QUESTION
W8
W8. ----2 pages---
SOAP format
Case:
A 67-year-old man is seen in the office with complaints of erectile dysfunction (ED). He says he has not had any desire for sex, and he has difficulty maintaining an erection.
Then:
Discuss what questions you would ask the patient, what physical exam elements you would include, what further testing you would want to have performed, differential and working diagnosis, treatment plan, including inclusion of complementary and OTC therapy, referrals and other team members needed to complete patient care.
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| Subject |
Nursing |
Pages | 3 | Style | APA |
|---|
Answer
Erectile Dysfunction (ED)
Subjective
Chief Complaints: Questions
- How long have the symptoms lasted and do they begin suddenly or gradually?
- Do you wake up with an erection and do you experience the same in the evenings?
- How firm are the erections that you experience once in a while, and does it make penetration difficult?
- How consistent is the issue, and how difficult is penetration on a scale of 10?
- Does the dysfunction vary from once circumstance to another, or is the issue persistent throughout all sexual encounters?
- Do you think the erectile dysfunction issue is triggered by another sexual dysfunction?
- What is the impact of the issue of your sexual satisfaction, sexual confidence, or your relationship with your partner?
Objective
Physical Exam Elements
A physical exam is essential for all patients with erectile dysfunction, and more emphasis will be adjusted on vascular, genitourinary, and neurological systems (Donnelly et al., 2019). Thus, the physical examination will entail an assessment of sensation, blood pressure (BP), size and texture of the testes, peripheral pulses, the status of genitalia and prostrate, presence of epididymis and vas deferens, and evaluation of likely penile abnormalities such as Peyronie plaques and hypospadias (Donnelly et al., 2019). Further testing that I would want to have performed includes complete blood count, urine test, fasting blood glucose test, lipid profile, prolactin level test, serum creatinine test, and morning serum testosterone test determining the cause of erectile dysfunction issue.
Assessment
Differential and Working Diagnosis
For many patients, differential diagnosis is best made through a physical exam, taking a patient's medical history, and answering questions to assess the condition's causes. It is the best approach to help doctors diagnose dysfunction and recommend the best treatment approach (Gazzaruso et al., 2016). If the patient has existing health conditions or the doctor gets to suspect the possibility of an underlying condition, it is essential to recommend further tests or make consultations with a specialist for better diagnosis (Donnelly et al., 2019). From the case, the working diagnosis is that the patient has erectile dysfunction following his incapacity to get and maintain a firm erection for sexual intercourse. He also suffers from lower sexual drive, soft erections, and anxiety issues that cause such erection issues. The most common physical causes of erectile dysfunction include blood pressure issues, blood circulation, heart diseases, high cholesterol levels, atherosclerosis, and high blood pressure (Donnelly et al., 2019). The patient is 67 years old, which explains why these underlying conditions can be the main cause of his erectile dysfunction issue.
Plan
The Treatment Plan, including the Inclusion of Complementary and OTC Therapy,
Depending on the severity of ER and underlying health status, doctors might suggest diverse treatment options. Specifically, oral medications have been successful in treating ER in men, and the doctor should recommend Avanafil (Stendra), Sildenafil (Viagra), Vardenafil (Levitra, Staxyn), and Tadalafil (Adcira, Cialis) (Donnelly et al., 2019). Other OTC supplements include Dehydroepiandrosterone (DHEA), Viasil, or Ginseng. The patient can work closely with the healthcare team, such as nurses, doctors, therapists, and pharmacists, to ensure the condition is prevented. First, the most effective strategy is making healthy lifestyle choices and managing any existing health conditions. For instance, the doctor should work with this elderly patient to manage diabetes, heart disease, and other significant chronic health conditions. The doctor should assign the patient for regular checkups, medical screening tests, and exercise regularly (Gazzaruso et al., 2016). The patient can work closely with therapists in rehabilitation centers to help him quit alcohol or use drugs (depending on whether he indulges), therapeutic stress management to help manage depression, and any other significant mental health concernstraining, equipment, and training to conduct and close up an arson investigation successfully.
References
Donnelly, D. W., Kearney, T., McCaughan, E., Downing, A., Weller, D., Glaser, A. W., & Gavin, A. (2019). Treatment for erectile dysfunction among older men in Northern Ireland. International Journal of Clinical Practice, 73(1), e13259.
Gazzaruso, C., Coppola, A., Pujia, A., Falcone, C., Collaviti, S., Fodaro, M., ... & Luzi, L. (2016). Erectile dysfunction as a predictor of asymptomatic coronary artery disease in elderly men with type 2 diabetes. Journal of geriatric cardiology: JGC, 13(6), 552.