NR 601 Week 6 Discussion: Urologic Concerns in the Maturing and Older Adult 2023 Latest Rated A+

NR 601 Week 6 Discussion: Urologic Concerns in the Maturing and Older Adult 2023 Latest Rated A+. Firstly, the American Urology Association early detection of prostate cancer guideline recommends against PSA screening in men under age 40 years (Carte, et al., 2018). They report that in ages younger that 40 there is a low prevalence of clinically detectable prostate cancer, no evidence demonstrating benefit of screening and likely the same harms of screening as in other age groups (Carte, et al., 2018). They also say that routine screening in men between ages 40 to 54 years at average risk should not be done, however, for men younger than age 55 years at higher risk, decisions regarding prostate cancer screening should be individualized (Carte, et al., 2018). At high risk includes men of African American race and those with a family history spanning several generations, affecting multiple first-degree relatives, and that developed at younger ages (Carte, et al., 2018). Next, the Panel strongly recommends shared decision-making for men age 55 to 69 years that are considering PSA screening and proceeding based on a man's values and preferences (Carte, et al., 2018). Lastly, the greatest benefit of screening appears Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 4/44 to be in men ages 55 to 69 years and the AUA does not recommend routine PSA screening in men age 70+ years or any man with less than a 10 to 15 year life expectancy (Carte, et al., 2018). If you do decide to draw a level what specific counseling should you include in your education today? Firstly, I would begin by explaining that there is strong evidence that PSA screening can reduce the number of deaths from prostate cancer, however, prostate cancer is frequently so slow growing that it would not cause any problems (Eastham, Vickers, Lilja, & Scardino, 2019). Therefore, most men do not benefit from treatment for prostate cancer and can unnecessarily suffer from its side effects, such as long-term problems with urinary and sexual function (Eastham, Vickers, Lilja, & Scardino, 2019). The reason it is recommended to be screened is if detected most men with prostate cancer can be followed by active surveillance (Eastham, Vickers, Lilja, & Scardino, 2019). The diagnosis of prostate cancer is just information used to help make decisions, not necessarily an indication for immediate treatment (Eastham, Vickers, Lilja, & Scardino, 2019). Thank you, Pessy Sorry my references seem to have not posted.... References Carte, H., Albertsen, P., Barry, M., Etzioni, R., Freedland, S., Greene, K., . . . Zietman, A. (2018, June). Early Detection of Prostate Cancer Guidelines. Retrieved from American Urological Association (AUA): Eastham, J., Vickers, A., Lilja, H., & Scardino, P. (2019). Prostate Cancer Screening Guidelines. Retrieved from Memorial Sloan Kettering Cancer C: Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 5/44 Michels, T., & Sands, J. (2015). Dysuria: Evaluation and Differential Diagnosis in Adults. American Academy of Family Physicians (AAFP), 787-788. Retrieved from Recurrent Urinary Tract Infections. (2016). Retrieved from American Academy of Family Physicians (AAFP).org: Rowe, T., & Juthani-Mehta, M. (2014). Diagnosis and Management of Urinary Tract Infection in Older Adults. Infectious disease clinics of North America, 75-89. doi:10.1016/.2013.10.004 Urinary Tract Infection. (2018). Retrieved from powered by the American Academy of Family Physicians : (http Marie Mompoint (Instructor) Apr 10, 2019 Thanks for the references page. Dr. Mompoint (http Marie Mompoint (Instructor) Apr 10, 2019 Hi Pessy, Thanks for the information and overview of the issues of the GU system. I agree that women are more likely to get UTI. The issue with men who present with UTI symptoms is that the infection could be superimposed. Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 6/44 If Protastitis is suspected in a male patient, what would be the anticipated treatment plan? Dr. Mompoint (http Pessy Kramer (h5ps: / Apr 11, 2019 Week 6: Urologic Concerns in the Maturing and Older Adult Discussion Hi Dr. Mompoint, According to the American Academy of Family Physicians (AAFP) acute bacterial prostatitis is an acute infection of the prostate gland that causes pelvic pain and urinary tract symptoms, such as dysuria, urinary frequency, and urinary retention, and may lead to systemic symptoms, such as fevers, chills, nausea, emesis, and malaise (Coker & Dierfeldt, 2016). Before getting into the treatment plan one must first describe the importance on proper diagnosis. The diagnosis is predominantly made based on history and physical examination (Coker & Dierfeldt, 2016). The physical examination must include abdominal, genital, and digital rectal examination to assess for a tender, enlarged, or boggy prostate (Coker & Dierfeldt, 2016). It is important to point out that a urine cultures should be obtained in all patients who are suspected of having acute bacterial prostatitis to determine the responsible bacteria and its antibiotic sensitivity pattern (Coker & Dierfeldt, 2016). The AAFP reports that most patients can be treated as outpatients with oral antibiotics and supportive measures (Coker & Dierfeldt, 2016). However, hospitalization with broad-spectrum intravenous antibiotics should be considered in patients who are systemically ill, unable to voluntarily urinate, unable to tolerate oral intake, or have risk factors for antibiotic resistance (Coker & Dierfeldt, 2016). The primary treatment plan as per AAFP guidelines is a Single dose of ceftriaxone (Rocephin), 250 mg intramuscularly, or single dose of cefixime (Suprax), 400 mg orally then Doxycycline, 100 mg orally twice daily for 10 days (Coker & Dierfeldt, 2016). Other treatment options are listed in the AAFP guidelines and are available to investigate if necessary (Coker & Dierfeldt, 2016). References Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 7/44 Coker, T., & Dierfeldt, D. (2016). Acute Bacterial Prostatitis: Diagnosis and Management. American Academy of Family Physicians (AAFP), 114-120. (http Marie Mompoint (Instructor) Apr 11, 2019 Hi Pessy, Thanks for the additional information regarding the treatment options for prostatitis. Nice overview Dr. Mompoint (http Obed Orangi (h5ps: / Apr 13, 2019 Pessy, Your post regarding urologic concerns in the maturing and older adult was very informational and I enjoyed reading it. You especially narrated extensively about the challenges of treating UTIs in older adults, where providers usually prescribe antibiotics leading to the development of antibiotic resistance, evidenced in multi drug resistance organisms. Ahmed, Farewell, Jones, Francis, Paranjothy and Butler (2018) explain that, after antibiotic prescription and administration, resistant pathogens usually are persistent for a period of at least twelve months and thus, putting a patient at morbidity or mortality risk if they became ill and needed antibiotics for treatment. Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 8/44 Mody and Juthani-Mehta (2014) narrate that, it is important for providers to understand that symptomatic bacteuria/UTI should be the only form of UTI that should be considered for treatment with antibiotics, while asymptomatic bacteuria/UTI involving transient symptoms should be watched without necessarily prescribing antibiotics since the condition may resolve by conventional treatments such as hydration. In case of symptomatic UTI, treatment should involve use of narrow spectrum antibiotics for the shortest duration needed to clinically alleviate patient symptoms (Mody & Juthani-Mehta, 2014). Mody and Juthani-Mehta (2014) also explain that, asymptomatic bacteuria/UTI increases with increasing patient or adult age, and among women over the age of 70 years, about 50% of them may suffer from asymptomatic UTI which may concurrently occur with symptoms such as urine urgency, dysuria, anorexia, incontinence and fatigue. However, Mody and Juthani (2014) warn that, older patients presenting with these symptoms must be evaluated closely before antibiotics for UTI are prescribed because, older adults with or without bacteriuria will often have specific genitourinary symptoms mentioned above and prescribing antibiotics in this situation will not make a difference. Obed. References Ahmed, H., Farewell, D., Jones, H. M., Francis, N. A., Paranjothy, S., & Butler, C. C. (2018). Incidence and antibiotic prescribing for clinically diagnosed urinary tract infection in older adults in UK primary care, . PLoS ONE, 13(1), 1–13. Mody, L., & Juthani-Mehta, M. (2014). Urinary tract infections in older women: a clinical review. JAMA, 311(8), 844–854. (http Scofie-Lynn Hecht (h5ps: / Apr 14, 2019 Pessy, I found the PSA research to be interesting. Quite frankly I didn’t know much about it until we had to do this discussion post. My previous preceptor would order it on many of the male patients (it was an internal medicine practice with many older Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 9/44 adults) and my current preceptor will offer it for routine screenings but then provides education like we did in our posts. Many patients decline the screening. My previous preceptor who did screen would tell me that they get levels that are elevated often and that it will go back to normal. PSA levels can vary based on age, race, BMI, and prostate volume (Carter, et al., 2018). Prostate cancer also has a mortality rate of less than 3% so it’s not high like pancreatic cancer (Carter, et al., 2018). I think the PSA is an okay screening tool and this is why we have the discussion with our patients about benefits of screening, false positives, false negatives, and actual prostate cancer statistics as well and then the patient can make the decision what they would like to do. I’m not sure what I would do if I was a patient. If it is a covered screening test then why not right, but what if you get an elevated level, would that bother you a lot or would you monitor for it to go back normal. That is a tough one for me and I’m not sure what I would do. If the test wasn’t covered then it would be an easy choice for me. What would you do if you were an older male adult and given the information we have provided? Would you screen or not? Reference Carter, H. B., Albertsen, P. C., Barry, M. J., Etzioni, R., Freedland, S. J., Greene, K. L., . . . Zietman, A. L. (2018). Early detection of prostate cancer (2018). Retrieved April 10, 2019, from American Urological Association: -Scottie Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 10/44 There are many different risk factors that contribute to the development of a urinary tract infection (UTI) in men versus women. According to Goroll and Mulley (2014), the follow factors may contribute to a UTI in men: lack of circumcision, an enlarged prostate, sexual intercourse with other men, HIV infection with a CDF lymphocyte 200 mm3, the use of urethral or condom catheters, urinary incontinence, and a history of previous UTI’s (p. 1005). Women have many more risk factors, including but not limited to: being sexually active, use of spermicide, having a history or family history of UTI’s, urinary incontinence, atrophic vaginitis, estrogen deficiency, cystocele, pregnancy, increased post-void urine volume, urinary catheterization and functional status deterioration (Tan & Chlebicki, 2016,p. 487). Women are 30 times more likely than men to develop a UTI due to their anatomy. A woman’s urethra is much shorter and anatomically closer to the anus, thus increasing their risk for infection. Knowing when to treat a UTI and when not to is very important to our diagnosis and treatment management. Although it is hard to decipher between a UTI and asymptomatic bacteriuria (ASB), it is important to, because antibiotics are necessary for the treatment of symptomatic UTI, but not for ASB. Only those who repeatedly become symptomatic derive benefit suppressive antibiotic treatment. Treatment when not needed have consequences of such treatment, including adverse drug reactions and reinfection with resistant organisms (Rowe & Juthani-Mehta, 2013, p. 77-78). Benign Prostatic Hyperplasia According to the American Urological Association (AUA), the Panel recommends against PSA screening in men under age 40 years and does not recommend routine screening in men between ages 40 to 54 years at average risk. The AUA believes that shared decision-making for men age 55 to 69 years that are considering PSA screening involves weighing the risks and benefits. However, I think it is important to remember that the greatest benefit of screening appears to be in men ages 55 to 69 years (AUA, 2018). As for education, I would be sure to inform the patient that PSA screening is for the use of prostate cancer screening. I would also what to inform the patient that the benefit of screening as recommended is that early detection allows for more conservative management. In regards to frequency of screening, it would be important to let the patient know that studies now show that screening intervals of two years proves the most benefit and reduce overdiagnosis and false positives (AUA, 2018). References AUA. (2018). Early Detection of Prostate Cancer. Retrieved April 10, 2019, from Topic: Week 6: Urologic Concerns in the Maturing and Older Adult Discussion 11/44 Goroll, A. H., & Mulley, A. G. (2014). Primary care medicine: Office evaluation and management of the adult patient (7th ed.). Retrieved from ( Rowe, T. A., & Juthani-Mehta, M. (2013). Diagnosis and management of urinary tract infection in older adults. Infectious disease clinics of North America, 28(1), 75–89. doi:10.1016/.2013.10.004 Tan, C. W., & Chlebicki, M. P. (2016). Urinary tract infections in adults. Singapore medical journal, 57(9), 485–490. doi:10.11622/smedj.