Reference no: EM133483114

Assignment:

Nancy Gilbert is 71 years old and is in a loving. married relationship with Henry, her husband s of fifty years. She is visiting with her nurse practitioner, Cheryl, for an annual checkup at a local free clinic in their community. At the conclusion of the visit, Nancy indicates she is worried about Henry, who has been rising frequently at night to urinate and experiencing sudden urges to urinate. She has seen lots of commercials on television about enlarged prostate and she is concerned for Henry's well-being. Nancy requests a referral to a "gentleman practitioner" because she does not think Henry will discuss his issues with a female. Cheryl gives Nancy a referral to a male urologist.

Three months later Cheryl receives a call from Nancy indicating she and Henry would like an appointment to discuss Henry's prostate. After visiting with Henry and Nancy for awhile, Cheryl asks Henry what prompted him to visit with the urologist. Henry reports that he found himself unable to urinate one day after taking a dose of Benadryl (diphenhydramine) to control his allergy symptoms. Cheryl seeks additional information about Henry's past medical history. Henry is 71 years old, in overall good health, 5"11" tall and weighs 175 pounds. Henry takes Lipitor (atorvastatin calcium) 40 mg. PO daily to keep his cholesterol levels under control. He states that he read that the side effects can cause renal impairment and asks whether the Lipitor might have caused him to retain urine. How would you explain the difference between renal impairment and urinary retention to this patient? Why might the use of over the counter decongestants result in the inability to urinate?

Cheryl asks Henry about his appointment with the urologist and Henry reports the urologist performed a digital rectal exam (DRE) and took blood for a prostate-specific antigen (PSA) test. The DRE revealed and enlarged prostate and the PSA was within normal limits. The urologist recommended an ultrasound of the rectum and a prostate biopsy. Why is the urologist recommending these studies? What differential diagnoses are being considered? What medications might be ordered for Henry to improve his urinary patterns?

Two weeks later, Nancy calls to report the biopsy was negative and Henry is improved. What herbal remedy is proposed as an option for men with BPH? What information might Cheryl share in relation to sexual performance and BPH?