Patient Educational Plan
Tom Gremling
NUR/427 HEALTH AND CHRONIC DISEASE MANAGEMENT
April 17, 2011
Sharnee Moore-Jervis

Patient Educational Plan
Patient Description: Jorge Sanchez
Jorge Sanchez is a 53 year old Hispanic male, naturalized citizen from Mexico. He completed high school here in the United States, but struggled as English is his second language. He lives in Mesa, Arizona with his wife, mother, and three children. His wife was born here in the United States and works as a Realtor, she handles much of the family’s finances, health information and scheduling. He works as a concrete finisher and has been for 25 years. His family history includes coronary artery disease and renal problems. His father died at age 79 of an Acute Myocardial Infarction. His mother is living (73) and is currently receiving dialysis and has been for the last two years. His wife has no current health problems to note, nor do his three children ages 20, 17, and 15. He has been recently diagnosed with Benign Prostatic Hypertrophy (BPH) and has been prescribed Avodart 0.5 mg once daily by mouth. Although he has health insurance the drug is still expensive. He has decided to supplement the therapy with the herbal supplement Saw Palmetto; he is taking the Avodart one day, and then the Saw Palmetto on opposite days. He has presented to the Emergency Department with complaints of urinary retention and abdominal pain. He is assessed and is admitted to the Med/Surg Unit for Acute Urinary Retention. He prefers to learn in Spanish, he likes handouts with pictures or video in Spanish also. Mr. Sanchez currently shows a knowledge deficit related to medication and CAM therapy interactions, and knowledge deficit of the disease process. During the interview and assessment of the patient it was noted he deferred on numerous occasions to his wife for information.

The Disease Process
Benign prostatic hyperplasia (BPH) is a nonmalignant condition in which excessive smooth muscle and epithelial cell proliferation results in an enlarged prostate gland that constricts or deforms the lower urinary tract and causes difficulty with urination. BPH occurs primarily in older men, affecting 50% of men over the age of 60 and 80% of men over the age of 70. BPH is rare in men under the age of 40. Complications of BPH include bladder stones, prostatitis, hematuria, urinary retention, and renal failure. BPH is diagnosed based on patient history and a variety of tests, including digital rectal examination (DRE), prostate-specific antigen (PSA) blood test, ultrasound, and prostate biopsy. BPH must be differentiated from prostate cancer (CaP), urinary tract infection (UTI), prostatitis, urethral stricture, overactive bladder, neurogenic bladder, bladder cancer, poorly controlled diabetes, and neurologic conditions that produce neurogenic bladder and bladder symptoms (e.g., Parkinson’s disease, diabetic autonomic neuropathy, multiple sclerosis, spinal cord injury)( Auffenberg et al 2009).
Due to extensive work done recently in understanding the natural history of BPH and the knowledge of physiological effects of various medical interventions has greatly helped us in choosing therapeutic options for individualized treatment. This has resulted inconsiderable reduction in the rate of transurethral prostatectomy seen during the last couple of decades. Development of adrenoceptor blockade and hormonal manipulation has moved increasing number of men away from surgery towards pure medical management of BPH. We reviewed the current status of medical management in light of the evidence in support of each agent, and the correct selection of treatment (Longstroth, & Cyr 2010).

Age and Developmental Issues
Mr. Sanchez’s knowledge deficit’s relating to his disease process was traced back to the Urologist who did not speak Spanish, and Mr. Sanchez had attended this appoint alone and did not grasp the significance of the disease or in mixing medications and CAM therapies.
Quality of Life
Mr. Sanchez states that he was losing a lot of sleep prior to beginning treat for the BPH, although the medication is expensive, the decrease in nocturia was a welcome benefit. He was concerned about the impact of the cost on his family and was told about Saw Palmetto by a co-worker. He felt he was getting the same effect for half the cost by combining the Avodart with the Saw Palmetto.
Patients Educational needs and plan
Mr. Sanchez needs are to increase knowledge of medications and CAM therapy interactions. He also needs increased knowledge in the disease process that is in an understandable format for him. We will also need to address any financial issues relating to his treatment of the disease.
Plan
We have obtained information in Spanish relating to BPH, Avodart and Saw Palmetto; we broke the teaching sessions down by each of the needs with handouts and videos in Spanish, with a concluding overview at the end. A message was also given to the Urologist about the teaching that was provided the patient, and the patients need for information in Spanish. Prior to his discharge a comprehensive teaching session was given to his wife with Mr. Sanchez present. A follow up appointment has been scheduled for one week with the Urologist. We have gathered available resources for him regarding his medication costs. A review of the medication and the herbal therapy was provided including effects, side effects and need to select one or the other after consulting with his urologist.
Perceived Challenges
Mr. Sanchez believes he has a greater understanding of the disease process and the interactions of medications and herbal therapies. He further states that the information provided in the form of the handouts in Spanish has been extremely helpful, but still states a concern about the cost of the medication. We reinforced the information regarding available community and Manufacturer’s resources to assist in cost containment. His wife stated her understanding of the need to follow up with the Urologist and the medication interactions and side effects.
Summary
We have approach Mr. Sanchez’s knowledge deficits and addressed them in singular fashion, in and understandable manner, with handouts and video’s in Spanish. We have provided him and his wife with available resources concerning cost containment measures concerning medications. His Urologist has been informed of the educational needs that have been addressed and the need for information to been made available in Spanish. We have addressed his needs in regards to the medication regiment and the side effects, and need to check for interactions of other medications, or herbal therapies he may be taking.

References
Auffenberg, G. B., Helfand, B. T., & McVary, K. T. (2009). Established medical therapy for benign prostatic hyperplasia. ••Urologic Clinics of North America, 36(4), 443-459.
Bushman, W. (2009). Etiology, epidemiology, and natural history of benign prostatic hyperplasia. ••Urologic Clinics of North America, 36(4), 403-415.
Longstroth, D., & Cyr, P. R. (2010). Prostatic hyperplasia, benign (BPH). In F. J. Domino (Ed.), ••The 5-minute clinical consult 2011 (19th ed., pp. 1068-1069). Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Rosenberg, M. T., Miner, M. M., Riley, P. A., & Staskin, D. R. (2010). STEP: Simplified Treatment of the Enlarged Prostate. ••International Journal of Clinical Practice, 64(4), 488-496.
Thorner, D. A., & Weiss, J. P. (2009). Benign prostatic hyperplasia: Symptoms, symptom scores, and outcome measures. ••Urologic Clinics of North America, 36(4), 417-429.