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Nr603 week 5 part 2 APEA predictor
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NR 603 WEEK 5 PART 2 APEA PREDICTORPart 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
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