I need help to develop an advanced plan of care for this patient with GU problems with the criteria below.

Week 4: Genitourinary Clinical Case

HPI

A 60-year-old Hispanic male presents with the chief complaint of decreased urinary ow. The patient has been experiencing this over the past two years, but for the past two weeks, the symptoms
have increased signi cantly. The current symptoms are similar to what he experienced in the past. However, for the past two weeks, he has had increased nocturia, with decreased strength of urinary ow and slight terminal dysuria. Patient has had no treatment in the past. The nocturia has been very troublesome over the past two weeks. Yesterday he had signi cant di culty in starting his urine ow and this is interfering with daily activities. He needs to pass urine four to ve times every night. He has been urinating frequently and always needs to know if there are bathrooms around.

Patient does not complain of any other radiating pain. He has had no treatment or diagnostic work up in the past, but now the symptoms have been increasing in severity. He believes he had a low- grade fever yesterday. The patient is not sure what is going on but thinks he may have cancer. He had signi cant obstructive symptoms two days ago. Gradual worsening of symptoms has compelled him to seek medical help now.

PMH

Patient has not sought any medical care for this problem to date. He is being treated for hypertension and hypercholesterolemia. There is no known history of heart disease, but he was hospitalized ve years ago as a suspected case of angina. He was diagnosed with chest wall syndrome for which he was treated and then released. There are no recent hospitalizations and no surgeries.

ROS

Denies any other positive review of systems. Denies abdominal pain, nausea or vomiting. No blood in the stool. No gross hematuria.

MEDICATIONS

Cardizem 240mg daily
Zocor 20mg daily
Patient is compliant with the prescribed regimen and knows why he is being treated. ALLERGIES/REACTIONS
No known drug allergies

Page 1 of 3 NSG6001 — Advanced Nursing Practice I ©2015 South University

SOCIAL HISTORY

Patient has a master’s degree in engineering and his income is $65,000.00 per year. Though the patient is educated, he lacks an understanding of resources available to him. Patient has no problems with nances. He has excellent access to healthcare, but most often does not utilize the services to the extent that is expected. He has an excellent health insurance coverage including a prescription plan.

Patient is married and his spouse has excellent general health. He has two grown-up sons who live with their own families. They are 35 and 37 years old, both alive and well. Although the patient has a master’s in engineering, his knowledge of healthcare is inadequate. He believes that he is generally healthy.

His perception of self-e cacy is adequate. He has very little stress. His support systems include his wife and friends from work who provide him with the required emotional support. There is no family dysfunction. The patient is high strung and an over achiever. He gets little from social support outside the home or work.

Patient is originally from United States. He lives in a suburban setting. His resources include his wife and the people he works with. Though there are other resources available to him, he is not sure what they are.

HABITS

Smoking: Non smoker

Alcohol: Does not drink

Substance use: Denies substance abuse

DIET HABITS

His wife does most of the cooking. He believes that he gets adequate exercise, eats healthy, and maintains a regular checkup regime with his physician.

WORK HABITS

He is an engineer and has always done the same work.

FAMILY HISTORY

He has one sister and one brother. Both are alive and well. There is a remote history of heart disease among his aunts and uncles.

PHYSICAL EXAMINTAION

Vital Signs: BP right arm sitting 140/92; T: 99 po; P:80 and regular; R 18, non-labored; Wt: 200#; Ht: 71”

NSG6001 — Advanced Nursing Practice I Week 4: Gastroenterology Clinical Case

HEENT: WNL

Lymph Nodes: None

Lungs: Clear

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

Carotids: No bruits

Abdomen: Android obesity, non-tender

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

Genital/Pelvic: Circumcised, no penial lesions, masses, or discharge.Testes are descended bilaterally, no tenderness or masses

Extremities, Including Pulses: 2+ pulse throughout, no edema in the lower legs. Neurologic: Not examined
Lab Results/Radiological Studies/EKG Interpretation
Lab Results

PSA: 6.0
CBC: WNL
Chem panel: WNL Radiological Studies: None EKG: None

NSG6001 — Advanced Nursing Practice I Week 4: Gastroenterology Clinical Case

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