Video Case Study - Problems of the Prostate Gland

Nurse Suleena works on a Surgical Step-Down Unit and is caring for Pedro, a 55-year-old male with a history of benign prostatic hyperplasia, or BPH, who was admitted two days ago following a transurethral resection of the prostate, or TURP. After settling Pedro in his room, Nurse Suleena goes through the steps of the Clinical Judgment Measurement Model to make clinical decisions about Pedro's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action, and evaluating outcomes.

First, Nurse Suleena recognizes important cues, including vital signs, which are temperature 98.0 F or 36.7 C, blood pressure 140/ 90 mmHg, heart rate 88 beats per minute, respirations 20 breaths per minute, and oxygen saturation 95 percent on room air. She also notices Pedro grimacing and shifting uncomfortably in bed. When examining the collection bag for Pedro's continuous bladder irrigation, or CBI, Nurse Suleena notices large blood clots and amber-colored drainage.

Next, Nurse Suleena analyzes these cues. She knows that the CBI output should be light pink, and that blood clots and amber-colored urine in the CBI drainage bag can indicate that the irrigation rate likely needs to be increased. Also, Pedro's non-verbal cues and vital signs indicate he's experiencing discomfort, which is also likely due to his ineffective urinary drainage. She also recognizes that bladder spasms resulting from his TURP procedure can cause additional pain. Then, she reviews the electronic health record, or EHR, and notes that Pedro's last dose of pain medication was four hours ago.

Nurse Suleena: Pedro, how are you feeling after your procedure?

Pedro: I'm fine. Isn't there a male nurse on this floor?

Nurse Suleena: I understand that having a female nurse care for you after your TURP procedure can be unfamiliar. There are no male nurses available today, but I'm going to do my best to take care of you and make you comfortable. Is there anything I can do to help you?

Pedro: I feel like I need to go to the bathroom a lot. I don't like having the catheter.

Nurse Suleena: I can imagine it's uncomfortable, but the catheter is meant to help your prostate heal. How would you rate your pain from 0 to 10?

Pedro: Seven, it really hurts and feels like pressure.

Nurse Suleena: Okay, I'm going to perform an assessment now to make sure your catheter is working correctly. When I'm done, I'll check to see what medications the health care provider has ordered for your pain.

Now, using the information she's gathered, along with Pedro's medical history, Nurse Suleena chooses a priority hypothesis of impaired urinary elimination.

Then, she generates solutions to address Pedro's urinary elimination that will include pharmacologic and nonpharmacologic interventions, and she establishes the expected outcome that after intervening, Pedro will experience effective urinary elimination within one hour of treatment.

Nurse Suleena then takes action to implement these solutions. First, she checks the patency of his catheter and flushes it to clear the existing blood clots. Since the catheter appears to be working well, she increases the rate of the irrigation, per her facility's protocol, and ensures the fluid is draining properly.

Nurse Suleena: Your catheter is working well, so I increased the rate of irrigation. I'm also going to give you an antispasmodic medication that'll help keep your bladder from spasming to help with your pain.

Pedro: I can't wait to feel better. Thank you for helping me.

While continuing to monitor Pedro's CBI, Nurse Suleena administers the prescribed antispasmodic using safe medication administration principles. She then dims the lights in his room, provides a warm blanket, and encourages him to choose soothing music to play from his electronic device.

An hour later, Nurse Suleena evaluates the outcome of her interventions. Pedro's vital signs are temperature 98.4 F or 36.8 C, blood pressure 128/84 mmHg, heart rate 75 beats per minute, respirations 14 breaths per minute, and oxygen saturation 100 percent on room air. Nurse Suleena assesses Pedro's catheter bag and sees it's draining clear, light pink urine, and is free of clots. Also, Pedro rates his pain as 3 out of 10.

Alright, as a quick recap…. Nurse Suleena recognized and analyzed cues related to Pedro's urinary elimination and pain, prioritized hypotheses, and generated solutions to address this problem. She then took action to implement pharmacologic and nonpharmacologic measures to address Pedro's impaired urinary elimination and evaluated outcomes comparing by them to the expected outcome. Since Pedro's urinary elimination was improved, Nurse Suleena determined the plan of care was successful.