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NR 603 WEEK 5 APEA PREDICTOR ASSIGNMENT PART 1
NR 603: ADVANCED CLINICAL DIAGNOSIS AND
PRACTICE ACROSS THE LIFESPAN
Chief complaint: 52-year-old African American male presented to the office with
chief complaint of voiding difficulty and pain.
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.
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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
Downloaded by JAMES RUTHER ()
NR 603 WEEK 5 APEA PREDICTOR ASSIGNMENT PART 1
NR 603: ADVANCED CLINICAL DIAGNOSIS AND
PRACTICE ACROSS THE LIFESPAN
Chief complaint: 52-year-old African American male presented to the office with
chief complaint of voiding difficulty and pain.
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.
Downloaded by JAMES RUTHER ()
,2
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.
Downloaded by JAMES RUTHER ()
, 3
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
Downloaded by JAMES RUTHER ()
