Adult Nursing - Management of Long Term Conditions Essay Sample

MANAGEMENT OF LONG-TERM CONDITIONS

CASE STUDY 1 (EDITH)

 Introduction

In this essay, the focus is on a patient living with a long-term condition (LTC) of heart failure. It focuses on Edith's case, an 83-year-old lady, to demonstrate some of the key features of LTC and their impacts on the patients physical, social and psychological state. The paper briefly identifies the underlying pathophysiology of heart failure and applies relevant literature to discuss its impacts. It also explores relevant assessment and management strategies concerning the needs of this service user. Besides, the essay considers person-centred care approaches to promote self-management of this LTC and service user’s (SU’s) independence. Finally, the paper identifies and analyses the role of the nurse in managing SU's long-term needs.

Pathophysiology of heart failure

Heart failure is a condition resulting from some abnormality in myocardial function (Katz and Konstam, 2012). It affects normal body functioning in various ways, depending on its type. The abnormality inhibits the heart from delivering enough oxygenated blood to meet the body’s metabolic needs.

Acute Heart failure is caused by various conditions such as valve rupture, myocardial infarction, cardiac tamponade, and acute viral myocarditis, results in an abrupt reduction of cardiac output hence causing systemic hypotension.  Consequently, hypoxia to the cerebral and cardiogenic shock presents. On the other hand, the gradual development of chronic Heart failure is due to atherosclerosis of the coronary arteries resulting in myocardial ischemia,  arterial hypertension, and progressive acute heart failure into chronic; its pathophysiology depends on the side of the heart it affects (Katz and Konstam, 2012).

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Left-sided heart failure is brought about by mitral and aortic stenosis, systemic hypertension, ischaemic heart disease, and restrictive pericarditis; its pathophysiology is due to decreased left ventricular output. This results in the accumulation of fluid in the lungs resulting in pulmonary congestion. Pulmonary congestion presents itself with dyspnoea and orthopnea (Katz and Konstam, 2012).

A decrease in the left ventricular output leads to hypoperfusion of tissues, such as the brain(causes hypoxic encephalopathy); kidneys(causes ischaemic acute tubular necrosis). Right-sided Heart failure occurs following Left-sided heart failure; its clinical manifestations are portal venous congestion and reduced cardiac output. Venous congestion occurs in various tissues, such as congestion of the kidneys, ascites, liver, leg veins, and hydrothorax. This manifests itself as oedema. The reduction in cardiac output leads to anoxia, cyanosis, and cold extremities (Sperelakis, 2012).

Backward Heart Failure is due to a shoot in the end-diastole volume due to ventricles' failure to eject blood under normal circumstances. The atria consequently increase in pressure and volume and transmit the force into the veins leading to their distension. In Forward Heart Failure, the clinical manifestations result from the heart failing to directly pump blood, leading to a decrease in the blood flow to various tissues. This results in diminished renal perfusion.

Impacts of heart failure

Heart failure causes many complications and affects patients in various ways (Katz and Konstam, 2012). It can be challenging for the individual with this pathological condition to manage the disease and deal with the complications that may arise both physically and mentally. It also impacts the individual's daily life activities, including social, family, and spiritual involvement. Often, individuals have to disrupt their routine to seek medical help when symptoms arise (Nicole and Hollowood, 2019). The health effects on the lives of the individual cause discomfort. Vital organs in the body, such as the lungs and kidneys, are greatly affected. The lungs play a crucial part in the oxygenation of the blood. Edemas are formed when the heart weakens, and it cannot pump enough blood effectively. With a deficiency of oxygen-rich blood reaching the kidney, swelling occurs in the ankles, feet, and legs. The kidneys cannot cycle out excess water and waste products effectively. Fluid also forms in the lungs; a condition is known as pleural effusion. Some of the manifestations of fluid accumulation include shortness of breath when carrying out activities and during the night, wheezing, especially at night and at times a cough, progressive fatigue due to depletion of energy levels, swellings in the abdomen and legs, and a sharp rise in body weight. Heart failure patients often present with chest pain and fatigue since the heart valves are greatly affected. In heart failure episodes, the heart valves either narrow or do not close completely, leading to blood flowing back to the heart (Sperelakis, 2012).

The routine activities of the individual are affected. A person who was used to carrying out tasks quickly and efficiently could now perform them a bit slower (Nicole and Hollowood, 2019). With the disease's symptoms, one cannot carry out household chores effectively, like in Edith's case. Shortness of breath, feeling dizzy when bending over, and increased heart rate makes it difficult for her to perform household chores.  Moreover, having other conditions such as rheumatoid arthritis make it difficult for individuals to perform daily activities such as personal hygiene, walking, standing, dressing, and even using the toilet (Ahlstrand et al., 2012). The discomfort experienced while doing the chores makes many people avoid them. Also, doing many tasks poses them at the risk of having heart attacks. At times, it takes longer for one to perform a chore as they would often take breaks to catch a breath and regain energy to continue with the duties. Therefore, it is essential to surround themselves with people who understand their condition and are not pressurising them to perform the tasks fast, just like Edith's husband, Eric, who is very supportive.

According to Nicole and Hollowood (2019), people who experience stress at home and spend more time doing household chores recover less. The strain of household chores has dire consequences on individuals with heart failure. Research carried out by Nicol (2011) shows that worrying about household tasks like cleaning may worsen the heart. One has to rearrange the kitchen by setting up work areas so that similar chores can be performed together to minimize movements. It is also crucial to have the necessary tools and equipment to aid in effective duty performance. Edith has a long stool to prepare meals, which provides comfort and helps reduce symptoms. To prevent preparing the food and cooking regularly, one can freeze the extra food.

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The financial stability of the individual and the family is affected (Pattenden et al., 2007). The patient has to adhere to medication throughout life despite their high cost. Also, consultation with heart failure nurses is expensive as they charge high rates. With the change in the healthy lifestyle of the individual and diet, the family resources are strained. This affects the budget of the family to cater to the medication.

Management strategies

The golden responsibility in dealing with heart failure lies with the patient. This involves altering their daily activities to maintain quality healthcare. It implores the patient to monitor the symptoms' manifestations, follow their medication, diet strictly and manage them by adopting a healthy lifestyle or by seeking appropriate assistance from the medical personnel. Currently, Edith is on digoxin (treating heart failure), furosemide (reduce extra fluid caused by heart failure), Asprin, simvastatin (mild memory problems), ramipril (lowers blood pressure), bisoprolol (treating high blood pressure), methotrexate (treating severe rheumatoid arthritis), and paracetamol (for pain management) This reduces mortality risks and minimizes hospital admissions which allow patients in need of medical services (Nicol and Hollowood, 2019).

Self-monitoring is vital in achieving quality results, improving their quality of life (Nicol and Hollowood, 2019). This relies mostly on behavioural adaptations. Individuals may be required to embrace a new way of doing things such as self-monitoring symptoms and dealing with medical drugs.  Behaviour change is essential. Ceasing smoking, restricting sodium intake, regular exercising are some of the health habits the patient should adopt. This broadens the motivation demands of self-care. For the management to be effective, the patient must develop a sense of control over their health. Self-care offers such empowerment.

There should be a collaboration between the patient and the medical specialists for self-care to work effectively, just like in Edith's case, who works closely with her heart Failure Specialist Nurse. Trust is also vital in self-care as it the basis for its success. A patient cannot alter her medications without informing the nurse as it would breach trust between the two. The patient and the medical assistant should lay out a detailed communication channel to minimize the patient's delay in seeking help and encourage timely assistance. It is essential to conduct early screening of the patient to identify and solve capacity deficits such as physical impairment, which would negatively affect self-care. Some of the patients get into depression which causes poor adherence to the medication. This dramatically undermines self-management. Management of depressed patients is, therefore, critical for the patient’s self-care. 

In utilizing self-management benefits, it is crucial to introduce special programs to deal with diverse self-care issues. Self-management education and counselling should focus on skills and behaviour, as opposed to knowledge. Health care personnel should use such strategies to provide a favourable learning environment. It is also vital to integrate a system that supports both the patients and health practitioners. Having a positive perception, the patient will adhere to medications with ease. In the case of resistance from the patient, Self-care should not be an option, and the  patient must be under close observance with the medical team

Self- management and independence

Self-management involves the daily processes individuals are involved in handling a chronic illness (Nicol and Hollowood, 2019); thus, a patient-centred care approach. Optimal self-management entails monitoring the disease and developing and using physical and emotional strategies to maintain a quality life. It focuses mostly on the healthy lifestyle behaviours performed by an individual to alleviate their situation as the integration of the new condition with the patient's sense of self is likely to impact the effectiveness of treatments significantly. This promotes the individuals' independence on the family members, the community, and healthcare professionals (Nicol and Hollowood, 2019).

Independence emphasizes personal qualities such as self-regulation, control, and being able to make sound decisions concerning their health.  The family and society appreciate freedom and helps in tasks the individual is unable to perform. According to the research carried out by Donnellan (2015), being dependent on others is one of the greatest fears of older adults. Maintaining independence is a goal that adults embrace in improving their quality of life. Many are often neglected for being too dependent on others as human beings view it as if the individual is avoiding the chores. Martin explains that self-acceptance is critical in handling a chronic disease.

Consequently, it enables one to seek assistance whenever they are in a conflicted situation. This eases the treatment process as the patients handle themselves willingly (Nicol and Hollowood, 2019). Edith carries out her daily activities independently. She can pluck and bake without help from the husband; therefore, he does not carry the full responsibility of caring for the wife. Her condition has made her improvise some house tools like a stool to facilitate her movement and comfortability with the nurse and the spouse's help.

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Emphasizing patient responsibility is critical in encouraging self-management. Hence, it is vital to educate the individuals to note the challenges and solve the problems associated with their illness. Innovative self-management is essential in managing chronic conditions (Nicol, 2011). Health care providers facilitate self-management by coordinating self-management activities, recognizing that different self-management processes vary in importance to patients over time, and having ongoing communication with the patients and providers to create self-management plans.

Role of the nurse in impacting the experience and care of the patient

Nurses play an essential role in impacting the experiences and care of patients with heart failure. Generally, the medical personnel plays a critical role in helping the patients understand the disease's impact in their daily lives and create awareness of interventions that will significantly improve their health (Nicol, 2011). Edith is lucky to have Martin Melville as her nurse expertise. He is both caring and empathetic, virtues that have helped her in coping with the disease. She admits that Martin, her nurse, would always find a solution for her whenever she feels unwell. With the increased number of people living with long-term conditions, it is crucial to equip the nurses with the necessary knowledge and skills to cope with the varying complications (Nicol,2011). One needs to have proper medical expertise in dealing with the pathological condition of the patient. Martin best demonstrates this as he administers different drug combinations to his patient as the disease manifests. Also, with his diverse knowledge, he can design an effective care plan.

 It is expected that the nurse should be empathetic to the patient. Empathy in nursing helps build trust with the patient by focusing on the patient's perspective. This boosts the communication with the patient as one can understand how the patient is coping with the condition, which improves the patient's health outcomes, ensures satisfaction, and increases patient compliance rates. When Edith approached Martin, she insisted she had to get well to attend her grandson's wedding. He helped her to manage the symptoms, which enabled her to witness her grandson's marriage ceremony.

Open-mindedness is also crucial in managed care. This enables them to deal with different conditions rather than the primary condition with a lot of ease. With Edith spending most of her time at home, her muscles stiffness. Martin can discern the state and introduces her to swimming which she enjoys. She even says it is relaxing and sleeps in peace after the swimming session. Open-mindedness in dealing with long-term patients, helps deal with even complex cultural issues. One needs to appreciate that society comprises different individuals with different interests, competencies, ethnic backgrounds, languages, and traditions. Valuing diversity means recognizing different cultures, understanding that difference does not mean deficiency, appreciating the aspects offered by different cultures, encouraging participation of the diverse groups, empowering them to achieve their maximum potential, and celebrating the diverse nature of society. It ensures fairness in the care of the patient, which boosts the recovery rate.

Conclusion

Coping with LTCs such as heart failure disrupts the daily activities of the people living with them. Self–acceptance and appreciation help the patients to adhere to a healthy lifestyle and medication. Having effective communication channels between the patient and the medical specialist will facilitate access to quality healthcare. Similarly, receiving support from both family members, medical specialists, and the community reduces the impact of LTC on the patient. Individual self-care helps in promoting the patient's independence, especially elderly patients.  

 

References

Bonow, R.O., Mann, D.L., Zipes, D.P. and Libby, P., 2011. Braunwald's heart disease e-book: A textbook of cardiovascular medicine. Elsevier Health Sciences.

Carrier.J.,2016. Managing Long Term Conditions in Primary and Community care. Available at <www. magonlinelibrary.com>.

Donnellan, C., 2015. The Baltes’ model of successful aging and its considerations for Aging Life Care™/geriatric care management. Journal of Aging Life Care. Fall 2015.

Katz, A.M. and Konstam, M.A., 2012. Heart failure: pathophysiology, molecular biology, and clinical management. Lippincott Williams & Wilkins.

Nicol .J., and Hollowood, L., 2019. Nursing Adults with Long Term Conditions

Nicol, J., 2011. Nursing adults with long term conditions. Sage.

Pattenden, J.F., Roberts, H. and Lewin, R.J.P., 2007. Living with heart failure; patient and carer perspectives. European Journal of Cardiovascular Nursing6(4), pp.273-279.

Sperelakis, N. ed., 2012. Physiology and Pathophysiology of the Heart (Vol. 90). Springer Science & Business Media.

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