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8/7/2019 BENIGN PROSTATIC HYPERPLASIA.ppt2
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BENIGN
PROSTATICHYPERPLASIA
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THE PROSTATE
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ENLARGED PROSTATE
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Benign prostatic hyperplasia (BPH) also knownas benign prostatic hypertrophy (technically amisnomer), benign enlargement of the prostate
(BEP), and adenofibromyomatous hyperplasia,refers to the increase in size of the prostate inelderly men.
To be accurate, the process is one of hyperplasia rather than hypertrophy, but the
nomenclature is often interchangeable, evenamongst urologists.[1] It is characterized byhyperplasia of prostatic stromal and epithelialcells, resulting in the formation of large, fairlydiscrete nodules in the periurethral region of the prostate. When sufficiently large, the
nodules compress the urethral canal to causepartial, or sometimes virtually complete,obstruction of the urethra, which interferes the normal flow of urine. It leads to symptomsof urinary hesitancy, frequent urination, dysuria(painful urination), increased risk of urinary tract infections, and urinary retention.
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Predisposing/ Risk Factors:
>AGE: 50y/o and above
>FAMILY HISTORY>HORMONAL FACTORS:
TESTOSTERONE &
ESTROGEN; LATEACTIVATION OF CELL
GROWTH
>DIABETESMELLITUS>DIET-OBESITY
>SMOKING & ALCOHOL USE
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.
Incidence and Prevalence of
BPH
It is difficult to determine the
exact incidence and
prevalence of BPH because
research groups often use
different criteria to define the
condition. According to the
National Institutes of Health
(NIH), benign prostatic
hyperplasia affects more than50% of men over age 60 and
as many as 90% of men over
the age of 70.
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.
Sign and Symptoms
Obstructive voiding Symptoms
Weak urinary stream
Prolonged emptying of the
bladder
Abdominal straining Hesitancy
Irregular need to urinate
Incomplete bladder emptying
Post-urination dribble
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.
Irritative Symptoms
Frequent urination
Nocturia (need to urinate
during the night)
Urgency
Incontinence (involuntary
leakage of urine)
Bladder pain
Dysuria (painful urination)
Problems in ejaculation
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. Urinary retention
Renal impairment
Urinary tract infection
Gross hematuria
Bladder stones
Bladder damage
(trabeculations, cellules,
diverticula)
Overflow incontinence
COMPLICATIONS
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.
Management:
Treatment
Avoidance of anticholinergics,sympathomimetics, and
opioids
Use of -adrenergic blockers
(eg, terazosin , doxazosin ,tamsulosin , alfuzosin ) or 5-
reductase inhibitors (
finasteride , dutasteride )
Transurethral resection of theprostate or a less invasive
procedure
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.
Less invasive procedures include
microwave thermotherapy, laser ablation,
electrovaporization, high-intensity focused
ultrasound, transurethral needle ablation,radiofrequency vaporization, and
intraurethral stents. The circumstances
under which these procedures should be
used have not been firmly established, but
those done in the physician's office
(microwave thermotherapy and
radiofrequency procedures) are being
more commonly used and do not require
use of general or regional anesthesia.
Their long-term ability to alter the natural
history of BPH is under study.
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DEMOGRAPHIC
D ATA
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General Profile Name: Patient X Address: P-5, Estrella, San
Mateo, Isabela Age: 56 y/o Gender: Male Nationality: Filipino Birthday: 11/25/1954 Birthplace: San Mateo,
Isabela Civil Status: Married Educational Attainment:
College Undergraduate Occupation: Farming Religious Affiliation: Born
Again Christian Date and Time Admitted:
12/06/10; 8:00 PM
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Chief Complaints
>Difficulty of Urination
Final Diagnosis:
Benign Prostatic
Hyperplasia S/P Trans Urethral
Resection of the
Prostate Hypertension II
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NURSING HISTORY
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History of Present Illness
The patient is a hardworking farmer, he usually
spend 6-7 hours a day in
the farm. His father wasdiagnosed with Benign
Prostatic Hyperplasia
(BPH). Three years ago he
was also diagnosed to
have BPH.
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One week prior to consultationthe patient was admitted at
BPCSS due to difficulty of
urination. It was diagnosed as
Urinary Tract Infection (UTI). Hewas treated in the said hospital
accordingly. After a day he was
discharged with a Foley catheter
in placed, and was advised tocome back after one week for
the removal of the catheter.
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Two days prior to confinement patient was again
brough
t,Foley cat
heter was removed and serum PSAand ultrasound was requested for him to undergo but
not done.
The night of December 05, 2010, the patientexperienced chills and fever. His wife provided tepid
sponge bath to relieve the fever and put additionalblanket to keep the patient warm. The patient also tookparacetamol 500mg. In the morning, he and his wifeplanned to go to the market to buy their commoditiesfor the week but the patient felt sudden pain at the
hypogastric area and had body weakness and so heopted to seek consultation on December 06,2010 toCagayan Valley Adventist Hospital under the service of Dr.Mamuric for further care and management.
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PastMedical/Surgical History
The patient verbalized that he is unfortunate toreceive any childhood immunizations. But he was
able to acquire natural, active immunity throughhis exposure to the illnesses targeted by theimmunization such as measles, mumps, and
chicken pox. No further childhood illnessesrecalled.
According to the patient he was hospitalizedbefore due to common illnesses like cough andcolds, fever and diarrhea. He was also hospitalizeddue to hypertension and was advised to takeNorvasc 5 mg daily as his maintenance medicationbut not religiously taken.
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In the year 2007, he seek consultation to Dr.M
amuric due to dysuria and was considered asBPH. The doctor advised him to undergo series
of test regarding his illness for confirmation but
it was not done because of financial constraint.
Af ter a few months, he seek second opinion atChinese General Hospital and was prescribed totake Hytrin 1 tab once a day. He took themedication for 1 year and was advised to take it
as needed. He stopped taking the saidmedication because he thought he was fine, nopain felt and difficulty urinating.
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Socio-cultural Background
The patient is from Isabela. He speaks three different dialects:
Tagalong, Ilocano and English. He verbalized that he and hisfamily tends on farming as a means to provide their daily
resources.
The patient verbalized that he is an occasional alcoholic
beverage drinker, consumes approximately one bottle (500 ml)per session. He does not claim of being a smoker.
With regards to his personal medical beliefs, he professed on
the curative capability of herbal preparations. He utilizes a wide
array of herbal plants whether approved by the Department of Health is basis or not. These includes, Garlic, Guava, Lagundi,
etc. His basis lies on the traditional beliefs of the efficacy and
the effectiveness of such herbal preparation.
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13 Areas of Assessment
VIII.I Psychosocial
Mr. X, a 56 year old male, is a resident of P-5, Estrella,
San Mateo, Isabela. He is a farmer, and makes a living through
farming. His wife Mrs. X. works as a social worker at DSWD SanMateo chapter. She aids in the provision of financial resources for
the family. The patient is the head of the family and is the major
decision maker with regard to financial and health matters. He is
a father of three children.
The patient did not verbalized any specific earnings butassured that it is fairly adequate to meet the familys daily needs.
At present, his developmental task is reflected on the crisis of
Integrity versus despair, in which as per assessment , he is able
to equate.
The patient is baptized as a Roman Catholic but was then
converted as a member of Born Again Christian during his youngadult days. He is a mildly anxious with regard to the change or threat to his health status. The patient has a good relationship
with his family members and to his significant others as
claimed. During the course of his confinement , his immediate
family visits him.
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The patient appears to be coherent,
responds appropriately to several stimuli such
as verbal, noise and light, touch and pain
stimuli. The patient is oriented to time and
place, and does not experience confusion in
any form.
The patient is a college
undergraduate. He is able to read and write,
able to articulate himself in English, Filipino and
Ilokano. He is able to comprehend and follow
simple to complex directions. He also exhibitspositive affirmations regarding his present
health condition though at times feel anxious
about the change to or threat to his health
condition. The patient is not irritable and shows
appropriate mood and emotional response. At
present, he claims to have a good relationship
with his family members and SO. He also
interacts with the health care providers
appropriately. He is able to communicate and
verbalize his feelings, needs and concerns
regarding his condition.
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The patient is confined in the
VIP room under the service of
medical adult. The objects and
furnitures around him are well
arranged. There are no sources of
possible accident, fire, or chemical
hazards found in the room. The room
has good lighting condition, has
adequate ventilation and minimalnoise is observed.
With regard o infection
control, there are no present or
ongoing infections in the family. Onthe other hand, as a preventive
measure, they practice hand washing
and the use of pathogens that may
cause infection. Moreover, they also
practice proper pulmonary toileting
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VIII.IV Sensory Status
Visual Status
The patient has a fair visual acuity, no blurring of visionnoted. He verbalized that he is farsighted thats why he
uses reading glasses. Pupils are equally round and
reactive to light (intact CN3). Patient has good corneal
reflex. No known deficits such as color blindness as
well as any unusual sensations noted. He has pale to
pinkish palpebral conjunctiva. No lacrimal discharges or
tender mass were noted.
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Auditory
Patient is able to distinguish the loudness of voice at a certain distance. Has
good bilateral hearing. Ears are symmetrical, smooth in texture and are the
same color with the skin. No known deficits and discharges noted.
Olfactory Status
The patient can discriminate odors and could differentiate them accurately.
Patient has bilaterally patent nostrils. No obstruction and discharges noted.Gustatory Status
The patient is able to discriminate sweet, sour and salty foods (CN 10), he
does not verbalize a decrease in sense of taste. There is no difficulty in
swallowing as verbalized. He can protrude and move his tongue (CN 9). He
does not use any prosthetic device such as dentures. There are no lesions or
ulcerations noted on the gums and he is negative of halitosis.
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Tactile Status
The patient is able to discriminate sharp from dull
sensations on his upper extremities as assessed whenIV cannula was reinserted at his left metacarpal vein..
He is also able to discriminate light to firm touch. He is
able to perceive heat and cold sensations.
Language, Perceptions and FormationHis teeth are in good condition. No use of dentures
noted. He can protrude his tongue and no tongue
fasciculation was noted. He is able to understand andinitiate speech without difficulty. He is able to read and
write. He is able to articulate words properly and there
is absence of slurred speech.
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VIII.V Motor Status
The patient is in complete bed rest. The patient receives minimal assistance
from health care providers and significant others. He was uncomfortable to move
because of the catheter attached to him. The patient has a muscle strength of 5/5
on the upper extremities and 3/5 on the lower extremities. He is also observed to
have difficulty from his lying position to sitting position. No evidence of muscle
wasting or dystrophy or foot drop noted. It requires full assistance for him to
ambulate.
VIII.VI Nutritional Status
Patient is on DAT. He manifests a good appetite and consumes the foods
served. Moreover the patient prefers three main meals instead of small frequent
feedings. His meals is comprised of complex carbohydrates, vegetables, and
meat. He usually drinks coffee in the morning before breakfast.His height is 56 and weighs 64 kg (according to him before hospitalization).
Assessment revealed no changes as to weight loss/gain. Patient has medium built
body figure and there is absence of muscle wasting. Patient perceives food as a
life-giving force, he also verbalized that he has no religious restrictions to food
and has no food or drug allergy. He has an incomplete set of teeth and has
normoactive bowel sounds with a range of 6-15/minute.
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. m na on a us
Before the occurrence of BPH, he
normally urinates 6-8 times a day. And
defecates at least once a day. However, due
to BPH, it resulted to changes in his boweland bladder habits. During his confinement,
he has indwelling foley catheter. At first
hours post TURP, it drains dark red colored
fluid but in the latter days of confinement, itbecomes clear and light yellow colored.
With regard to bowel movement prior to
hospitalization, he normally defecates
everyday with irregularity in time (morning
or afternoon), but, due to BPH and postTURP, he claims that he had not yet
defecated since his admission on December
06, 2010. He was given Laxoberal but claims
to only have a small amount of stool upon
elimination.
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VIII.VIII Fluid and Electrolyte Balance
He normally consumes 1-2 liters of
fluids daily. After the operation intake and outputwas closely monitored. At present, he has no fluid
restrictions ordered.
The patient verbalized no episodes of vomiting prior to admission. The patients skin is
slightly dry with good skin turgor. Mucous
membranes are moist and there is no evidence of dehydration or edema noted.
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PHYSICALASSESSMENT
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PHYSICAL ASSESSMENT
(DECEMBER 09, 2010 8:00 PM)
Received pt awake, lying on bed with on going IVF of PNSS iLx KVO patent and infusing well.
General Appearance: Alert, conscious and coherent.
V/S
BP: 160/100
T: 36.5 CCR:110bpm
RR:24cpm
BODY PARTS METHOD ACTUAL FINDINGS INTERPRETATION
I.SKIN >INSPECTION >fair >NORMAL
II.HEAD >INSPECTION
>PALPATION
>Normocephalic
>No nodules
>Normal
>Normal
HAIR >INSPECTION >Thin hair >Normal
III.FACE >INSPECTION (+) facial grimace >d/t pain after the procedure
EYES
EYE BROWS >INSPECTION >symmetrical >Normal
CONJUNCTIVA >INSPECTION >Pink >Normal
SCLERA >INSPECTION >White >Normal
PUPILS >INSPECTION >PERRLA=3MM >Normal
EYE MOVEMENT >INSPECTION > move eyes upward and
downward
>Normal
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IV. EARS
AURICLE >INSPECTION >symmetrical >Normal
>PALPATION >Auricle aligned
with inner canthus
>Normal
V. NOSE >INSPECTION >intact nasal
septum>no discharge
>Normal
>Normal
VI. MOUTH
LIPS >INSPECTION >Pink >Normal
Tongue >INSPECTION >Pink >Normal
Teeth >INSPECTION >clean, complete >Normal
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VII. NECK
Lymph Nodes >INSPECTION >Not palpable >Normal
VIII. THORAX AND
LUNGS
>INSPECTION >Symmetrical chest
movement
>Normal
>AUSCULTATION >(-)abnormal breath
sounds
>Normal
IX. ABDOMEN >INSPECTION
>AUSCULTATION
>(-) distention
>(+) Bowel sounds
>non tender
>Normal
>Normal
>Normal
X. GENITALIA
PENIS
URETHRAL OPENING
>INSPECTION
>INSPECTION >(+)3 way Foley
catheter inserted
> For continuous bladder
irrigation and draining of
urine from the bladder
XI. NAILS >INSPECTION >capillary refill 3 sec >Normal
>pink nail bed >Normal
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LAB RESULTS
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PARAMETERS RESULT RANGE INTERPRETATIONCholesterol 3.28 0.00-5.20 NORMAL
Triglycerides 0.93mol/L 0.00-1.69 NORMAL
Direct HDLC 0.94 1.03-1.55 HDL cholesterol is lower
in pts with increased
risk for coronary heart
disease
LDL 1.92 1.55- 4.65 Optimal level
VLDL 0.43 0.00-0.77 NORMAL
Chol/dHDL 3.49 <5.20 NORMAL
LABORATORY RESULT
December 11, 2010
,
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PARAMETERS RESULT RANGE INTERPRETATION
HGB 129 110-180 NORMAL
HCT 0.38 27.0-54 NORMAL
PARAMETERS RESULT RANGE INTERPRETATION
GLUCOSE 8.51 3.9-9.5 NORMAL
,
December 08, 2010
December 08, 2010
Immunochemistry
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PARAMETERS RESULT
ABO GROUP O
Rh Type Positive
PARAMETERS RESULT INTERPRETATION
sPS HI >20.00mg/ml elevated d/t enlargement of the
prostate
Immunochemistry
December 08, 2010 (09:44 am)
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December 08, 2010
Chest X-Ray
>Lung fields are clear
>Heart is not enlarged
>the costophrenic sulci
and diaphragm are intact
>the bony thorax are
unremarkable
Remarks:
Normal Chest Findings
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PARAMETERS RESULT RANGE INTERPRETATION
Sp. Gravity 1.020 1.003-1.030 NORMAL
pH 5.5 4.60-8.00 NORMAL
Protein +2 +1,+2 NORMALGlucose N NEGATIVE
Ketone N NEGATIVE
Erythrocyte +3 - Indicates bacteria may be present in urine
Nitrite +3 - Indicates bacteria may be present in urine
urobilinogen N NEGATIVE
Bilirubin +1 NEGATIVE May indicate presence of liver diseaseLeukocyte +3 Indicates presence of Ifection
WBC/hpf Innumerable 0-4 Indicates presence of infection or
Rbc/hpf 5-6 0-3 Indicates presence of hematuria
Epithelial cell squamous occasional Normal
Epithelial cells round Occasional Normal
Amorphous sediments +3 Normal
Crystals N NEGATIVE
Mucus +2 Normal
December 07, 2010
Bacteria +4 indicates the presence of infection
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PARAMETERS RESULT RANGE INTERPRETATION
CREATININE 108.6
umol/L
58-110 NORMAL
SODIUM 137.2mmol/
L
137-145 NORMAL
POTASSIUM 3.57 3.50-5.10 NORMAL
PARAMETERS RESULT RANGE INTERPRETATION
WBC 29.5 5.00-10.00 elevated d/t presence of inflammation or
infection
RBC 4.6 4.00-5.00 NORMAL
HCT 0.40 0.40-0.54 NORMAL
HGB 132 130-180 NORMAL
December 06, 2010
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December 06, 2010
Ultrasound result: KUB, ProstateProstate is enlarged. It measures 6.65 x 5.80 x 5.35
cms or about 106 grams in weight. The contour is irregular.
Parenchymal echotexture is coarsened.
Conclusion:
Normal sonographic findings in the kidneys and
urinary bladder. Enlarged Prostate, correlation with trans
urethral ultrasound is suggested for further evaluation.
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PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
D5NSSiL x 8 hrs. 470
L=400 400 450D5 NaCl iL x 8 hrs 460 400
started 300
30
80
20
TOTAL 860 1850
FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
P.O #1 D5NSSiL x 8 hrs. PNSS 1000 40 Pnss irrigation 1000
L=540 540 1000 50 1000
P.O # 2 D5 NaCl iL x 8
hrs
300 1000 250 1000
started 1000 50 1000
1000 30 1000
1000 25 1000
1000 50 1000
1000 50 1000
840 8,0000 545 8,000
TOTAL 8,840 8,545
December 09, 2010
AM
PM
NOC,
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FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
P.O #2 D5NSSiL x 8 hrs. H20 210 PNSS 1000 175 Pnss irrigation 1000
L=700 700 1000 280 1000
P.O # 3 D5 NaCl iL x 8 hrs 500 1000 300 1000
started
1,200 210 755 3000TOTAL 1,410 3,755
NOC
NOC
FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
P.O #3 D5NSSiL x 8 hrs. H20 60 PNSS 1000 100 Pnss irrigation 1000
L=500 500 1000 275 1000P.O # 4 D5 NaCl iL x 8 hrs 150 1000 400 1000
started 1000 225 1000
1000 320 1000
1000
650 60 6,000 1,320 7000TOTAL 6700 7320
AM
DEC.10,2010 AM
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FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
P.O #4 D5NSSiL x 8 hrs. H20 150 PNSS 1000 300 PNSS Irrigation 1000
L=850 650 60 1000 375 1000
P.O # 5 D5 NaCl iL x 8 hrs 1000 80 1000
R-250 250 1000 105 1000
1000 375 1000
1000 275 1000
900 210 6,000 1510 6000
TOTAL 7110 7510
FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
P.O #5 D5NSSiL x 8 hrs. PNSS 1000 225 Pnss irrigation 1000
L=200 200 1000 215 1000
P.O # 6 D5 NaCl iL x 8 hrs 450 1000 100 1000
started
650 3,000 540 3000
TOTAL 3650 3540
PM
NOC
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FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
PNSS iL x KVO H20 240 PNSS 1000 180 Pnss irrigation 1000
L=580 200 430 1000 150 10001000 180 1000
1000 575 1000
200 670 4,000 905 4000
TOTAL 4870 4905
FLUID # PARENTERAL ORAL OTHERS URINE DRAINAGE OTHERS/SPECIFY
D5NSSiL x 8 hrs. H20 350 PNSS 1000 250 Pnss irrigation 1000
L=350 65 1000 495 1000
65 350 2,000 745 2000
TOTAL 2415 2745
DECEMBER 11, 2010
AM
PM
8/7/2019 BENIGN PROSTATIC HYPERPLASIA.ppt2
http://slidepdf.com/reader/full/benign-prostatic-hyperplasiappt2 49/49
T H
EENd
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