Healthcare Plan for the Management of Genitourinary Disorders
Objective of this paper is to carry out a care plan for the patient, aged 60 years, who is suffering from genitourinary disorder. The study carries out the case evaluation and identifies the symptoms of the patient complication. The study also provides a comprehensive healthcare plan used for the treatment of the patients.
Case Study Evaluation
HPI (History of Present Illness).
Evaluation of the case study reveals that the patient is a Hispanic male, aged 60 years of age and complains of a decline of urinary flow. While the patient has experienced the symptom for more than two years, however, the symptom has increased significantly for the past two weeks. Although, the patient has not been diagnosed in the past, however, he faces difficulties in achieving a free flow of urine that interferes in his daily activities. The gradual worsening of the patient’s case makes him seeking for medical helps. Moreover, the patient has complained of increased in nocturia within the past two weeks, which consequently decline his strength of urinary flow as well as slight terminal dysuria.
While the patient seeks for no treatment in the past, however, he faces a significant problem with regard to nocturia within the last two weeks. Moreover, the patient faces a significant challenge to start urine flow. While the patient has not been diagnosed or have a treatment in the past, the symptoms have been severed in the last few days.
PMH (Past Medical History)
Although, the patient has not sought for medical care with regard to his problem, however, he been treated for hypercholesterolemia and hypertension in the past. Moreover, the patient does not have a known history of heart disease. However, he has been hospitalized five years ago for an angina case and diagnosed for chest wall syndrome which he has been treated and discharged. The patient does not have a known history of surgeries and no recent record of hospitalization.
ROS (reactive oxygen species)
The patient does not have blood in his stool, no gross hematuria. Moreover, he does not have abdominal pain, vomiting or nausea.
The patient has been taking various medications, and are follows:
Zocor 20mg- daily
Cardizem 240mg- daily
While the patient does not have known drug reactions and allergies, however, the patient complains of the prescribed regime.
Differentiates between Normal Development and Disorder
The genitourinary system is an organ of urinary system and reproductive organs. The normal genitourinary developments of an individual without genitourinary disorder are grouped are proximity to one another. The urinary tract composes of organ system that is responsible for filtering and cleaning of waste material and excess fluid from the blood. The urinary system composes of ureters, kidneys, bladder, and urethra. Under normal development, the kidney filters blood and removes wastes from the body and produce urine. The urinary bladder, urethra as well as urinary tract serve as a plumber that store and drain urine. Moreover, urinary maintains homeostasis of ions, water, blood pressure and ions within a normal development. The urinary bladder also assists in storing urine, which is located at body’s midline. The bladders can hold between 600 and 800 milliliters of urine. More importantly, the urethra consists of tube where urine pass through the bladders to the body exterior. The urethra is linked to male or female reproductive organs. The urethra assists in free flow of sperm and urine out of the body.
However when a genitourinary disorder has occurred, the situation can impair normal function of urinary and reproductive system. Genitourinary disorder refers to the problem within the urinary system attributed to chronic and acute kidney failure, obstruction in urinary tract and urinary tract infections. Typically, urinary tract infections can lead to a kidney failure. Some diseases that can cause kidney damage, which leads to genitourinary disorder include polycystic kidney disease, urinary tract, infections, hydronephrosis, and glomerulonephritis. Genitourinary disorder occurs when the illness occurs, when genital organs and urinary organs are not functioning properly. The disorder may be due to injury, illness and ageing. The Genitourinary disorder can impair free flow of urine, which can consequently decrease the urine that flows out of the body. The urinary tract infection can lead to storage symptoms such as voiding symptoms, urinary incontinence, post-micturition symptoms and incomplete emptying.
Thus, under a normal development, an individual will experience free flow of urine, and will not experience pain or obstruction when passing out the urine. However, the case of genitourinary disorder will impair free flow of urine, which will consequently reduce the amount of urine coming out from the urinary organ.
Psychological and Physical demands that disorder places on Family and Patient
Finnegan-John, & Thomas (2013) identify depression as one of the psychological demands of the disorder. The patient is likely to experience the psychological trauma because the mind of the patient will be preoccupied with the constant thought of the disease. Typically, the psychological trauma interferes with the ability of the patient to effectively cope with treatment of the disease. Additionally, the panic attacks can interfere on his works as an engineer, which can consequently interfere with the quality of the work delivered for the clients. The lifestyle restriction is another psychological effect of the disease. The change in mood, fatigue, and change in the physical body can impair sexual activity of patient. It is essential to realize that lack effective sexual activity plays an important role in undermining the intimacy of patients with his spouse since his sexual activity is likely to be compromised.
Zgourides (2007) identifies a stress as another psychological demand of the patient. For example, the patient will need to spend a significant time to treat himself, and the option can be very stressful for the patient. The stress can affect the progress of patient at workplace, and can affect his performances at the workplace. It is essential to realize that long time stress can lead to a work burnout, and affect ability of patient to copy socially. Bluie, Campbell, Fuchs et al. (2010) argue that the problem behavior is one of the symptoms of gastrointestinal disorder . For example, the patient can exhibit the problem behaviors such as self-injury and aggression.
Key Concepts to be shared with Family and Patient to achieve optimal disorder outcomes and management
The first step in enhancing the optimal outcomes and management of the disorder is to educate the patient about the risk factors associated to the disorder. The family and patient need to understand the importance of carrying out the treatment immediately in order to avoid further complications. The risk factors associated to genitourinary disorder include:
Catheterization that lead to a placement of a tube in order to drain urine from bladder
Irritant or Chemical exposures
Low fluid intake
The next step is to educate the patient about dietary and pharmacological agents to manage the disorder. Whitfield & Shulman (2009) identify change in dietary pattern, medical treatment and change in cognitive behavioral as the effective strategies to manage the patient’s disorder and enhance his optimal outcome. The patient should indulge in eating lactose-free diet to manage the disorder and enhance his health outcomes. For example, the patient should indulge in eating lactose-free soy. The patient should also eat low-fructose diet regularly because high low-fructose diet can cause abdominal pain.
Bluie, Campbell, Fuchs et al. (2010) argue that education of family and patient is an effective strategy to manage the patient’s disorder and enhance his health outcomes. The family of the patient should be educated on the method to carry out the pharmacologic treatment of the disorder. Since the disorder is characterized by depression, thus, the patient should take antidepressants. The antidepressants that include monoamine, and tricyclic should be used treat depression of the patient.
While the pharmacological agents and diets can be used to manage the disorder, however, the psychological interventions should be used for patients. The family and patient should understand that the CBT (cognitive behavioral therapy) need to be used to manage the cognitive problem that the patient might have faced. Additionally, family therapy should be carried out to train family the strategy to support the patient through self-management skills, and self coping. The psychotherapy and cognitive behavioral therapy will allow the patient to cope with the problems using the problem solving techniques.
Key Interdisciplinary Health and Team personnel to achieve Optimal Management and Outcomes of the Disorder
Professionals play a critical role in the treatment of genitourinary disorder. (Jaarsma. 2005). The team personnel to manage the disorder of the patient in order to achieve clinical outcomes include genitourinary nursing practitioner, physician, social worker, general medical practitioner, physical therapist, clinical and behavioral psychologist. The team should use different strategy to manage the patient disorder and enhance the patient outcome. The health education should be appropriate in improving the knowledge of the patient on the strategy to manage his health disorder. The home-based management is one of the optimal disorder managements that can enhance the management of the disorder. The team should deliver the care program to patient at home. More importantly, the healthcare provider should come in person to meet the patient at home in person to educate the patient about the strategy to manage his disorder. In essence, the team should visit the patient multiple times according the established guidelines. An home-base specialist nurse should provide a comprehensive counselling, health education, and adherence to medication. The benefit of home-based model is that it will assist the health care providers to deliver care for the patient at home and educate him on the disorder management.
The team should also use the tele-monitoring to care for the patient using the telecommunication system. The technological equipment can be installed at patient’s home to collect patient’s blood pressure, weight, body temperature, and respiratory rate. The benefit of tele-monitoring is to reduce rate of patient’s visit to the hospitals.
Barriers and Facilitators and barriers to Optimal disorder Outcomes and Management
A barrier to home-based model is time consuming. Moreover, access to patient’s medical record, specialist consultation, and medical equipment might not be possible using the homebased model. The time factor is another barrier to achieve the optimal disorder management. Since the patient is an engineer, the patient may not have enough time to carry out the treatment, the time taken for the management of disorder can interfere with the time of the office work. The costs are the barrier to the effective management of disorder. Although, the patient has the health insurance, nevertheless, the costs of treatment may be so high to cover the health management.
Strategies to overcome the Barriers.
Different methods can be employed to overcome the barrier. First, the team should carry out a comprehensive health education for patient in the first week of their visits to patients. The education will enhance a greater understanding of patient, and will make the patient to carry out the self-care with little intervention from the team. Moreover, the patient should use his health insurance to cover the costs of the treatment to alleviate the costs. Additionally, the team should visit the patient only in the weekend to reduce the time barrier to the care management.
Care Plan Synthesis
Based on the symptoms identified in the patient, the healthcare practitioner should carry out a comprehensive diagnosis of patient. First, the practitioner should carry out the imaging tests to detect the location of the disorder. A multiple CT ( computed tomography) scan should be carried out. Moreover, the abdominal x-ray should be carried out to identify the major cause of problem.
Additionally, the physical examination of the genital of the patient should be carried out. The evaluation of scrotum, penis and scrotal contents should be carried out, and physical examination should be carried out in the warm room to allow for a muscle relation. The next action after the diagnosis is the treatment. The medical practitioner should prescribe the antibiotics for the patient to treat the associated urinary infection. The suggested antibiotics include:
Amoxicillin (Trimox or Amoxil),
nitrofurantoin (Macrodantin or Furadantin),
sulfamethoxazole / trimethoprim (Septra or Bactrim).
The antibiotics will make the symptoms to improve after few days of taking the medications.
The patient should be advised to take the medications as being prescribed because stopping the medications can make the infection to return, which may lead to a development of a bacteria that may be resistance to treatment and difficult to treat.
Moreover, the Anticholinergics medications should be prescribed for the patient. The medication is anticholinergics, and will assist in treating the patient’s overactive bladders. The drugs will prevent urinary retention and relax the muscles of the patient bladder. The approved anticholinergics are:
Darifenacin / Enablex, and solifenacin succinate, which is VESIcare used to treat overactive bladders.
Medications such as hyoscyamine, tolterodine, oxybutynin chloride, and propantheline bromide can be used have to treat the poveractive bladders. The drug should be taken daily to reduce the symptoms. The physical therapy should out be carried out for the patient. The goal of physical therapy is to restore functions, reduce pain, and improve mobility.
The paper carries out a comprehensive healthcare plan for the patient, and the patient is a 60-year-old engineer suffering from genitourinary disorder. The paper identifies professional team, who can assist the patient to achieve a better health outcome. The health education has been identified as an effective treatment strategy to enhance a greater understanding of the patient about self-care. The study also suggests different medications that can make the patient to achieve better health outcomes.
Benedetti, F. (2008). Placebo Effects: Understanding the Mechanisms in Health and Disease. Oxford Scholarship Online.
Bluie, T. Campbell, D.B. Fuchs, G.J. et al. (2010). Evaluation, Diagnosis, and Treatment of Gastrointestinal Disorders in Individuals With ASDs: A Consensus Report. Pediatrics. 125( 1): S1-S18;
Finnegan-John, J. & Thomas, V.J. (2013). The Psychosocial Experience of Patients with End-Stage Renal Disease and Its Impact on Quality of Life: Findings from a Needs Assessment to Shape a Service. Journal of Renal Care. 40(1): 74-81.
Jaarsma. T. (2005). Inter-professional team approach to Patients with Heart Failure. Heart. 91(6): 832-838.
Whitfield, K.L. & Shulman, R. (2009). Treatment Options for Functional Gastrointestinal Disorders: From Empiric to Complementary Approaches. Pediatr Ann. 38(5): 288-294.
Zgourides, G.D. (2007).CliffsQuickReview Developmental Psychology. Houghton Mifflin Harcourt.
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