Question

Mr.Smith 74 year old blind due to Choroideremia a genetic rare disease, hypertension and diabetes is under control now. Mr. smith referred to a surgeon for prostatectomy. During his clinic appointment with his surgeon, Surgeon was frustrated with Mr. Smith. The surgeon usually uses visual aids to explain to his patients the procedure to be preformed but could not rely on them with Mr. Smith. He tried to explain to Mr. Smith the procedure and the potential complications if his cancer spread. When Mr. Smith asked further questions on the procedure, the surgeon became increasingly frustrated with his inability to communicate. One question Mr. Smith wanted a clear answer on was whether the procedure caused sexual dysfunction. He was not able to get a clear answer from his surgeon.

Mr. Smith was scheduled for a follow up visit in 1 month and when he returned, a surgical Nurse Practitioner, saw him. She (Nurse Practitioner) read his file and noted the social and medical history as well as the surgeon's inability to connect with Mr. Smith.

What can a Surgical Nurse Practitioner help connect with Mr. Smith during this visit. How would Surgical Nurse Practitioner should approach Mr. Smith and explain the procedure, risks, and post-op care?

Answer 1

Choroideremia

It is a condition characterized by progressive vision loss that mainly affect males. The first symptom of this condition is night blindness which can occur in an early childhood.

Prostate Cancer

It is a malignant tumor of the prostate gland. It is an androgen dependent adenocarcinoma.

It can spread by three routes;

a) Direct extension

b) Lymph system

c) Blood stream

Prostectomy

The entire prostate gland, seminal vesicles & part of the bladder neck are removed. The entire prostate is removed because the cancer tend to be in many different locations with the gland.

In the given scenario;

The surgeon is failed to communicate clearly to the patient about the procedure of the surgery & complications ( if the cancer spreads to other areas ).

It is mainly because the patient is blind & the surgeon was having the habit of educating the client's using visual aids. So for a blind client he didn't find a way to communicate clearly.

So because of that Mr.Smith still have a doubt that, wether the procedure cause sexual dysfunction.The surgical nurse practitioner understood this while the patient came for the follow up.

A nurse practitioner can make use of the following methods to educate Mr. Smith

1 ) Vision substitution techniques

The nurse can make use of the Braille Books / Flash Cards while educating a blind patient.

Audio Aids can also be used for more understanding & to support the teaching session.

Communication Techniques

Many people are uncomfortable around a blind or partially blind because they are not sure what behaviour are appropriate.

Sensitivity to the patients feelings without being overly solicitous or stifling the patients independence is vital in creating a therapeutic nursing prescence.

a )Introducing people who approached the client is essential

b )The nurse should always communicate in a normal conversational tone & manner with the patient

c ) She should address the patient & not the family member accompanied with him

d ) Using vision substitution techniques she can explain clearly about the surgical procedures & complications, risk & post operative care ( nurse should include bladder irritation, catheter, complications such as hemorrhage, bladder spasm, etc, & Kegel exercises , dietary interventions)

e ) Also mention about the sexual function following radical prostatectomy (i.e if the Mr. Smith is desired to retain sexual dysfunction Nerve sparing procedure will be a choice. Most men undergoing prostectomy usually prefer it if they are in the early stage & cancer confined only to prostate gland )

f ) Saying goodbye on leaving.