問題導向學習教案設計表(範例)
學習主題(Topic)：Urinary Incontinence
課程目的(Curricular Goals)
To understand the causes and treatment options for urinary incontinence in female patients
具體學習目標(Learning Objectives)
1. Identify the anatomy of the bladder, ureters, and urethra and describe their relationships to other pelvic
organs
2. Describe the innervation of the bladder
3. Describe the role of collagen in the pathogenesis of incontinence
4. List and describe the anatomic, physiologic, and pathologic causes of incontinence
5. Describe the differences between frequency, urgency, dysuria, and urge and stress incontinence
6. Identify the age-specific causes of urinary incontinence
7. Take a sensitive history about incontinence
8. Recognize how incontinence affects the ability to perform activities of daily living
個案病史
Ms. Emily Johnson is a 38-year-old patient [6] of yours who has come for her yearly well-check
appointment. Ms. Johnson is married and has two children, ages 14 and 10. Both pregnancies were normal,
with vaginal deliveries. She is an elementary school teacher in a suburban school district. Despite trying to
quit smoking on several occasions, she has not been successful and still smokes about 15 cigarettes a day.
Upon review of her interval history, she indicates that she had been using a mini-pad because of urine
dribbling [5]. Further inquiry indicates that she has stress and urge incontinence and that it has been
increasing in the past year [5]. She says that she is quite embarrassed and is afraid that she will not have the
time to go to the bathroom while teaching and will have an “accident”[8]. In discussion, she tells you that
she keeps an extra set of clothing in her classroom [8]. Upon questioning, she informs you that she has had
no episode of fecal incontinence [7].
Menstrual history: LMP two weeks ago, periods are regular approximately every 28-30 days, uneventful
with a few clots.
理學檢查 [4]
General: 160 cm, 75kg, BP 140/80, P 84, RR 16
HEENT: normal
Neck: supple, no goiter
Chest: clear breathing sound
Breast: no mass palpable, no axillary adenopathy
Heart: RHB, no murmur or gallop
Abdomen: good bowel sound, soft, non-tender, no organomegaly
Back: no scoliosis, nor costovertebral tenderness
Pelvic: vagina: mucus discharge, urine leakage with cough
cervix: no erosion
uterus: antiverted, no mass palpable
Rectal: external and internal hemorroid
Extremities: no clubbing cyanosis or edema
After you finish the exam, Ms. Johnson asks you about possible choices of birth control. She would
like to consider what options are available to her and her husband because, as she tells you, “Using my
diaphram is so messy, and I don't want to get pregnant.” You order the following laboratory studies,
including blood glucose, due to Ms. Johnson's family history of type II diabetes.
實驗室檢查 [4]
Urinalysis: within normal limits
T-chol, LDL, HDL are within normal limits
Homocysteine levels within normal limits
Mammogram: normal
Pap smear: normal
Stool: no occult blood
After you review the laboratory results, you contact Ms. Johnson. You assure her that all the tests were
normal. You have a discussion with her about the need to stop smoking and arrange for her to be oriented
about smoking cessation through your office's health education programs. You refer Ms. Johnson to an
urologist specializing in pelvic floor disorders to further evaluate her urinary incontinence [1,2,3,4].
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