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Nur 427 Patient Education Plan

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Patient Education Plan
NUR 427
Sidoney Roache

Ulcerative Colitis Patient Education Plan

Patient Description

Larry Garcia is a 45 year old sales representative with 3 children. He has been married for 18 yrs to Monica, who is 8 yrs. his junior. Mr. Garcia has come to the emergency department reporting abdominal pain, cramping and frequent diarrhea with blood and pus in his stool for the past 2 days. He also has been having difficulty absorbing fluids and nutrients and as a result lost 4 1bs. His symptoms started at age 22 along with lactose intolerance. Larry is Caucasian and of Jewish descent. His regular diet consists of whole-grain breads with eggs for breakfast and for lunch he eats a bagel with cheese and some whole milk. Every Wednesday Larry eats cereal for breakfast and has pasta for lunch. He has a history of abdominal pain for the past 10 years.
Mr. Garcia’s preferred learning style is visual as he explained in the initial interview. He learning style is visual because he prefers to read the material independently. He does not absorb verbal information easily.

Introduction to the disease process for the Patient Education Plan:

The disease process usually begins in the rectosigmoid area and spreads proximally. Pathologic change starts with degeneration of the reticulin fibers beneath the epithelial mucosa. This causes occlusion of the subepithelial capillaries and infiltration of the lamina propria with lymphocytes, leukocytes, eosinophils, mast cells, and plasma. The result eventually is abscess formation, necrosis, and ulceration of the epithelial mucosa. This in turn reduces the colon’s ability to absorb sodium and water. (Ludwig, 2007). Ulcerative colitis is a form of colitis, a chronic disease of the intestine, specifically the large intestine or colon, that includes characteristic ulcers, or open sores, in the colon. It is quite similar to crohn’s disease and together they are known as Inflammatory Bowel Disease (IBD) Ulcerative colitis causes inflammation and sores (ulcers), in the top layers of the lining of the large intestine. Ulcerative colitis rarely affects the small intestine except for the lower section, called the ileum.

The inflammation makes the colon empty frequently, causing diarrhea. Ulcers form in places where the inflammation has killed the cells linking the colon. The ulcers bleed and produce pus and mucus.

Age and Developmental Issues for the Patient Education Plan:
Ulcerative colitis usually appears between ages 15 and 30, although it can develop at any age. The inflammation tends to flare up multiple times throughout life, which causes recurring signs and symptoms.
A variety of genetic and environmental factors are likely involved in the development of ulcerative colitis. Recent studies have identified variations in dozens of genes that may be linked to ulcerative colitis; however, the role of these variations is not completely understood. Researchers speculate that this condition may result from changes in the intestinal lining's protective function or an abnormal immune response to the normal bacteria in the digestive tract, both of which may be influenced by genetic variations. Several of the genes that may be associated with ulcerative colitis are involved in the protective function of the intestines. The inner surface of the intestines provides a barrier that protects the body's tissues from the bacteria that live in the intestines and from toxins that pass through the digestive tract. Researchers speculate that breakdown of this barrier allows contact between the intestinal tissue and the bacteria and toxins, which can trigger an immune reaction. This immune response may lead to chronic inflammation and the digestive problems characteristic of ulcerative colitis. Other possible disease-associated genes are involved in the immune system, particularly in the maturation and function of immune cells called T cells. T cells identify foreign substances and defend the body against infection. Certain genetic variations may make some individuals more prone to an overactive immune response to the bacteria in the intestines, which may cause the chronic inflammation that occurs in ulcerative colitis. Another possible explanation is that ulcerative colitis occurs when the immune system malfunctions and attacks the cells of the intestines, causing inflammation.

Effect on Quality of Life for the Patient Education Plan:
Quality of life is vitally important to patients with chronic illnesses such as ulcerative colitis and has been assessed in observational, cross-sectional, and cohort studies. However, relatively few clinical trials have evaluated the quality of life of patients with UC. Recently, greater availability of the necessary tools has facilitated the undertaking of studies showing that quality of life of patients with UC is reduced significantly compared with that of the general population. Studies using disease-specific instruments have identified disease severity as the strongest predictor of quality of life, with other disease-related predictors including type of medical or surgical treatment and the efficacy, tolerability, and acceptability to patients of particular types of medical or surgical treatments. Other factors, such as comorbid medical or psychosocial problems and adherence to treatment, also affect quality of life. Combined use of generic and disease-specific instruments in clinical trials can ensure that all clinically relevant unexpected events (generic instrument) and important improvement or deterioration (disease-specific instrument) are captured. For accurate outcomes assessment, the use of comprehensively validated instruments is critical. The need for the development and evaluation of new instruments will be determined by the mechanisms and targets of novel therapies. Ultimately, quality of life assessment of effective therapies will play a strong role in pharmacoeconomic evaluations, providing health policy makers with the evidence to support the treatments that can most effectively normalize quality of life through complete symptom resolution, minimal side effects, and convenient administration.

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

Mr. Garcia will be taught about Ulcerative Colitis. Homoeopathic medicines have proven their efficacy in all sought of Inflammatory Bowel conditions and help by reducing the inflammation & ulcerations and helping in restoring intestinal functions back to normal. It also helps by enhancing ones immune response. If homoeopathic treatment is sought early it helps in preventing the progress of disease and preventing any complications from occurring, which are usually associated with the disease. It helps by reducing the ulcerations at first and over a period of time by healing them. He will be provided with diet charts, and a guide on how to modify his lifestyle to benefit his health. The patient’s perceived challenges for the Patient Education Plan:

Mr. Garcia went to the emergency department complaining of abdominal pain, cramping and frequent diarrhea with blood and pus in his stool for the past 2 days. His last physical exam was 6 yrs. ago. He takes no prescription medications, but does take a multivitamin daily. The patient has been following a diet of whole grain foods for several years and is not ready to eliminate it from his diet. He does not believe that changing his diet will help maintain the disease. He is not receptive to the idea of surgery or taking medications, however he is open to speaking with a doctor for consultation and recommendation purposes.
The main challenge for Mr. Garcia is: the change of diet and medication. He would be recommended to eat lactose-free versions of dairy foods such as cheese, and ways to get enough non-dairy calcium. Mr. Garcia would also be encouraged to avoid foods that are irritating such as high-fiber foods, raw fruits and vegetables. If he chooses surgery, counseling would be advised. The choice of medicine usually depends on how bad the disease is, the part of the colon affected, and any complications a patient may have. The drug therapy he would be recommended are Prednisone and Sulfa. A good herbal therapy to consider would also be Multidophilus 3 billion, 2 capsules with a glass of water twice a day, an hour before breakfast and at bedtime to build up his immune system, and fish oil (now use Minami Platinum 1 BID with meals) to reduce inflammation. Other recommendations from the doctor Yoga to help relieve stress and occasional massage therapy.

Summary for the Patient Education Plan:

Mr. Garcia came to the emergency department with signs & symptoms of Ulcerative Colitis. He was interviewed and assessed and information was gathered to prepare an educational plan. He was given detailed education about the disease process. His perceived challenges were determined and he has consulted with the Doctor and is compliant to the Doctor’s recommendations for the betterment of his health. He was discharged to home with brochures, guidelines and internet resources to help him get more information on the disease. For follow-up purposes, He was referred to a GI doctor for more information.

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