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Chronic Health Problems Case Scenario and Case Report

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Table of Contents

Scenario 1

Part A

  1. The patient should undergo the given nursing care plan during the process of admission.

Diagnosis

Discussion

Identified for anaemia

An increase in white blood cells count can prompt septic screen. The limb that is subjected to amputation may have any kind of infection.

Diagnosis of electrolyte abnormalities

It should be done to identify the condition of hypokalaemia or hyperkalaemia. Coagulation screening should also be done and any sepsis if present should be corrected before surgery.

Blood Sugar Level monitoring

In preoperative period, blood sugar level should also be monitored because condition of hyperglycaemia is prominent in diabetic patients. (Cervantes & Camargos, n.d.)

Twelve lead ECG

Twelve lead ECG should be done apart from general baseline tests as it helps in identifying arrhythmia or acute coronary syndrome.

Echocardiography

Echocardiography should be performed in order to check the presence of any valvular disease.

Effective Pain Management

. Effective pain control should also be done as the patient suffers from post-surgical pain.

Diet

Diet control plan should also be given to patient in order to control the blood sugar level and prevent any sudden increase in blood sugar level.

 

  1. After the surgery it is important to take proper care of the residual limb, it affects the overall health of your body and affects the healing time. The most crucial part of the surgery is prevention of infection, so it is very important for the patient to follow the given instructions in rehabilitation centre as we as in their homes. Here are some of the dos and don’ts provided which are to be followed strictly irrespective of the situation. At home if the person is unable to carry out these steps then they are advised to ask for a nursing staff specialised to do the post-surgical care operations. (2019)

Dos are:

  • Change the dressing only as instructed by the nursing staff of the health care unit.
  • After the incision is completely healed and all the stiches and staples are removed, the residual should be properly washed with mild soap and luke warm water before changing the dressing.
  • After bathing use a soft towel to dry up the area of residual limb. Special attention is to be given while doing it and the area should not be scrubbed but it should be patted.
  • Examination of skin from all the sides should be done every day in presence of proper light.
  • In case of any abnormalities visible over to skin the health care team should immediately be called for attention.

Don’ts are:

  • Do not remove any scab from the residual limb.
  • Do not soak the residual limb in water for any duration of time, as it increases the chances of infection.
  • Do not apply lotion, cream or ointment unless and until it is prescribed by surgeon.
  1. Psychological understanding and stress are left uncovered under treatment plan for patients undergoing amputation surgery. It not only affects the mobility of the person but also it affects the body image of the person. Here are some assessment techniques that can be used for checking the understanding of the patient towards amputation surgery. Reassurance should be provided by the surgeon as well as the nursing staff of the health care unit to the amputee as we as their family members. The psychological support should be given in a phased and continuous manner where it is to be checked that the patient is not left unmonitored and stressed. The patient or amputee should also be encouraged speaking their views about the amputation and should be assisted to the right thought process if they seem deviated from it. Proper ventilation should be provided to the amputee as the act of limb loss has a deep and complex grief response. The amputee should not be discouraged talking about the surgery and post-surgical problems that he or she may face once shifted to rehabilitation centre or home. This is the best period in which the amputee should be educated about post-surgical operations and conditions that they might need to face before getting adapted to the residual limb. The amputee should be given counselling by psychologist in order to fix the body image that has changed due to surgery. It also tells about the submission of amputee to the situation where psychologist can bring a conclusion that whether the patient is taking the operation in healthy manner. ("Assessment of the amputee", 2019)

Part B

  1. Rheumatoid arthritis is one of the biggest chronic health problems that Paula is going through. Rheumatoid arthritis causes pain and swelling in joints and it also restrict the mobility of the person along with loss in body strength. (Kristiansen, Primdahl, Antoft & Hørslev-Petersen, 2011) The morning of the person is painful and stiff that makes it difficult to get up from the bed and immediately start running for doing the regular morning chores like cleaning, cooking, gardening, laundry. Another important part of life is work as it helps the person to earn money, and well as social independence. It becomes difficult to sit or stand in one position for longer duration of time for the person who is suffering with rheumatoid arthritis. Some of the patients suffering from rheumatoid arthritis find it difficult to drive every day for general operations. The patient loses confidence and often avoids going on the roads in the bus hours of the day. Along with hindering to do daily operations rheumatoid arthritis also affects the sexual relationship of the person. Due to stiffness and pain the patients become sexually inactive. Diabetes is another chronic illness that tends to affect the daily activities of Paula. Diabetes is responsible for causing many neuropathies. The neuropathy results in several sensory and motor changes in body, along with its micro vascular injuries are most common in such patients. (Melsom & Danjoux, 2011) smart Micro vascular injuries reduce the flow of blood and this lowers the muscular strength of the body. Loss in muscular strength reduces the ability of person to perform their daily activities. (arthritis, 2019)
  2. Diabetes has different effects on our body, and it has varied symptoms in people of different age. In older people there are mainly two symptoms and one is increase in chances of infection in urinary tract. The second symptom is complex and often results in acute feeling of fatigue in the person. The patient suffers from numbness and tingling in arms, legs, hands and feet. This happens due to damage of circulatory and nervous system. There are very high chances that Paula is suffering from diabetic retinopathy where the damage to retina occurs. Due to increase in blood sugar level, many of the small blood vessels get blocked, these small blood vessels are responsible for maintaining the health conditions of retina. (2019) Due to blockage the retina fails to restore the damage that happens due to normal wear and tear. As the conditioned gets prolonged, more and more vessels get blocked and round retina develops a scarred tissue that causes detachment of retina. In some cases, problem of glaucoma occurs and in severe conditions complete blindness is observed. ("What Is Diabetic Retinopathy?", 2019) The two most common manifestations of rheumatoid arthritis are stiffness in joint, fatigue and weight loss. It has several medical effects over to the body along with limitation to the functionality of body for doing daily life operations. Rheumatoid arthritis brings high risk of osteoporosis, it is a condition in which bones become very weak and they become prone to fracture. (Alana Biggers, 2017) (CVA, 2017)
  3. Local wheelchair support services are very important for a person who has shifted to his home from rehabilitation centre. It helps in easing the mobility of the amputee so their contact number should always be present with the amputee. There are chances of falling after coming to home as the patient operates on himself. Due to that the patient should always have the contact number of physiotherapists so that they can manage the complications that might have come due to falling. The amputee should have contact number of clinical nurse specialist because there are chances that the patient might find it difficult to do the dressing on his own due to loss of mobility and confidence after the surgery. ("Assessment of the amputee", 2019)
  4. The main problem that an amputee faces after the surgery is damage to the body image. The person becomes totally dependent on someone and this lowers up the confidence and brings up a feeling of burden. As the person fails to perform his daily operations, he loses the enthusiasm to go anywhere and socialize himself. Many a times, it also stops the person from doing their job as there are jobs that require fully functional mobility. This brings economic stress to the person as the health care cost is very high. The expenditure over post-surgical operations and management is also very high and it increases the daily expenses of the patient. It is very important that amputee has a family member not only to look after the daily operations but also help him financially so that the medicines, aids and services are not stopped before the person becomes medically fit. (Payne, Janzen, Earl, Deathe & Viana, 2016)

Scenario 2

  1. The person suffering from COPD suffers from skeletal muscle dysfunction where anatomical changes are seen in composition of muscles and along with it the strength of the muscle is also affected. This causes the stiffness and fatigue in patient and restricts the ability to move. The metabolism in brain and nervous system is also affected and due to this the person is most likely to be affected by depression. ("Healthcare Team Who Treat COPD | COPD.net", 2019) COPD increases the chances of cardio vascular diseases. ("Distortion of Body Image Following Lower Limb Amputation: Implications for Comprehensive Rehabilitation", 2017) The patient also suffers from abnormalities in nutrition as it brings alterations to calorie intake, disturbs the metabolic rate of the body and this results in frequent weight loss. The breathlessness is caused due to severe asthma as the airways of lungs get narrowed up that cause’s tightness in chest. (Agusti, 2005)
  2. COPD symptoms don’t appear at initial stages of the diseases and they only appear when high intensity damage has been done mainly to the respiratory and circulatory system of the body. The earliest symptoms include over production of sputum and cough in the patient. Shortness of breath while performing physical activities like walking, running or jogging is another symptom of the disease. Cyanosis is also observed in some patients where bluishness is observed in lips and beds of the fingernails. The patient also becomes more prone to respiratory infections that further cause damage and inflammation in the respiratory system of the body. In late stages the patient suffers from weight loss and disturbed metabolism. ("COPD - Symptoms and causes", n.d.)
  3. The patient of COPD needs a pulmonologist, nutritionist and a physiotherapist for his treatment and care. Pulmonologists are the doctors that are responsible for treating the patients who are suffering from lung diseases. They help in carrying out special tests that are required in COPD patients. COPD results in gradual weight loss and it becomes difficult for patient to maintain weight. Nutritionists help patients in having balanced and healthy diet in order to maintain their health as well as weight. Underweight patients require special diet plan that fulfils the extra need for minerals and nutrients. A physiotherapist helps the patient to maintain his mobility and keep his joints and muscles flexible as it can give rise to several other chronic problems. ("Healthcare Team Who Treat COPD | COPD.net", 2019)
  4. The chronic illness lays an adverse effect over social, mental and physical well-being of the person. Dependency of the person over medicines decreases the confidence of the person as they alter the daily life of the patient. While patients with chronic illness are set on prolonged treatment plan they are not allowed to do many activities without control. For instance, they are not allowed to eat apart from diet plan, and they are not allowed to do physical activities beyond the limits set up by the physicians. The treatment costs bring the economic stress over to the patients and the income prospects also gets reduced due to limitations at work. ("REDUCING ADL DISABILITY IN VULNERABLE ELDERS: FINDINGS FROM A PILOT COMPARATIVE TRIAL", 2016)

Case Report

  • Brief introductionThe patient is an adolescent that has gone through renal transplant and is also suffering from Type 2 diabetes and have condition of hyperglycaemic hyperosmolar state. The patient is also suffering from deficiency in growth hormone and has obesity. The patient has been given with intravenous insulin. He has lost weight and the growth hormone therapy has also stopped. (Rosenbloom, 2010)
  • Presenting complaint, assessment data and diagnosisThe age of the patient is 16 years and has renal impairment since birth. The boy is suffering from Bardet Biedl Syndrome. He has been brought to clinic because of constant high blood sugar level that was identified by regular screening. The renal transplant was done one year back, and growth hormone deficiency is also screened. The boy is also suffering from hypogonadism and has a micropenis. There have been instances of learning difficulties. (Forsythe & Beales, 2012)
  • Past medical and health history including medicationsThe patient was kept on immunosuppression therapies and growth hormone therapies since he was 9 years old. In the past he was on Tacrolimus drug 1.5 mg, Prednisolone 5 mg given on alternate days, GH 1.8 and 1.9 mg given alternatively by subcutaneous route on daily basis.
  • Discuss the clinical manifestations of the chronic health problems on the body systemsThe patient when was brought for presentation reported the history of suffering with polydipsia and for that he had been drinking sugary drinks in large quantities every day. The patient has disturbed body mass index and was overweight. The BMI of patient was 30.3 kg/m² and BMI SDS 2.62. The patient had a blood pressure of 121/69 and tachycardiac and heart rate of 100 bpm.
  • Identify two (2) actual and two (2) potential health issues of the patientTwo actual health issues are Deranged Renal Function and Hyperglycaemic Hyperosmolar State. Two potential health issues are Insulin Resistance and Metabolic Syndrome. (Forsythe E et. al. 2012)
  • Explain current treatments for the identified chronic problems. Name and explain a few resources and support services which can be utilised to meet patient’s care needs.The patient was given with fluid resuscitation using normal saline for period of one hour. The fluid deficit of 5% was replaced for 2 days. Initially he was given with insulin by intravenous route and once the condition got controlled then insulin was administered through subcutaneous route.

Answer following:

  1. Identify two (2) nursing interventions you performed based on the patient’s needs according to continuum of chronic disease mproving nutrition and teaching about insulin.
  2. Discuss the patient’s (as appropriate, with family or carer to confirm their) understanding of the conditions and its impact. The patient was adolescent therefore he had less understanding about the problem he had but the family of the patient understood his medical conditions
  3. List other agencies and interdisciplinary team members involved in supporting patient’s care. Nephrologist, Endocrinologists, General Physicians, Psychologists.
  4. Formulate an action plan for the patient which includes referral to community support services or rehabilitation services or other support services as needed The patient can be referred to phasic counselling therapy after which he can be sent to community sessions which explain about leading healthy life irrespective of health problems through healthy diet and active living.
  5. Explain how you actively involved the patient in the development of strategies to manage their condition. Write what progress notes documentation you did for this patient. The patient was regularly asked to express his thought over to the treatment given to him and his mental state was also assessed by cross questioning. He was asked to tell about future planning that he has in his mind for himself.
  6. Explain how you identified and meet own role and responsibilities in communicating and reporting the person’s response to nursing interventions. The patient initially was troubled with his early symptoms and fatigue, and clinical help was not relieving his mental stress.
  7. Enlist at least any two variations in person’s needs and explain your response to these variations in the context of a coordinated service approach. The patient was not speaking to anyone and was found silent always. In response to it nursing intervention was done to make him talk about his current condition and develop his understanding towards it.
  8. Explain what and how you identified the level and type of contribution and support made by family or carer. The patient received independent level of care because he was able to carry out daily operations like bathe, toilet, eat, dress on his own without intervention from family or nursing staff.

References

  • Agusti, A. (2005). Systemic Effects of Chronic Obstructive Pulmonary Disease. Proceedings Of The American Thoracic Society2(4), 367-370. doi: 10.1513/pats.200504-026sr
  • Alana Biggers, M. (2017). Type 2 diabetes: Symptoms, early signs, and complications.             Retrieved from https://www.medicalnewstoday.com/articles/317462.php
  • Cervantes, C., & Camargos, M. How does having diabetes affect ADL disability in             elders? [Ebook]. Retrieved from https://iussp2009.princeton.edu/papers/93106
  • COPD - Symptoms and causes. Retrieved from https://www.mayoclinic.org/diseases-            conditions/copd/symptoms-causes/syc-20353679
  • CVA, K. (2017). https://www.medwinpublishers.com/JOBD/JOBD16000139.pdf. Journal Of             Orthopedics & Bone Disorders1(7). doi: 10.23880/jobd-16000139
  • Distortion of Body Image Following Lower Limb Amputation: Implications for             Comprehensive Rehabilitation. (2017). Current Advances In Neurology And             Neurological Disorders, 9-14. doi: 10.29199/cann.101015
  • Forsythe, E., & Beales, P. (2012). Bardet–Biedl syndrome. European Journal Of Human            Genetics21(1), 8-13. doi: 10.1038/ejhg.2012.115
  • Healthcare Team Who Treat COPD | COPD.net. (2019). Retrieved from             https://copd.net/basics/healthcare-team/
  • Kristiansen, T., Primdahl, J., Antoft, R., & Hørslev-Petersen, K. (2011). Everyday Life with     Rheumatoid Arthritis and Implications for Patient Education and Clinical Practice: A      Focus Group Study. Musculoskeletal Care10(1), 29-38. doi: 10.1002/msc.224
  • Melsom, H., & Danjoux, G. (2011). Perioperative care for lower limb amputation in vascular           disease. Continuing Education In Anaesthesia Critical Care & Pain11(5), 162-166. doi: 10.1093/bjaceaccp/mkr024
  • Payne, M., Janzen, S., Earl, E., Deathe, B., & Viana, R. (2016). Feasibility testing of smart   tablet questionnaires compared to paper questionnaires in an amputee rehabilitation clinic. Prosthetics And Orthotics International41(4), 420-425. doi:             10.1177/0309364616661257
  • REDUCING ADL DISABILITY IN VULNERABLE ELDERS: FINDINGS FROM             A PILOT COMPARATIVE TRIAL. (2016). The Gerontologist56(Suppl_3), 689-     689. doi: 10.1093/geront/gnw162.2806
  • Rosenbloom, A. (2010). Hyperglycemic Hyperosmolar State: An Emerging Pediatric             Problem. The Journal Of Pediatrics156(2), 180-184. doi:             10.1016/j.jpeds.2009.11.057
  • What Is Diabetic Retinopathy?. (2019). Retrieved from             https://www.webmd.com/diabetes/diabetic-retinopathy#1

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