Introduction
The purpose of the educational program is the provision of secondary intervention for the female adolescent of 14 years old with congenital vascular dysplasia of a lower limb (Klippel-Trenaunay syndrome). The patient complains about the progressive swelling of the right lower limb. The talocrural area is increased in volume. The skin is hyperemic (persistent pigmentation) on the anterolateral surface of the tibia, and the diffuse increase in the subcutaneous venous network is observed on the lower leg and foot.
The patient noticed the increase in the leg volume and the occurrence of the malformed veins about nine years ago. She addressed the physicians and was exposed to conservative treatment. Recently, swelling and pigmentation increased. The patient experiences pains and discomfort throughout the right lower limb and loins. The girl doesn’t have the history of any past illnesses, and she is not burdened by heredity. The health condition is satisfactory.
It is expected that the educational program and intervention will help to reduce the influence of negative factors provoking the adverse development of the disorder. The factors are related to the lifestyle as a whole and the specific activities aimed at the decrease of disorder symptoms and alleviation of pain.
Work Site Description
The worksite is the medical center specialized in surgical treatment. The hospital has the department of pediatric and adolescent surgery, and the department of vascular and endovascular surgery as well (Department of Surgery, 2016). The staff group consists of highly professional doctors and assistants. Moreover, the medical site participates in scientific and technological development. There is the research department where the professional scientists in the field of medicine work on an everyday basis. Thus, the surgeons, physicians, and the nursing staff have access to hi-tech medical technologies that help them to provide high-quality treatment for the patients. Although the site is located in Miami, it receives the patients from other regions as well, both adults and children characterized by the different levels of disorder severity.
Literature Review
The dysplasias are the malformations of vascular development that become clinically manifested in childhood or adolescence. The malformations are associated with the severe hemodynamic impairments of the affected limb causing an early disability of patients.
Klippel-Trenaunay syndrome is one of the forms of the congenital angiodysplasia of lower limbs which implies the partial or total obstruction of the main veins (usually the popliteal or femoral) (Forbes, Walwyn, Rao, Ellis, & Lee, 2013, p. 254). According to the statistical data, the syndrome is reported only in 2 to 5 cases per 100.000 births (Suman, Sinha, Kumari, Sengupta, & Gautam, 2015, p. 5981). The most common causes of deep vein block are the congenital strangulation of veins by fibrous strands and aberrant arterial branches, compression of the popliteal vein by atypically located muscles stretching from the internal femoral condyle to the outer edge of the tibia (Jellouli & Dafiri, 2014, p. 71). It also can be caused by the congenital absence (aplasia) or underdevelopment (hypoplasia) of deep veins. And the less common cause of the main veins’ block may be the phlebectasias representing the cavities with multiple partitions that prevent venous outflow.
In Klippel-Trenaunay syndrome, the blood flow is performed through the venous collaterals that were not subjected to the reverse development in the embryonic period (Suman et al., 2015, p. 5981). However, this mechanism of the venous outflow does not eliminate the regional venous hypertension, and, as a result, the blood from the deep venous system rushes into the subcutaneous venous network. The increased pressure in the venous departments of the microvasculature leads to the disclosure of arterial-venular anastomoses, and it impairs the blood flow in the terminal bloodstream. As a result, the severe hypoxia, trophic transformations in tissues, edema, and the lymphocytosis of the affected limb may develop.
Educational Plan
- Provision of theoretic information related to Klippel-Trenaunay syndrome’s causes and developmental outcomes.
- Provision of information about the lifestyle peculiarities that affect disorder development both positively and negatively: physical activity, habits, etc.
- Specific recommendations for the alleviation of symptoms, such as compression hosiery and pharmacological remedies (Detralex).
- Physiotherapeutic intervention and education.
The best results in the patient’s disorder treatment can be achieved merely with the surgery. However, the intervention and education aimed at the adoption of good habits of healthy physical activities and development of intentions for patient’s self-care and preservation will help to attain sustainable positive outcomes and decrease the pace of disorder evolving. It is observed that the educational program that lasts for eight weeks may be considered effective in terms of patients’ encouragement and adoption of self-management techniques (John et al., 2011, p. 123). In this time-frame, the patient will learn to practice the behavior changes, and it will be possible to evaluate the efficiency of the program design and make the necessary corrections.
According to the patient education principles, the lack of information about the healthy lifestyle, the promotion of the particular modes of life in mass media, as well as the lack of awareness and the low culture of self-preservation, provoke the deterioration of individuals’ health. It is considered that the Theory of Planned Behavior (TPB) is the most effective in the patients’ education (John et al., 2011, p. 125). The theory states that the individual’s behavioral pattern is based on his/her intentions that are formed under the influence of the accepted norms, values, and beliefs (Su et al., 2015). As many other behavioral theories, TPB regards the social influence as the critical factor affecting human behavior and decisions. “The recognition and management of psychological antecedents and behavioral responses” in medical practice can improve the effectiveness of treatment procedures and provoke positive outcomes (Su et al., 2015, p. 44). Therefore, the integration of the TPB principles can be beneficial in the improvement of physicians’ performance and patients’ responses.
References
Department of Surgery. (2016). Web.
Forbes, N., Walwyn, M., Rao, G., Ellis, D., & Lee, M. G. (2013). Klippel-Trenaunay syndrome. The West Indian Medical Journal, 62(3), 254-256.
Jellouli, O., & Dafiri, R. (2015). Syndrome de Klippel-Trenaunay associé à une hémimégalencéphalie. Archives De Pédiatrie, 22(1), 71-74.
John, H., Hale, E. D., Bennett, P., Treharne, G. J., Carroll, D., & Kitas, G. D. (2011). Translating patient education theory into practice: Developing material to address the cardiovascular education needs of people with rheumatoid arthritis. Patient Education and Counseling, 84(1), 123-127.
Su, X., Li, L., Griffiths, S., Gao, Y., Lau, J., Mo, P. Smoking behaviors and intentions among adolescents in rural China: The application of the Theory of Planned Behavior and the role of social influence. Addictive Behaviors, 48, 44-51.
Suman, S., Sinha, A., Kumari, S., Sengupta, B., & Gautam, S. Klippel Trenaunay syndrome: A case report. Journal of Evolution of Medical and Dental Sciences, 4(34), 5981-5985.