Patient Education Plan -
NUR 427 Example 1

EXAMPLE OF A PATIENT EDUCATION PLAN...

Patient Education Plan - NUR 427

Benign Prostatic Hyperplasia Patient Education Plan

Patient Description:

Richard Land is a 69-year-old home economics teacher who has two adult children. His father had urinary problems before he died over thirty years ago. Mr. Land has come to the emergency department reporting severe lower abdominal pain and inability to urinate for the past 20 hours. He has been getting up three to four times a night to urinate. He frequently has to strain to initiate a stream of urine. His urine stream has lessened over the past several months. He occasionally sees pink-tinged urine. Mr. Land has a history of prostatic infections for the past 15 years.

Based upon the initial interview for the Patient Education Plan, Mr. Land’s preferred learning style is visual. He prefers information he can read himself. He likes to ask questions after reading the information. Mr. Land needs education on urinary retention, overflow urinary incontinence, insomnia, and risk for infection.

Introduction to the disease process for the Patient Education Plan:

Normally, the prostatic capsule is thin and attached to the underlying tissue. With aging, the glandular units in the prostate undergo an increase in the number of cells, also known as tissue hyperplasia. This results in an enlarged prostate or prostatic hypertrophy. High levels of dihydrotestosterone (DHT), a testosterone derivative, may accumulate in the prostate and increase cell growth. Although benign prostatic hypertrophy is the more common term used to describe this problem in the clinical setting, benign prostatic hyperplasia is the most accurate term for the pathologic process (Ludwig, 2007).

When the prostate gland enlarges, it extends upward and inward into the bladder, causing bladder outlet obstruction. In response, the urinary system is affected in several ways. The detrusor muscle then hypertrophies or thickens and cannot contract effectively. As a result, the patient has either an increased residual urine or stasis or acute or chronic urinary retention. Increased residual urine causes overflow urinary incontinence, in which the urine leaks around the enlarged prostate causing dribbling. Urinary stasis can result in urinary tract infections and bladder calculi or stones (Ludwig, 2007).

When the prostate gland enlarges, it extends upward and inward into the bladder, causing bladder outlet obstruction. In response, the urinary system is affected in several ways. The detrusor muscle then hypertrophies or thickens and cannot contract effectively. As a result, the patient has either an increased residual urine or stasis or acute or chronic urinary retention. Increased residual urine causes overflow urinary incontinence, in which the urine leaks around the enlarged prostate causing dribbling. Urinary stasis can result in urinary tract infections and bladder calculi or stones (Ludwig, 2007).

In a few patients, the prostate becomes very large making it so a male cannot void. In other patients, chronic urinary retention results in a backup of urine and causes a gradual dilation of the ureters (also called a hydroureter) and kidneys (also called hydronephrosis). These problems can lead to chronic kidney disease (Ludwig, 2007).

Age and Developmental Issues for the Patient Education Plan:

Until recently, BPH was thought to be a single disorder with varying symptoms that resulted from aging. However, researchers have found two types of the problem—a milder form and a more severe form. Mr. Land has the milder form of BPH. Men with the severe form of BPH have high levels of protein made by an androgen-related gene called JM-27. These patients have more serious bladder damage that can lead to renal involvement. A serum biomarker test to measure the presence and amount of JM-27 protein is available now and being considered for approval by the U.S. Food and Drug Administration (Cannon, Mullins, Lucia, Hayward, Lin, Liu, et al., 2007).

Effect on Quality of Life for the Patient Education Plan:

Quality of life in patients with BPH can vary significantly based upon the degree of the enlargement of the prostate. The main element that is bothered is sexuality. Many men will base what treatment they choose based upon if it can improve their sexual function. The physical role can be compromised by urinary retention or overflow urinary incontinence. This can also effect social functioning of men who are active in the community. Men would be less likely to keep social roles if they had trouble holding their urine in public. Urinary retention could cause bodily pain due to the feeling of urgency and not being able to generate a stream of urine. This would likely cause a potential problem with general health perception, and possibly disabling men’s emotional mental health. Mr. Land had just had the beginnings of sexual dysfunction, and urinary incontinence overflow. He does not like to go out to social gatherings like he used to (Emberton and Martorana, 2006).

Educational Needs of the Patient, and Plan on How They Can Be Met for the Patient Education Plan:

Many educational topics about BPH will be taught to Mr. Land. Some are sensitive issues to men. Drugs, such as anticholinergics, antihistamines, and decongestants should be avoided because they can cause urinary retention. Any potential health care provider would need to be informed about the diagnosis of BPH so that these drugs are not prescribed. He will learn that frequent sexual intercourse or masturbation reduces obstructive symptoms of because of the release of prostatic fluid. These measures are helpful for men whose obstructive symptoms result from an enlarged prostate with a large amount of retained prostatic fluid. Also, teaching him to avoid drinking large amounts of fluid in a short time; to avoid alcohol, diuretics, and caffeine; and to void as soon as he feels the urge are useful in alleviating uncomfortable symptoms (Carlson, 2004).

Mr. Land has sought complementary and alternative therapies. Over 2 million men use herbs and foods to help manage the symptoms of BPH, especially saw palmetto extract (a natural herb) and lycopene (a botanical found in tomatoes). Many men with early to moderate BPH believe these agents have relieved their symptoms and prefer this treatment over prescription drugs or surgery. Studies on the effectiveness of saw palmetto have been contradicting. Teaching patients who want to try these herbs and other natural substances that scientific evidence to prove they are useful is lacking (Bent, Kane, Shinohara, Neuhaus, Hudes, Goldberg, H., et al., 2006).

Based upon the initial evaluation, this patient’s learning needs are visual. Brochures, booklets, and Internet sites with information about BPH would be provided. Once he evaluates the information, he would be set up with an appointment with his health care provider to answer additional questions, and for guidance on therapies.

The patient’s perceived challenges for the Patient Education Plan:

Mr. Land came to the emergency department based on the presenting signs of urinary retention, overflow urinary incontinence, insomnia, and risk for infection. He now believes that the herbal remedies and botanical extracts he has been using are not working satisfactorily at this time. He was not open to surgery or pharmacological medications, and is still afraid of them. He is however willing to try with the appropriate recommendations, and a physician that he likes.

According to Ludwig (2007), the main challenges he identified are: the pharmacological medications for urinary retention, his social status as a teacher with his overflow urinary incontinence episodes, sexual dysfunction, insomnia due to getting up to go to the bathroom many times during the night, and his risk for infection when he cannot urinate.

For the drug therapy, he would be recommended a 5-alpha reductase inhibitor to lower the DHT level, or an alpha-blocking agent to reduce urethral pressure and improve urine flow. Alternative herbs and natural remedies have already been determined not to work. For the sexual dysfunction, he will be taught to have frequent intercourse or frequent masturbation to relieve retained prostatic fluid (Ludwig, 2007).

For the overflow urinary incontinence he will be taught to identify patterns of incontinence, to keep the skin area clean, and to void as soon as the urge is felt. The problem of insomnia will be dealt with by teaching Mr. Land to avoid caffeine, alcohol, and diuretics. He will also need to change medication schedules recommended by his physician as needed if he is not sleeping well (Carlson, 2004). The risk of infection can be alleviated by increasing fluid intake over longer periods of time, and by eating a well-balanced diet (Ludwig, 2007).

Summary for the Patient Education Plan:

Mr. Land presented in the emergency department with presenting signs of BPH. After his social, family, and medical history was taken, his preferred method of learning obtained, his needs assessed; an educational plan was implemented. He was educated about the disease process of BPH. Then, it was determined that Mr. Land has the milder form of BPH. After the effects on his quality of life were assessed, it was determined that he wanted help returning to his normal level of sexual function. Educational needs were then determined, and Mr. Land was sent home with educational pamphlets, brochures, and Internet sites for more sources of information. He was referred to an Urologist for an appointment for additional information and treatment after his education plan was implemented at the hospital, and will be taken over by his referred doctor.

End of the Patient Education Plan

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