ST.

MARY'S COLLEGE
NURSING PROGRAM
Tagum City

A CASE STUDY
on

HYPERTENSIVE URGENCY, HYERTENSIVE CARIOVASCULAR DISEASE,

CORONARY ARTERY DISEASE, LEFT VENTRICULAR HYPERTROPHY, SINUS
RHYTHM, NOT IN FAILURE; PROSTATE CANCER STAGE III

___________________________

Presented to:

EVIE LUZ S. DOCENA, RN, MN

Clinical Instructor

In Partial Fulfillment of the Requirements

In

Related Learning Experience

(RLE)

__________________________

By:

Castillo, Kent John N.

Rodriguez, Michael Roy B.
Cinco, Romruth C.
Sedico, Quenny Lou A.
Presores, Gerlie Mae

August 2009
 TABLE OF CONTENTS

A. Introduction - - - - - - - - -

B. Objective of the Study - - - - - - -

C. Assessment - - - - - - - - -

• Biographic Data
• Chief Complaint
• History of Present Illness
• Past medical and Nursing History
• Personal, Social-Economic History
D. Patient Need Assessment - - - - - - -

E. General Survey - - - - - - - - -

F. Course in the ward - - - - - - - -

G. Laboratories and Diagnostic Examinations - - - -

H. Review of Anatomy and Physiology - - - - -

I. Symptomatology - - - - - - - -

J. Etiology of the disease - - - - - - -

K. Pathophysiology - - - - - - - -
 • Written Pathophysiology
• Diagram
L. Synthesis of clients conditioned status from
admission to present - - - - - - - -

M.Evaluation of the Objective of the study - - - -

N. Nursing Care Plan - - - - - - - -

O. Bibliography - - - - - - - - -

A. INTRODUCTION

Heart disease is the leading cause of death for all people in the US, and stroke is
the third leading cause of death. Heart disease and stroke are also major causes of
disability and significant contributors to increasing health care costs in the US. The
mortality rate for cardiovascular disease (heart disease, stroke, and chronic obstructive
pulmonary disease) is greater than the combined rate for all leading causes of death
(cancer, unintentional injuries, pneumonia/influenza, diabetes, suicide, kidney disease,
chronic lever disease and cirrhosis). (US DHHS, 2000). The major risk factors for
cardiovascular disease are hypertension, smoking, hypercholesterolemia, high alcohol
consumption, and lack of physical activity. (Tamir and Cachola, 1994). In 2001 there
were approximately 460,000 indigenous people in Australia, accounting for 2.4% of the
population. However persons greater than 40 years old account for proportionately
fewer indigenous people, reflecting the fact that indigenous people are much more likely
to die before they are old than the general Australian public: men at 56 years; women at
63 years. In addition, death rates are estimated to be four times higher in indigenous
than in non-indigenous Australians.
In 2002 the leading cause of death in indigenous people was cardiovascular
disease (CVD), responsible for 1/3 of all deaths, followed by ischemic heart disease
(16%) and stroke (9%). Of indigenous Australians aged 35–44 years, 16% reported a
cardiovascular condition, with the rate increasing to 31% for those aged 45 to 54 years,
and to 47% for those aged 55 years and over. The prevalence of cardiovascular
disease is greater in remote areas. Coronary heart disease is 3–4 times higher for
males and females than in non-indigenous people. Indigenous people are much more
likely to die of CVD than non-indigenous people at any age, especially in younger age
groups – the death rate among 25–54 year olds was 10 times higher than other
Australians.
Every hour, nine Filipinos die of cardiovascular or heart diseases. In fact,
cardiovascular diseases (CVD) remain the No. 1 cause of death in the Philippines.
About one out of four deaths in the country are traced to cardiovascular diseases,
according to the Department of HealthOne out of 20 adults (40 years and older) suffers
from coronary/ischemic heart disease. And one out of 10 adults (15 years and older)
suffers from hypertension, or high blood pressure. Five out of 100 adults suffer from
coronary artery disease. Surveys made by the DOH show that Central Luzon had the
highest cases of cardiovascular diseases (225 per 100,000 population). Metro Manila
registered the highest mortality rate (99 per 100,000) while the lowest was in Central
Mindanao (16 per 100,000).
During the past three years, eight of the ten leading causes of morbidity in Davao
Region were communicable but highly preventable diseases. In 2002, the illnesses
registered were the upper and lower respiratory tract infections, pneumonia, diarrhea,
influenza, tuberculosis, malaria and dengue. The non-communicable leading causes of
morbidity were hypertensive diseases and genitourinary system diseases. In 2002-
2004, cerebrovascular diseases topped the leading causes of mortality, indicating the
need to examine closely the lifestyle of the at-risk population in the region. In 2002,
heart diseases ranked second to cerebrovascular diseases. Other leading causes of
death among all ages include pneumonia, accidents, malignant neoplasms,
tuberculosis, hypertensive diseases, diabetes mellitus, lower respiratory infections and
septicemia.
Cumulative risk and trends in prostate cancer incidence in Mumbai, India.
Information relating to cancer incidence trends in a community forms the scientific basis
for the planning and organization of prevention, diagnosis and treatment of cancer. We
here estimated the cumulative risk and trends in incidence of prostate cancer in
Mumbai, India, using data collected by the Bombay Population-based Cancer Registry
from the year 1986 to 2000. Methods; During the 15 year period, a total of 2864
prostate cancer cases (4.7% of all male cancers and 2.4% of all cancers) were
registered by the Bombay Population-based Cancer Registry. Results; Analysis of the
trends in age-adjusted incidence rates of prostate cancer during the period 1986 to
2000 showed no statistically significant increase or decrease and the rates proved
stable across the various age groups (00-49, 50-69 and 70+) also. The probability
estimates indicated that one out of every 59 men will contract a prostate cancer at some
time in his whole life and 99% of the chance is after he reaches the age of 50.
Department of Urology, National Taiwan University Hospital and National Taiwan
University College of Medicine, Taipei, Taiwan. Although Asian people have the lowest
incidence and mortality rates of prostate cancer in the world, these rates have risen
rapidly in the past two decades in most Asian countries. Prostate cancer has become
one of the leading male cancers in some Asian countries. In 2000, the age-adjusted
incidence was over 10 per 100000 men in Japan, Taiwan, Singapore, Malaysia, the
Philippines and Israel. Although some of the increases may result from enhanced
detection, much of the increased incidence may be associated with westernization of
the lifestyle, with increasing obesity and increased consumption of fat. The differences
in incidences between native Americans and Asian immigrants are getting smaller,
reflecting a possible improvement of diagnostic efforts and changes of environmental
risk factors in Asian immigrants. Nevertheless, the huge variations in incidences among
ethnic groups imply that there are important genetic risk factors. The stage distributions
of prostate cancer in Asian populations are still unfavorable compared to those of
Western developed countries. However, a trend towards diagnosing cancer with more
favorable prognosis is seen in most Asian countries. Both genetic and environmental
risk factors responsible for elevated risks in Asian people are being identified, which
may help to reduce prostate cancer incidence in a chemopreventive setting. The
incidence of prostate cancer has risen by 5-118% in the indexed Asian countries (age-
specific and age-standardized) based on incidence and mortality rates data for prostate
cancer in Asian countries for 1978-1997. Incidence at centers in Japan rose as much as
102% (Miyagi 6.3-12.7 per 100,000 person-years) while the incidence in Singaporean
Chinese increased 118% from 6.6 to 14.4 per 100,000 person-years. The lowest
incidence rate recorded was in Shanghai, China and the highest rates were in Rizal
Province in the Philippines, although still much lower than those in the United States of
America (USA) and many European countries.
Prostate Cancer is the fourth most common male malignancy worldwide.
Incidence and death rates vary tremendously among countries, however in the
Philippines, more and more cases are being seen every year. Local interest in Prostate
Cancer has also been in the spotlight since the last Presidential Elections when
Presidential Candidate Raul Roco revealed that he was diagnosed to have advanced
disease.
In the 1990s, Quijano did a research in Guihing, Davao Del Sur, where he
attributed the high incidence of prostate and breast Cancer and other illness there to the
patients’ prolonged exposure to pesticide in the nearby banana plantations. “Although
other factors — such as malnutrition and the lack of sufficient housing — also
contribute, long pesticide exposure was largely to blame for those diseases,” he said,
citing similar symptoms among people living near banana and pineapple plantations in
South Cotabato and different parts of Davao city.
According to Local Studies Related to Aerial Spraying regarding Health and
Environmental Conditions of People Living in Three Communities of Davao City Where
Aerial Spraying of Pesticides is a Common Practice. September 2006. Of the 22 cases
of cancer: 6 cases (27.3%) –prostate cancer, 4 cases (18.2%) – breast cancer, 2 cases
each (9.1%) – brain, uterine, bone cancer, 1case each (4.5%) – liver, colon, leukemia,
throat, thyroid, lung cancer.
B. OBJECTIVES
General:
After apprehensive case study, students will be able to extend and improve their
knowledge and understanding with regards to the causes, effects, complications, signs
and symptoms and nursing implementation for Hypertensive Urgency, HCVD, CAD,
LVH, SR, NIF; Prostate CA Stage III for them to be able to attain a comprehensive and
thorough learning experience with regards to their study that would benefit not only
them but also for their readers and for the patients that they will be catering in the future
with such kind of disease.

Specific:
• Study the patient’s history of past and present illness
• Conduct a synoptic physical assessment of patients with Hypertensive Urgency,
HCVD, CAD, LVH, SR, NIF; Prostate CA Stage III
• Be able to review the anatomy and physiology of the affected organs and
systems
• Distinguish the affected system
• Trace and analyze the pathophysiology of the infirmity
• Classify the ordered drugs and associate its action or effects to the patient
 • Consider laboratory results and relate it to patient’s condition
• Construct nursing care plan for patients with Hypertensive Urgency, HCVD, CAD,
LVH, SR, NIF; Prostate CA Stage III
• Identify prognosis of the patient
• Evaluate the client’s condition from the time of admission up to the present

C. ASSESSMENT

A. Biographical Data
Name: Megatron
Age: 78 years old
Gender: Male
Civil Status: Married
Birthdate: November 11, 1930
Birth Place: Dumangas, Iloilo
Nationality: Filipino
Religion: Protestant
Occupation: Pastor
Name of Spouse: Starscream
Admitting Diagnosis: Hypertensive Urgency, HCVD, CAD, LVH, SR, NIF; Prostate CA
Stage III
Admitting Physician: Precy Gem T, Sanchez, M.D.

B. Chief Complaint
Admitted due to dizziness, inability to walk and loss of appetite
 VS upon admission:
T – 37.3oC PR – 89 bpm
RR – 32 cpm BP – 170/110 mmhg
Weight – 77 kgs. Height: 5 feet 4inches

C. History of Present Illness

Megatron experienced dizziness, loss of appetite and inability to walk prior to
admission. Patient was admitted last July 28, 2009 & was diagnosed with Hypertensive
urgency, HCVD, CAD, LVH, SR, NIF, PROSTATE CA STAGE III. Since then, patient
experienced difficulty and painful urination. Progressive lower extremity weakness noted
after the patient complained of lumbosacral pain. Two days after his admission, result of
UXD of prostate released & revealed a Grade 3 prostatic enlargement where patient
was suggested for PSA correlation. He has FBC attached to urobag draining a bloody
urine. Abdominal distention and bipedal edema noted. He is hypertensive, has Diabetes
Mellitus & is a cigarette smoker and alcoholic drinker during adolescent stage up to
adulthood stage.

D. Past Medical History

Megatron had undergone surgical operation of the Right eye as out-patient last
July 2002 due to cataract. Four months after his operation, last November 2002, he was
admitted due to hematemesis & was diagnosed with gastric ulcer. Patient underwent
surgical operation of the prostate twice; last January & October 2004 at Davao Regional
Hospital, where he has diagnosed with Hypertension and prostate CA stage III. He had
never undergone chemotherapy. Since then, patient underwent PSA testing quarterly
for 5 years, inconstantly and inconsecutively. Antineoplastic medications and
antihypertensive medications were prescribed to him as home medications.

E. Personal, Family History

Megatron belongs to nuclear family and youngest among 9 siblings. By the age
18-32 y/o, patient was fun of smoking everyday and drinking alcoholic beverages almost
4x a week. After a year until 70 y/o, patient gradually minimized his vices into moderate
amount and occasionally. Patient was fun of eating meaty products, salty and sweet
foods before. Patient has no family history of any type of cancer and diabetes mellitus.
His father has history of hypertension as well as his siblings.

F. Socio-Economic History
Megatron belongs to middle class family. For 15 years of being a farmer way
back 1964-1979, he earned P50.00 – P100.00 monthly as usual income. Immediately
after being a farmer, he became then a pastor and receives an honorarium monthly of
about P2,000-3,000 monthly. Her wife is a plain housewife while most of his children
now has stable job.

D. PATIENT NEED ASSESSMENT

Date: July 30, 2009

NAME OF PATIENT: Megatron _AGE__78___SEX_M__STATUS_Married___
ADMISSION; Date/Time____July 28, 09 8: 00 pm___
ADMITTING MEDICAL DIAGNOSIS: Hypertensive urgency, HCVD, CAD, LVH, SR, NIF,
PROSTATE CA STAGE III
ARRIVED ON UNIT BY___per stretcher__ FROM_Emergency Room
ACCOMPANIED BY___wife_and children__
ADMITTING WT/VS: 77 kls. T- 37.3oC; RR-32cpm; PR-89bpm; BP- 170/110mmHg__
CLIENT’s PERCEPTION OF REASON FOR ADMISSION: -Client unable to verbalize-
HOW WAS PROBLEM BEEN MANAGED BY CLIENT AT HOME: “Naga-inom ra man siya sa
iyang maintenance” – as verbalized by the child of the patient
ALLERGIES_____no known allergies______
MEDICINE (at home) Casodex (antineoplastic agent)

PHYSIOLOGIC NEEDS
I. OXYGENATION
 BP__140/80__ RR 25 cpm____CR___88bpm
 (CHARACTER) tachypneic___
 LUNGS (per auscultation: character, lung sound, symmetry of chest expansion,
breathing character and pattern):crackles sounds heard upon auscultation, w/
symmetrical chest expansion, intercostals retraction noted, use of accessory
muscles noted.
 CARDIAC STATUS (per auscultation) sounds, character, chest pain.
__”Lub-dubb” sound heard with increased intensity per auscultation, chest pain
not noted
• CAPILLARY REFILL good capillary refill of less than 3
seconds_
• SKIN CHARACTER AND COLOR_skin is brown, dry, flaky
and wrinkled.
• LIFE SUPPORTING APPARATUS: with O2 @ 3LPM via
nasal cannula
• OTHER OBSERVATIONS (related) Patient shows
discomfort with the nasal cannula by removing it.
II. TEMPERATURE MAINTENANCE
 TEMPERATURE: 37.2 oC_

 SKIN CHARACTER_Skin is dry, flaky, wrinkled and

not warm to touch_
 OTHER OBSERVATION (related)_patient did not
experience fever anymore_
III NUTRITIONAL FLUID
 HEIGHT/WT 5”4’/77 kg _ AMT. FOOD CONSUMED: w/ good appetite, able to
consumed the OF served
 PRESCRIBED DIET: LSLF, OF of 1.8kcal/day
 PROBLEM (nausea, vomiting, no. of times and frequency, amount and character) not
noted
 EATING PATTERN: 3x a day_
 INTAKE (IVF; FLUID/WATER: with IVF of PNSS 1L@300cc/hr, water = 300cc
 Other OBSERVATION (related)\: Skin is dry, has poor skin turgor
IV ELIMINATION
 Last BOWEL MOVEMENT(frequency, amount, character)__defecated Last June 28, ’09
on small amount, in brown color soft stool.
  NORMAL PATTERN 1- 2x a day,
 URINATION(Frequency, character, sensation)_able to urinate last July 30, 2009, with
FBC attached to urobag, draining a bloody urine @100 cc level
 OTHER OBSERVATION (Related)_Bladder is distended per palpation
V REST-SLEEP
 BED TIME _6-7 pm_WAKING UP__5:30 am_

 SLEEP (pattern, amount of sleep)_10-11 hours_

 PROBLEM AS VERBALIZED -can’t able to verbalize-

 OTHER OBSERVATION (related)_Patient can easily be distracted, thus, having difficulty in

sleeping back again
VI PAIN AVOIDANCE
 RATE PAIN_-can’t able to verbalize- TIME STARTED__7:30 PM_
 LOCATION _genital area__BEHAVIOR (restlessness, facial expression, irritable,
diaphoretic)frequent change of position noted, grimace face and guarding behavior
noted on genital area
 FREQUENCY_continuos_
 CHARACTER can’t able to describe, can’t able to verbalize
 OTHER observation (related) Patient has difficulty in sleeping due to pain felt
VII SEXUALITY REPRODUCTIVE
 LMP__N/A__ AOG__N/A__

 GRAVIDA/PARITY__N/A__ PRENATAL__N/A__

 MENSTRUAL CYCLE__N/A__ GYNECOLOGIC PROBLEM__N/A__

 EDC__N/A__
 FMILY PLANNING METHOD USE: calendar method
 CHILDREN (no.) __9__ MENARCHE__N/A__
VIII STIMULATION ACTIVITY
 WORK: Before: farmer & pastor During: needs assistance in performing activities of
 RECREATION/PAST TIME: daily living, can’t able to sit, episodes of napping &
 HOBBIES/VICES: sleeping, a moderate smoker and drinker before
SAFETY AND SECURITY
 NEURO VS____GCS of 10/15, eye opening – to verbal command, motor response –to
localized pain, and verbal response – makes incomprehensible sounds _____
  MENTAL STATUS (Coherent, Responsive, conscious, unconscious) conscious, able to
respond by making incomprehensible sounds
 EMOTIONAL PROBLEM (diaphoretic, trembling, restless)_restlessness: frequent
change of position due to pain felt________
LOVE BELONGING NEED
 CHILDREN (living with?) Patient is loving and supportive as verbalized by her child and
 HUSBAND (living with) wife. Due respect and care was given to him
SELF ESTEEM NEED
He is a good person and a loving father, husband and pastor. He has a moderate self
esteem, also because he is a friendly type of person and being loved by family members.

SELF ACTUALIZATION NEED

According to one of his children, the ultimate goal of his father is to see his children
succeed and become better persons. For now, his children have stable jobs.

Assessed by:
______A4_________ __Evie Luz Docena, RN, MN__
SN-SMC CI

E. GENERAL SURVEY
Date of Assessment: July 30, 2009
On bed, awake, unresponsive and tachypneic. With isocoric pupils of 2mm less
briskly reactive to light and accommodation. Pale conjunctiva of the eye noted. With O2
@ 3LPM via nasal cannula, with NGT @ Right nostril patent and intact, with distal end
close. (+) use of accessory muscles; (+) intercostal retraction; crackles sound heard per
auscultation on both lung fields. With symmetrical chest expansion. With IVF of # 5
PNSS 1L @ 300cc/hr @ 200 cc level infusing well @ Left metacarpal vein. Pale
nailbeds noted with capillary refill returns within 3 seconds. Bladder distention noted.
With FBC attached to urobag draining a bloody urine @ 100 cc level. Bipedal edema
noted.
B. Vital Signs upon admission and present

VITAL SIGNS

Date Shift Time T BP RR PR

7/28/09 7-3 9:35 37.8 160/100 32 92
10:50 37.5 150/90 25 89
11-7 12:10 37.1 140/80 18 83
4:30 36.9 130/90 20 82
7/29/09 7-3 8:45 37.3 170/100 23 84
12:00 37.7 160/90 26 89
3-11 4:00 38.1 140/90 26 78
8:00 37.2 150/90 24 81
11-7 12:30 37.3 130/90 17 83
4:00 37.1 120/80 19 85
7/30/09 7-3 8:00 37 140/80 20 82
12:20 37.4 150/100 20 80
3-11 4:00 37.2 160/100 26 97
5:00 37.1 150/90 25 94
6:00 37.3 140/80 27 89
7:00 37.3 140/80 25 88
8:00 37.4 150/90 30 81
9:00 37 140/80 28 85
10:00 36.9 140/80 29 77

C. Nutritional Status
Megatron stands 5”4’ and weighs 77 kilos. On low salt, low fat diet. With NGT at
Right nostril patent and intact, with distal end close. On osteorized feeding of 1.8
kcal/day. With IVF of #5 PNSS 1L @ 300cc/hr infusing well at Left metacarpal vein.
With poor skin turgor. Denies malnutrition during childhood. Weight loss noted from 85
kg to 77 kg.
D. Neurologic Status
Glasgow Coma Scale of 10/15; eye opening – to verbal command, motor
response – to localized pain & verbal – makes incomprehensible sounds, unclear.
Restlessness: frequent change of position noted. Can’t able to speak out clearly to
express feelings and ideas.
E. Integumentary System
Skin is dry, flaky and wrinkled. Flat tan to brown-colored macules noted as large
as 1-2 cm on exposed body area such as face, neck, arms, hands and legs. Skin loses
its elasticity, appears thin and translucent. The skin takes longer to return to its natural
shape after being tented between the thumb and finger.
Hair is gray in color, thin and loss of scalp noted. Presence of parasites not noted.
Bristle-like hairs of the eyebrows noted.
Fingernails slightly long in length, pale and thick. Capillary refill returns within 3
seconds.
F. HEEN
Head is symmetrically rounded. Dry lips noted. Neck symmetrical without masses
and scars. Lymph nodes non palpable.
Eyes. Eyeballs appear sunken. Skin folds of the upper lids is more prominent &
lower lids sag. The eyes appear dry and lusterless. A thin, grayish white arc or ring
appears around the part of the cornea. Pupil reaction to light and accommodation is
normally symmetrically equal but less brisk. Pale conjunctiva of the eyes noted. Visual
acuity is decrease.
Ears of equal size and similar appearance noted. Pinna aligned with corner of
eye, smooth without nodules. Bilateral on auditory canals noted. Contain moderate
amount of waxy secretion. Difficulty of hearing sounds noted.
Nose is symmetrical & straight, uniform in color, non-tender & without lesions.
The sense of smell markedly diminish.
G. Pulmonary System
Respiratory rate is above normal range, with an RR of 32 cpm. Shortness of
breath & dyspnea as well as use of accessory muscles upon breathing is observed,
crackles sounds heard per auscultation on both lung fields. Use of intercostals retraction
upon breathing. With O2 @ 3LPM via nasal cannula.
H. Cardiovascular System
Cardiac rate plays around 80-90 bpm. “Lubb-dubb” sound heard with increased
intensity per auscultation. Chest pain not noted. The anteroposterior diameter of the
chest widens, with symmetrical chest expansion.
Blood pressure dramatically changes from the lowest taken BP of 140/80 & the
highest was 150/100mmHg. Clubbing of fingers not noted. Pallor is observed.
Has history of hypertension.
I. Gastrointestinal System
Abdomen is round. Enlarged border on Right side of abdomen noted upon
palpation as well as distention of bladder. With surgical scar noted on left iliac region.
Bowel movements usually experienced 1-2 times a day with soft and brown color
stool on small amount as described by watcher. Denies presence of hemorrhoids.
J. Musculoskeletal System
Needs assistance in performing activities of daily living. Progressive lower
extremity weakness noted after the patient complained of lumbosacral pain. Presence
of bipedal edema noted.
K. Genito-Urinary System
No bulging or masses that can be palpated in inguinal area. Scanty amount of
pubic hair noted. With FBC attached to urobag draining a bloody urine @ 100 cc level
within the shift. Prior to the insertion of the foley catheter, watcher verbalized that client
has scanty amount of urine about 30-50cc of urine per urination with the absence of
blood and bloody urine was noticed after the insertion of the foley catheter. Urinary
elimination normally once a day. Bladder is distended. Unable to verbalize pain upon
urination. No presence of lesions in the genital area.
F. COURSE IN THE WARD
DATE SHIFT NURSE’S NOTES DOCTOR’S ORDER
07/28/ 311 Admitted this 78 years old Admit under reverse
09 8:00p male patient awake, isolation ward under
m conscious, and coherent in onco/cardio
due to increase BP and body v/s q4
weakness, vital signs taken  Labs: CBC, pH, BT,
and recorded. Seen and U/A, ECG
examined by Dr. Sanchez 12 leads, Serum
with new orders made, elec.,
started with IVF of D5NSS 1L Creatinine, RBS,
@ 120cc/o regulated and CXR-PA, PSA
infusing well, lab exams Start IVF with D5NSS 1L @
requested, ECG and CXN 120cc/hr
done. Watched out for signs Meds:
of unusualities, endorsed to
• Captopril 50g
NOD.
now q6hrs if BP >
140/90
• Amlodipine 10g
1tab now OD
6am
• Metoprolol 100g
1tab BID PO
• Atorvastatin 80g
1tab OD @ HS
• Moriamin S2 1tab
TID
Refer for persistent
elevated BP
LSLF diet
Refer accordingly

9:50p Received form ER per Tramadol 50mg for pain

m stretcher, awake and q8 PO
conscious, with IVF of D5NSS
1L @ 120cc/o; regulated;
placed comfortably on bed,
lab exams and medications
followed up; vital signs
checked and recorded,
watched out for any
unusualities, needs attended
to.

117 Received conscious and

11:00 responsive with IVF of
pm D5NSS @ 120cc/o – on.
L.S.L.F. diet. Vital signs
checked- followed up labs,
needs attended to, watched
and cared for.
07/29/ 73 Soft diet
09 9:20a IVF D5NSS 1L @ 120cc/hr
m
G. LABORATORIES AND DIAGNOSTIC EXAMS

ARTERIAL BLOOD GAS

7-30-09
9:00am
Ph (7.35- pCO2 (35- PO2 (80- HCO3 (22- BE (2 O2 sat%
7.45) 45mmHg) 100mmHg) 26mmol/L) mmol/L) (95-100%)
7.43 17.8 88.3 16.9 -9.7 97.2
Interpretation: partially compensated respiratory alkalosis
Analysis: When a respiratory acid-base imbalance is present, it is compensated for by
a physiologically induced-metabolic disturbance. In primary respiratory alkalosis,
compensation occurs by metabolic means. Bicarbonate reabsorption by kidneys is
reduced and bicarbonate is excreted through the urine. Occasionally, the
hyperventilation that causes respiratory alkalosis is followed by an increase in lactate
and pyruvate in the blood, which aids in compensation by producing a base deficit.

RBS
7-29-09
TIME RESULT MED GIVEN REFERRED
 2:30pm 27mmol 10units IVTT HR Dr. Edgar
given
10:30pm 32.7 HR 15units IVTT Dr. Espina
2:00pm 470mg/dl HR 2units IVTT Dr. Edar
5:00pm 30.1mmol/l
11:00pm 33.3

7-30-09
TIME RESULT MED GIVEN REFERRED
5:00pm 21.5 10units HR Dr. Edar
7:00pm 310.9 8units HR cSS
9:00pm 13.8 4units HR cSS
11:00pm 286 6units HR cSS
2:00pm 26.2
10:00am 32.7

HEMATOLOGY
7-28-09
EXAM NAME RESULT NORMAL INTEPRETATION ANALYSIS
VALUE
Hemoglobin 116 M: 140- Decreased Blood loss,
Mass 170g/L hemolytic anemia,
Concentration F: 120- bone marrow
140g/L suppression, sickle
cell anemia

Leukocyte No. 5,0- Normal

9.9
Concentration 10,0x109/L
Segmenters 0,73 0,55-0,65
Eosinophils 0,03 0,02-0,04 Normal
Lymphocytes 0,24 0,25-0,35 Decreased Adrenal
corticosteroids and
other
immunosuppressive
drugs, autoimmune
diseases
Thrombocyte Normal
150-
Number 257
400x109/L
Concentration
Erythrocyte M: 0,40-0,50 Decreased Iron deficiency
Volume 0,34 F: 0,37-0,43 anemia
Fraction
Blood Group B(+)

7-30-09
EXAM NAME RESULT NORMAL INTEPRETATION ANALYSIS
VALUE
Hemoglobin 87 M: 140- Decreased Blood loss,
 Mass 170g/L hemolytic anemia,
Concentration F: 120- bone marrow
140g/L suppression, sickle
cell anemia
Leukocyte No. Increased Acute infection,
Concentration circulatory disease,
5,0-
14.1 hemorrhage,
10,0x109/L
trauma, malignant
disease
Neutrophils 0,79 0,55-0,65 Increased Stress and acute
infection
Eosinophils 0,01 0,02-0,04 Decreased Associated with
congestive heart
failure, infectious
mononucleosis, and
aplastic and
pernicious anemia
Lymphocytes 0,20 0,25-0,35 Decreased Adrenal
corticosteroids and
other
immunosuppressive
drugs, autoimmune
diseases
Erythrocyte Decreased iron deficiency
M: 0,40-0,50
Volume 0,25 anemia
F: 0,37-0,43
Fraction

ELECTROLYTES
7-30-09
EXAM NAME RESULT NORMAL VALUE INTEPRETATION ANALYSIS
Creatinine M: 53.3- Increased Associated
115.0umol/L primarily with
F: 44.0- renal disease
240.2
96.0umol/L and obstructive
urinary tract
disease.
Sodium 156.6 135-148mmol/L Increased Hypernatremia
Potassium 3.25 3.5-5.0mmol/L Decreased Hypokalemia
Calcium 1.27 1.13-1.32mmol/L Normal

URINALYSIS
RESULT
Color Light yellow
Transparency Clear
pH 5.0
SG 10.20
Pus cells 0-2
Epithelial cells occasional

ULTRASOUND
Name: Megatron Age: 78 years old
Address: Sto. Tomas, Dvo del Norte Date: 07-30-09
File No.: 09-1382 Department: Medicine
Exam: Abdomen and prostate Service of: Dr. Cuarte

Abdominal UXD: A physiologically distended gallbladder is noted with no calcification

within. Wall is not thickened. The liver shows an echogenic but homogenous
echotexture with no mass nor defects seen. Intrahepatic ducts & CBD are not dilated.
Hepatic vessels are normal. Spleen and pancreas are unremarkable.
The right kidney measures 9.1 x 4.85cm. with a cortical thickness of 1.85cm. while the
left 9.05 x 4.25cm. With a cortical thickness of 1.7cm. Both show normal cortico-
medullary parenchymal echotexture. Both central echo complexes show mild (Grade1)
dilatation with no calcification seen.
Urinary bladder is normal. Prostate is enlarged measuring 4.6 x 5.1 x 4.55cm (53gms)
and shows irregular borders.
Impression: Fatty liver
Grade 3 prostatic enlargement suggest PSA correlation
Grade 1 hydronephrosis. Bilateral.

H. ANATOMY AND PHYSIOLOGY

CARDIOVASCULAR SYSTEM
A. Heart Chambers
The heart has four chambers, two atria and two ventricles. The atria are smaller
with thin walls, while the ventricles are larger and much stronger.
Atrium
There are two atria on either side of the heart. On the right side is the atrium that
contains blood which is poor in oxygen. The left atrium contains blood which has been
oxygenated and is ready to be sent to the body. The right atrium receives de-
oxygenated blood from the superior vena cava and inferior vena cava. The left atrium
receives oxygenated blood from the left and right pulmonary veins.
Ventricles
The ventricle is a heart chamber which collects blood from an atrium and pumps
it out of the heart. There are two ventricles: the right ventricle pumps blood into the
pulmonary circulation for the lungs, and the left ventricle pumps blood into the systemic
circulation for the rest of the body. Ventricles have thicker walls than the atria, and thus
can create the higher blood pressure. Comparing the left and right ventricle, the left
ventricle has thicker walls because it needs to pump blood to the whole body. This
leads to the common misconception that the heart lies on the left side of the body.
Septum
The interventricular septum (ventricular septum, or during development septum
inferius) is the thick wall separating the lower chambers (the ventricles) of the heart from
one another. The ventricular septum is directed backward and to the right, and is curved
toward the right ventricle. The greater portion of it is thick and muscular and constitutes
the muscular ventricular septum. Its upper and posterior part, which separates the aortic
vestibule from the lower part of the right atrium and upper part of the right ventricle, is
thin and fibrous, and is termed the membranous ventricular septum.
 B. Coronary Artery
The coronary circulation consists of the blood
vessels that supply blood to, and remove blood
from, the heart muscle itself. Although blood fills
the chambers of the heart, the muscle tissue of
the heart, or myocardium, is so thick that it
requires coronary blood vessels to deliver blood
deep into the myocardium. The vessels that
supply blood high in oxygen to the myocardium
are known as coronary arteries. The vessels that
remove the deoxygenated blood from the heart
muscle are known as cardiac veins. The coronary arteries that run on the surface of the
heart are called epicardial coronary arteries. These arteries, when healthy, are capable
of auto regulation to maintain coronary blood flow at levels appropriate to the needs of
the heart muscle. These relatively narrow vessels are commonly affected by
atherosclerosis and can become blocked, causing angina or a heart attack. The
coronary arteries are classified as "end circulation", since they represent the only
source of blood supply to the myocardium: there is very little redundant blood supply,
which is why blockage of these vessels can be so critical. In general there are two main
coronary arteries, the left and right. • Right coronary artery. Left coronary artery Both of
these arteries originate from the beginning (root) of the aorta, immediately above the
aortic valve. As discussed below, the left coronary artery originates from the left aortic
sinus, while the right coronary artery originates from the right aortic sinus.

PROSTATE GLAND

The prostate is one of the male sex glands. The other major sex glands are the
testicles and seminal vesicles. Together these glands secrete the fluids that make up
semen.

The normal prostate is about the size of a walnut. It lies just below the bladder
and surrounds the beginning of the urethra. The urethra is the tube that runs through
the penis. It carries urine from the bladder and semen from the sex glands.
 As the prostate is a sex gland, its growth is influenced by male sex hormones.
The chief male hormone is testosterone, which is produced mostly by the testicles.

Overview of Male Reproductive System Structure and Function

STRUCTURE LOCATION & DESCRIPTION FUNCTION

Secretion of gelatinous seminal fluid called pre-
Pea sized organs posterior to ejaculate. This fluid helps to lubricate the urethra
Bulbourethral
the prostate on either side of for spermatozoa to pass through, and to help
glands (2)
the urethra. flush out any residual urine or foreign matter. (<
1% of semen)
Cells of Leydig
Adjacent to the seminiferous Responsible for production of testosterone.
(Interstitial cells
tubules in the testicle. Closely related to nerves.
of Leydig)
Raises and lowers scrotum to help regulate
Cremaster
Covers the testes. temperature and promote spermatogenesis.
muscle
Voluntary and involuntary contraction.
Contraction by wrinkling to decrease surface
Layer of smooth muscular fiber area available for heat loss to testicles, or
Dartos muscle outside the external spermatic expansion to increase surface area available to
fascia but below the skin promote heat loss; also helps raise and lower
scrotum to help regulate temperature
Part of the testes and connect
Efferent ductules the rete testis with the Ducts for sperm to get to epididymis
epididymis
Begins at the vas deferens,
Causes reflex for ejaculation. During ejaculation,
Ejaculatory ducts passes through the prostate,
semen passes through the ducts and exits the
(2) and empties into the urethra at
body via the penis.
the Colliculus seminalis.
 Tightly coiled duct lying just
Epididymis outside each testis connecting Storage and maturation of sperm.
efferent ducts to vas deferens.
Three columns of erectile
tissue: two corpora cavernosa Male reproductive organ and also male organ of
Penis
and one corpus spongiosum. urination.
Urethra passes through penis.

Surrounds the urethra just Stores and secretes a clear, slightly alkaline fluid
Prostate gland below the urinary bladder and constituting up to one-third of the volume of
can be felt during a rectal exam. semen. Raise vaginal pH.(25-30% of semen)

Pouch of skin and muscle that Regulates temperature at slightly below body
Scrotum
holds testicles. temperature.

Usually white but can be yellow,

Components are sperm, and "seminal plasma".
gray or pink (blood stained).
Seminal plasma is produced by contributions
Semen After ejaculation, semen first
from the seminal vesicle, prostate, and
goes through a clotting process
bulbourethral glands.
and then becomes more liquid.

About 65-75% of the seminal fluid in humans

Convoluted structure attached
Seminal vesicles
to vas deferens near the base
(2)
of the urinary bladder.
originates from the seminal vesicles. Contain
proteins, enzymes, fructose, mucus, vitamin C,
flavins, phosphorylcholine and prostaglandins.
High fructose concentrations provide nutrient
energy for the spermatozoa as they travel
through the female reproductive system.

Long coiled structure contained

Seminiferous Meiosis takes place here, creation of gametes
in the chambers of the testis;
tubules (2) (sperm).
joins with vas deferens.

Junctions of the Sertoli cells

form the blood-testis barrier, a
Cells responsible for nurturing and development
structure that partitions the
of sperm cells , provides both secretory and
Sertoli cells interstitial blood compartment of
structural support; activated by FSH. Also called
the testis from the adluminal
"mother cells" or "nurse cells".
compartment of the
seminiferous tubules.

Gonads that produce sperm and male sex

Testes Inside scrotum, outside of body. hormones.Production of testosterone by cells of
Leydig in the testicles.
Testicular Branch of the abdominal aorta.
arteries It is a paired artery. Each
Supplies blood to the testes.
(Gonadal passes obliquely downward and
arteries) laterally behind the peritoneum.

Tubular structure that receives urine from bladder

Connects bladder to outside
Urethra and carries it to outside of the body. Also
body, about 8 inches long.
passage for sperm.

Muscular tubes connecting the
left and right epididymis to the
Vas deferens ejaculatory ducts to move
sperm. Each tube is about 30
cm long.
During ejaculation the smooth muscle in the vas
deferens wall contracts, propelling sperm
forward. Sperm are transferred from the vas
deferens into the urethra, collecting fluids from
accessory sex glands en route

The prostate is a glandular structure that weighs approximately 20 grams, and is

bounded superiorly by the bladder, inferiorly by the urogenital diaphragm (containing the
membranous urethra), anteriorly by the pubic symphysis, laterally by the puborectalis
muscle, and posteriorly by the rectum.

The prostate can be roughly divided into

three different zones of tissue that
include the 1) peripheral zone, 2)
transition zone, and 3)
central/periurethral zone.

The male reproductive system.

The prostate gland is comprised of 30–50 glands arranged in acini, which empty
the prostatic secretion into the prostatic urethra.
The function of these different zones is not clear; however, in the prostate gland of the
young adult the peripheral zone is composed of glandular tissue (65%), the transition
zone (10%), and the central zone (25%).
The central or periurethral zone appears to be most sensitive to estrogen, and is
the site where benign prostatic hyperplasia tends to occur. Most prostatic carcinomas
develop in the peripheral zone, which is particularly sensitive to androgens.
The hypothalamic-pituitary-testicular axis

In response to the hormones secreted by the hypothalamus, the pituitary gland

secretes luteinizing hormone (LH), follicle-stimulating hormone (FSH) and
drenocorticotrophin (ACTH). These hormones enter the circulation, and subsequently
exert their effects on the testes and adrenal glands.
The final target organs in the hypothalamic-pituitary-testicular axis are the male
gonads, or testes. Each testis contains a network of seminiferous tubules, which
produce sperm. Between these tubules there is a system of testosterone-producing
Leydig cells. FSH acts on the seminiferous tubules to promote sperm production, while
LH acts on the Leydig cells to stimulate production of testosterone. The testes produce
about 5–10 mg of testosterone each day. The growth and maintenance of the prostate
gland is critically dependent upon testosterone.
About 5% of total plasma testosterone is also produced by the adrenal glands.
ACTH stimulates the adrenal glands to produce the adrenal androgens
androstenedione and dehydroepiandrosterone, which are converted into testosterone in
peripheral tissues and in the prostate gland.
Negative feedback control
 Testosterone controls its own release via a negative feedback effect it exerts on
the hypothalamic-pituitary-testicular axis. When testosterone levels in the bloodstream
are raised, the hypothalamus reduces the secretion of LHRH, which inhibits the
secretion of LH from the pituitary gland. The overall effect is to reduce the amount of LH
acting on the Leydig cells, therefore reducing testosterone secretion.
Prostatic cell function
Most testosterone (97%) circulates in the bloodstream, and is bound to one of
two proteins, either sex hormone binding globulin (SHBG) or albumin. The remaining 2–
3% of testosterone remains unbound, and is thought to affect the glandular cells of the
prostate gland.

Free testosterone passes through the prostate cell membrane, where it is

metabolized to dihydrotestosterone (DHT) by the enzyme 5-alpha-reductase. DHT is 2.5
times more potent as a male sex hormone than testosterone, and binds to androgen
receptors (AR) within the glandular cells. This complex of AR with DHT then targets
DNA sequences, known as androgen response elements, that activate various cell
functions, including growth and proliferation.

I. SYMPTOMATOLOGY

Prostate Cancer

ACTUAL
CLINICAL MANIFESTATION IMPLICATION
SYMPTOMS
• Difficulty starting

urination
Due to the presence of
• Interrupted flow of urine  tumor in the prostate
gland
• Difficulty in having an

erection
• Painful ejaculation 
• Pain when passing

urine
• Feeling that your 
 bladder is not emptying
completely when you
urinate
• Nocturia 
Painful urination due to
narrowing, obstruction
• Dysuria 
and trauma to the
passageway of the urine.
The presence of red
• Hematuria  blood cells (erythrocytes)
in the urine due to tumor.

CORONARY ARTERY DISEASE

ACTUAL
CLINICAL MANIFESTATION IMPLICATION
SYMPTOMS
• Profuse sweating 
• Restlessness  Inability to relax or calm
oneself due to improper
oxygenation.
• Cold and clammy skin 
• Shortness of breath  Breathing difficulty in due
to compensatory
mechanism of the body.
• Dizziness  Impairment in spatial
perception and stability
due to poor oxygenation.
• Nausea 
• Vomiting 
• A loss of consciousness 
• Abnormal heartbeat 
• Angina 
• Heart murmur 
• Heart attack 

HYPERTENSIVE CARDIOVASCULAR DISEASE

ACTUAL
CLINICAL MANIFESTATION IMPLICATION
SYMPTOMS
• Chest pain 
• Confusion 
• Irregular heartbeat 
• Weakness  Inability to exert force
with one's muscles to the
degree that would be
 expected given the
individual's general
physical fitness due to
poor oxygenation in the
body.
 Impairment in spatial
• Dizziness perception and stability
due to poor oxygenation.
• Nausea 
 Physical and/or mental
exhaustion that can be
triggered by stress,
• Fatigue medication, overwork, or
mental and physical
illness or disease such as
Hypertension.
 Breathing difficulty in due
• Shortness of breath to compensatory
mechanism of the body.
• Nausea 
• Anxiety 
• Nose bleeds 
• Vomiting 
• Heart palpitations 

LEFT VENTRICULAR HYPERTROPHY

ACTUAL
CLINICAL MANIFESTATION IMPLICATION
SYMPTOMS
• Chest pain 
• Palpitations 
 Impairment in spatial
• Dizziness perception and stability
due to poor oxygenation.
• Fainting 
 Breathing difficulty in due
• Dyspnea to compensatory
mechanism of the body.
• Angina 
• Abdominal discomfort 
 Abnormal accumulation
of fluid beneath the skin,
• Swelling (edema)
or in one or more cavities
of the body.
J. ETIOLOGY
Prostate Cancer
The exact cause of Prostate Cancer is unknown. What is known, however, is that
Prostate Cancer, like other cancers, is an uncontrolled growth of abnormal cells, and
that the growth of Prostate Cancer is related to the male hormones, called androgens,
the most prevalent being testosterone. These abnormal cells can form a malignant
(cancerous) tumor. In some cases, the cancer can spread (metastasize) to other organs
of the body. This occurs when cancer cells break away from a cancerous tumor and
move through the blood and lymph nodes to other areas of the body.
While the exact reasons why one man gets Prostate Cancer and another man
does not are unknown. There are risk factors that have been associated with the
incidence of Prostate Cancer in certain populations:
• The incidence of Prostate Cancer increases with age more rapidly than any other
cancer. More than 75% of all cases of Prostate Cancer are in men over 65 years
of age. The average age of men newly diagnosed with Prostate Cancer is 70.
• The risk of Prostate Cancer is twice as high for men of African descent as it is for
Caucasian men.
• Family history: a man is more likely to develop Prostate Cancer if he has first-
generation relatives (such as father or brother) who have been diagnosed with
Prostate Cancer.
 Early Prostate Cancer is often asymptomatic. That is, there are no symptoms
caused by the cancer. However, more advanced Prostate Cancer can cause symptoms
including urination problems: a more frequent need to urinate, especially at night;
difficulty starting or stopping urination, blood in urine or ejaculate, and painful urination
or ejaculation. It’s important to note that these symptoms are not limited to Prostate
Cancer, and may be indicative of another, non-cancerous, condition, such as an
infection. If you experience any of the above symptoms, call your doctor.
(http://www.suite101.com/lesson.cfm/17126/1004/2)
The specific causes of prostate cancer remain unknown. A man's risk of
developing prostate cancer is related to his age, genetics, race, diet, lifestyle,
medications, and other factors. The primary risk factor is age. Prostate cancer is
uncommon in men less than 45, but becomes more common with advancing age. The
average age at the time of diagnosis is 70. However, many men never know they have
prostate cancer. Autopsy studies of Chinese, German, Israeli, Jamaican, Swedish, and
Ugandan men who died of other causes have found prostate cancer in thirty percent of
men in their 50s, and in eighty percent of men in their 70s. In the year 2005 in the
United States, there were an estimated 230,000 new cases of prostate cancer and
30,000 deaths due to prostate cancer.
Dietary amounts of certain foods, vitamins, and minerals can contribute to
prostate cancer risk. Men with higher serum levels of the short-chain ω-6 fatty acid
linoleic acid have higher rates of prostate cancer. However, the same series of studies
showed that men with elevated levels of long-chain ω-3 (EPA and DHA) had lowered
incidence. A long-term study reports that "blood levels of trans fatty acids, in particular
trans fats resulting from the hydrogenation of vegetable oils, are associated with an
increased prostate cancer risk." Other dietary factors that may increase prostate cancer
risk include low intake of vitamin E (Vitamin E is found in green, leafy vegetables),
omega-3 fatty acids (found in fatty fishes like salmon), and the mineral selenium. A
study in 2007 cast doubt on the effectiveness of lycopene (found in tomatoes) in
reducing the risk of prostate cancer. Lower blood levels of vitamin D also may increase
the risk of developing prostate cancer. This may be linked to lower exposure to
ultraviolet (UV) light, since UV light exposure can increase vitamin D in the body.
There are also some links between prostate cancer and medications, medical
procedures, and medical conditions. Daily use of anti-inflammatory medicines such as
aspirin, ibuprofen, or naproxen may decrease prostate cancer risk. Use of the
cholesterol-lowering drugs known as the statins may also decrease prostate cancer risk.
More frequent ejaculation also may decrease a man's risk of prostate cancer. One study
showed that men who ejaculated five times a week in their 20s had a decreased rate of
prostate cancer, though others have shown no benefit. Infection or inflammation of the
prostate (prostatitis) may increase the chance for prostate cancer. In particular, infection
with the sexually transmitted infections chlamydia, gonorrhea, or syphilis seems to
increase risk. Finally, obesity and elevated blood levels of testosterone may increase
the risk for prostate cancer.
Prostate cancer risk can be decreased by modifying known risk factors for
prostate cancer, such as decreasing intake of animal fat.
(http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html)

Coronary Artery Disease

Usually, CAD is due to subintimal deposition of atheromas in large and medium-
sized coronary arteries (atherosclerosis—see Arteriosclerosis). Less often, CAD is due
to coronary spasm. Rare causes include coronary artery embolism, dissection,
aneurysm (eg, in Kawasaki disease), and vasculitis (eg, in SLE, syphilis).
(http://www.merck.com/mmpe/sec07/ch073/ch073a.html)
K. PATHOPHYSIOLOGY
Written (Prostate Cancer)
When normal cells are damaged beyond repair, they are eliminated by apoptosis.
Cancer cells avoid apoptosis and continue to multiply in an unregulated manner.
Prostate cancer is classified as an adenocarcinoma, or glandular cancer, that begins
when normal semen-secreting prostate gland cells mutate into cancer cells. The region
of prostate gland where the adenocarcinoma is most common is the peripheral zone.
Initially, small clumps of cancer cells remain confined to otherwise normal prostate
glands, a condition known as carcinoma in situ or prostatic intraepithelial neoplasia
(PIN). Over time these cancer cells begin to multiply and spread to the surrounding
prostate tissue (the stroma) forming a tumor. Eventually, the tumor may grow large
enough to invade nearby organs such as the seminal vesicles or the rectum, or the
tumor cells may develop the ability to travel in the bloodstream and lymphatic system.
Prostate cancer is considered a malignant tumor because it is a mass of cells which can
invade other parts of the body. This invasion of other organs is called metastasis.
Prostate cancer most commonly metastasizes to the bones, lymph nodes, rectum, and
bladder.
(http://our-medical-center.blogspot.com/2007/12/prostate-cancer.html)
Coronary Artery Disease
 Coronary atherosclerosis is often irregularly distributed in different vessels but
typically occurs at points of turbulence (eg, vessel bifurcations). As the atheromatous
plaque grows, the arterial lumen progressively narrows, resulting in ischemia (often
causing angina pectoris). The degree of stenosis required to produce ischemia varies
with O2 demand.
Occasionally, an atheromatous plaque ruptures or splits. Reasons are unclear
but probably relate to plaque morphology, plaque Ca content, and plaque softening due
to an inflammatory process. Rupture exposes collagen and other thrombogenic
material, which activates platelets and the coagulation cascade, resulting in an acute
thrombus, which interrupts coronary blood flow and causes some degree of myocardial
ischemia. The consequences of acute ischemia, collectively referred to as acute
coronary syndromes (ACS), depend on the location and degree of obstruction and
range from unstable angina to transmural infarction. It can cause mesenteric ischemia;
and in the renal arteries, it can cause stenosis leading to hypertension.
L. SYNTHESIS OF THE CLIENT’S CONDITION/STATUS FROM ADMISSION TO
PRESENT
A. Conclusion
We therefore conclude that the study portrayed its importance and helped us
know all about Hypertensive Urgency, HCVD, CAD, LVH, SR, NIF; Prostate CA Stage
III. It also helped us understood the causes and effects of the diseases that enabled us
to determine the predisposing and precipitating factors and traced the pathophysiology
of these disorders. This also had given us the knowledge to identify where and when it
had started and how the disease progressed and we had also interpreted the laboratory
and diagnostic exam results of the client and recognized the implication of it. We also
identified the different pharmacologic treatments indicated to the condition, considering
the effects, actions and different nursing considerations with regards to the
administration of the medications. We have also identified and formulated the nursing
interventions that we could render to the patient that will help us attain our goal of care
to our patient basing from the nursing care plan we have formulated.
B. Patient’s Prognosis
After some point in time, as the medical and the nursing management of the
patient is constantly done, a development of her present health status is anticipated.
Continuous administration of medications will result to termination of the signs and
symptoms that was caused by the patient’s disease such as fatigue, weakness, weight
loss, high blood pressure, bipedal edema, dyspnic, and palpitations. Furthermore, vital
signs are expected to stabilize. However, prostate cancer, like all other types of cancer,
is an incurable type of disease, and the form of therapy is only palliative which only
alleviates the signs and symptoms of this disease. And most probably after 3-7 days
from the day of our interaction with him, he is expected to be discharged.
C. Recommendations
On the basis of the findings of this study, the following measures are
recommended:
1. Client should take his prescribed medications religiously. He must create a
schedule in order for him to be guided as when to take the medicines and for him
not to be able to forget in doing so.
2. Follow the prescribed diet. His prescribed diet is a low-salt, low-fat diet, therefore
client should avoid salty and fatty foods and client must take note that all canned
goods are high in sodium even if it says that it is good for the heart.
3. Have an oral fluid intake with in cardiac tolerance.
4. Lifestyle modification is also important in order to prevent the severity of the
condition that will further contribute complications such as cessation of smoking
and drinking alcoholic beverages.
5. Visit his doctor regularly for constant check-ups and to continuously monitor his
condition.
D. Discharge Plan
Medicine - Keep a written list of the medicines you take, the amounts, and when and
why you take them. Bring the list of your medicines or the pill bottles when you see your
caregivers. Learn why you take each medicine. Ask your caregiver for information about
your medicine. Do not use any medicines, over-the-counter drugs, vitamins, herbs, or
food supplements without consultation. Always take your medicine as directed by
caregivers. Call your caregiver if you think your medicines are not helping or if you feel
you are having side effects. Do not quit taking your medicines until you discuss it with
your caregiver. If you are taking medicine that makes you drowsy, do not drive or use
heavy equipment. Take the medications directly as prescribed. Do not skip doses or
double up on missed doses.
Exercise - Talk to your caregiver before you start exercising. Together you can plan the
best exercise program for you. It is best to start slowly and do more as you get stronger.
Exercising makes the heart stronger, lowers blood pressure, and keeps you healthy.
Stay active. Exercise helps keep your bones stronger. If pain keeps you from being
active, ask your doctor about ways to lessen the pain. It is also important to mobilize the
client in order to prevent activity intolerance and prevent constipation. Active range of
motion exercises are taught to the patient to avoid joint stiffness and promote proper
circulation. Few steps and mobilization will help as well. Diaphragmatic breathing and
coughing exercises will be demonstrated to lessen feeling of pain sensation and prevent
atelectasis.
Treatment - You may be given medicine to take at home to take away or decrease
pain. Your caregiver will tell you how much to take and how often to take it. Take the
medicine exactly as directed by your caregiver. Avoid taking non-steroidal anti-
inflammatory medicines (NSAIDs). Do not wait until the pain is too bad before taking
your medicine. The medicine may not work as well at controlling your pain if you wait
too long to take it. Tell caregivers if the pain medicine does not help or if your pain
comes back too soon.
Hygiene - Good oral hygiene and proper dental care apply to all age groups but the
needs of the elderly population can be slightly different than the needs of younger
people. Client should also observe regular hand and body hygiene to decrease the risk
of acquiring infection. Daily bath is recommended as well as frequent hand hygiene, not
only for the client but also for the client’s significant others.
Diet - It is important that you get good nutrition when you have cancer. Eat a variety of
healthy foods from all the food groups. The food groups include breads, vegetables,
fruits, milk and milk products, and protein (beans, eggs, poultry, meat and fish). Eating
healthy foods may help you feel better and have more energy. You may need to make
diet changes depending on your tolerance, the location of your cancer, or treatment side
effects. But you have hypertensive problems due to presence of a Coronary Artery
Disease, thus you should watch out with your diet and have a low sodium and low fat
diet. Furthermore, if you have trouble swallowing, try eating foods that are soft or in
liquid form, ask your caregiver if you should add special drinks or vitamins to your diet.
Tell your caregiver if you are nauseated, vomiting, or have other problems eating or
digesting your food. Men 19 years old and older should drink about 3.0 Liters of liquid
each day (close to 13 eight-ounce cups). Women 19 years old and older should drink
about 2.2 Liters of liquid each day (close to 9 eight-ounce cups). If you are used to
drinking liquids that contain caffeine, such as coffee, these can also be counted in your
daily liquid amount. Drink even more liquids if you will be outdoors in the sun for a long
time. You should also drink more liquids if you are exercising. Try to drink enough liquid
each day, and not just when you feel thirsty. The best liquids to drink have water, sugar,
and salt in them. These liquids help your body hold in fluid and help prevent
dehydration. Ask your caregiver what liquids are best to drink if you are on a low salt or
low sugar diet.

M. EVALUATION OF THE OBJECTIVE OF THE STUDY

After few days of conducting thorough study about the case of Megatron, we
were able to trace the history of her disease locally, nationally and globally. We have
come up with a comprehensive assessment of the patient’s biographical data, cephalo-
caudal physical assessment as well as pertinent medical information with regards to the
client’s health condition. Apart from that, we were also able to have a clearer view on
how the disease affects the patient’s body by tracing the pathophysiology of the disease
process and identifying the different organs involved by reviewing its anatomy and
physiology. By understanding fully the mechanism and effects of the disease to the
patient, we have interpreted different laboratory results related to her condition. We
have also identified and traced some medications and how these drugs affect the
patient’s physiological functioning. Appropriate therapeutic care was well planned and
provided to the client. And lastly, we have come up with a discharge plan pertaining to
the patient’s early recovery.
N. BIBLIOGRAPHY
Book
1. Smeltzer, Suzanne C., et. al. Brunner & Suddarth’s Textbook of Medical-Surgical
Nursing. 11th Edition. Volume 1 and 2. Lippincott Williams and Wilkins. © 2008.
2. Nurse’s Pocket Guide. 11th Edition
3. Davis’ Drug Guide. 10th Edition

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