Miami Dade College A Treatment Plan for Nephrolithiasis Discussion

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Miami Dade College A Treatment Plan for Nephrolithiasis Discussion

Description
MY TOPIC THAT MUST BE USED: Nephrolithiasis

For Week 5 of the course the faculty will not be providing a case study.

Instead you will choose from an area that you have an opportunity for improvement that was identified on your APEA predictor exam.

You will research that area of content in relation to complaints and disorders that commonly occur in family practice. Please work up a case study that begins with a chief complaint commonly seen in primary care based on that body system. The case should be clear and include all elements of a normal case that might be presented in class (subjective, objective, assessment, diagnostic testing and 5point plan in part 2.The clinical logs will be helpful for this process,or notes you have taken in clinical regarding cases. The case should be clear, organized, and meet the following guidelines:

Part 1 and Part 2 is to be completed in separate word documents, both in APA 7 edition formation with a minimum of 2 scholarly references.

Week 5: APEA Predictor Assignment – Part 1
Chief complaint: 52-year-old African American male presented to the office with chief
complaint of voiding difficulty and pain. Miami Dade College A Treatment Plan for Nephrolithiasis Discussion
HPI: “I been having some dribbling and discomfort pain after peeing for some time now. I have
been going to the bathroom more often since I do not feel like I have finish peeing all the way.
The reason I am here today is because last night, I noticed a small amount of blood in my semen
after having intercourse with my wife. I did not want to come, but this is really scaring me and
my wife said this is not normal.”
Patient Medical History: Current treatment for diabetes, hyperlipidemia, hypertension, erectile
dysfunction
Childhood illnesses: Varicella, common cold
Patient surgical history: Hernia repair
Hospitalizations: None
Immunization: Up to date on all vaccinations
Allergies: NKDA
Current medications: Metformin 500 mg BID daily, Atorvastatin 20mg at bedtime, Amlodipine
10 mg daily and Cialis 10mg PRN.
Family History: Children are healthy. Mother has diabetes and cholesterol. Father has HTN,
BHP, and hyperlipidemia. Brother: BPH, PGM: Deceased unknown causes and PGF: erectile
dysfunction died at 73 from heart attack.
Lifestyle: In monogamous married relationship with his wife of 20 years. The patient works at
the local High school as a math teacher. Due to the COVID-19 quarantine, he has been working
from home, lives a sedentary lifestyle, increase his weight and food intakes.
PE: Height 5’11’, Weight 234 pounds
Vital signs: BP 151/94, Temp. 97.8, P 86, Oxygen sat 99% on room air.
General: African-America male. Alert, oriented, cooperative. Pt appears unease and changing
positions in chair every couple of minutes.
Skin: Skin warm, moist, intact. Skin color dark brown skin tone without cyanosis or pallor.
HEENT: Head norno-cephalic. Hair thin coarse hair with a bald circular spot on back of head.
Eyes: Sclera clear, conjunctive: white, PERRLA. EOMs intact with no AV nicking noted.
Nose: Nares patent without exudate. Sinuses non-tender to palpation. Nasal septum without
deviation.

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Throat: Oropharynx most without lesion or exudate. Teeth in need of repair. Gums swollen and
red. Tongue midline, pink, smooth without lesion.
Lungs: Lungs clear bilaterally to auscultation without labored breathing. Chest symmetrical
without rashes or lesions noted.
CV: Heart S1 and S2 noted without murmurs, noted. No parasternal lifts, heaves, and thrills.
Peripheral pulses equally bilaterally. PMI 5th ICS displaced 4cm laterally. Trace edema in lower
extremities.
Abdomen: Abdomen round, soft without bowel sounds noted on all four quadrants.
Rationale in the identified body system:
Based on the National Institute Diabetic and Digestive and diabetes and digestive and kidney
disease (NIDDK), men over 40-year-old with associated risk factor and family history of benign
prostatic hyperplasia are prevalence of developing urological conditions. Urology was selected
as the body system based on the patient chief compliant of dribbling, discomfort pain after
voiding and the presence of blood after intercourse, which are all signs and symptoms of the
three-differential diagnosis. The patient also has associated risk factors such as diabetes,
hyperlipidemia, hypertension, erectile dysfunction, age, obesity, lack of physical exercise and
African American descent (NIDDK, 2021a).
Differential Diagnosis:
For proper diagnosis and treatment, it is essential to be able to differentiate and identify the
origins of each condition using the patient’s physical exam, medical history, and chief complaint.
The following are the three differential diagnoses.
1. Benign Prostatic Hyperplasia (BPH) (N40.0)
2. Acute Prostatitis (N41.0)
3. Malignant neoplasm of prostate (C61)
The prostate is a walnut-shaped gland that produces prostate fluid to aid in the transfer of semen.
Prostate fluid is an essential component in a man’s fertility. The urethra is the mode that transfer
semen and urine out of the body through the penis (NIDDK, 2018). Benign prostatic hyperplasia,
acute prostatitis and malignant neoplasm are all abnormal conditions of the prostate that
originate from different origins. Many of the sign and symptoms along with risk factors of these
conditions may overlap making it difficult to diagnose. Understanding the pathophysiology and
knowing the risk factors, demographics, occurrences, and clinical presentation of each condition
can assist in narrowing the diagnose for proper treatment.
Pathophysiology:
Benign prostatic hyperplasia (BPH) is characterized by increase proliferation of epithelial cell
and smooth muscle with the prostatic resulting in hyperplasia and an enlargement of prostate
(Lokeshwar, S. D., el. at, 2019). As the prostate gland enlarges it presses against the urethra
decreasing urine and prostate fluid flow. The pressure thickens and weakens the bladder wall
decreasing ability to completely empty out the bladder resulting in urine residue (NIDDK,
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2021b). BPH is a progressive condition. Unlike BPH, acute prostatitis (AP) is an inflammation
of the prostate and possible surrounding areas is usually caused by bacteria. AP usually appears
suddenly and last for a short period of time (NIDDK, 2021a). Malignant neoplasm of prostate /
prostate cancer (PC) is a progressive condition like BPH. MNOP are prostate glands cells that
mutate into cancer cells known as adenocarcinoma. These cancer cells form small clumps and
can spread to other surrounding area such as the bladder, rectum or seminal vesicles and even
enter the blood stream and lymphatic system (Salih, F.A.M, Mustafa, M., el. at, 2016). Miami Dade College A Treatment Plan for Nephrolithiasis Discussion
Risk factors:
BPH associated risk factor included non-modifiable and modifiable risk factors. Non-modifiable
risk factors include male age, genetics, and race. Modifiable risk factors include metabolic
syndrome, obesity, diabetes, diet, physical activity, and inflammation. BPH associated risk factor
consent more of modifiable risk factors, which are based on individual lifestyle choice such as
physical inactivity and diet leading to obesity or metabolic syndrome, and proper management of
diabetes (Lim, K.B, 2017). Unlike AP, risk factors are mostly associated with mode of
transportation or malformation, such foreign antigens entering the prostate or
obstruction/decreased of fluid exiting the body such as urine via the penis though the urethra.
The following are associated risk factors of AP, such as phimosis, unprotected vaginal/anal
intercourse, intraprostatic ductal reflux, indwelling catheter, urinary tract infection, sexual abuse,
transurethral biopsy/surgery, and congenital abnormality of the ureter (Davis, N.G., & Silberman
M., 2020). PC has non-modifiable and modifiable risk factors like BPH such as age, family
history, ethnicity, obesity, gender (male), persistently elevated testosterone levels, hypertension,
and agent orange exposure (Leslie, W. S., et, al., 2020).
Demographics and Occurrences:
The prevalence of men affected by BPH increases with age. Up to 50% of men over 50-year-old
and up 80% of men over 80 years old experience BPH symptoms. Studies have demonstrated
that black men are at greater prevalence of BPH than those of white descent. Male relative and/or
brother with BPH have great incident of having BPH (Lokeshwar, S. D., el. at, 2019). Prostatitis
true incidence is unknow, however there is a peak incidence in men between the ages of 20 to 40
and men older than 70-year-old. The most common cause of prostatitis is Escherichia coli
ascending into the urethra and infecting the prostate (Coker, T.J., Dierfeldt D.M., 2016). PC is
the second most common malignant cancer and the sixth leading cause of death in men resulting
in 256,000 death worldwide. After the age of 50 the risk of cancer increases rapidly, six in every
ten cases of PC are men over the age of 65. Incidence of PC are rare before the age of 40.
African American descent and men from Caribbean island North America, Australia,
northwestern Europe are along the most common to develop PC. Family history of PC doubles
and those with brothers are at risk greater risk than those with father of PC. The greater the
number of relatives with PC, the higher the risk of BPH especially the younger the relative
(Salih, F.A.M, Mustafa, M., el. at, 2016 / ACS, 2021). The patient has a brother with a history of
BHP and his is not within the peak incidence for prostatitis nor does he have a history of PC.
Presentation:
Clinical presentation of BHP mimic symptoms of lower urinary tract infection such as nocturia,
frequency, dysuria, weak or interrupted stream, difficulty initiating micturition, urgency and
difficulty emptying after micturition. Prostatitis typically present abruptly and with fever unlike
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BHP. Other symptoms may include malaise, dysuria pelvic pain, myalgias, suprapubic
tenderness and fullness, chills, pain (genital, groin, lower abdomen, or lower back area), nausea,
vomiting, and body aches. Both BHP and prostatitis have overlapping symptoms such as urinary
frequency and hesitancy, weak or interrupted stream, and pain after urination (Davis, N.G., &
Silberman M., 2020 /NIDDK, 2021b /Lokeshwar, S. D., el. at, 2019). As per PC initially there
are not early symptoms and men who are diagnosed with PC are symptomatic men who may
present with lower urinary tract symptoms, visible hematuria and/or erectile dysfunction. Late
symptoms may include paralysis from the spinal metastases, fatigue due to anemia, renal failure,
and bone pain (Leslie, W. S., et, al., 2020/ Merriel, S.W.D., Funston, G., el. at, 2018).
Diagnostic Testing:
Diagnosing of BHP include patient and family history, laboratory studies (PSA levels), physical
exam including a DRE, urinalysis, cystoscopy, and diagnostic imaging such as an ultrasound or
MRI of the prostate (Lokeshwar, S. D., el. at, 2019/NIDDK, 2021). Diagnosing of prostatitis
included patient and family history, urinalysis, and urine culture (Davis, N.G., & Silberman M.,
2020). Diagnostic testing for PC is not routinely tested unless there is sufficient warrant to test
for PC. Testing may include DRE, PDS levels biopsy, GleasonSore and staging (Salih, F.A.M,
Mustafa, M., el. at, 2016).
Several overlapping and similar symptoms make it difficult to differentiate one condition from
the other. The pathophysiology pathway of the three differential diagnoses can all cause dripping
and discomfort pain due to obstruction or inflammation blocking or decreasing urethra diameter.
BPH and PC can cause a narrowing of the urethra causing dripping and discomfort pain due to
obstruction, which is the patient chief complaint. AP can cause narrowing of the urethral
decreasing urine flow, dripping and pain, however the patient does not complian of decreasing
urine, but increase in frequency (NIDDK, 2021b/ (Lokeshwar, S. D., el. at, 2019/Salih, F.A.M,
Mustafa, M., el. at, 2016).BHP and CA have similar associated risk factors such as obesity,
family history, male gender, and African American descent, which make it a greater probability
than AP. AP is mostly caused by bacteria infection and typically presented abruptly with fever
along with other symptoms such as nausea, fatigue, chills, suprapubic tenderness, or fullness.
(Davis, N.G., & Silberman M., 2020 /NIDDK, 2021b /Lokeshwar, S. D., el. at, 2019/Leslie, W.
S., et, al., 2020/ Merriel, S.W.D., Funston, G., el. at, 2018). Diagnostic testing can also help
distinguishe between the three differential diagnoses and can be achieved based on the patient
conditions. BPH can be distinguished by voiding obstruction symptoms, a negative urine culture,
nontenders and enlargement of the prostate, while bacterial prostatitis can be distinguished by a
positive urine culture. PC can be distinguished by DRE for the presence of nodules on the
prostate. The patient does not have fever and a negative urine culture can rule out bacterial
prostatitis. A DRE without the presence nodules can assist in ruling out PC. After a proper
diagnose is made and treatment plan can be created based on the results (Coker TJ, Dierfeldt
DM., 2026).
What do you suspect is the correct diagnosis, what is your justification, and what plan
would you propose? Miami Dade College A Treatment Plan for Nephrolithiasis Discussion
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References
American Cancer Society. (2021). Prostate Cancer Risk Factors. Retrieved from
https://www.cancer.org/cancer/prostate-cancer/causes-risks-prevention/risk-factors.html
Coker TJ, Dierfeldt DM. (2026). Acute bacterial prostatitis: Diagnosis and management.
American Family Physician. Retrieved from https://www.aafp.org/afp/2016/0115/p114.html
Davis, N.G., & Silberman M. (2020). Bacterial Acute Prostatitis. StatPearls Treasure Island.
Retrieved from: https://www.ncbi.nlm.nih.gov/books/NBK459257/
Leslie, S.W., Soon-Sutton, T.L., Sajjad H, etal. (2020). Prostate Cancer. StatPearls. Retrieved
from: https://www.ncbi.nlm.nih.gov/books/NBK470550/
Lim K. B. (2017). Epidemiology of clinical benign prostatic hyperplasia. Asian journal of
urology, 4(3), 148–151. https://doi.org/10.1016/j.ajur.2017.06.004
Lokeshwar, S. D., Harper, B. T., Webb, E., Jordan, A., Dykes, T. A., Neal, D. E., Jr, Terris, M. K.,
& Klaassen, Z. (2019). Epidemiology and treatment modalities for the management of benign
prostatic hyperplasia. Translational andrology and urology, 8(5), 529–539.
https://doi.org/10.21037/tau.2019.10.01
Merriel, S.W.D, Funston. G. & Hamilton, W. (2018). Prostate cancer in Primary care. Retrieved
from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6133140/
National Institute of Diabetic and Digestive and Kidney Diseases (NIDDK). (2021a). Prostatitis:
Inflammation of the prostate. Retrieved from https://www.niddk.nih.gov/healthinformation/urologic-diseases/prostate-problems/prostatitis-inflammation-prostate
National Institute of Diabetic and Digestive and Kidney Diseases (NIDDK). (2021b). “Prostate
Enlargement (Benign Prostatic Hyperplasia)”. Retrieved from
https://www.niddk.nih.gov/health-information/urologic-diseases/prostate-problems/prostateenlargement-benign-prostatic-hyperplasia#benign
Salih, F.A.M., Mustafa, M. & Suleiman, M. (2016). Prostate cancer: Pathophysiology, diagnosis,
and prognosis. Journal of Dental and Medical Science. Retrieved from
http://www.iosrjournals.org/iosr-jdms/papers/Vol15-Issue%206/Version-2/B1506020411.pdf

Week 5 Part 1:

Step 1. Review your Week 4 APEA Predictor Exam Results and focus on the “Percent Correct by Knowledge Area” Choose a knowledge area on which you scored the lowest to work on this week.

Step 2. Once you’ve chosen the subject, research and work up a common chief complaint from that system that you haven’t learned already in the program and present your findings in the discussion threads. Push yourself to explore diagnoses in this area that are still common to primary care, but not a repeat of content learned in this or other courses.

Step 3. Respond to at least one other student’s CC work up as well as any questions posed to you by faculty.

Work up includes:

Chief complaint, PMHx, Demographics, PSHx, allergies, lifestyle, HPI

Associated risk factors/demographics that contribute to the chief complaint and differential diagnoses

Three common differential diagnoses represented by the CC including pathophysiology and rationale in the identified body system i.e., if pulmonary was your body system than a chief complaint could be persistent cough and three pulmonary differentials;

Discuss how the three differential diagnoses differ from each other in: occurrence, pathophysiology and presentation (NOTE: Simply listing the diagnoses and their occurrence, pathophysiology and presentations separately does not confer an understanding of how they differ. Your discussion should compare and contrast these items against each other among the three differentials chosen);

Relevant testing required to diagnose/evaluate severity of the three differential diagnoses; and

Review of relevant National Guidelines related to the Diagnosis and Diagnostic testing for these diagnoses . Miami Dade College A Treatment Plan for Nephrolithiasis Discussion