Case Study: Erectile Dysfunction

Adult Case Study Erectile Dysfunction Joey Park M00351341 InterAmerican University of Puerto Rico- Metro Campus May 2011

Introduction Patient is a 75 year old male patient with a history of hypertension , diabetes, prostate cancer, presenting to urology clinics with erectile dysfunction refractile to oral medications. He will be scheduled for a prosthesis replacement. Patient has had history of several abdominal surgeries. For that reason, ambicor prosthesis will be placed.

Case Presentation Erectile dysfunction (ED, "male impotence") is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis during sexual performance. A penile erection is the hydraulic effect of blood entering and being retained in sponge-like bodies within the penis. The process is often initiated as a result of sexual arousal, when signals are transmitted from the brain to nerves in the penis. Erectile dysfunction is indicated when an erection is difficult to produce. There are various circulatory causes, including alteration of the voltage-gated potassium channel, as in arsenic poisoning from drinking water. The most important organic causes are cardiovascular disease and diabetes, neurological problems (for example, trauma from prostatectomy surgery), hormonal insufficiencies (hypogonadism) and drug side effects. Psychological impotence is where erection or penetration fails due to thoughts or feelings (psychological reasons) rather than physical impossibility; this is somewhat less frequent but often can be helped. Notably in psychological impotence, there is a strong response to placebo treatment. Erectile dysfunction, tied closely as it is about ideas of physical well being, can have severe psychological consequences. Treatment can involve prostaglandin tablets in the urethra, injections into the penis, a penile prosthesis, a penis pump or vascular reconstructive surgery.

Medications Received After Surgery

GENTAMICIN SULFATE INJ, SOLUTION 80 ML IN 0.9% SODIUM CHLORIDE INJ 100 ML IVPB INFUSE OVER 60 MINUTES QH8 VANCOMYCIN INJ 1000 ML IN 0.9% SODIUM CHLORIDE INJ 250 ML IVPB INFUSE OVER 120 MINUTES Q12H 0.9% SODIUM CHLORIDE ING 1000 MLIV 80ML/HR Non-VA ASPIRIN TAB, CHEWABLE 81 MG CHEW AND SWALLOW ONE TABLE EVERYDAY. OXYCODONE HCL 5MG/APAP 325 MG TAB 2 TABLETS PO Q4H PRN AS NEEDED FOR PAIN METROPOLOL TARTRATE (LOPRESSOR) TAB 50 MG PO BID FUROSEMIDE TAB 20 MG PO AM ASAP GEMFIBROZIL TAB, ORAL 300 MG PO BID

Nursing Diagnosis The patient demonstrated inability to be aroused which indicates sexual dysfunction or ineffective sexuality pattern. Sexual Dysfunction is a change in sexual function that is viewed as unsatisfying, unrewarding, inadequate, and painful (NANDA). Nursing intervention is to educate patient in regards to special devices to manipulate genitalia. Patient also demonstrated negative feelings about self and self and sexual capabilities. Nursing intervention is to educate patient to cope and begin to accept problem and verbalize positive aspects about himself (self-esteem; body image).

Treatment Patient underwent a penile prosthesis. A penile prosthesis is another treatment option for men with erectile dysfunction. These devices are either malleable (bendable) or inflatable. The simplest type of prosthesis consists of a pair of malleable rods surgically implanted within the erection chambers of the penis. With this type of implant the penis is always semi-rigid and merely needs to be lifted or adjusted into the erect position to initiate sex. Many men choose a hydraulic, inflatable prosthesis, which allows a man to have an erection whenever he chooses and is much easier to conceal. It is also more natural.

Personal Observations and Feedback

During my time with this patient, I was able to learn a great deal of knowledge in regards to erectile dysfunctions along with the procedures and treatments with this this disorder. I did not realize the emotional, mental, and physical stress it can have on men. Although, the patient was a little embarrassed about the procedure he underwent, I was able to do enough research to openly speak with him in regards to his prosthesis and educate him post-operatively. Although he was experiencing low self-esteem in regards to his dysfunction, I was able to help find some positive aspects about him to prevent him from feeling down or depressed about his situation. After the treatment and undergoing his penile prosthesis, one could definitely tell the change in his mood, health, and confidence. Having a history of hypertension, diabetes, and prostate cancer does not prevent my patient from doing his hobbies and fun activities. The patient controls his health by eating healthy, not smoking, and exercising on a daily basis. I believe it was his age that caused him erectile dysfunction.