Section-A
A. Chronic Condition |
B. Signs & Symptoms |
C. Pathophysiology and Quality of Life/Independence |
a. Type 2 Diabetes Mellitus |
Urination regularly Increased thirst and a constant desire to eat Blurred Vision Slow-healing sores Frequent infection Increased appetite Dark-skinned patches Yeast infections and itching (Faselis et al., 2020) |
Type 2 Diabetes Mellitus (T2DM) is a common metabolic disorder marked by a combination of two fundamental factors: reduced production of insulin by pancreatic β-cells and inadequate tissue response to the insulin (Galicia-Garcia et al., 2020) As a result, comprehensive management approaches that encompass family, friends, and the medical team that cares for people with T2DM should be implemented. |
b. Osteoarthritis |
Tenderness and pain in the joint When an individual is idle for a long time, their pain and stiffness will increase. The joints appear to be a little bigger. The joint will have a limited range of motion. Bony changes and joint deformities cause crepitus (McCulloch et al., 2017). |
The etiology of this disease involves the cartilage deterioration, bone remodeling, and inflammation of the surrounding tissues due to an active response of chondrocytes in the articular cartilage (McCulloch et al., 2017). When compared to healthy persons, the quality of life of the patient with this disease will alter, including physical health, the level of independence, surroundings, and personal belief. |
c. Peripheral Vascular Disease |
Intermittent pain, pain relief while resting Numbness Increased discomfort (typically in the legs) after exercise Coolness in the affected area of the body (Flora & Nayak, 2019) |
It is a type of atherosclerosis that progressively restricts the plaque restricting the blood flow resulting in the formation of a blood clot. The advancement of atherosclerotic disease, which leads to macro and microvascular dysfunction, is the primary cause of the peripheral vascular disease (Rognoni et al., 2015). |
d. Chronic Obstructive Pulmonary Disease |
Dry cough Lack of energy Tightness in chest Difficulty in berating Weight loss (André et al., 2019) |
A blend of inflammatory processes is the cause of COPD in the airways and compression of the airways. As a result of decreased airflow and the degradation and mortality of alveoli, terminal bronchioles, and surrounding capillary veins and tissues, gas transfer capacity is diminished (André et al., 2019). Patients should have healthy lifestyles and avoid smoking if they do, as this can make them irritated and reliant. |
e. Peripheral Neuropathy |
Numbness Pain that is either sharp or scorching Touch sensitivity is high (Yagihashi et al., 2011). |
Diabetic peripheral neuropathy has a complex etiology. It is assumed to be triggered by vascular ailment, endothelial dysfunction, a deficiency of myoinositol, which alters myelin creation and reduces sodium-potassium ATPase (ATPase) activity, and persistent hyperosmolarity, which consequences in nerve trunk edema (Yagihashi et al., 2011). Since the disease weakens different body parts including feet and hands, it also majorly impacts body functions making an individual dependent. |
2. Part-1
Implications to Patient and/or family and loved ones |
|
A. Social |
Throughout a wide range of chronic diseases, a person with a chronic condition tends to have similar effects on other family members. No matter what kind of chronic ailment the patient had, the effects on other family members would be the same (Golics et al., 2013). The characteristics, of society, may not recognize the patient as a normal, healthy person at times. They may acquire a pessimism about the patient's relatives, as though they are scared the disease will spread to them. There's a chance that family members will feel left out of social events. For the family of a chronically ill patient, society may unwittingly create an unwelcoming environment (Golics et al., 2013). |
B. Emotional |
Families and patients may feel emotional discomfort as an outcome. As a result, the family may experience emotional exhaustion. Along with the bonding and connection that takes place during the process. As a result, the sufferer may feel guilty about their situation. On the other side, their bond is so deep that they can effectively care for the sick (Thomas et al., 2017). |
C. Physical |
It will also have an impact on day-to-day family life, as there will be a shift in the schedule. Time should be given to the patients that should emphasize the patient's physical condition in mind when devising a strategy (Golics et al., 2013). |
D. Psychological |
Worry, sorrow, and other negative feelings are common in patients with chronic illnesses. Friends, family, and society as a whole may be lost to them. Families are also forced to deal with similar conditions, which has a negative psychological impact on how they view one another (Thomas et al., 2017). |
E. Financial |
The expense of treating chronic diseases is prohibitively expensive. It is something that should be done for the rest of one's life. The expense of health care is increasing as the cost of treatment, prescription, and medical services all rise, putting consumers under more financial burden (Thomas et al., 2017). |
3. Part-1
Five Strategies:
Strategy / technique / equipment |
Benefit |
Multidisciplinary Team Member / s |
Occupational Therapy |
This therapy aids in the provision of self-care and daily living activities training, pain management, and pain control (Hill, 2016). Mr. McFarlane has severe diabetes and a past history of osteoarthritis that requires necessary self-management skills. Therapist train patients in life skills like time management, managing expenses and budget making, using public transport, and engaging in domestic chores to help them handle their daily activities and keep them engaged. Also, therapists can help people struggling with depression, alcoholism, drug abuse and other disorders (Hill, 2016). |
Occupational Therapists |
Psychological Rehabilitation Technique |
Rehabilitation psychologists do research and provide direct treatment to people with disabilities or chronic illnesses to help them overcome difficulties and improve their quality of life. It guides the patients like McFarlane with chronic disease to follow various healthcare precautions (Prerna & Harik, 2020). |
Rehabilitation Psychologist |
Podiatric Care |
Assistance in the provision of services to enhance healthy walking and foot mobility. Podiatrists are specialists who are qualified to inspect nerve damage in the feet, categorize exact foot problem and advice required cure and precautionary plans (Al-Busaidi et al., 2016). |
Podiatrists |
Exercise and Physiotherapy |
It is helpful in promoting health programs to patients, building strength and deterrence of falls. It is a therapeutic way of treating the patients for improving their mobility functions making the person active and strengthening their muscles (Moore et al., 2020). Since McFarlane’s toe has been recently operated, he needs to be adapted with walking and mobility with the aid of wheelchair, for such purpose exercising is important in his case. |
Occupational therapists, physiotherapists |
Formulating Diet plan |
It helps in the assessment of food status and minimizes the risk of malnutrition or undernutrition. Provide advice and solutions for dealing with a long-term health issue. Changing lifestyle is always advised to a diabetic patient as it detrimentally helps in faster recovery. McFarlane is suffering from type-2-diabetes which insists on consuming a healthy sugar-free diet, in this case, it is important to follow the nutritionist’s advice (Early & Stanley, 2018). |
Nutritionists, Dieticians |
Part-2
Technique |
Technique Used |
a) Hydrotherapy
|
Hydrotherapy, also known as hydropathy or water cure, is a sort of complementary medicine that involves the use of water for pain relief and treatment. Occupational therapy and physiotherapy are attributable components of hydrotherapy. It aids in the re-establishment of sensory organ sensation (Nagaich, 2016) |
b) Pilates
|
Pilates is an excellent workout alternative for injury recovery since it increases agility and superb posture by strengthening the core and conditioning the body. Pilates strengthens and aligns the body's spinal and pelvic muscles, making it better able to battle and ward off sickness and injury (Di Lorenzo, 2011). |
c) Art therapy
|
This non-invasive manual treatment procedure, also known as the active release technique, is used to alleviate soft tissue restrictions that cause discomfort and restricted movement. The goal is to break away scar tissue and adhesions, allowing the body to function more efficiently (Ghodrati et al., 2017). |
d) Prosthetics |
A prosthesis, also known as a prosthetic implant, is an artificial device that replaces a missing biological component that was lost at birth due to an accident, illness. The purpose of prostheses is to restore the normal function of a body part that has been severed (Saini et al., 2015). |
4. Prevention: This will involve educating McFarlane regarding his smoking and bad eating habits. Patient counseling related to diabetes is an important aspect of this scenario. He is advised to eat a nutritious diet, exercise on a daily basis as well as maintain a healthy weight. Moreover, he is encouraged to self-management by keeping his BGL under regular check (Galicia-Garcia et al., 2020).
Social workers, occupational therapists, physiotherapists, and dietitians must all be involved after a brief hospital stay. He should also see his primary care physician regularly to keep up with his health.
Nursing diagnosis |
Planning - (Nursing intervention) |
Multidisciplinary team member to provide support |
Link to personal needs |
Expected Outcome |
1. The possibility of a BGL imbalance |
Insulin was given as prescribed. Educate the patient on the necessity of following the meal plan that has been prescribed. |
Nurse Nutritionist |
Physical needs |
Assists the patient in maintaining his BGL. |
2. Acute Pain (score: 7)
|
Assist with a pain reliever to help to feel better. Distract the patient using music therapy. |
Nurse, Physiotherapist |
Physical and Emotional needs |
In 24 hours, the pain was decreased to a 4/10. |
3. Ineffective airways clearance
|
Coughing and breathing exercises should be encouraged and taught. If the patient is comfortable doing so, raise him to his feet. |
Nurse, Podiatrist |
Physical needs |
Observed Spo2 is greater than 93% |
Section-2
The Flinders Model (Program)
The Flinders Chronic Condition Management Program or The Flinders Program attributes to a significant model that assists healthcare practitioners to promote their client's well-being. It is designed to help people manage chronic illnesses. It is divided into four sections: Management of diseases, Self-discipline, Coaching, and coordination.
Patients and healthcare providers can utilize this technique to create their path toward good behavioral change. It is one on one model based on a client-centered approach bridging the gap between patients and healthcare practitioners. When it comes to creating goals and achieving them, the multidisciplinary team and the patient collaborate to the best of their abilities. These are programs aimed at assisting persons with chronic conditions in improving their overall health (Flinders University, 2020)
Continuum of Chronic Disease Model
Fig 1. Core elements of the continuum of chronic disease prevention and care (National Health Priority Council, 2006)
People living in Australia are severly impacted by the chronic illness that is the main reason for decline in their overall well-being. The continuum of chronic disease model aims to reduce the prevelance of chronic disease. The goal of this model promotes the alleviation of complications in people suffering with chronic illness by implementing best practices for disease control and management. The given figure determines the strengthening activities for individuals, promoting their health during end of life care. It depicts that the patient, the carers and the family are an important elements who holistically takes part in the overall treatment strategy. However, different developmental stages of a chronic illness are thoroughly illustrated for the different groups of people (people at high risk, at early staege and people with complicated symptoms). It also involves patient care with the help of allied care, multidisciplinary team members that provides person-centered care. This model also supports evidence based clinical mangement for better client facilitation. Thus the complete continuum of care promotes well-being and better health outcomes by focussing on elements like health promotion, prevention strategies, rehabilittation and so on (National Health Priority Council, 2006).
8. Part
Disease/Chronic Health Condition |
Clinical Manifestation |
Chronic Asthma |
Shortness of breath causes chest discomfort. Wheezing Prolonged expiration Diminished breathing sounds Restlessness and elevated heart rate Anxiety Limited activity Coughing, wheezing, or shortness of breath prevents the patient from sleeping (Barnes, 2017). |
Chronic pain including back pain |
Stiffness: It may be difficult to move or straighten the back. Getting up from a seated position can take some time for some people, and they may need to walk or stretch to relax. restricting one's freedom of movement Patients with back pain may find it difficult to stand up straight. There are several ways to stand so that torso and spine are not aligned. Muscle spasms or contractions in the lower back are frequent following a strain. Muscle spasms can be exceedingly painful, making it difficult or impossible to stand or move in any other way (Arendt‐Nielsen et al., 2018). |
Chronic renal failure |
Increased urination frequency, especially during the night, frothy urine (indicates proteins are present in the urine) Edema of the lungs, tiredness and elevated blood pressure are all symptoms of chronic renal failure (Romagnani et al., 2017). |
Congestive heart failure |
Shortness of breath or inability to breathe correctly. Breathing issues might occur as a result of exercise, relaxation, or lying flat in bed. Shortness of breath occurs when fluid builds up in the lungs (congestion). Physical effort causes leg heaviness and exhaustion (fatigue). If the heart does not pump enough oxygen-rich blood to the organs and muscles, the person feels tired. Swelling in the ankles, legs, and abdomen, as well as an increase in weight. The body retains liquids and fluids due to a lack of renal function (Ziaeian & Fonarow, 2016). |
Eczema |
Dry Skin Itching that worsens at night, particularly if it's severe Red to brownish-grey skin lesions, most usually on the fingers and toes, wrists and neck, upper chest and eyelids, and inside the bend of the elbows and knees. If scraped, little raised lumps on the skin might cause fluid to flow out and develop a crust. As a result of the trauma, scratched skin is red and inflamed (Damour et al., 2020). |
Incontinence |
A person may experience frequent urination while laughing or exercising. Urge to urinate that hits the patient out of nowhere and won't go away. Urination regularly is necessary. Having frequent urine bouts in the middle of the night. Having a desire to urinate in midnight that makes patient uncomfortable and awkward (Beele et al., 2018) |
Neurological injury |
It results in long term or short term unconsciousness A headache that refuses to go away or worsens. Vomiting or feeling unwell regularly. A seizure or epileptic episode. An increase in the size of one or both of the eyes' pupils. Drainage from the nose or ears that is clear in color (Krishnamoorthy et al., 2016) |
Long-term unconsciousness |
Vision issues can be caused by depressed brainstem reflexes, such as a lack of reaction from the pupils to light. There are no limb reactions other than reflex motions. There is no response to painful stimuli other than reflex movements. Unpredictable breathing Closed eyes (Squire & Dede, 2015) |
Parkinson’s disease |
Tremoring begins with a hand and arm tremors. It's possible to get it in addition to the jaw and foot. In the early stages of the condition, it usually only affects one side of the body or one limb. Bradykinesia is a sluggish movement caused by the brain taking too long to provide the necessary information to all of the body's components. Rigid muscles/stiff limbs: Rigidity is defined as the inability of muscles to relax appropriately. This stiffness is caused by uncontrolled muscular tension, which makes it difficult to move around (Capriotti & Terzakis, 2016). |
Rheumatoid arthritis |
Inflammation and pain in the joints Stiffness, especially first thing in the morning or after a long period of sitting Deficiency (tiredness and excessive sleepiness) Each person's experience with rheumatoid arthritis is unique. The majority of people's joint problems may occur gradually over years. In certain people, rheumatoid arthritis can advance quickly. After a short period, some patients with rheumatoid arthritis go into remission (Joaquim & Appenzeller, 2015). |
Stroke |
Numbness or weakness that arises quickly, often on one side of the body (arm, leg, face). Pins and needle sensation All of a sudden, there is confusion, trouble speaking or understanding speech. In one or both eyes, new or worsening vision difficulties. Drowsiness, dizziness, or unsteadiness may occur suddenly (Ojaghihaghighi et al., 2017). |
Systemic lupus erythematosus |
Fever, malaise, arthralgias, myalgias, headache, appetite loss, and weight loss are all common symptoms of the condition. Nonspecific tiredness, fever, arthralgia, and weight changes are common symptoms in new instances or recurring active SLE patients (Kuhn et al., 2015). |
9. Palliative care also encompasses holistic treatment. Chronically ill persons work to manage their stress with the help of their family and a multidisciplinary team. Care encompasses physical, social, cultural, spiritual, psychological, and legal dimensions. As a nurse, I must collaborate with the full multidisciplinary team to provide the best possible care to the patient (Fitch et al., 2015). Palliative care is primarily concerned with reducing pain and suffering in patients and their families who are dealing with a chronic illness. Palliative care can improve the patient's and family's quality of life. As nurses, they have the power to provide medication quickly as well as help the patients with their activities of daily living. However, the nurses must also consider the patient's mental health. Healthcare workers must constantly respect the patient's autonomy and decision while giving care and help (Ahlström et al., 2018).
10. The common types of cancer prevalent among Australians:
11. Breast cancer is a type of cancer that develops in or emerges from breast tissue. It is the common cancer type prevalent in women that is caused due to abnormal cell growth in the cell lining or the breast lobules (Cancer Council Australia, 2020a).
12. Skin cancer is cancer that originates on or in the skin of the body. It is usually caused when the skin is exposed to the UV radiation. Abnormal cell proliferation in body parts is the main cause for skin cancer (Cancer Council Australia, 2020b).
13. Prostate cancer is a tumor of the male reproductive system's microscopic seminal gland, which is the size of a walnut. It is prevalent in males targeting male’s reproductive system (Cancer Council Australia, 2020c).
14. In the event of an obstruction of the airways above the trachea, a tracheostomy is performed as a last option. This technique is usually performed for one of three reasons: to bypass a blockage in the upper airway, to clean or eliminate secretions, or to safely and quickly give oxygen to the lungs (Freeman, 2017).
Permanent Tracheostomy: There is no way to wean or remove a permanent tracheostomy. Laryngeal or nasopharyngeal malignancies, motor neuron illness, locked-in syndrome, severe head injuries, spinal cord injuries, and vocal cord paralysis are among the underlying long-term, progressive, or irreversible conditions for which it is inserted (Wrapson et al., 2017).
Temporary tracheostomy: Before the procedure, the patient is laid on his or her back and the neck and chest are swabbed with an antiseptic solution. The skin of the throat is first shaved clean. The thyroid gland is excised or pushed back to gain access to the trachea. The tube will be secure once those stitches are completed. The tube must be plugged in to receive oxygen. A non-emergency tracheostomy can be performed for a variety of reasons, such as before throat or mouth surgery so that the patient can breathe thereafter (Myatt, 2015).
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