Nursing Care Plan for a Genitourinary Patient
Genitourinary disorders are common among the aging population. For example, urinary incontinence accounts for close to 10million of the elderly persons in the USA. Thus, helping them to cope with this inevitable aging change is of the essence in the plan of care instituted by a nurse. Central to the care plan are the three phases, namely, assessment, diagnosis, and interventions. The assessment will enable the nurse to gather the relevant information that will give a clue to the patient’s health problems (diagnoses). Lastly, formulation of nursing interventions is attainable from the diagnoses made. With such a strategy in place, the elderly persons are no exception to a high quality of life despite their predicaments in the old age.
Nursing Care Plan for a Genitourinary Patient
Genitourinary disorders are common in the aging population given their body changes. A case in point of such a disorder is urinary incontinence that can occur independently or in combination with other conditions. In the USA, approximately 10million elderly patients suffer this fate and thereby leading a poor quality of life (Gorina, Schappert, Bercovitz, Elgaddal, & Kramarow, 2014). Thus, helping this population adapt to this challenge should be central in their plan of care. In essence, explanation of such a care plan forms the theme of this discussion.
Care Plan Template
Patient Initials: H.M Age: 60 years Sex: Male
Client Complaints: Increased incidences of decreased urinary flow (2/52), dysuria (2/52), nocturia (4-5 times), increased frequency of urination and mild fever.
HPI (History of Present Illness)
The onset of the decreased urinary flow dates back two years ago, but in the past two weeks, it has become more severe alongside the other manifestations named above. The patient reports the absence of pain radiation and no use of treatment to relieve his symptoms.
PMH (Past Medical History)
He is a known hypertensive patient with hypercholesterolemia, which is currently under control via medications. Also, he has had treatment of a chest wall syndrome, which was initially thought to be angina. Apart from that, he has no history of hospitalization or surgery. Currently, he is on Zocor 20mg OD and Cardizem 240mg OD. Lastly, he has no known drug allergy.
Significant Family History
The patient has a distant history of heart disease among his aunties and uncles.
The patient is a university graduate that works as an engineer and earns a yearly salary of $ 65,000. He is married to a healthy wife and has two grown-up sons that are living in another city.
Besides, he reports an undisrupted self-efficacy and has a good support system that helps him emotionally. Moreover, he has a medical insurance that fully covers his medical expense and visits his medical practitioner regularly. His dietary practices are good since the wife cooks all the meals and asserts that he eats healthily. Additionally, he reports that he has adequate exercise.
Finally, he is a non-smoker, non-alcoholic and does not use any substance of abuse.
Description of Client’s Support System
He has an excellent and readily available support system that involves his wife and workmates, who are ready to help him emotionally.
Behavioral or Nonverbal Messages
He exhibits anxiety through his thoughts of having cancer.
Client Awareness of Abilities, Disease Process, Health Care Needs
The patient demonstrates a limited understanding of the condition he is suffering from through his worry that he might be having cancer.
Vital Signs including BMI
He has a slightly high blood pressure of 140/92 of the right arm while sitting, a high temperature of 99 per oral, a normal respiratory rate of 18breaths/minute and a slightly high BMI of 27.7kg/m2.
Physical Assessment Findings
Of significance to this scenario, the patient has a heart murmurs on the right side of the sternal body. Additionally, he has android obesity with a non-tender abdomen. On rectal examination, he has heme positive stool and a prostate that is enlarged, boggy and tender. Also, genital/ pelvic exam shows no signs of its association to the presenting symptoms. Lastly, extremities show no evidence of edema and have the pulse are palpable.
Lab Tests and Results
The patient has an elevated PSA level (6.0), with a complete blood count and blood chemistry that are within the normal ranges.
Client’s Locus of Control and Readiness to Learn
Patient demonstrates an internal locus of control as he seeks medical attention on his own without coercion from another person. Furthermore, he shows a high level of readiness to learn since he reports to going for medical check-ups regularly.
ICD-10 Diagnoses/Client Problems
The likely diagnoses in this scenario are acute prostatitis (N41.0), benign prostatic hyperplasia with lower urinary tract symptom (N40.1), essential hypertension (I10), and hypercholesterolemia (E78.00).
Also, elevated PSA (R97.20), undiagnosed cardiac murmur (R01.1), nocturia (R35.1), and dysuria (R30.0) are also possible to this scenario (Centers for Medicare & Medicaid Services, 2016).
Advanced Practice Nursing Intervention Plan
Firstly, the nurse must take a comprehensive history of the patient to gather all the necessary information that can point to his underlying disease. History taking is an essential and most basic nursing intervention, whose vitality is beyond question in the nursing practice (Wilson & Giddens, 2014). In this case, the patient’s information will entail both the subjective and objective data, which will further point to his current diagnosis.
Secondly, the nurse must afterward request for necessary diagnostic tests from other departments. The tests are necessary for the affirmation of the potential diagnoses picked from the patient’s history. The renal function test is central to this scenario since it will help one to rule out kidney causation of the presenting symptoms. Additionally, a colonoscopy test whose indication is to eliminate the possibility of colon cancer as the source of heme in the patient’s fecal matter given his absence of hemorrhoids is also a priority. Colon cancer has the potential of causing occult bleeding (Robbins, 2012).
Besides, the nurse must address the patient symptoms to enhance comfort. Central to this is the administration of appropriate medications. For instance, a quinolone or Trimethoprim-sulfamethoxazole is essential in the treatment of prostatitis, which is a possible diagnosis (Lehne, 2013). Also, one should administer NSAIDs for pain relief and pyrexia control of the patient. Doxazosin, an Alpha antagonist medication is also applicable in this case if one affirms a Benign Prostate Hypertrophy (BPH) diagnosis that is a likely cause for the patient’s predicaments. Doxazosin is crucial to this scenario since it has the potential to address the blood pressure and BPH (Lehne, 2013).
That notwithstanding, health education and counseling are of the essence in this scenario. The nurse must reinforce the need of complying with the prescribed medications. Drug compliance is necessary for successful antibiotic therapy (Leekha, Terrell, & Edson, 2011). Furthermore, teaching the patient on dietary modification is another health topic relevant to this scenario. A cardiac diet (low salt and fat) is the recommended diet for patients with hypertension and hypercholesterolemia (Gibney, Margetts, Kearney, & Arab, 2013).
During the follow-up care, the nurse has a significant role to play. For instance, the nurse must perform regular blood pressure monitoring to determine its control. Additionally, he/she should utilize the interdisciplinary team at his disposal to manage the patient effectively. Collaborative management affords the best evidence-based practice that all health care professionals must use in their routine activities (Sidani & Fox, 2013). In this case, the nurse should refer the patient to the cardiologist who will conduct an echocardiogram and provide an expert opinion of the murmurs heard on auscultation. Consulting a mental health care professional is also important for this patient. He/she will assist the patient to adopt proven strategies to address his challenge of insomnia secondary to nocturia. Psychotherapy is an example of such interventions. According to Craighead and Dunlop, (2014) psychotherapy intervention is crucial in the management of depression in ill health situations.
Lastly, emphasizing the need of utilizing community resources is another nursing intervention. In this action, the nurse can encourage the maintenance and expansion of support systems for the patient. Cook and colleagues, (2013) are of the opinion that medical personnel must rely on support systems because of their invaluable contribution to the health care sector. Nevertheless, the nurse must also sensitize the patient on the need to utilize community resources such as hospitals during sickness and wellness. With such a practice, the patient is in pole position to have the timely medical attention that will optimize his wellbeing.
In closure, caring for a patient with a genitourinary condition entails a comprehensive approach, to which the nursing care plan is a perfect example as evident in this scenario. Thus, nurses must show reliance on the same if they are to manage such patients effectively.
Centers for Medicare & Medicaid Services,. (2016). Medicare Coverage Database – Centers for Medicare & Medicaid Services. Cms.gov. Retrieved 3 November 2016, from https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx?KeyWord=hypertension&bc=AAAAAAAAAAAQAA%3d%3d&
Cook, S., Fillion, L., Fitch, M., Veillette, A., Matheson, T., & Aubin, M. et al. (2013). Core areas of practice and associated competencies for nurses working as professional cancer navigators. Canadian Oncology Nursing Journal, 23(1), 44-52. http://dx.doi.org/10.5737/1181912×2314452
Craighead, W. & Dunlop, B. (2014). Combination Psychotherapy and Antidepressant Medication Treatment for Depression: For Whom, When, and How. Annual Review Of Psychology, 65(1), 267-300. http://dx.doi.org/10.1146/annurev.psych.121208.131653
Gibney, M., Margetts, B., Kearney, J., & Arab, L. (2013). Public Health Nutrition. Somerset: Wiley.
Gorina, Y., Schappert, S., Bercovitz, A., Elgaddal, N., & Kramarow, E. (2014). Prevalence of incontinence among older Americans. National Center for Health Statistics.
Leekha, S., Terrell, C., & Edson, R. (2011). General Principles of Antimicrobial Therapy. Mayo Clinic Proceedings, 86(2), 156-167. http://dx.doi.org/10.4065/mcp.2010.0639
Lehne, R. (2013). Pharmacology for nursing care (8th ed.). St. Louis, Mo.: Saunders Elsevier.
Robbins, L. (2012). Preventing disease. [Place of publication not identified]: Springer.
Sidani, S. & Fox, M. (2013). Patient-centered care: clarification of its specific elements to facilitate interprofessional care. Journal Of Interprofessional Care, 28(2), 134-141. http://dx.doi.org/10.3109/13561820.2013.862519
Wilson, S. & Giddens, J. (2014). Health assessment for nursing practice (5th ed.). London: Elsevier Health Sciences.