NR 603 Week 5 APEA Predictor Assignment – Part 2- DOWNLOAD TO SCORE AN A GRADE

Part 2 APEA Predictor Part Two – First line treatment plan for Benign Prostate Hyperplasia (40.1) Chief Complaint: Urinary frequency, dribbling, dysuria and occasional low back pain HPI: A.C. is a 69-year-old Hispanic male that comes into the clinic complaining of urinary frequency worse at night with frequent dribbling accompanied by dysuria. Pt also complains of occasional low back pain. Pt states pain is a 6/10 at worse and doesn’t take anything for the pain. Pt states these symptoms started about 2 months ago but have become increasingly worse over the last 2 weeks. Differential Diagnosis: Benign Prostate Hyperplasia (40.1) Medication Flomax 0.4 mg Sig: 1 tablet PO daily Disp #30 Refill: 1 Labs/Diagnostics: A urinalysis was obtained to evaluate for infection and hematuria. Serum creatinine and a PSA obtained. The AUA does not recommend routine measurement of serum creatinine or serum PSA in the initial evaluation. (AUA, 2019) Imaging is not necessary unless there is hematuria, elevated creatinine. The diagnosis does not require histologic confirmation, and prostate biopsy is only warranted if there is concern about prostate cancer. Some patients with more severe prostatic enlargement may need surgery, transurethral resection of the prostate (TURP) a procedure to reduce pressure on the urethra by reducing the size of the prostate (Davis, 2018). Medication: The AUA recommends obtaining a severity of symptoms for assessing BPH before initiating pharmacological treatment. (AUA, 2019) For moderate to severe symptoms, a Long-acting alpha-1 antagonist is the first line treatment for BPH. I will prescribe Tamsulosin (Flomax) 0.4 gm, orally once per day. (AUA, 2019) Education: Possible side effects of Flomax that include decreased ejaculation volume. Empty the bladder every two to three hours to prevent overfilling the bladder. Avoid spicy foods that can irritate the bladder. Avoid caffeine and alcohol as they act as a diuretic and increase the need to urinate. Refrain from taking cold medication such as decongestants, antihistamines and diarrhea medications because they can increase the symptoms. Avoid drinking liquids two hours before bedtime. Try to double void to empty the bladder. Administer at the same time each day, half an hour after a meal. Take exactly as directed by your doctor. Do not increase or decrease the dosage of Flomax without his or her advice. Do not crush, chew or open Flomax capsules. Call the office if you cannot urinate or if your symptoms become worse. Referral: Urology referral is not recommended at this time for this patient. However, a referral will be warranted if his urinary symptoms do not improve with treatment. Urologic referrals are also recommended for patients with prostate symptoms or significant urinary retention, or if other urologic diagnoses are suspected. Follow up: I will recommend the patient follow up in 2 weeks to see if symptoms improve Reference American Urological Association. (2019). What is benign prostatic hyperplasia (BPH)? Retrieved from