Comprehensive Care Plan: Genitourinary Case

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Dysuria and Nocturia

These genitourinary disorders may result from an inappropriate work of the irritated urethra that could be caused by some infection or trauma (Bremnor & Sadovsky, 2002). Their main signs are frequent urination, loss of bladder control, and pain during urination. They may progress in enlarged prostatitis, some sexually transmitted diseases, or impotence. It is suggested to take the following tests to diagnose this disorder: urinalysis, ultrasound examination of the bladder, and testing for possible UTIs and STDs (Michels & Sands, 2015). The main treatment options depend on the causes of the disorders. As a rule, it is suggested to use antibiotics to deal with the infections that can be spread through the patient’s organism.

Abnormal PSA, BHP, Prostatitis, and Enlarged Prostate with Lower Urinary Tract Symptoms

These genitourinary disorders have similar to the previous disorders’ pathophysiology. They first develop in the periurethral transition zone of the prostate and can be developed as soon as problems with hormones, prostatic smooth muscles, and neuroreceptors occur with age (Roehrborn, 2008). Sometimes, men with the identified disorders may have no signs of BPH, prostatitis, or enlarged prostate. With time, patients may feel pain starting a urine stream, observe a weak flow of urine, the cases of dribbling after the process of urination, and a constant feeling that the bladder is not empty. The cases of progression are frequent and may result in prostate cancer that can hardly be treated with antibiotics. In addition to a urinalysis, it is possible to take a PSA test that can help to identify the possibility of prostate cancer and to take a digital rectal exam with the help of which the size and quality/severity of the prostate can be identified. With age, doctors admit the impossibility to treat the majority of genitourinary disorders. Therefore, the main treatment task is to decrease the symptoms and the level of pain. Antibiotics that can help to control the development of bacterial prostatitis, UTIs, and STDs can be used. Home treatment: frequent relax activities or the possibility to spend much time on urination.

Hyperlipidemia and Hypercholesterolemia

These disorders take place when the elevation of fat proteins occurs in the blood. Their pathophysiology is all about the decreased clearance of triglyceride-rich lipoproteins, insulin resistance, and decreased effective plasma albumin circulation (Harikumar, Althaf, Kumar, Ramunaik, & Suvarna, 2013). They may be developed on the basis of similar family (genetic) history or poor diets chosen by the patient. One of the evident signs of this kind of disorder is fatty growths around the eyes. The possible complications may gain the form of heart attacks or strokes, the development of diabetes, or pancreatitis (Harikumar et al., 2013). Blood tests to evaluate the level of cholesterol can be taken. Skin tests to investigate the presence of fatty deposits can be offered. The main treatment method is the choice of a proper healthy diet and the establishment of several lifestyle habits.

Hypertension

The main causes of hypertension are connected with wrong interactions between a person’s genes and the environment. It may happen because of kidney problems. There are no evident symptoms of high blood pressure. Still, sometimes, people may have headaches or shortness of breath. The peculiar feature of its complications such as heart attacks, strokes, or an aneurysm is a fast possibility of spreading. The measurement of blood pressure is the only test that can be taken to identify the level of pressure. Finally, to avoid complications and prevent serious health problems, it is offered to take certain treatment measurements such as certain medications’ prescriptions that can stabilize the patient’s pressures (the choice of drugs depends on the level of hypertension and other peculiarities of the organism). Alfa- and beta-blockers are usually suggested.

Systolic Murmur

Systolic murmurs are the sounds that can be identified during a heartbeat cycle with the help of a stethoscope. As a rule, the murmurs are innocent and may be caused by increased physical activity, anemia, or hypertension. In addition to the doctor’s analysis made with the help of stethoscope, the patient may take chest X-ray and ECG tests to clarify the possible reasons for murmurs. Treatment may include medications that help to prevent blood clots, statins that help to low the level of cholesterol, or beta blockers that may prevent the changes of blood pressure and help to avoid such complications as heart attacks and strokes.

Chest Wall Syndrome

It is also known as costochondritis, an inflammation of a specific cartilage that takes responsibility for the connection of a rib with a breastbone. Injury, joint infection, or some physical strain may cause this syndrome. It is usually characterized by sharp pain that occurs in the left side of the breastbone that can be worsened with every new deep breath. ECG or X-rays can be used to test this diagnosis. As soon as it is proved, special non-steroidal drugs can be offered to reduce pain, or physical therapy can be used to work-out the organism.

Anxiety, Insomnia, and Stress

The symptoms of these types of disorders cannot be understood fully because each person may have their own explanations and conditions. As a rule, they can be caused on the basis of the already gotten medical problems such as diabetes, prostatitis, chronic pain, etc. The main signs are feeling tired, inabilities of gain full control of an organism, troubles with sleep, increased heart rate, etc. Self-quizzes are offered to people to check the reasons and possible outcomes of their insomnia, stress, and anxiety problems. Social isolation, depression, and even suicide thoughts may be regarded as the complication of these disorders. Special psychological programs and the creation of a healthy lifestyle may be offered as the treatment method.

Overweight and Possible Pre-Diabetes

Possible pre-diabetes problems in overweight people may be explained by the inability to control an increased insulin rate in the organism. Though insulin resistance alone cannot be defined as the significant cause of type 2 diabetes (Goran, Lane, Toledo-Corral, & Weigensberg, 2008), it should be taken into consideration. Besides, there are other symptoms such as frequent urination, fatigue, and physical activity problems. The main complications are connected with the possibilities of strokes, high cholesterol, and heart or kidney diseases. Glycated hemoglobin test can be used to identify diabetes, and obesity may be diagnosed after the analysis of the Body Mass Index, blood tests, and ECG can help to identify the causes of obesity problems. Treatment should be based on a properly chosen diet, physical activities, and medications prescribed by a doctor.

Differentiation of the Disorder from Normal Development

The normal development of a 60-year-old Hispanic male patient may have the following characteristics:

Possible decline of vision, hearing, and immune-system functions;
Age-related loss of muscle mass (Kyle et al., 2001);
The intentions to participate in different physical activities (Kyle et al., 2001); and
Inabilities to gain control of all parts of a body (anemia, urination, etc.).

In comparison to the normal development of the organism of a 60-year-old male, the genitourinary disorder may be expected as the outcome of the fact that the organism gets older, and more relax activities, well-developed diets, and the use of supportive drugs can be offered as precautionary methods.

Physical and Psychological Demands of the Disorder

The patient should not choose bed rest as the main decision. It is necessary to consult the doctor and identify what kind of physical activities may be chosen. For example, walking in the fresh air (Barnett et al., 2016) can be used as one of the best methods to promote blood circulation and the establishment of a normal blood pressure. The psychological demands are connected with the necessity to stay alone and cope with the outcomes of social isolation from time to time. Urination problems can be solved with time, and to avoid a shame that may trouble the patient, it is probably better to stay alone for some period of time.

Key Concepts to Achieve Optimal Disorder Management and Outcomes

The genitourinary disorder can be managed in several steps to be taken:

Elimination of the current infection;
Identification of the factors that may influence the urination problems;
Prevention of the development of complications by using antibiotics and following hygiene rules; and
Education about the possible complications of genitourinary disorders, psychical transmissions, and the importance of the balance between physical activities and relaxation; and
Evaluation of urination frequency from time to time.

The outcomes may be as follows: the patient may feel relief, pain can go away, urination process may stabilize, and the abilities to sleep well occur.

Key Interdisciplinary Team Personnel Details

The role of the team in care for a patient with a genitourinary disorder is crucial indeed. The team of nurses should realize that the patient is a 60-year-old male that did not have significant health problems in the past. Now, the person cannot control his urination and feels pain. The team should provide him with the following kind of support:

Communication during which the possible complications are discussed;
Clean conditions in toilets;
Possibilities to ask for help 24/7;
Monitoring of urinary elimination;
Instructions to drink the required portion of fluids; and
Implementation of a catheter in case pain causes serious sufferings.

Strategies to Overcome the Barriers

There are two main strategies for consideration. First, the establishment of specific NP practice components and communication could facilitate collaboration between nurses and the patient and choose the most appropriate treatment in regards to the needs and expectations of the patient. Second, the use of special collaboration models may help to differentiate the responsibilities of physicians and nurses, identify the goals of nursing care, and eliminate the uncertainties that can worsen care.

Care Plan Synthesis

Comprehensive and Holistic Recognition and Planning for the Disorder

The genitourinary disorder care should be properly recognized and planned. First, urinary incontinence care should be offered (monitoring of the urinary tract function and the instructions of how much fluids should be used hourly). Second, urinary retention care is important for recognition (implementation of a catheter in cases of emergency, provision of enough time to empty the bladder, and the instructions to avoid stool impaction). Finally, a teaching process should take place (the explanation of the pathophysiology of the disorder and its complications, the instructions on how and when to report on other signs and symptoms, and the description of the therapies that can be offered).

Patient’s Socio-Cultural Background Importance

Having a master degree in engineering, the patient has rather poor knowledge in healthcare. He believes he is a healthy person. His income and relations within his Hispanic family are normally stable. Therefore, the patient does not know how to ask for help and why specific treatment is required. His past history and possible complications should be integrated to explain that in-time treatment and the attention to his diet and physical activities are crucial for his future life without pain.

Evidence-Based Approach to Address Key Issues Identified

Kyle et al. (2001) and Barnett et al. (2016) underline the importance of physical activities for people under 60. Still, the authors mention that any kind of activity, even the easiest one, should be discussed with a number of doctors that can identify the number and duration of activities. Besides, Bremnor and Sadovsky (2002) inform about the necessity to clarify the causes of the genitourinary disorder and eliminate the infection (if any) in the organism. It does not take much time, but it requires the patient’s attention and desire to take the tests and provide the experts with an opportunity to check urine and blood thoroughly.

Comprehensive Approach to Disorder Management

The genitourinary disorder management is a complicated issue. People should understand that the problems with urination may have a various nature. The problems may be local or influence the work of the whole organism with time. Therefore, the management process should be divided into three logical parts to be effective:

The identification of the causes of the genitourinary disorder;
The evaluation and treatment of the main health problem;
The explanation of the theoretical material that can be used in practice as soon as the main treatment is over.

References

Barnett, A., Cerin, E., Zhang, C. J., Sit, C. H., Johnston, J. M., Cheung, M. M., & Lee, R. S. (2016). Associations between the neighbourhood environment characteristics and physical activity in older adults with specific types of chronic conditions: the ALECS cross-sectional study. International Journal of Behavioral Nutrition and Physical Activity, 13(1), 1.

Bremnor, J. D., & Sadovsky, R. (2002). Evaluation of dysuria in adults. American family physician, 65(8), 1589-1598.

Goran, M. I., Lane, C., Toledo-Corral, C., & Weigensberg, M. J. (2008). Persistence of pre-diabetes in overweight and obese Hispanic children association with progressive insulin resistance, poor β-cell function, and increasing visceral fat. Diabetes, 57(11), 3007-3012.

Harikumar, K., Althaf, S. A., Ramunaik, M., & Suvarna, C. H. A Review on Hyperlipidemic. International Journal of Novel Trends in Pharmaceutical Sciences, 1(3), 59-71.

Kyle, U. G., Genton, L., Hans, D., Karsegard, V. L., Michel, J. P., Slosman, D. O., & Pichard, C. (2001). Total body mass, fat mass, fat‐free mass, and skeletal muscle in older people: cross‐sectional differences in 60‐year‐old persons. Journal of the American Geriatrics Society, 49(12), 1633-1640.

Michels, T. C., & Sands, J. E. (2015). Dysuria: Evaluation and Differential Diagnosis in Adults. American family physician, 92(9).

Roehrborn, C. G. (2008). Pathology of benign prostatic hyperplasia. International journal of impotence research, 20, S11-S18.

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