Instructions:
What other subjective data would you obtain?
I would ask this patient about the onset of his dysuria, whether it was sudden or gradual. I would gather more information about the timing his pain, for example, “Does the pain occur every time you urinate?”, and “Does the pain happen before, during, or after urination?”. I would ask about the specific location of his pain, whether it radiates anywhere else, and what the pain feels like. I would attempt to quantify the severity of the patient’s pain with a 0-10 rating scale or by asking the patient to describe what impacts the pain has on his life. I would ask the patient if anything makes the pain better or worse, and I would inquire about any treatments he has tried and what the result was. I would inquire about associated symptoms, such as pain in the flank, abdomen, back, or over the bladder, nausea or vomiting, body aches, blood in the urine, or change to the color or smell of the urine. I would also inquire about any history of exposure to sexually transmitted infections (Rhoads & Petersen, 2021).
What other objective findings would you look for?
I would assess this patient for CVA, abdominal, and suprapubic tenderness. I would assess the penis for any erythema, lesions, sores, or rashes. Digital rectal examination (DRE) of the prostate provides important objective information in the diagnosis of both prostatitis and prostate cancer; however, it is important to note that evidence of prostate cancer is not always evidence upon DRE (Cadet et al., 2019; Kanani et al., 2020).
What diagnostic exams do you want to order?
A urinalysis with culture and sensitivity would assist in the diagnosis of prostatitis and urethritis (Kanani et al., 2020; Rhoads & Petersen, 2021; Sell et al., 2021).
Name 3 differential diagnoses based on this patient’s presenting symptoms?
Acute bacterial prostatitis, Urethritis Prostate cancer
Give rationales for each of your differential diagnosis.
Acute bacterial prostatitis: According to Kanani et al. (2020), acute bacterial prostatitis accounts for approximately 10% of prostatitis cases, and is characterized by irritative urinary symptoms and painful inflammation of the prostate. Intraprostatic urinary reflux is cited as one of the mechanisms by which pathogens may enter the prostate and cause prostatitis. Given this patient’s history of BPH, and clinical presentation of dysuria, nocturia, urinary frequency, fever and chills, and warm, swollen, painful prostate gland, acute bacterial prostatitis is the likely diagnosis. Urethritis: Urethritis is characterized by dysuria, mucopurulent discharge from the urethra, erythema of urinary meatus, urethral discomfort (Sell et al., 2021). Prostate cancer: Prostate cancer may present with similar symptoms such as dysuria, nocturia, and urinary frequency or urgency (Cadet et al., 2019).
What teachings will you provide?
I would educate this patient that acute bacterial prostatitis can quickly become life-threatening. I would educate this patient on signs of worsening infection, such as fever, malaise, and body aches. I would address indications for emergency medical attention, such as signs of sepsis, urinary retention, or inability to take medications orally. I would discuss how to take prescription medications, as well as potential side effects and importance of antibiotic compliance. I would also discuss with this patient the increased risk of falls in the presence of lower urinary tract symptoms, and discuss strategies for ameliorating fall risk (Kanani et al., 2020).
Peer 2
Melany
What other subjective data would you obtain?
I would inquire about the duration of the headaches and seek clarity of the frequency of the headaches through time estimation. I would also inquire when the accelerated frequency began which prompted the patient to visit the hospital and if there was any trigger that the patient could remember. I would also ask whether the pain in the temporal region radiates to other parts of the body. I would also ask the patient to evaluate the worst pain they have from a range of 1 to 10 using the Numerical Rating Scale. I would investigate any history of trauma, the patient’s sleep patterns, and any family history of migraines. I would also inquire about the time of the menstrual cycle in which the headaches happen. Additionally, I would also question if the patient has any mental health challenges.
What other objective findings would you look for?
One of the objective findings I would look for is any characteristics that point out eye involvement. I would examine the eye to check if there are any visual disturbances. I would also check for any pupillary abnormalities since the patient is sensitive to light. I would also check out for other signs such as neck stiffness, fever, drowsiness, or seizures to investigate meningitis. I would also investigate for any features that would indicate anxiety or potential stressors coupling it up with the subjective data obtained from the patient.
What diagnostic exams do you want to order?
Some of the diagnostic exams that I would consider ordering are neuroimaging tests starting with a computed tomography (CT) scan. A CT scan can help in detecting any structural abnormalities in the brain such as tumors, abnormalities in blood vessels, and cysts. Tumors have the potential to cause headaches by exerting pressure on surrounding structures. CT scans can also detect any areas of infarction that may indicate ischemia or could point out other vascular abnormalities such as aneurysms. I would also conduct a complete blood count to screen for any signs of infection or inflammation. I would also conduct an erythrocyte sedimentation rate to screen for anemia.
Name 3 differential diagnoses based on the patient’s presenting symptoms.
The three differential diagnoses are menstrual-related headaches, migraine without aura, and temporal arteritis.
Give rationales for each differential diagnosis.
Some of the patient’s presenting symptoms point out to migraine without aura. These are pulsating pain in the temporal region, and sensitivity to light (Lucas, 2021). Migraine without aura also presents with strong nausea without vomiting which are among the symptoms the patient expresses. The headaches usually improve when one sleeps.
Menstrual-related headaches are common and occur in women due to a decline in estrogen during certain phases of the menstrual cycle. (Moy & Gupta, 2022). The headaches have a pulsatile characteristic which is one of the symptoms exhibited by the patient. The headaches are also associated with sensitivity to light (Moy & Gupta, 2022).
Temporal arteritis presents with pulsating headache in the temporal region (Ponte et al., 2020). The headaches are usually severe and persistent. The temporal regions also feel tender, and the patient feels dizzy. Temporal arteritis is an emergency and should be ruled out first when managing the patient.
What teaching will you provide?
I will provide teaching on ways that the patient can prevent headaches. One of the basic ways is ensuring that one is hydrated. One should also establish a good consistent sleep schedule and adapt good stress management methods and relaxation techniques such as meditation. One should also avoid foods that may trigger headaches such as caffeine. It is also important to seek medical guidance on managing hormonal changes.
Discussion Six
There are several reasons why the issues that persist in today’s workforce culture exist. The nursing workforce is affected by things such as inadequate staffing, reduced resources, and inadequate compensation (Gardener et al, 2015).
Inadequate staffing, which is a common problem in the healthcare field, puts a strain on the nursing workforce and leads to burnout and high turnover rates (ANA, 2019). Nursing shortages can be attributed to patient acuity, cost cutting, senior staff leaving, and negative impacts on mental health for healthcare workers (ANA, 2019). Shortage in staffing affects the quality of care provided to patients, leading to poor health outcomes and reduced patient satisfaction scores (ANA, 2019). Reduced resources, such as limited access to technology and medical supplies, also affect the quality of care provided by nurses.
Inadequate compensation is another significant issue that affects the nursing workforce. Many nurses work long hours and are often required to work overtime, yet their compensation does not reflect this. This can lead to low morale and job dissatisfaction, which can ultimately affect patient care (Barry et al., 2009). There is disparities in healthcare trying to retain staff for their education level, skill level, and tenure (Gardener et al., 2015).
In addition to lack of compensation for staff there is inadequate access to healthcare services and health disparities that are influenced by economic constraints (Gardener et al, 2015). In many instances, the lack of funding for healthcare services results in inadequate access to care, particularly for vulnerable populations. The lack of resources also leads to shortage of staff which in turn cause patients to have a harder time accessing care (HHS, n.d.) Shortages in resources and supplies can cause frustation for staff causing further disparties in healthcare.
It will take many different efforts and strategies to try to mend this issue. Working to retain the staff we have now, increasing education capacity for clinical and programs, and creating policies can all be a place to start (Gardener et al., 2015).
Peer 4
Heather
Issues in Today’s Workforce and Why They Persist
The issues in today’s nursing workforce are numerous. Mason et al., (2016) specifically address the nursing shortage, diversity, and turnover rate issues. Unfortunately, these issues are just as important now as they were several years ago, especially in the post COVID-19 pandemic era.
The reason behind the current nursing shortage is multifaceted. Firstly, the last of the Baby Boomers will be entering retirement around year 2030. This means that 44.7 million Americans will be 65 or older and will constitute the largest group of retirees in Unites States history (Wessel, 2017). Additionally, 19.0% of the registered nurse (RN) workforce is aged 65 or older. Licensed practical nurses (LPNs) account for 18.2% of the nursing workforce (Smiley et al., 2021). It can be expected that these two large cohorts of nurses will be retiring soon. Therefore, more people will be requiring care and being hospitalized, yet there will be less nurses to be able to care for them. Mason et al., (2016) suggested that the most important interventions in expanding the workforce are increasing the number of nursing education programs, implementing nurse residency programs to support the transition from university to clinical practice, and improve nursing retention strategies. Increasing the amount of nursing programs allows more individuals to have access to the necessary educational requirements to become a registered nurse. However, increasing the amount of nursing programs has proven to be a difficult task due to the lack of funding to hire additional faculty members and lack of qualified applicants (Mason et al., 2016).
Diversity is also an issue in today’s workforce. Only 9.4% of RNs are male (Smiley et al., 2021). Additionally, only 13.9% of nurses reported being non-Caucasian (Smiley et al., 2021). These statistics are important because in order to provide culturally competent care and properly meet patient’s needs, the diversity of the workforce should match the diversity of the country. In order to entice more men and people of different ethnicities to nursing, we should steer away from marketing campaigns that feature white women as the face of all nurses. Increasing the visibly of men and racial minorities within the nursing profession will help draw more diverse employees to the workforce.
It is difficult to talk about nursing workforce issues without discussing the terrible conditions that nurses are forced to deal with. For example, the lack of staffing and increased number of patients in the hospital has led to overcrowding and an increase in nurse-to-patient ratios. This puts more strain on the nurse as they attempt to manage sicker patients with less resources and support. The COVID-19 pandemic forced many nurses to retire early. The impact of COVID-19 on a nurse’s mental health was severe. This resulted in many institutions, including my own, to focus on strategies to improve a nurse’s mental health, reduce burnout, and make mental health resources available to those who need it. With this renewed focus on mental health, many nurses are refusing to work overtime and tolerate abhorrent working conditions. This may lead to more nurses leaving bedside to retire, change careers, or advance their education.