Chapter 8

Prostate Cancer Case Study

Answers

1. A – Assess pain level and provide pain relief measures. While all answer options are important aspects of Mr. Jackson’s care, the priority nursing assessment is to address his pain. The client is experiencing acute pain related to his diagnosis. Managing his pain effectively will allow for other assessments and interventions to be more successful. Although his anxiety is significant, untreated pain can exacerbate anxiety and hinder coping mechanisms. While monitoring vital signs and evaluating his understanding of the diagnosis are part of routine care, they are not the immediate priority in this situation.
2. B – Local tumor growth affecting the prostate gland. The most likely etiology for Mr. Jackson’s urinary changes, including increased frequency and urgency, is the local tumor growth affecting his prostate gland. Prostate enlargement, often due to tumor growth, can compress the urethra, leading to obstructive voiding symptoms. While anxiety can exacerbate urinary symptoms, it is less likely to be the primary cause in this case. Pain medications like morphine can cause urinary retention but are less likely to cause increased frequency and urgency. There is no mention of a urinary tract infection in his presentation or history.
3. B – Impaired urinary elimination. While all the options could be potential nursing diagnoses for Mr. Jackson, “Impaired urinary elimination” is the most important based on his presenting symptoms of urinary frequency, urgency, and scant urine output. These symptoms directly relate to his prostate cancer and require immediate attention to prevent complications such as urinary retention and infection. Addressing this diagnosis effectively will also contribute to his comfort and overall well-being. The other options, while relevant to his overall care, are not the most immediate concern at this time.
4. C – Side effects of radiation therapy may include fatigue, skin changes, and urinary issues. It is essential to educate Mr. Jackson that side effects of radiation therapy may include fatigue, skin changes in the treatment area, and urinary issues. Radiation can irritate the bladder and urethra, leading to symptoms like frequency, urgency, and discomfort. Providing this information helps manage expectations and allows the client to be proactive about managing potential side effects. Radiation does not eliminate the need for hormone therapy, nor does it always cause hair loss. Additionally, radiation for prostate cancer is often delivered on an outpatient basis.
5. C – Encourage him to express his feelings and concerns, providing a supportive and non-judgmental environment. While options A, B, and D may be helpful to some extent, the most appropriate intervention to address Mr. Jackson’s anxiety is to encourage him to express his feelings and concerns, providing a supportive and non-judgmental environment. Actively listening to his fears and validating his emotions help build trust and allow him to process his anxiety in a healthy way. Providing false reassurance can damage trust, and while education is important, it doesn’t directly address his emotional needs at this moment. Distraction may be temporarily helpful, but it avoids addressing the root of his anxiety.
6. C – Contact the physician to request a higher dose of pain medication. The order for morphine allows for administration every four hours, and his last dose was only two hours ago. Ondansetron is for nausea and not indicated at this time. While repositioning and relaxation techniques can be helpful, they are insufficient for his reported pain level.  Contacting the physician to discuss a higher dose of pain medication is the best action to address his immediate need for adequate pain relief.

Vaginal Discharge Case Study

Answers

1. B – Vulvovaginal candidiasis. The client’s symptoms of thick, white, curd-like vaginal discharge, along with vulvar itching and burning, are classic signs of vulvovaginal candidiasis. While bacterial vaginosis can cause discharge, it is typically thin and grayish with a fishy odor. Trichomoniasis presents with a frothy, yellow-green discharge and a foul odor. Chlamydia is often asymptomatic but can cause cervicitis, leading to pelvic inflammatory disease if left untreated.
2. C – Acute Pain. Maria Hernandez presents with a pain level of 5/10, making acute pain the most appropriate nursing diagnosis. While the client is experiencing vulvar irritation, there is no indication of impaired skin integrity. In addition, there is no evidence to suggest impaired urinary elimination. Although Maria expresses embarrassment about her condition, there is no evidence to support ineffective coping.
3. D – Recent antibiotic therapy for an ear infection. The most likely cause of Maria Hernandez’s vulvovaginal candidiasis is recent antibiotic therapy. Antibiotics can disrupt the normal balance of vaginal flora, leading to an overgrowth of Candida albicans, the fungus responsible for yeast infections. While unprotected sexual intercourse can transmit sexually transmitted infections (STIs), it is not a common cause of vulvovaginal candidiasis. While wearing tight-fitting clothing can increase moisture and promote fungal growth, this is less likely to be the primary cause of a yeast infection in this scenario. Living in a humid climate can contribute to moisture in the genital area, potentially increasing the risk of yeast infections, but it is not the most likely cause in this case.
4. B – Provide cool compresses or sitz baths for symptomatic relief of itching and burning. Cool compresses or sitz baths can offer soothing relief from the itching and burning associated with vulvovaginal candidiasis. Hydrocortisone cream, while helpful for some skin conditions, should not be used for vaginal itching without consulting a health care professional. Feminine hygiene products and douching can disrupt the natural vaginal flora and potentially worsen the infection, so they are not recommended.
5. B – “While some infections can be sexually transmitted, vulvovaginal candidiasis is not considered one of them. It is caused by an overgrowth of yeast that is already present in the body.” It’s important to address the patient’s concern while providing accurate information. While some vaginal infections are sexually transmitted, vulvovaginal candidiasis is not. It is caused by an overgrowth of yeast already present in the body, often triggered by factors like antibiotic use or hormonal changes. While the other options might be partially relevant, they don’t directly address the client’s statement or provide accurate information about the nature of yeast infections.
6. C – “It’s okay to use a vaginal deodorant to mask any unpleasant odors.” Vaginal deodorants can disrupt the natural vaginal flora and increase the risk of yeast infections. The other statements reflect accurate information about preventing future yeast infections, such as wearing breathable clothing, avoiding douching and scented products, and changing out of wet garments promptly.

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