NSG2NCI-Nursing Case Study On LIZ

Disorder that Liz might develop:

The BMI of the patient is found to be 32. This value of BMI shows that the patient falls in the category of the obesity. She undertakes exercises with her dog but only for 15 minutes that are not enough physical activity that is required for maintaining a healthy body weight. Researchers are of the opinion that patients suffering from obesity should have at least of 30 minutes of brisk walking which is important to maintain their body weight. The patient is also suffering from high level of cholesterol in the blood as well as from hypertension. The patient stated that all her family members suffer from issues of high cholesterol.  Therefore, it can be stated that she might develop the chronic disorder of hypercholesterolemia. Therefore, the patient has the risk of development of Hypercholesterolemia that might in turn lead to another chronic condition making the patient suffer from heart disorders mainly coronary heart disorders.

Hypercholesterolemia is one of the conditions that is characterized by very high levels of cholesterol in the blood. Researchers are of the opinion that cholesterol is a waxy, fat like substance that is produced by the body (Marwick et al., 2015). This is also obtained from the foods that come from the animals like that of eggs, meat, poultry as well as dairy products and fish. The body mainly needs this substance for building up of the cell membranes and helps to make certain important hormones. It also helps in the production of compounds that help in the digestion of fats. Too much of cholesterol helps in increasing the risk of the person in development of the heart disorders (Kawaahiri et al., 2014). 

People with high levels of cholesterols like that of the patient in the case study also have the risk of developing a form of heart disorder called the coronary artery disorders. This type of condition is seen to occur when excessive cholesterol in the blood stream is seen to be deposited in the walls of the blood vessels of the individuals particularly in the arteries that are seen to supply the blood to the heart called the coronary arteries (Upadhyay, 2015). This form of abnormal build up of cholesterol is seen to form clump like structures that are called plaques. These plaques are responsible for narrowing as well as hardening of the arterial walls. When the clumps are seen to grown bigger, they are seen to clog the arteries. This causes restriction of the flow of the heart (D’Erasma et al., 2018). This form of buildup of the plaque in the coronary arteries is one of the main causes of the form of chest pain called angina. It also increases the risk of developing heart attack situation. Therefore, the patient named Liz is at a high risk for developing coronary arterial disorders and she needs to undertake support from different healthcare services that would help in prevention of such situations.

Services in Australia:

Liz has the chance of developing cardiovascular disorders with the main reason of suffering from the chronic symptoms of Hypercholesterolemia. Therefore, the services that she would be mainly needing is the primary healthcare services. These forms of services are mainly focused on the early detection and intervention as well as effective management of the risk factors of the early disorders. This would help in the early promotion of the health of the heart thereby playing an important role in the supporting of the recovery and ongoing chronic disease management (Woodruffe et al., 2015). These services mainly help in intervening in reduction of the exposure of the patient to different risk factors for developing the disorder like that of smoking, increased cholesterol, excessive habits of drinking, obesity and many others. The primary healthcare professionals should first try to realize the risk factors of the patient that is resulting in the increasing chances of the patient being affected with the cardiovascular disorders.

Researchers are of the opinion that general practitioners are the first point of contact who would help the patients identified with the cardiovascular disorders to provide referral to the different types of appropriate specialist services and ongoing management of the disorders (Harris et al., 2015). Besides, the general practitioners, the primary healthcare nurses would be also playing important roles. The primary healthcare nurses have huge roles in educating the patients and developing their health literacy. In the case study, the patient is seen to believe that her symptoms would have gone away easily and that she did not require any care (Patel et al., 2016). This shows that she is not well developed in her knowledge of health. Therefore, there is high chance that she would not know ways to care about how to take her own care of the heart disorders. The nursing professionals would educate Liz about the management of the physical exercises as well as the diet interventions required and would teach her how these management styles would help her to prevent heart disorders. 

Community healthcare services are another form of healthcare services that are specialized in giving personalized care for people living in the communities. Community nursing can be determined as the nursing that occurs outside the acute care hospitals either in the homes or in the community health services (Mossialos et al., 2015). In such settings, community nurses like nurse educators are also present along with public health nurses and care home nurses.

These nurses would be helping her to develop knowledge on the steps she would need to take prevent such hear disorders. They might be educating the patient about controlling the blood pressure and would also routinely check her blood pressure weekly or daily if Liz seeks support from them. Nurse educators would teach her about the ways to mange her cholesterol levels and triglyceride levels under control (Coventry et al., 2015). She might be advised to consult with dieticians of the community services to be more confident with her diet. She should be taught about the physical activities she needs to take for strengthening of the heart and improving the circulation. They should also guide limiting alcohol and issue in smoking.

Occupational therapist or counselors might also help her to manage her stress and anxiety with the help of mindfulness therapy and similar others. Such services are also available in home or she might visit the community centers for getting such services. She is quite upset about not being able to drive, as this was her way of earning money. Therefore, occupational therapists can also be assigned to her who would be helping her to gradually start living better quality life by helping her to learn and be competent in the activities of daily living (Coultier et al., 2015). Social support services are also available in the nation. Such social support workers might be visiting her home and provide her support in different activities like maintaining proper diet, helping her to exercise and maintain her activities of daily living, manage her stress and anxiety and others. This would also help to prevent cardiovascular disorders. 

Reflection on the above services and identification of the gaps:

The present day researchers are of the opinion that healthcare professionals need to provide holistic care to the patients. The care would be such that it would help to meet the psychological, physical, mental, emotional as well as spiritual needs of the patient. Studies have criticized the biomedical model of care. Bio-psycho-social model of care need to be provided by the every healthcare service to the patients so that the care is not only comprehensive but ensures the meeting of all need and requirements of the patients helping them to live better quality and satisfactory life (Gibson et al., 2015).

Services provided the primary healthcare nursed and general practitioners is indeed helpful as they would be helping in identification of the risks associated with the health condition of the patient and thereby educate her about the disorders she might develop and refer her to expert services. Community nurses would have a high rile in educating the patient about the interventions that she need to take to reduce the risks of developing heart disorders. Occupational therapists would help her to get back in normal life by helping her to undertake therapies to manage her stress and conduct activities of daily life (Zwar et al., 2017). On the other hand, social care workers would be helping het to mange her diet, understand activities, and do the different works of her household and others creating less pressure on her health after discharge. 

One of the most important benefits of community services and primary healthcare services in the nation in the present day is that they tend to look over not only the medical aspects but also the overall issues of the patient. It has been found that Liz is emotionally and mentally drained because she is concerned about the financial security and wants to join the employment as soon as possible. Therefore, the care she would get, would be also helping to support her socially and mentally making her feel that her feel that her concerns are handled with care. The healthcare professionals of these services believe in developing therapeutic relationship with patients and this would help Liz to a greater extent. Her concerns would be understood and accordingly care should be provided to her.

One gap that Liz might face is the cultural competency of the nurses. Through, healthcare system in the nation is trying to develop the cultural competency of professionals; it is not being able to entirely successful a reports of culturally incompetent care still are reported in cultural departments. She has come from java and the professionals might not be able to give her culturally competent care that aligns with Asian traditions, customs and preferences. This is the only gap that Liz might face in the nation healthcare service. 

References

Coulter, A., Entwistle, V. A., Eccles, A., Ryan, S., Shepperd, S., & Perera, R. (2015). Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database of Systematic Reviews. https://aura.abdn.ac.uk/bitstream/handle/2164/5609/CD010523.pdf?sequence=1

Coventry, P., Lovell, K., Dickens, C., Bower, P., Chew-Graham, C., McElvenny, D., … & Baguley, C. (2015). Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease. bmj, 350, h638. doi: https://doi.org/10.1136/bmj.h638

D’Erasmo, L., Minicocci, I., Nicolucci, A., Pintus, P., Van Lennep, J. E. R., Masana, L., … & Ascaso, J. F. (2018). Autosomal recessive hypercholesterolemia: long-term cardiovascular outcomes. Journal of the American College of Cardiology, 71(3), 279-288. DOI: 10.1016/j.jacc.2017.11.028

Gibson, O., Lisy, K., Davy, C., Aromataris, E., Kite, E., Lockwood, C., … & Brown, A. (2015). Enablers and barriers to the implementation of primary health care interventions for Indigenous people with chronic diseases: a systematic review. Implementation Science, 10(1), 71. https://doi.org/10.1186/s13012-015-0261-x

Harris, M. G., Hobbs, M. J., Burgess, P. M., Pirkis, J. E., Diminic, S., Siskind, D. J., … & Whiteford, H. A. (2015). Frequency and quality of mental health treatment for affective and anxiety disorders among Australian adults. The Medical Journal of Australia, 202(4), 185-189. doi: 10.5694/mja14.00297 

Kawashiri, M. A., Hayashi, K., Konno, T., Fujino, N., Ino, H., & Yamagishi, M. (2014). Current perspectives in genetic cardiovascular disorders: from basic to clinical aspects. Heart and vessels, 29(2), 129-141. https://doi.org/10.1007/s00380-013-0391-5

Marwijk, H. W., Kooy, K. G., Stehouwer, C. D., Beekman, A. T., & Hout, H. P. (2015). Depression increases the onset of cardiovascular disease over and above other determinants in older primary care patients, a cohort study. BMC cardiovascular disorders, 15(1), 40. https://doi.org/10.1186/s12872-015-0036-y

Mossialos, E., Courtin, E., Naci, H., Benrimoj, S., Bouvy, M., Farris, K., … & Sketris, I. (2015). From “retailers” to health care providers: transforming the role of community pharmacists in chronic disease management. Health Policy, 119(5), 628-639. https://doi.org/10.1016/j.healthpol.2015.02.007

Patel, V., Chisholm, D., Parikh, R., Charlson, F. J., Degenhardt, L., Dua, T., … & Lund, C. (2016). Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities. The Lancet, 387(10028), 1672-1685. https://doi.org/10.1016/S0140-6736(15)00390-6

Upadhyay, R. K. (2015). Emerging risk biomarkers in cardiovascular diseases and disorders. Journal of lipids, 2015. https://dx.doi.org/10.1155/2015/971453

Woodruffe, S., Neubeck, L., Clark, R. A., Gray, K., Ferry, C., Finan, J., … & Briffa, T. G. (2015). Australian Cardiovascular Health and Rehabilitation Association (ACRA) core components of cardiovascular disease secondary prevention and cardiac rehabilitation 2014. Heart, Lung and Circulation, 24(5), 430-441. https://doi.org/10.1016/j.hlc.2014.12.008

Zwar, N., Harris, M., Griffiths, R., Roland, M., Dennis, S., Powell Davies, G., & Hasan, I. (2017). A systematic review of chronic disease management. https://openresearch-repository.anu.edu.au/bitstream/1885/119226/3/final_25_zwar_pdf_85791.pdf