NRSG366 Partnerships In Chronicity

Question

Read the Case Study-A 48 year old man with morbid obesity, poorly controlled diabetes type 2, sleep apnoea and obesity ventilation syndrome

Multiple factors influence the care of patients with chronic conditions. As a Primary Heath Care nurse, it is important that care given is prioritised based on clinical and patient needs. Prioritisation of the patient needs for care is integral to daily nursing practice. This requires integrating and collaborating different aspects of patient needs in order to maximise care activities and the effectiveness of nursing interventions. This case study is designed to demonstrate the integration of various principles of managing care of patients with chronic conditions. You will be expected to analyse the case scenario, identify the care needs and from the list of identified needs discuss two complex care priorities.

Answer

Care Plan for Chronic Disorder

Introduction

Chronic diseases are influenced by multiples different factors, all of which should be addressed, while planning care services for a patient with chronic disease, because all these factors are interrelated with each other. As a primary health care nurse, thus, it is crucial to prioritise actual clinical and patient’s needs, based on patient’s past history as well as current situation. Prioritizing the patient’s needs for care should be collaborative and integral in respect to maximize the effectiveness of nursing interventions. In this assignment, the key focus is analysis of the case of a 48 years old obese patient and demonstrating his care priorities and recommended interventions.

Analysis of the case scenario

Considering patient situation analysis

In the case scenario, the patient is Michael Anderson, who is 48 years old, suffering from morbid obesity and type 2 diabetes. The key issue for his admission to the medical ward is the poorly controlled diabetes, mainly as a result of negligence of the situation along with obesity ventilation syndrome and sleep apnoea. Key symptoms presented by the patient are shakiness, diaphoresis, increased hunger, high BGL level and breathing difficulties during sleep. It has been reviewed that a he was recommended to adhere to low energy, high protein diet for weight management; however, he did not show any interest in losing weight. From medical history, his BP has also found to be high, enhancing the risk of other disease. On the other hand, from his social history, it is revealed that he lost his job, since then he began to put on weight significantly. Being obese, he also face difficulties in finding a job, which further made him unsocial, which is a key issue worsening his health status.

Identifying the care needs

Collect cues

Michael’s case study revealed that the key health issue of Michael is obesity; currently he is severely obese, as his current BMI is 57.09, 165 kg weight. In addition to this, he is also suffering from hypertension, BP, 180/92. Others vital signs are HR 102, RR 23 and SPO2 95 % at RT. One notable fact in Michael’s case is his least effort or adherence with previous care plans regarding weight management. He is currently admitted to medical ward, with symptoms of shakiness, diaphoresis, increased hunger, high BGL levels and breathing difficulties during sleep. His past medical history also revealed gastro oesophageal disease reflux disease and depression. Since he lost his job, he gained weight and became isolated, i.e. from 95 kg to 165 kg. He feels embarrassed to go out, due to his size. He lives alone, his family rarely visit him. Currently he is feeling difficulties in performing ADLs.

Process information

To identify appropriate care services for Michael, it is important to identify his care needs and prioritize the vital aspects in his medical status, based on which, the care plan would be made. Here, from the case study, it has been revealed that he is current living with severe obesity along with hypertension, which are interrelated and lead to other severe diseases including cardiovascular issues (Gulanick & Myers, 2013). He was diagnosed with type 2 diabetes 9 years ago; there is a significant association within these three health issues. However, he shown no significant initiative to reduce his weight (Gordon, 2014). His other symptoms, i.e. sleep apnoea, On the other hand, it has been revealed that after losing his job, due to health status, he didn’t find another job, he is divorcee and his children rarely visit him. All these factors contributed to his loneliness and social isolation, gaining more weight made him to feel embarrassed, while going out (Sullivan et al., 2013). Analyzing these factors, it can be interpreted that social isolation is the key reason behind his depression. Therefore, two main concerns of Michael, i.e. obesity and isolation are interrelated. He is current on medication for controlling hypertension, pain and diabetes.

Discussion of complex care priorities

Identifying the problem

Reviewing and analyzing Michael’s case, some key problems has been identified, which are needed to be addressed, while planning care services for Michael. In this context, the first key problem identified for Michael is poor management of weight, i.e. obesity, which is linked with type 2 diabetes and hypertension. The second key problem identified for Michael is his social isolation, which is due to unemployment and led to symptoms of depression. This issue has not been addressed in past health care practices provided to Michael. Both of the problems, if controlled, the other issues including sleep apnoea, gastrointestinal problems, reduced self image would be eliminated at the same time (Taylor et al., 2015).

Establishing goals

It is important to make goals according to the identified problem, for meeting the most expected outcomes through the development of an effective care plan. The goals for Michael are as follows:

For 1^st prioritized problem:

Health promotion for weight management and diet control
Motivation for physical activity

For 2^nd prioritized problem

Community support for depression reduction
Socialization, self management and occupational therapy

Undertaking action

Goals	Actions
Health promotion for weight management and diet control	A health promotional session would be arranged for Michael to engage promotes his awareness regarding his health status. It would help him to understand the importance of weight management for a severely obese patient (Roth, 2015). In addition, the health promotion would also help to promote his willingness to adhere with his physical activities and diet plan, as recommended by his GP and dietician. It is clear that lack of awareness is the key reason for his non-compliance with the previous care plans and poor management, with a supportive relationship through the health promotion sessions, he would be willing to adhere with the management procedure (Martin-Rodriguez et al., 2015)
Motivation for physical activity	Motivation is a key strategy to make patient feel comfortable in therapeutic practices. Physical activity is the most important goal for Michael to reduce the chance of co-morbidity. Along with the health promotional session, a physical therapist would be appointed to make a strict 6 months physical exercise program for Michael (Pratt & Brody, 2014). Throughout the session, a strong therapeutic relationship should be built up with Michael for motivating him towards his goals. In addition to the aerobic exercise, some conventional methods for relaxation would also be included in his regular activity plan such as yoga and meditation.
Community support for depression reduction	Community and social supports are needed for Michael’s well being, as obesity has significantly increased his stress, leading to depression. Cognitive behavioural therapy has been recommended as one best way to reduce depression symptoms, thus, integration of CBT in Michael’s care plan would be beneficial for his well being and reduction of depression and stress related symptoms. In the CBT sessions, he would be motivated with positive relationship establishment, showing empathy and support and assisting him to adopt the coping mechanisms for living with obesity and type 2 diabetes (Swift et al., 2014). In addition to CBT, he would be recommended to include relaxation techniques, yoga, meditation and acupuncture to reduce stress.
Socialization, self-management and occupational therapy	Michael lives alone and he has an impaired self-image, which are the reasons his social isolation. Thus, initially, community support programs needed to be arranged for him, where through counselling, empathy and support, his self image would be re-constructed with re-orientation of his negative thoughts related to his self-image. He would be motivated to take part in social programs, for instance, referrals for obesity club and other social programs can be provided to him for making him social, meet different people and build up his self image again (Weber & Kelley, 2013). Modified self-image would motivate him to regain his self management skills and complete his ALDs. In addition, social support will be provided to find a suitable job for him, which will enhance his socialization and reduce depression.

Evaluation

Michael needs significant support to meet his therapeutic as well as personal life goals. Thus, the goals for the care plan have been set by prioritizing his key problems and support required by him. For instance, each goal is specific for a particular domain of well being; measurable through ongoing progress in Michael’s health improvement, weight reduction and improved self image; attainable through collaborative activities among the health professionals and allied health care workers, including dietician, physical therapist and social and community service workers; reliable as it would lead to a holistic improvement and well being of Michael; and time-specific, as these goals would be achieved within a period (Zinman et al., 2015).

Reflection

While dealing with the case of Michael, as a responsible primary health care nurse, I have revealed that there is a need for prioritizing patient’s key care needs for avoiding kinds of medical or ethical issues as well as for ensuring the best possible health outcomes of the patient. Being a primary health care nurse, I need to show empathy, dignity and respect, while communicating with the patient like Michael, who is living with a cormorbid chronic disease. Finally, I have revealed that motivation and support are the key to a holistic and patient-oriented care approach, which can influence a patient to adhere to the care approaches, thereby maximizing the therapeutic effects. Finally, I have revealed that partnership is a key to ensure the best heath care service provision through effective communication.

Conclusion

In this assignment, the key focus was to analyze the case of severely obese patients, who is suffering from several others problems. Identifying the key problems and prioritizing the problems to set appropriate goals for care intervention has been discussed here, as key nursing activities.

Reference List

Gordon, M. (2014). Manual of nursing diagnosis. Jones & Bartlett Publishers.

Gulanick, M., & Myers, J. L. (2013). Nursing care plans: nursing diagnosis and intervention. Elsevier Health Sciences.

Martin-Rodriguez, E., Guillen-Grima, F., Martí, A., & Brugos-Larumbe, A. (2015). Comorbidity associated with obesity in a large population: The APNA study. Obesity research & clinical practice, 9(5), 435-447.

Pratt, L. A., & Brody, D. J. (2014). Depression and obesity in the US adult household population, 2005–2010. Women, 20, 39.

Roth, C. L. (2015). Hypothalamic obesity in craniopharyngioma patients: disturbed energy homeostasis related to extent of hypothalamic damage and Its implication for obesity intervention. Journal of clinical medicine, 4(9), 1774-1797.

Sullivan, M. D., Katon, W. J., Lovato, L. C., Miller, M. E., Murray, A. M., Horowitz, K. R., … & Johnson, J. (2013). Association of depression with accelerated cognitive decline among patients with type 2 diabetes in the ACCORD-MIND trial. JAMA psychiatry, 70(10), 1041-1047.

Swift, D. L., Johannsen, N. M., Lavie, C. J., Earnest, C. P., & Church, T. S. (2014). The role of exercise and physical activity in weight loss and maintenance. Progress in cardiovascular diseases, 56(4), 441-447.

Taylor, R. W., Cox, A., Knight, L., Brown, D. A., Meredith-Jones, K., Haszard, J. J., … & Williams, S. M. (2015). A tailored family-based obesity intervention: a randomized trial. Pediatrics, 136(2), 281-289.

Weber, J. R., & Kelley, J. H. (2013). Health assessment in nursing. Lippincott Williams & Wilkins.

Zinman, B., Wanner, C., Lachin, J. M., Fitchett, D., Bluhmki, E., Hantel, S., … & Broedl, U. C. (2015). Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. New England Journal of Medicine, 373(22), 2117-2128.

Bibliography

Marmorstein, N. R., Iacono, W. G., & Legrand, L. (2014). Obesity and depression in adolescence and beyond: reciprocal risks. International journal of obesity, 38(7), 906-911.

Papadavid, E., Vlami, K., Dalamaga, M., Giatrakou, S., Theodoropoulos, K., Gyftopoulos, S., … & Rigopoulos, D. (2013). Sleep apnea as a comorbidity in obese psoriasis patients: a cross?sectional study. Do psoriasis characteristics and metabolic parameters play a role?. Journal of the European Academy of Dermatology and Venereology, 27(7), 820-826.

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2016). Fundamentals of nursing. Elsevier Health Sciences.

Wadden, T. A., Volger, S., Sarwer, D. B., Vetter, M. L., Tsai, A. G., Berkowitz, R. I., … & Chittams, J. (2011). A two-year randomized trial of obesity treatment in primary care practice. New England Journal of Medicine, 365(21), 1969-1979.

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