Goodpasture’s Syndrome
Goodpasture’s syndrome is a rare disease caused by an autoimmune disorder. The history and disease process will be reviewed during the education process. Following the review, this education plan will direct methods of learning, challenges, impact of quality of life for a 44-year-old male patient, named Jim. Shah, M, and Hugghins, S (2002) describe case results of a study completed about Goodpasture’s syndrome. Based on their study, the median age of a patient presenting with Goodpasture’s syndrome was 44 and the patients were predominantly male. This gentleman is the manager of a shoe store and has a history of good health. This Caucasian gentleman also has a wife of Spanish descent, and a teenage daughter.
Shah, M., & Hugghins, S (2002) found the first reported case of Goodpasture's syndrome was found in an 18-year-old male patient coughing blood and presenting with renal failure. During this presentation of symptoms the pandemic of 1919 was also taking place, 2002. Stanton and Tange, 1958) used the term "Goodpasture's syndrome" to identify patients with pulmonary hemorrhage and damage to the filtrating system of the kidneys called, glomerulonephritis. In 1967 the autoimmune quality of Goodpasture's syndrome was discovered after finding antiglomerular basement membrane antibodies.
Presentation of Symptoms
Like most patients, Jim, presented with hemoptysis, a cough, shortness of breath on exertion, and fatigue. Other symptoms include signs and symptoms of the flu like chills, fever, diaphoresis, and weight loss. Urinary symptoms include hematuria. On physical exam the patient was pale because of the anemia and breath sounds included crackles and rhonchi. Urinalysis revealed gross hematuria, Shah, M., & Hugghins, S (2002).
Educational Objectives and Instruction
Jim’s goals are to understand the process that causes Goodpasture’s syndrome, understand the complications, continue medications, complete follow-up treatment, and prevent it from happening again.
Education Assessment
Redman, B (2007) recommends in beginning the education process the patient is first assessed to determine readiness to learn. After questioning Jim, it was determined that he highly inquisitive and interested to learn about the disease process, treatment and how to prevent the disease from happening again. Further discussion reveals that Jim often repeats phrases and writes down what he hears. Visual and verbal reinforcement at adult learning level will be used in his education plan. He will also be asked to repeat information to verify accuracy. REALM testing with a score of 66 reveals he can understand high school reading and will be able to understand most printed pamphlets, Redman, B. (2007). He is a skilled computer and Internet user. To include his wife in the learning experience, materials in Spanish are also offered. Information will be offered to Jim in the form of pamphlets, reciprocal demonstration, dialogue and discussing his diary as he documents what he hears.
Education of Etiology and Pathogenesis
Explanation is given to Jim about the etiology Goodpasture’s syndrome. Jim is instructed that the disease is caused by and autoimmune response to cigarette smoking, upper respiratory infections like the flu, genetics and/or hydrocarbon exposure. Shah, M., & Hugghins, S. (2002) suggests the damage occurs to the alveoli or glomerular tissue after the trigger makes it easier to bind the autoantibody to the Goodpasture’s antigen. In the kidneys the autoimmune response damages the vasculature of the kidneys and decreases the kidney’s ability to filter the blood. The blood is released into the renal system causing hematuria and anemia. In the lungs, the principal is the same, except the blood leaks into the lungs causing hemoptysis.
The British medical Journal, (1984) notes that most cases are caused by hydrocarbon exposure, and occur when the patient is exposed to industrial chemicals or to recreational abuse of hydrocarbons as many aerosols contain hydrocarbons. Some other items that have hydrocarbons are cleaning solvents, insecticides, industrial solvents, diesel fumes, hard metals, and chlorine gas.
Jim is reminded to report shortness of breath, blood in the sputum and blood in his urine. After questioning Jim the next day, he opened his notes to verify the signs and symptoms.
Education of Treatment and Prognosis
Explanation is given to Jim that the initial treatment after the diagnosis of Goodpasture’s syndrome is plasmapheresis to remove the antibodies. Hajime, N., Michiko, A., Atsunori, K., Tatsuo, K., Yuko, N., Naoki, O., et al. (2009) note that plasmapheresis removes the plasma from the blood because that is the part of the blood that contains the antibodies. The plasma is discarded. Another fluid is replaced by the plasma and the blood is returned to the patient. This process takes several hours. The Vaculitis Foundation (n.d.) website describes the treatment Jim will receive. He will receive intravenous immunosuppressive treatment to stop the production of the antibodies. The final goal is to find and remove the trigger, Shah, M., & Hugghins, S (2002).
Jim will follow up regularly in the medical clinic and his anti-GBM titers will be retested in six months. Jim will probably remain on low dose immunosuppressant therapy throughout follow-up, Shah, M., & Hugghins, S (2002). Most of the time this treatment will treat the disease, but sometimes the patient will require hemodialysis.
To discover the trigger, Jim is questioned about his history and it is determined that the store he works in has a smoking lounge for all employees, and the copy machine is located in a small room in the back of the store with no ventilation. Jim recently maintained the machine and spilled the chemicals. Between the usual interruptions at work, it took several hours to clean up the spill.
Perceived Challenges
Jim expresses concerns about losing his job if he discusses that the smoking lounge and the copy machine room may need to be changed to accommodate him. Reinforcement is given that these areas should be avoided and he should discuss with the owner of the store the possibility of moving the copy machine to a ventilated area and moving the smokers to an area outside of the building.
After discussing the Pro’s and cons of these challenges and supporting Jim to make a decision, Jim determined that it was imperative that he discuss risks to the store owner. Jim made the commitment to discuss the danger to him and potential danger to the other employees. Redman, B (2007).

Conclusion
After thorough assessment, Jim’s education plan was implemented to compliment his unique learning style and needs. His plan allowed him to make his own decisions and to learn in the way he most comfortable.
Although Goodpasture’s syndrome is a rare disease, Jim must remain vigilant to stay away from the triggers. A repeat of Goodpasture’s syndrome could lead to chronic renal failure and a dependency on dialysis to survive.

References
(1984). Exacerbation of Goodpasture's syndrome after inadvertent exposure to hydrocarbon fumes. British Medical Journal (Clin Res Ed), 288(6412), 188. Retrieved from Academic Search Complete database.
Hajime, N., Michiko, A., Atsunori, K., Tatsuo, K., Yuko, N., Naoki, O., et al. (2009). A case report of efficiency of double filtration plasmapheresis in treatment of Goodpasture's syndrome. Therapeutic Apheresis And Dialysis: Official Peer-Reviewed Journal Of The International Society For Apheresis, The Japanese Society For Apheresis, The Japanese Society For Dialysis Therapy, 13(4), 373-377. Retrieved from MEDLINE with Full Text database.
Mazidi, P., Bajestani, S., Khan, M., Khair, T., & Laos, L. (2008). Goodpasture's Syndrome: A Case Report And Review Of Literature. Internet Journal of Internal Medicine, 7(2), 6. Retrieved from Academic Search Complete database.
Redman, B. (2007). The Practice of Patient Education (10th ed.). Detroit, MI: Mosby.
Shah, M., & Hugghins, S. (2002). Characteristics and outcomes of patients with Goodpasture's syndrome. Southern Medical Journal, 95(12), 1411-1418. Retrieved from MEDLINE with Full Text database.
Stanton, M.,& Tange, J. (1958). Goodpasture's syndrome: pulmonary haemorrhage associated with glomerulonephritis. Aust Ann Med, 7,132-144. Retrieved from MEDLINE with Full Text database. Vaculitis Foundation. (n.d.). Plasmapheresis. Retrieved from http://www.vasculitisfoundation.org/plasmapheresis