NUR2101 Chronic Care Across The Lifespan A
Question:
Purpose:
Develop critical thinking and clinical reasoning skills in managing patients with chronic conditions.
To prepare students to effectively manage chronic care within various health care contexts.
To develop students abilities to provide relevant information to patients about their condition with consideration of the patients individual needs and context for example, health literacy, developmental stage, culture and existing knowledge.
Objectives :
Demonstrate an understanding of chronic illness across the lifespan and the wider impact on the individual, family, community including the needs of culturally diverse, disadvantaged, and vulnerable groups with chronic conditions.
Identify and examine the pathophysiological and pharmacological aspects of chronic disease management in alignment with the National Strategic Framework for Chronic Diseases.
Examine the psychosocial impacts of individual adjustment in living with a chronic disease Identify collaborative models for care and health promotion and Information strategies in alignment with the National Strategic Framework for Chronic Diseases.
Task Introduction:
You are provided with 4 case scenarios (located at end of this document) you only need to choose ONE (1) scenario to discuss in this assignment. In each of the scenarios the patient has both a chronic disease and a presenting condition, you may also identify other comorbidities which may be relevant to the patient.
Part A: Written Case Analysis Essay
In this essay you will analyse the case study you have chosen giving a brief description of the chronic condition and the presenting health issues for the person. This will give context to the patient Information resource you create in Part B.
Rationale for Part A: The case study analysis forms the background and research leading to the creation of a Patient Information Resource. Through this assessment students will demonstrate an understanding of chronic illness across the lifespan and the impact on the individual, family and community. Students will also have the opportunity to consider, through the assignment, the needs of culturally diverse, disadvantaged and vulnerable groups with chronic conditions.
What you need to include in your essay:
- Identify both the chronic disease and the presenting condition.
- Succinctly describe the pathophysiology, symptoms, anatomy and physiology associated with the chronic condition and the presenting issue.
- Provide a brief outline of the relevant diagnostic and ongoing tests (e.g. blood tests, vital signs, x-rays, physiotherapy), associated with the patient’s condition.
- Outline two (2) potential problems (complications) associated with the chronic disease.
- Briefly outline the developmental, cultural and health literacy considerations for the person in your case study. Developmental theorists have been identified in the modules on the StudyDesk, you are encouraged to use your recommended texts and library resources.
- Describe three (3) priorities of nursing management for the patient’s chronic and presenting condition.
These may include nursing management, and/ or pharmacological /non-pharmacological management and/ or self-management.
Task Part B – Patient Information Resource.
The patient Information resource, can be written in the style of a pamphlet or hand out, or alternately, a blog or website article for the patient and family/ carer in your case study, about the chronic condition being experienced. It will describe what the condition is, and the care and self-management required to ensure a healthy lifestyle is maintained. You must consider the developmental considerations, cultural needs and health literacy of the patient in your case scenario and produce a resource that would be appropriate for their needs. All of the information for your patient resource you should have already covered in the case analysis essay, this resource requires you to simplify it and explain it in plain language for your patient. This resource only requires you to focus on the chronic condition.
Case Scenarios, please choose one.
Case Scenario Topic 1:
A 6-year-old boy with Cystic Fibrosis who has recurrent chest infections, and newly diagnosed with type 1 diabetes
Adam (6 year old) boy was diagnosed with Cystic Fibrosis soon after birth. He has recently recovered from a chest infection and is refusing to attend prep, due to increased fatigue. He has just recovered from his 3rd chest infection in 9 months and was hospitalized for 2 weeks. He often refuses treatments such as his daily nebuliser and physio routine. Whilst in hospital he was diagnosed with Cystic fibrosis related diabetes and the family is now learning to manage his insulin regime.
Case Scenario Topic 2:
A 42-year-old Type 1 diabetic male who has had his forefoot amputated.
Manny has been recently sent home from hospital however, the wound has not healed and is still draining haemo-purulent exudate. He is finding it difficult to complete his activities of daily living. Manny tells you (the community nurse), in times of stress he often has erratic Blood Glucose control. He has been prescribed an antibiotic called Keflex 500mg every 6 hours.
Case Scenario Topic 3:
A 76-year-old female with COPD and R) sided heart failure.
Gladys is attending the GP clinic complaining of increased breathlessness, wheeze and swollen legs. She is finding it more difficult to mobilise and is short of breath on completing activities such as bathing and walking 15 meters to her letterbox. Gladys is anxious and worried and is not sure what the GP means by heart failure or how it will be treated. She lives alone and her sons live interstate. She expresses concern about what this means for her future and how she will be able to cope.
Case Scenario Topic 4:
45-year-old female nurse recently diagnosed with chronic pain from a back injury.
Raelene works in a rural hospital and has not been able to work for 4 months since she had a work place injury assisting a bariatric patient who had fallen. Prior to this Raelene had been getting pain and swelling in her hand and finger joints, affecting both hands. She has now also been diagnosed with Rheumatoid Arthritis (RA). She suffers from constant lower back pain and it is affecting her sleep and ability to carry out her activities of daily living. She is currently on alternating Panadol and Meloxicam. She has a history of chronic depression which had been well managed until the accident. Her partner is concerned that she is depressed but Raelene is reluctant to see anyone and access to services is limited.
Answer:
Introduction:
With the global burden of disease, right-sided heart failure has emerged as the leading cause of premature morbidity every year. Heart failure along with COPD is considered as one of the most crucial public health concern, accounting for 10 million deaths every year (Ko et al., 2016). The recent report of National Health Survey suggested that 464,000 people individuals experience chronic obstructive pulmonary disease in Australia (Jones et al., 2016). 1 individual out of 20 individuals experiences chronic obstructive pulmonary disease, accounting for 4.8% of the death in Australia. Majority of the population with the chronic obstructive pulmonary disease often subjected to death due to right-sided heart failure (Www.aihw.gov.au. 2020). The case scenario represents COPD and associated right-sided HF of a 76 years old woman Gladys, who presented in the clinic due to swollen leg, wheezing and increased breathlessness. She was experiencing difficulties in mobilization. The purpose of the essay is to discuss the chronic pathophysiology, diagnosis, complication, knowledge consideration along with management in the following paragraphs.
Chronic condition and pathophysiology:
The scenario represents COPD and associated right-sided HF of a 76 years old woman Gladys, who presented in the clinic due to swollen leg, wheezing and increased breathlessness. Chronic obstructive pulmonary disease is defined as a respiratory illness that characterised by obstruction of airway that inhibits with inhalation (Tay et al., 2017). Shortness of breath is considered as the hallmark clinical manifestation of COPD (Jones et al., 2016). Shortness of breath directly contributed the right-sided heart failure because of low oxygen level of the body increase pulmonary hypertension and provide extreme strain on the right ventricle that results in signs and symptoms such as swollen feet, oedema at thigh and abdominal (Stafyla et al,2018).
Considering the pathophysiology, due to risk factors such as smoking, genetics, asthma, occupational exposure to the chemical, the airway of lungs irritated which leads to obstruction (Jones et al., 2016). The inflammation of lungs results in the secretion of IL9, IL5 and IL13 and secretion of mucous. The mucous secretion narrowed the airway passage which hindered the normal movement of oxygen and shortness of breath. The inadequate oxygen due to shortness of breath reduced the normal function of lungs for transporting oxygen (Finks, Rumbak & Self, 2020). The inadequate oxygen results in pulmonary hypertension since the lungs experience an increase in blood pressure rapidly. Pulmonary hypertension posed extreme pressure on the right ventricle and weaken the heart muscle (Granger, Morris & Holland, 2019). The weak heart muscle due to rise to pulmonary hypertension followed by R-sided congestive heart failure (Ko et al., 2016). Wheezing observed in Gladys since congested air passages of lungs covered with excessive mucus which results from inflammation and it appeared as musical sounds (Izbicki et al., 2019). The swollen feet is typical represents of COPD followed by right heart failure. In this case, pulmonary hypertension and impaired right ventricle blocked the blood and fluid in the veins throughout the body (Ko et al., 2016). The fluid slowly accumulated to different parts of the body. Fluid gradually moves to gather in the lower extremities of the body.
Relevant diagnosis:
To gain an understanding of the COPD and associate heart failure the patient, the relevant diagnosis is to evaluate the lungs function by using spirometer. Chest x-ray along with computerized tomography (CT) can be used for a diagnosis to assess the condition of the heart and lungs (Dennis et al., 2017). In order to measure the capability of heart for pumping blood, an echocardiogram can be used which will provide the idea of heart failure severity. Moreover, an arterial blood test can be done for measuring acidity, carbon dioxide and oxygen level of blood from the artery since the acidity the level will indicate the capability of the lungs to transport oxygen to blood and eliminate CO2 at the same time. It will also indicate pulmonary arterial hypertension (Yang et al., 2017). The laboratory test relevant to the diagnosis of the patient is tested for B-type natriuretic peptide (Tromp et al., 2018). It will indicate severity because heart releases B-type natriuretic peptide as a biomarker when heart incapable of pumping blood.
Complication associate with the patient:
The most frequently observed potential complications that negatively impact the quality of life include depression and respiratory infection. The individuals with the COPD often catch cold followed by pneumonia results in difficulties of breath and damages to the lungs tissue. Without immediate action, the patient may experience respiratory failure (Yang et al., 2017). In this context, flu vaccination against pneumonia can prevent such complication. Niyonsenga et al. (2018), highlighted that anxiety and agitation are common amongst patients with COPD since COPD results in shortness of breath and hinder patients to involve in daily activities. In this context, the patient leaves alone and experience difficulties mobilization due to shortness of breath and swollen feet that led to anxiety. Prolong anxiety can give rise to depression.
Development, health and cultural literacy:
The case scenario indicated that the patient had COPD associated with heart failure that results in swollen feet, deep breathing and she lacks skills to cope with it. At this juncture, the identified psychosocial factors which impact health illness include immobility because of swollen feet, sedentary lifestyle that results in social exclusion and lack of social support (Knight, 2017). The case scenario indicated she lived away from the son which might contribute to the anxiety. According to psychosocial development theory of Erik Erikson’s, she was in a stage of Ego Integrity vs. Despair where social disconnection and involvement with the community common instances due to low productivity and health condition (Knight, 2017). Therefore, this stage is required to consider as a part of literacy. In this context, cultural consideration for health literacy would be the identification of cultural beliefs, traditional practice as health conditions and lifestyles are greatly shaped by cultural value and beliefs (Heraganahally et al., 2016). Health literacy would be provided using pamphlet and PowerPoint where she will be explained the psychosocial factors that impact her health. She would be provided with an explanation of COPD and associated heart failure, possible self-management skills for anxiety, medication adherence, and proper nutritious along with options for traditional practice (Jones et al., 2016).
Nursing management:
The case study suggested that patient experienced breathlessness, swollen feet and anxiety that restricted her recovery. Therefore, three nursing management are following:
- Dyspnoea:
She experienced breathlessness due to tightened airways associated with bronchospasm. It is considered as the hallmark characteristics of COPD (Jones et al., 2016). In this context, the most appropriate management would be the administration of salbutamol, a selective beta-2 adrenergic receptor agonist that will reduce shortness of breath. It works by acting on relaxing airway smooth muscle responsible for bronchoconstriction and widen the airway (Dispas et al., 2017). Additionally, oxygen therapy can be provided for delivering adequate oxygen so that shortness of breath can be reduced.
- Swollen feet:
Swollen feet is the result of fluid build-up in the feet due to functional impairment of the heart and lungs. Therefore, the second priority is the management of swollen feet of the patient. Before providing any management interventions, TOTAP (Touch, Observe, Talk, Active Movement and Passive Movement, and Skill Test) assessment is required to conduct for gain an understanding of the severity of swollen feet. After the evaluation, the patient must be supported with physiotherapy with the assistance of physiotherapist so that she can walk freely (Hoaas et al., 2016). As compression stocking is effective in decreasing blood clot of the patients and the possibility for a further clot, it can be provided to her. Additionally, her dietary habit can be altered by eliminating salts from her diet and incorporating fruits and vegetables.
- Anxiety:
May and Pridmore (2020) highlighted that anxiety is often common amongst patients who experience server shortness of breath and have no skills for management of it as observed in this case. In this context, the severity of her anxiety can be measured through the Hamilton Anxiety Rating Scale so that appreciate intervention can be provided (May & Pridmore, 2020).. After the assessment, she can be involved in relaxation techniques such as yoga and deep breathing as it reduces anxiety, negative thought and boost self-esteem.
Conclusion:
To conclude, it can be said COPD and associated heart failure is considered as most frequently occurring public health issues that lead to premature mortality every year. The essay involves a patient of 76 years with COPD and associated R sided HF that results in swollen feet, shortness of breath and anxiety. COPD developed due to exposure to the smoke, chemicals and other triggers which results in bronchoconstriction. The bronchoconstriction increases pulmonary hypertension followed by increasing stress on the right ventricle and right-sided heart failure. In this case, the most relevant diagnosis are chest X-ray, echocardiogram, arterial gas test and B-type natriuretic peptide test. She can be provided with cultural literacy, developmental and health literacy so she can be involved in self-management. Lastly, for addressing her health condition, she can be provided with salbutamol for shortness of breath, compression stockings for swollen feet and relaxation therapy for anxiety.
References:
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