retention of urine after the treatment due to the formation of the clot. If the patient is able to pass the urine comfortably then he should be questioned about the presence of any clots in the flow of urine and if it is so then he should be asked about the clot size, and the difficulty he faced while passing through it. Clot retention has been noticed in the patient of Mr. X so the further treatment is recommended where it required the insertion of three-way Foley catheter which is similar to that of the standard two-way catheter (Page, et al., 2015). The presence of additional channels will be allowing the irrigation of the fluid to be passed through the bladder by clearing all the clots from the bleeding site.

Importance of Clear Instructions for Managing Hematuria

If the patient is not suffering from any kind of cardiovascular disorders than there is no reason to be an inpatient that is there would be no evidence of acute renal failure, retention of clots, sepsis, not able to take more amount of oral fluids, or social circumstances. After deciding that now it is safe for the patient to get discharged as he is treated for urinary retention and hematuria it is very much important in advising the patient with clear instructions on how to manage the hematuria in occurring again (Parisotto, et al., 2016). So Mr. X was suggested appropriately and was asked to seek further medical attention if he faces any complications

He has been advised to take a lot of clear fluids so that plenty of urine can be flushed out through the urinary tract. This would be the best solution in treating hematuria and clear it off and prevent the formation of any type of clots and problem of urinary retention. In addition to this, the patient has been advised that if the accumulation of urine in permitted in the bladder after some point of time due to, for instance, insufficient intake of fluids then he can notice the darkening of hematuria or passage of small clots (Scanlon, 2014). Then it should be considered as the sign of worry and has to clear it off in few voidings if he starts taking an adequate intake of fluids.

The catheterization was found to be successful for this patient so he has been discharged home after being examined with the urology follow up which was noticed to fit into the closed leg-bag foley system and he was educated in the management of catheter at home. After catheter therapy for preventing infection, the integrity of the catheter system that is closed is maintained and it has to be removed as soon as possible (Sinclair, Bowen & Donkin, 2013). It is not required to use the routine prophylactic antibiotics because its use might promote the resistance and might lead to further complications.

However, before discharge, a dose of oral antibiotic has been recommended as it was found to be appropriate for this patient X as the urinary catheters manipulation was excessive in this patient. If the patient is facing a systemic illness like hypertension, fever, or multiple comorbid medical conditions then he might require getting hospitalized again as he was facing multiple complications earlier too so it might lead to decompression (Sprinks, 2014). It is not necessary that by limiting the urine-emptying and gradual drainage the occurrence of hematuria after complete bladder emptying is most likely of little clinical significance.

Conclusion

The current case study is regarding Mr. X who has been suffering from metastatic prostate cancer and is also associated with multiple complications. The patient has been admitted with urinary retention and hematuria who has been suffering from severe pain out of these complications. So here usually I found that diagnosis is self-evident (Van der Berg & Daniels, 2013). The patient was found to be very much uncomfortable in passing the urine and he was facing difficulty in doing so. However, diagnosing is such conditions are necessary. The history of the patient is closely examined and the cause of such complications has been identified.

The patient is treated with multiple treatments available such as catheterization, bladder drainage, urinary discharge, etc. and finally he was relieved from the pain and was discharged. While discharging he was given necessary advice and suggestions of proper intake of fluids so that the reoccurrence of this problem will be low in future. It has been found that medications will play a significant role in treating the patients with urinary retention and hematuria (Vincent, et al., 2014). Research has been carried out extensively and many of the clinical studies have supported that as a part of the first line of medical therapy pharmacological agents will play a role.

Within the staff of nursing, the catheterization of the urinary bladder is found to be an exclusive procedure of the nurse which will be requiring enough practice and scientific knowledge has to be performed. It can be explained as the drainage of the urine by introducing the catheter into the urethra so that it reaches the interior of the urinary bladder. It has to be handled carefully by the nurses as the improper handling might be a discomfort to the patient. Accordingly, in the urethra, the length of the stay and the intervals between the process the urinary catheterization can be labeled as relieving (West, et al., 2017). It has been reported that among the key complications of the procedure is the urinary tract infection. So, the nursing practice should be appropriate not to make patients fall into such cases.

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