Nursing care of a patient with erectile dysfunction after myocardial infarction – case study

INTRODUCTION

Erectile dysfunction is one of the most common symptoms of sexual dysfunction in men affecting a decline in quality of life [1, 2]. According to the accepted definition, erectile dysfunction is associated with a persistent inability to achieve and/or maintain a penile erection sufficient for satisfactory sexual intercourse [3].
Worldwide epidemiological data highlight the incidence of erectile dysfunction in men after myocardial infarction. A study by Ruzić et al. highlights that up to 82% of men experience erectile dysfunction after an ischaemic heart attack [4]. According to data obtained in a study by Rinkūnienė et al. more than half of the respondents (62%) reported the presence of erectile dysfunction related to myocardial infarction [5]. The discrepancies in statistical data in scientific studies are due to the diversity of study sample selection, co-morbidities, and drug therapy used, affecting the occurrence of erectile dysfunction in men.
A study by Hodžić et al. showed a correlation between cardiovascular risk factors and the occurrence of erectile dysfunction in men. Risk factors such as obesity, diabetes, hypertension, dyslipidaemia, sedentary lifestyle, smoking, and the use of certain medications (β-blockers, diuretics, and statins) influence the occurrence of atherosclerosis and endothelial dysfunction in the arterial system of the heart and penile system [6].
Caring for patients after myocardial infarction requires a holistic approach by the multidisciplinary team. Correct prioritisation of needs, taking into account the intimate sphere, is crucial. Engaging in sexual activity by the patient should be considered as engaging in any other physical activity that improves the overall functional capacity of the body [7].
A fundamental task of health care professionals is health education. According to a study by Lunelli et al., only 4% of patients hospitalised for myocardial infarction received reliable information on the impact of myocardial infarction on sexual activity [8]. Effective health education can contribute to improved health and increased quality of life.
The aim of this paper is to provide an overview and knowledge of nursing care towards a patient with erectile dysfunction after myocardial infarction, using an individual case study.

MATERIAL AND METHODS

This study uses a qualitative research method – an individual case study, including a clinical description of the condition of a patient with erectile dysfunction after myocardial infarction. The aim was to analyse and assess the nursing problems present in depth.
Informed consent was obtained from the patient to participate in the study and relevant consent from the facility where the patient was hospitalised. The subject was informed of the anonymity of the study, which is used for research purposes only. The following research techniques were used:
• nursing interview,
• free and directed observation,
• analysis of medical records,
• physical examination.
The following research tools were used during the study:
• medical history,
• diagnostic test results,
• nursing interview questionnaire,
• individual patient care chart,
• International Intrasexual Evaluation Scale for Men (IIEF-5),
• Beck Depression Inventory (BDI).
Integrated care outcome measures according to the Comprehensive Hospital-Based Integrated Care Pathway (C-HOBIC) were also used in the patient case report [9]. The nursing process was based on the reference terminology of the International Council of Nurses (ICNP^®) [10]. Based on the research techniques and tools used, nursing diagnoses and nursing interventions were established with life and health prioritisation, and the ISO 18104:2023 standard [11]. The developed nursing process was implemented in patient care and an evaluation of the actions taken was carried out. The outcome of the evaluation was a nursing diagnosis referring to an improvement in the patient’s condition or a condition with no change. The nursing diagnoses adopted were detailed into sub-diagnoses. Six care plans were constructed using the ICNP^® dictionary in Polish, as well as a web-based tool provided on the International Council of Nurses website [12].

CASE REPORT

A patient, aged 59 years, initials W.D., was admitted to the cardiology sub-unit for selective coronary angiography with a primary diagnosis of ST-segment elevation myocardial infarction (STEMI) of the anterior wall in 2022. The patient’s admission was preceded by venous blood laboratory tests and monitoring of basic vital signs (blood pressure, pulse, saturation, body temperature) in the setting of the Hospital Emergency Department; the results are summarised in Table 1.
On admission to the ward, the patient’s general condition was described as good, with normal vital signs, conscious, allo- and autopsychically oriented, and no signs of sudden deterioration. The patient was classified in nursing care category II and placed in the patient room.
A nursing history was taken, and a peripheral intravenous line was inserted; the patient was prepared for the procedure. Empirical data obtained during the interview were as follows: Personal data: Initials W.D., age 59 years, male sex, married, secondary education, manual worker.
Medical situation: Status post myocardial infarction in 2022, with effective revascularisation of the anterior descending branch (DES Xience Pro 2.5x16), herniated nucleus pulposus at the level of the lumbar spine L4-L5.
Comorbidities: Ischaemic heart disease, first-degree hypertension, discopathy. Pharmacotherapy used: Acetylsalicylic acid (75 mg) 1 × 1, clopidogrel (75 mg) 1 × 2, ramipril (2.5 mg) 1 × 2, pantoprazole (20 mg) 1 × 1, tramadol (50 mg) 1 × 1.
Allergies: None.
Addictions: Occasional consumption of alcohol in small amounts.
Eating habits: Patient takes meals irregularly and makes numerous dietary errors, fluid intake unsystematic.
Sleep rhythm: The patient reports no problems falling asleep.
Physical activity: The patient is physically active, doing regular exercise twice a week of moderate intensity, such as walking, cycling.
Mental state: The patient’s mood is depressed, the patient fears for his or her health, shows tendencies towards depressive states. He scored 16 points according to the Beck Depression Inventory.
Patient’s and family’s knowledge of self-monitoring and self-care: The patient and his family have knowledge deficits related to the principles of correct self-monitoring, they lack the ability to correctly take blood pressure measurements and to adequately assess emerging symptoms of disease exacerbation.
The collected diagnostic data on the functioning of the different anatomical systems of the body are presented in Table 2.
During the interview, the patient paid particular attention to the deterioration of sexual function. He complained of problems with maintaining an erection and decreased libido. He emphasised the negative impact of sexual dysfunctions on well-being, self-esteem, and relationships with the partner. He asked for help and support.
After initial diagnosis of the patient’s condition, the patient was transported to the haemodynamics laboratory, where coronary angiography was performed using vascular access from the right radial artery. The examination revealed a good angiographic effect of the previous angioplasty of the anterior descending branch in the middle part. The patient returned to the ward without any complications.
During hospitalisation, detailed diagnosis of erectile dysfunction was performed. The ward doctor performed a Doppler ultrasound examination of the penis using intracavernous pharmacostimulation (papverine 40 mg injection) – arterial disorders were diagnosed. The following test results were obtained: peak-systolic velocity (PSV = 19.8 cm/s), end-diastolic velocity (EDV = 5 cm/s), and resistance index (RI = 2.96).
In addition, the patient was asked to complete the IIEF-5 scale. The patient obtained a result of 19 points, which indicates the occurrence of erectile dysfunction. Oral pharmacotherapy was initiated (phosphodiesterase type 5 inhibitors). Health education on lifestyle changes was provided and psychosexual therapy was offered.
The total hospitalisation time of the patient was 4 days, and the patient was discharged from the ward in good general condition. Medical and nursing recommendations were provided.

ICNP NURSING PROCESS

The assessment was based on the C-HOBIC scales, observation, documentation analysis, and the nursing interview conducted, creating a nursing process based on ICNP^®. The assessment of functional status (ADL Scale) is provided in Table 3.
The assessment of the functional status allowed one negative diagnosis to be singled out in Table 4.
Table 5 includes discharge readiness assessment – terminology for the acute care area.
Tables 6-10 provide further nursing diagnoses.

SUMMARY

Paying attention to men’s intimate lives during the therapeutic process is crucial because it has a major impact on quality of life and overall well-being. Ignoring this aspect can lead to negative consequences such as frustration, depression, lowered self-esteem, and relationship problems. Sexual functioning can be an important indicator of a man’s overall health, so it is worth observing and assessing this area during patient care. It is essential that healthcare professionals are prepared to talk about this topic of sexuality and support patients in addressing any problems.
The nursing actions taken in the present nursing process of a patient with erectile dysfunction after myocardial infarction contributed significantly to improving the patient’spatient’s health and quality of life. Collaborative therapy planning within the interdisciplinary team and the promotion of a healthy lifestyle were crucial to improving the patient’s condition. Using a variety of research tools and techniques and nursing terminology, it was possible to effectively diagnose, plan, and evaluate nursing interventions, which contributed to satisfactory results in the nursing process.
Nursing care of the patient with erectile dysfunction incorporates a holistic approach that addresses both physical and psychosocial aspects [13]. The essential elements of the nursing process include the following:
1. Patient education: Providing the necessary information about erectile dysfunction, identifying possible causes, potential treatments, and coping strategies.
2. Psychosocial assessment: Identifying the impact of erectile dysfunction on the patient’s life, interpersonal relationships, self-esteem, and quality of life levels.
3. Emotional support: Providing support to the patient, communicating options for coping with emotional tension, guilt, shame, or frustration.
4. Treatment planning: Working together with the interdisciplinary team, planning a treatment tailored to the patient’s preferences and abilities.
5. Promote a healthy lifestyle: Encourage the patient to lead a healthy lifestyle, follow dietary recommendations, be regularly physically active, and avoid risk factors for erectile dysfunction.

Disclosures

This research received no external funding.
Institutional review board statement: Not applicable.
The authors declare no conflict of interest.

References