University of Pangasinan Phinma Education Network Arellano St., Dagupan City Prostate Cancer A Case Study Presented to the Faculty of U NIVERSITY OF P ANGASINAN PHINMA EDUCATION NETWORK College of Nursing In partial fulfillment of the requirements for RLE III Presented by: Cerdan, Ariane M. Cerezo, Haidee M. Cerezo, Jofelyn I. Cervantes, Kemberly M. Cervantes, Mary Grace M. Delos Santos, Christian G. Dion, Quennie P. Dismaya, Ma. Zharina P. Doctolero, Orlando Jr. B (Level III ) August S.Y. 2010-2011 Presented to: Mr. Chris Villamil, RN
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University of PangasinanPhinma Education Network
Arellano St., Dagupan City
Prostate Cancer
A Case Study Presented to the Faculty of
U NIVERSITY OF P ANGASINAN PHINMA EDUCATION NETWORK
College of Nursing
In partial fulfillment of the requirements for RLE III
Presented by:
Cerdan, Ariane M.
Cerezo, Haidee M.
Cerezo, Jofelyn I.
Cervantes, Kemberly M.
Cervantes, Mary Grace M.
Delos Santos, Christian G.
Dion, Quennie P.
Dismaya, Ma. Zharina P.
Doctolero, Orlando Jr. B
(Level III )
August S.Y. 2010-2011
Presented to:
Mr. Chris Villamil, RN
Clinical Instructor
Pangasinan Medical Center
Dagupan City, Pangasinan
2nd Floor (OB and Surgical Ward), 3-11 Shift
TABLE OF CONTENTS
I. Acknowledgement
II. Objectives
a. General Objectives
b. Specific Objectives
III. Significance of the Study
a. Field of Nursing Education
b. Field of Nursing Practice
c. Field of Nursing Research
IV. Patient Demographic Data
a. Patient Profile
b. History of Present IIlness
V. Anatomy and Physiology
VI. Disease Presentation of Prostate Cancer
a. Pathophysiology
b. Clinical Manifestations
c. Predisposing Factors
d. Complications
VII. Laboratory Test
VIII. Management of Prostate Cancer
a. Medical Management
b. Surgical Management
c. Nursing Management
IX. Discharge Planning
X. Glossary
XI. Bibliography
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ACKNOWLEDGEMENT
In the deepest recesses of our hearts we, the student nurses assigned at
Pangasinan Medical Center, would like to express our sincerest joy and gratitude to the
following for the invaluable assistance that they have provided for the success and
completion of this case study. Without them, the accomplishment of this case study will
never be possible.
First and foremost, the Almighty father, for the unconditional love and for the
strength and wisdom He has given unto us to finish this endeavor.
To our clinical instructor, Mr. Chris Villamil, for the guidance and assistance he
imparted to us. We are grateful for his expertise and immense patience whenever we
are in the area and for showing and demonstrating to us on how to implement such
nursing intervention and procedure in order for us to gain knowledge, skills and
confidence that we will be needing in this field. And also we thank him for pushing and
motivating us to do better in our studies.
To the whole staff of Pangasinan Medical Center, especially to the nursing
director and staff nurses of the OB and Surgical Ward, for their warm welcome and for
sharing their time and knowledge whenever we have questions and their experiences in
the clinical area for us to gain insights on what we are supposed to learn in the hospital
setting.
To our patient, Mr. X for the cooperation in answering all of our questions,
despite his health condition so as to obtain the data we needed for this case study. We
also want to thank his relatives for the assistance they extended whenever Mr. X
doesn’t remember some pertinent information we needed.
And finally, to our beloved parents and guardians for their undying and unselfish
love and support to us so that we can continue our studies.
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I - INTRODUCTION
Prostate cancer is one of the most common malignancy in males. Prostate
cancer is a malignant (cancerous) tumor (growth) that consists of cells from the prostate
gland. Generally, the tumor usually grows slowly and remains confined to the gland for
many years. During this time, the tumor produces little or no symptoms or outward signs
(abnormalities on physical examination). However, all prostate cancers do not behave
similarly. Some aggressive types of prostate cancer grow and spread more rapidly than
others and can cause a significant shortening of life expectancy in men affected by
them. A measure of prostate cancer aggressiveness is the Gleason score which is
calculated by a trained pathologist observing prostate biopsy specimens under the
microscope.
As the cancer advances, however, it can spread beyond the prostate into the
surrounding tissues (local spread). Moreover, the cancer also can metastasize (spread
even farther) throughout other areas of the body, such as the bones, lungs, and liver.
Symptoms and signs, therefore, are more often associated with advanced prostate
cancer.
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II - OBJECTIVES
A. General Objectives:
Our general objective in formulating this case study is to be able to gain
more knowledge about Prostate Cancer including all related information about
the said condition and to be able to apply the nursing assessment and
intervention regarding the aforesaid malignancy.
B. Specific Objectives:
To be able to be familiarized with the different terminologies associated
with prostate cancer.
To be able to have understanding about the causes and risk factors that
triggers prostate cancer.
To be able to know the different interventions and management regarding
prostate cancer.
To be able to have an understanding on the stages of prostate cancer.
To be able to have knowledge about prevention, curative and rehabilitative
phases of prostate cancer.
To be able to practice the theoretical study presented in this case study.
To serve as research material as future reference.
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III - SIGNIFICANCE OF THE STUDY
Nursing Education
It is beneficial to the nursing education for this will serve as a study guide and as
teaching materials for classroom discussions, case studies, and other school related
research works on the lifestyle modification of patients with Prostate Cancer. This will
provide a firsthand view on the patient’s problems with regards to the risk of having this
malignancy.
Nursing Practice
It is beneficial to the nursing profession and to its practitioners for this research
works will serve as a reference on what changes that will be done on the patient
diagnosed with Prostate Cancer, and to have a better understanding of the illness. The
problems of the participant will help the nursing institution to be able to help provide
some solutions on how to prevent such problems in the future. This study will serve as
an eye opener for all nurses to know the current situation of this patient, how he is
coping with the situation and how did he come up with this malignancy, so that in the
future, other nurses will have better insights of the condition and can give their hundred
percent care with patients in the same situation.
Nursing Research
The nursing institutions and research shall benefit from this study for it will serve
as a reference for other extensive researches on the extent of knowledge of the
students of UNIVERSITY OF PANGASINAN-PEN regarding Prostate Cancer. This
research work can also be a source of information for other researches to be
Patient was brought to Pangasinan Medical Centerl, accompanied by his
daughter on April 13, 2010 at 4:11 in the afternoon. He was admitted with chief
complaints of fever, difficulty of breathing and cough. He was on the same condition two
days prior to admission. Upon admission, patient was assessed as febrile with a body
temperature of 38°C, with flushed skin, warm to touch and was positive of having a
productive cough.
Physician’s impression was Coronary Obstructive Pulmonary Disease.
Past History
The patient says that he doesn’t have any childhood disease before, especially those diseases that are related to his current condition.
Family History of Illness He stated that his father and some uncles are hypertensive, but none of his brothers
and sisters has such diseases. And according to him, his 6 siblings don’t have any illness.
Functional Health PatternA. Health Perception and Health Management Pattern
Mr. Xyz claimed that he is a chain smoker since he graduated from high school. And he drinks alcohol occasionally and moderately. But he doesn’t take any illegal drugs. When the time that he’s already experiencing such pain in his abdomen, he thinks that it is because of his regular alcohol intake. So, he decided to minimize drinking alcohol.
B. Nutritional and Metabolic Pattern Patient stated that he loves to eat vegetables especially the green leaf one.
C. Elimination Pattern Patient said that he doesn’t have any difficulty upon urinating also in bowel
elimination. And he also has a regular perspiration.
D. Activity-Exercise Pattern He considered that working in the farm every morning is a form of exercise.
E. Sleep-Rest Pattern Patient verbalized that he has sleep-pattern disturbance due to the
intermittent pain he’s suffering that made him awake and couldn’t go back to sleep. There are times that he could only sleep for about 3 hours. But usually take naps every afternoon after their lunch.
F. Cognitive-Perceptual Pattern
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Mr. Xyz had been long suffering from mild abdominal pain but still manages to tolerate it. His illness had not yet affected any of his senses and he states that he was perfectly fine before the onset of the disease
G. Self Perception and self concept Pattern Mr. Xyz admits that he worries about his family. Without him working on their
farm would put their financial problems to worsen. He claims that he feels restless and not much of a use while staying in the hospital bed all day.
H. Role Relationship Pattern Mr. Xyz was a “hands on” father according to his wife but since he started to
fell the pain on his abdomen, he cannot perform some of chores that he used to do specially his work to their farm. But his family tries to help him and his oldest son did the job in the farm so that they can still earn money.
I. Coping-Stress Tolerance Pattern The sudden onset of his disease made him irritable to stress. An
uncomfortable experience he claimed. Being in a complete bed rest and all could not help him fix some of their financial burden. But still, the presence of his wife beside him helped him alleviate some of the problems that had been bothering him.
J. Value-belief Pattern Despite of what was happening to him, Mr. Xyz still believe and trust God. He
doesn't even blame god for what is happening to him; in fact, he said that his faith to Him became much stronger this time. He claimed prayers are very important and his family gives him the strength.
Impression:
Mr. Xyz experiences allot of problem which causes him depression, but he seemed positive on facing things. There is nothing left for him to be worried about as long as his family is beside him. His condition gravely affects their family’s income since he is responsible for funding their family, yet his family is very supportive to help in every way they could.
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IV - DEVELOPMENTAL DATA
Erik Erikson’s Psychosocial Theory of Development
Late Adulthood (55 or 65 to Death): Integrity vs. Despair
This is when we begin to reflect on our lives, accepting it for what it was. If we have done well in previous stages, especially stage seven, we can feel a sense of fulfillment and accept death as an unavoidable reality with dignity. If we haven't done well, we can be filled with regret, despair over the time running out and fear of death.
Sullivan’s Developmental Theory
Adulthood
To establish relationships of love for some other person, in which relationship the other person is as significant, or nearly as significant, as one's self. This really highly developed intimacy with another person is not the principal business of life, but is, perhaps, the principal source of satisfaction in life; and one goes on developing in depth of interest or in scope of interest, or in both depth and scope, from that time until unhappy retrogressive changes in the organism lead to old age
Robert Havighurist’s Developmental Theory
Later maturity (60 and over)
The developmental tasks of later maturity differ in only one fundamental respect from those of
other ages. They involve more of a defensive strategy--of holding on the life rather than of
seizing more of it. In the physical, mental and economic spheres the limitations become
especially evident; the older person must work hard to hold onto what he already has. In the
social sphere there is a fair chance of offsetting the narrowing of certain social contacts and
interests by the broadening of others. In the spiritual sphere there is perhaps no necessary
shrinking of the boundaries, and perhaps there is even a widening of them.
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V- ANATOMY AND PHYSIOLOGY
Anatomy:
The prostate gland is an organ that is located at the base or outlet (neck) of the
urinary bladder. The gland surrounds the first part of the urethra. The urethra is the
passage through which urine drains from the bladder to exit from the penis. One
function of the prostate gland is to help control urination by pressing directly against the
part of the urethra that it surrounds. The main function of the prostate gland is to
produce some of the substances that are found in normal semen, such as minerals and
sugar. Semen is the fluid that transports the sperm to assist with reproduction. A man
can manage quite well, however, without his prostate gland. In a young man, the normal
prostate gland is the size of a walnut (<30g). During normal aging, however, the gland
usually grows larger. This hormone-related enlargement with aging is called benign
prostatic hyperplasia (BPH), but this condition is not associated with prostate cancer.
Both BPH and prostate cancer, however, can cause similar problems in older men. For
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example, an enlarged prostate gland can squeeze or impinge on the outlet of the
bladder or the urethra, leading to difficulty with urination. The resulting symptoms
commonly include slowing of the urinary stream and urinating more frequently,
particularly at night.
Physiology:
The prostate gland produces a secretion known as prostate fluid that makes up
most of the liquid part of semen, which is discharged from the penis during sexual
orgasm. The prostate gland is composed of both glandular tissue that produces prostate
fluid and muscle tissue that helps in male ejaculation. Prostate fluid also helps to keep
sperm, which is found in semen, healthy and lively, thereby increasing the chances that
fertilization will occur.
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VI - Disease Presentation of Prostate Cancer
Prostate cancer is a form of cancer that develops in the prostate, a gland in the
male reproductive system. Most prostate cancers are slow growing; however, there are
cases of aggressive prostate cancers. The cancer cells may metastasize from the
prostate to other parts of the body, particularly the bones and lymph nodes. Prostate
cancer may cause pain, difficulty in urinating, problems during sexual intercourse, or
erectile dysfunction. Other symptoms can potentially develop during later stages of the
disease.
Rates of detection of prostate cancers vary widely across the world, with South
and East Asia detecting less frequently than in Europe, and especially the United
States. Prostate cancer tends to develop in men over the age of fifty and although it is
one of the most prevalent types of cancer in men, many never have symptoms, undergo
no therapy, and eventually die of other causes. This is because cancer of the prostate
is, in most cases, slow-growing, symptom-free, and since men with the condition are
older they often die of causes unrelated to the prostate cancer, such as heart/circulatory
disease, pneumonia, other unconnected cancers, or old age. About 2/3 of cases are
slow growing "pussycats", the other third more aggressive, fast developing being known
informally as "tigers".
Many factors, including genetics and diet, have been implicated in the
development of prostate cancer. The presence of prostate cancer may be indicated by
symptoms, physical examination, prostate specific antigen (PSA), or biopsy. There is
controversy about the accuracy of the PSA test and the value of screening. Suspected
prostate cancer is typically confirmed by taking a biopsy of the prostate and examining it
under a microscope. Further tests, such as CT scans and bone scans, may be
performed to determine whether prostate cancer has spread.
Treatment options for prostate cancer with intent to cure are primarily surgery,
radiation therapy, and proton therapy. Other treatments, such as hormonal therapy,
Patient education is a major component of pulmonary rehabilitation and includes
a broad variety of topics. Depending on the length and setting of the program, topics
may include normal anatomy and physiology of the lung, pathophysiology and changes
with COPD, medications and home oxygen therapy, nutrition cessation, sexuality and
COPD, coping with chronic disease. Communicating with the health care team and
planning for the future (advance directive, living wills, informed decision making about
health care alternatives).
Breathing Exercises. The breathing pattern of most people with COPD is shallow,
rapid, and inefficient; the more severe the disease, the more inefficient the breathing
pattern. With practice, this type of upper chest breathing can be changed to
diaphragmatic breathing, which reduces the respiratory rate, increases alveolar
ventilation, and sometimes helps expel as much air as possible during expiration.
Pursed lip breathing helps to slow expiration, prevents collapse of small airways, and
helps the patient to control the rate and depth or respiration. It also promotes relaxation,
enabling the patient to gain control or dyspnea and reduce feelings of panic.
Inspiratory Muscle Training. Once the patient masters diaphragmatic breathing, a
program of inspiratory muscle training may be prescribed to help strengthen the
muscles used in breathing. This program requires that the patient breathe against
resistance for 10 to 15 minutes every day. As the resistance is gradually increased, the
muscles become better conditioned. Conditioning of the respiratory muscles takes time,
and the patient is instructed to continue practicing at home (Larson, Covey, Wirtz et al.,
1999; NIH 2001)
Activity Pacing. A patient with COPD has decreased exercise tolerance during specific
periods of the day. This is especially true on arising in the morning, because bronchial
secretions collect in the lungs during the night while the person is lying down. The
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patient may have difficulty bathing or dressing. Activities requiring the arms to be
supported above the level of the thorax may produce fatigue or respiratory distress but
may be tolerated better after the patient has been up and moving around for an hour or
more. Working with the nurse, the patient can reduce these limitations by planning self-
care activities and determining the best time for bathing, dressing and daily activities.
Self-Care Activities. As gas exchange, airway clearance, and the breathing pattern
improve, the patient is encouraged to assume increasing participation in self-care
activities. The patient is taught to coordinate diaphragmatic breathing with activities
such as walking, bathing, bending, or climbing stairs. The patient should bathe, dress,
and take short walks, resting as needed to avoid fatigue and excessive dyspnea. Fluids
should always be readily available, and the patient should begin to drink fluids without
having to be reminded. If postural drainage is to be done at home, the nurse instructs
and supervises the patient before discharge or in the outpatient setting.
Physical Conditioning. Physical conditioning techniques include breathing exercises
and general exercises intended to conserve energy and increase pulmonary ventilation.
There is a close relationship between physical fitness and respiratory fitness. Graded
exercises and physical conditioning programs using treadmills, stationary bicycles, and
measure level walks can improve symptoms and increase work capacity and exercise
tolerance. Any physical activity that can be done regularly is helpful. Lightweight
portable oxygen systems are available for ambulatory patients who require oxygen
therapy during physical activity.
Oxygen Therapy. Oxygen supplied to the home comes in compressed gas, liquid, or
concentrator systems. Portable oxygen systems allow the patient to exercise, work, and
travel. To help the patient adhere to the oxygen prescription, the nurse explains the
proper flow rate and required number of hours for oxygen use as well as the dangers of
arbitrary changes in flow rates or duration or therapy. The nurse cautions the patient
that smoking with or near oxygen is extremely dangerous. The nurse also reassures the
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patient that oxygen is not "addictive" and explains the need for regular evaluations of
blood oxygenation by pulse oximetry or arterial blood gas analysis.
Nutritional Therapy. Nutritional assessment and counseling are important aspects in
the rehabilitation process for the patient with COPD. Approximately 25% of patients with
COPD are undernourished (NIH, 2001; Ferreira, Brooks, Lacasse& Goldstein, 2001). A
thorough assessment of caloric needs and counseling about meal planning and
supplementation are part of the rehabilitation process.
Coping Measures. Any factor that interferes with normal breathing quite naturally
induces anxiety, depression, and changes in behavior. Many patients find the slightest
exertion exhausting. Constant shortness of breath and fatigue may make the patient
irritable and apprehensive to the point of panic. Restricted activity (and reversal of
family roles due to loss of employment), the frustration of having to work to breathe, and
the realization that the disease is prolonged and unrelenting may cause the patient to
react with anger, depression, and demanding behavior. Sexual function may be
compromised, which also diminishes behavior. Sexual function may be compromised,
which also diminishes self-esteem. In addition, the nurse needs to provide education
and support to the spouse/significant other and family because the caregiver role in
end-stage COPD can be difficult.
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X - DISCHARGE PLANNING
A. MEDICATION
1. Advice the patient to continue the medication as ordered by the physician.
2. Inform the patient’s guardian on the right dose and the right time in taking the
medication.
3. Explain in layman’s term the actions of the drugs the patient taking.
Medication:
Cefuroxime
Salbutamol
Hydrocortisone
B. EXERCISE
1. Instruct the patient to do deep breathing exercise regularly for lung expansion.
C.TREATMENT
1. Let the patient in a daily routine bath for proper hygiene unless contraindicated.
2. Provide a safe and clean environment
3. Promote water therapy
D. HEALTH TEACHING
Advise the guardian of the patient to:
1. Emphasize the importance of hand washing to prevent the spread of microbes.
2. Use disposable tissue to wipe any secretion, use once and throw them immediately
and properly.
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3. Encourage the patient to have adequate and sufficient intake of fluids to at least 8-10
glasses a day for internal hydration.
4. Avoid exposing patient to smoky places.
5. Never take medications that are not prescribed by the physician.
E. OPD
1. If there are onset signs and symptoms of the illness, consult the physician
immediately.
2. Have a regular check-up.
F. DIET
1. Feed with head elevated.
2. Maintain adequate high calorie diet such as chicken, soup, fish.
3. Increase food intake high in protein, carbohydrates and minerals. Because they
provide energy, build and repair tissue which is also important in growth and
development.
4. Increase intake of vitamins especially Vitamin C to boost up immune system.
5. Raw juices such as apple, citrus, pineapple.
6. Well balance diet of natural food with emphasis on fresh fruits and vegetables.
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XI - GLOSSARY
Angiosgenesis- is a physiological process involving the growth of new blood vessels from pre-existing vessels.[1] Though there has been some debate over terminology, vasculogenesis is the term used for spontaneous blood-vessel formation, and intussusception is the term for new blood vessel formation by splitting off existing ones.[
Apoptosis-is the process of programmed cell death (PCD) that may occur in multicellular organisms. Biochemical events lead to characteristic cell changes (morphology) and death
Bladder-Any pouch or other flexible enclosure that can hold liquids or gases but usually refers to the hollow organ in the lower abdomen that stores urine
Colliculusseminalis/verumontanum-An elevation, or crest, in the wall of the urethra where the seminal ducts enter it.
Cryotherapy- medical treatment that involves cooling the body, especially by applying ice packs.
Dennonvillier’s fascia-The part of the pelvic fascia that separates the prostate and the vesiculae septum from the rectum. It consists of a single fibromuscular structure with several layers that are fused together and covering the posterior aspect of the prostate and surrounding the seminal vesicles.
Dolichoetatic aortic arch- Terminal dribbling- when described as a urinary symptom, refers to the dribbling of urine at the end of the stream. When combined with other urinary symptoms it can be a sign of prostate cancer.
Hyperplasia-which is the formation of new muscle cells.
Hypertrophy-is the increase of the size of muscle cells.
Resection-Excision of a portion or all of an organ or other structure.
Resectoscope-is a hysteroscope with a built in wire loop (or other shape device) that uses high-frequency electrical current to cut or coagulate tissue. It was developed for surgery of the bladder and the male prostate over fifty years ago to allow surgery inside an organ without having to make an incision.
Retrogade ejaculation-sometimes referred to as a "dry orgasm." Retrograde ejaculation is not life threatening but is one cause of male infertility. Men often notice during masturbation that they do have an orgasm but there is no semen production.[1] Another underlying cause for this phenomenon may be ejaculatory duct obstruction.
Stoma-The supportive framework of an organ (or gland or other structure), usually composed of connective tissue. The stroma is distinct from the parenchyma, which consists of the key functional elements of that organ. The stroma of the thyroid gland is the connective tissue that supports the lobules and follicles of the thyroid gland.