SCENARIO: S.M. is a 68-year-old man who is being seen at your…

Question Answered step-by-step SCENARIO: S.M. is a 68-year-old man who is being seen at your… SCENARIO: S.M. is a 68-year-old man who is being seen at your clinic for routine health maintenance and health promotion. He reports that he has been feeling well and has no specific complaints, except for some trouble “emptying my bladder.” Vital signs (VS) at this visit are 148/88, 82, 16, 96.9° F (36.1° C). He had a CBC and complete metabolic panel (CMP) completed 1 week before his visit, and the results are listed below.While obtaining your nursing history, you record no family history of cancer or other genitourinary (GU) problems. S.M. reports frequency, urgency, and nocturia × 4; he has a weak stream and has to sit to void. These symptoms have been progressive over the past 6 months. He reports he was diagnosed with a large prostate a number of years ago. Last month, he began taking saw palmetto capsules but had to stop taking them because they “made me sick.The primary care provider (PCP) performs a digital rectal examination (DRE) and asks for post-void residual (PVR) urine testS.M. returns in 8 months to report that his symptoms are worse than ever. He has tried several different medications, but medication management failed, and he is told that surgical intervention is necessary. S.M. choose an outpatient procedure. He did well postoperatively and was discharged to home. The outline will be as follows:Assessment ((Based on systems: cardio, resp, GI/GU, mobility, Neuro, Safety, skin, pain, psychosocial)) Obj:_____________________________________________________________________________________________________________________________________________________________________________ Subj:_________________________________________________________________________________________________________________________________________________________________________________ Nursing Diagnosis (2) Must be prioritized. Must be Nanda using three part statement (Based on systems: cardio, resp, GI/GU, mobility, Neuro, Safety, skin, pain, psychosocial) Stem (DX): Etiology (Cause) : as evidenced by (Signs and symptoms) Abnormal Assessment Findings. (1)_________________________________________________________________________________________ _____________________________________________________________ __________________________ (2)_________________________________________________________________________________________ ____________________________________________________________________________ Planning (Patient goals), Must be SMART goalsPt. will (verbalize, demonstrate, be able to, increase & maintain, or decrease & maintain) by the: (end of shift, end of day, discharge day) or within: (two hours; 12 hours, etc.) ________________________________________________________________________________________________________________________________________________________________________________  Implementation (Specific nursing interventions that were performed during your shift): Must contain the following: Assess {observe, palpate, percuss}; Monitor; Administer; Collaborate w/ specific multi-disciplinary team; & Teach ______________________________________________________________________________________________________________________________________________ Evaluation (What was the outcome: Goal; Met or Not met or Partially met and How to revise.) ____________________________________________________________________________________________ ______________________________________________________________________________________ Nursing Application AssessmentInclude activities throughout the day performed in relation to the following NCLEX content categories. See content category examples below as cited by NCSBNManagement of Care _________________________________________________________________________________________ _________________________________________________________________________________________  Safety and Infection Control _________________________________________________________________________________________ _________________________________________________________________________________________  Basic Care and Comfort _________________________________________________________________________________________ _________________________________________________________________________________________  Health Science Science Nursing NURS 5541 Share QuestionEmailCopy link Comments (0)