Approaches to Nursing Adults with Long Term Health Conditions

Approaches to Nursing Adults with Long Term Health Conditions

Adult Living with Long-Term Condition

Nursing practices basically revolves around offering patient care services to various individuals who require varying health service requirement. Among these patients are those suffering from Long term conditions. These kind of health conditions are not curable but are managed by applying appropriate nursing care, therapies, and proper medication (Goodwin et al., 2010). According to the department of health service (2012), Long Term Conditions (LTC) are defined by as a condition that cannot be cured but controlled by medication or other treatments like therapies. Patients suffering from LTCs are intensive users of our National Health Service (NHS) and account for 50% of GP appointments and 70% of health and care spending (Department of Health 2012). In order to manage pressures that mount to the health and social care services, patients living with long term conditions require special support to make lifestyle changes in order to effectively self-manage (Nicol 2015). In this essay, pseudonyms have been used in place of the patient’s name so the patient cannot be identified, therefore maintaining their confidentiality in line with the Nursing and Midwifery Code (2015).

Case study

Bertha has been suffering from schizophrenia since birth and has been diagnosed to be suffering from diabetes type 2 in the last 7 years. She hasn’t been taking her medication, resulting in her admission to the acute unit center (ICU). The disease is worsened by her family members and friends who continuously bring her sugary food, which is unhealthy for a person with diabetes. There is a rising complaint from the medical staff that Bertha is skipping her medications and frequently refusing to undergo a blood test to determine her glucose level before and after the meal. When forced to check on her blood pressure, the results indicate that she has a high blood pressure accumulating to 16mml to 19mml. She has been found to oversleep and frequently complain of dizziness and being weak. At night, she complains of continuous urination amounting to 6 to 5 times in one night. She has difficulties in breathing during supervision. Bartha is aware of health complications that are linked with diabetes, but her mental health, she isn’t following the appropriate medication. She has gained a lot of weight recently due to the use of o9f Metformin.

Diabetes mellitus is a health disorder associated with the inability of the body to utilize glucose, proteins, and fats. It’s also a state of insulin deficiency or weakening due to primes of Hyperglycaemia and Glycosuria (Dunning, 2014). The condition occurs when the body is unable to utilize glucose in the absence of insulin due to the absence of exhaustion of cells that produce insulin in the pancreas (Dunning, 2014). The essence of insulin that is produced in the pancreas is that it helps in completing fat metabolism and maintaining blood sugar levels in the body (Dunning, 2014). However, there is an increased breakdown of proteins leading to the growth of hyperglycemia, weight loss, body weakness, and the development of lethargy.

The blood glucose level depends on the sensitivity happening between fasting and the fed state as well as the simultaneous functioning variables that include hormones, tissue sensitivity on glucose, and exercise (Dunning, 2014). The release of insulin happens in two broad ways. According to Dunning (2014), the first phase helps in controlling the postprandial blood glucose and disappears in the early progression to type 2 diabetes (T2D).

Metabolic syndrome is a collection of metabolic disorder consisting of cardiovascular diseases, obesity, and T2D. It reveals that it comes from a generic origin and environmental factors like inactivity, smoking, high-fat content, some medicine, a person’s age, and normal imbalance (Dunning, 2014). These factors lead to maternal obesity and metabolic stress. Signs of T2D in aged people include inconsistency, constipation, cognitive changes, frequent UTI, dehydration, and candida.

Abdominal fats are resistant to antilipolytic consequences of insulin, leading to the loss of a large number of carboxylic acid. Furthermore, according to Dunning (2014), both saturated and unsaturated fats lead to insulin becoming resistant to muscle and liver cells, leading to a rise in gluconeogenesis in the liver. Besides adipocytes becoming too large, they reduce their potential to store fats, causing a significant amount of fat to be stored in the muscle and liver, leading to increased insulin resistance.

T2D occurs mostly when beta cells defect in the pancreas as well as increased resistance of insulin in the body. According to Diabetes UK (2017), one person in ten people who are over forty is diagnosed with T2D. About 3.8 people in the UK have T2D, with those having high glucose level disease remaining diagnosed, which increases the chances of people to suffer from high sugar levels.

The long-term complications that are classified as macrovascular diseases are very common to T2D patients who are enhanced by metabolic syndrome, which confers to cardiovascular, cerebrovascular, and peripheral vascular disease. The common microvascular disease is Nephropathy, peripheral that commonly affect feets legs and feet that have a high possibility of causing hypoglycaemic gastroparesis awareness (Dunning, 2014)

Among health issues linked with Bartha were high sugar level, commonly known as Hyperosmolar Hyperglycaemia Nonketotic Syndrome (HHS). Effects of HHSN are increased urge to urination and dehydration diabetes, 2014). The body tries to lose some of the excess sugars in the body, leading to increased urination. Through osmosis, the excess water in the body is then removed through osmosis into the bloodstream. Consequently, the kidney dumps excess glucose into the urine, leading to increased blood osmolality due to excessive water loss (Diabetes, 2014).

Under increased osmolality, due to high glucose intake and little intake of fluid in the body, both oral and injection, the chances of dehydration increases as well. When dehydration occurs, the body cells as well become progressively dehydrated due to the elimination of water from the cells (Diabetes care, 2014). In relation to Bartha’s case, electrolyte imbalances are dangerous as t can lead to dehydration, which can cause death, coma, and seizures. According to diabetes care (2014), electrolyte occurs to people with type two diabetes who have filed to control glucose levels in their bodies, leading to dehydration. Therefore, people with T2D are linked with injury, stroke, stress, and continuous take of steroid medication (Diabetes UK, 2017).

Another physical health complication linked with Bartha’s case is the presence of Cystic Fibrosis (FC) originating from birth that affects both adolescents and the poor in the UK. People with this condition have a problem in the function ability of their pancreas, causing the pancreas insufficient as well as lack of insulin that results in a huge illness. (Cystic Fibrosis Related Diabetes, 2017).

The mental and physical health of diabetic people is negatively impacted by fluctuations in the levels of blood glucose. This is linked to anxiety, making it difficult to live with diabetes (McEvoy, 2013). People will deal with diabetes according to the mood they are in, where even family members can be victims of anxiety that is made worse by Glycated hemoglobin and irregular self-management that is common to diabetes patients (McEvoy, 2013). According to McEvoy (2013), patients who fear needles and hypoglycemia have a high percentage of suffering from anxiety as well as failure to implement self-care activities. Poor who fear needles will avoid doing self-care management like injections, self-monitoring sensors to check blood glucose levels (SIGN, 2017). Fear of hypoglycemia will cause an underdose intake of insulin or omission. This will limit the possibility of preventing low levels of blood glucose and hormonal systems like fight or flight (Dunning, 2014).

After gaining consent from Bartha, mindful training, along with cognitive behavior therapies, were organized for people with anxiety disorders that negatively affected medical self-care, social functions, and occupational of an individual with diabetes and family members. For T2D, blood glucose awareness training, which is an early identification method for neuroglycopenic and physical symptoms of hyper and hypoglycemia, was recommended for Bartha as a cure for self-monitoring management of blood glucose.

The House of Care Model (HoC) framework, is an appropriate strategy that can help Bartha to manage her mental and physical health while trying to fight T2D (Coulter et al., 2016). According to (Coulter et al., 2016), the HoC model enables both the clinicians and individuals to have LTCs to work toward shaping and determining the necessary support to allow them to handle their complicated condition. Coulter et al. (2016), described the UK’s Chronic Care Model as a house due to the availability of many components that can be looked into to enhance a personalized and a well-coordinated care plan. Since Bertha suffers from Schizophrenia, it increases complications of how she handles her diabetes. Her competency and confidence levels are raised when she is allowed to make her own priorities.

The integration of a personalized care plan for people is one of the primary goals of HOC. It is achievable when clearly defined in the community strategy (Coulter et al., 2016). the resources such as training in various system, are required to support care planning must be commissioned(Sign 2017). The community and volunteers must also be involved alongside setting a method of measuring the outcome. Also, the integrated team of social and support workers, psychologists, and community of nurses as a whole were developed to discuss the type of bertha (diabetes UK 2017). The group gives a recommendation of which the patient was at risk through an assessment like mental capacity.

Appendix

CARE PLAN

Bertha was monitored with cholesterols level HBA1c waist circumference and blood glucose level and was needed for psychologist and individual care as suggested by (Nice 2015). Cookery classes were put in place to ensure that Bertha had a healthy diet inward and home. She must conduct physical excises through the garden, and also, social isolation was to tackled through volunteer and best friends (coulter et al. 2016). The group and locally available services that were helpful to the patient were also considered. It depends on the willingness of the health boards, local authorities, and NHS commissioners to dietary advice were provided to ensure she had a balanced diet.

As suggested by (Nice 2015), she should take a diet of carbohydrates that has low glycemic-index, fruits, and vegetables, whole grains and fiber, fish reach in oil, dairy products with low fat (Nice 2015). Foods that are trans-fatty and saturated acid are discouraged from eating. Bertha should be taking good care to consider her beliefs and emotions that are improving health outcomes. People-centered care should assist the patient in her decision making by conducting questioner (Counter et al. 2015). The information that is both verbal and written is an essential element for the patients to know their role in treatment because it helps in recording good quality measurements of care.

The X-PERT and DESMOND are the nursing tools that were utilized in the sampling analysis of how Bertha type 2 Diabetes could become manageable. The X-PERT focused von the enhancement of understanding skills and knowledge of diabetic individuals and assist them in making better life choices that can assist in the management of glucose level (Counter et al. 2015). The DESMOND involves in the pathway of care, modules, and toolkits that give management of people education and those that are at risk of contracting Type 2 Diabetes (Diabetes UK 2017. Professionals are also able to train local communities when they are equipped with DESMOND.

Patients with Type 2 diabetes should be group educated to meet their literacy, linguistic, and natural, cultural needs of the patient. The primary objects of diabetes management are to achieve rather than to sustain near-normoglycemia, which slows the progression and delays the onset of diabetes to improve healthy (Nice 2015). People with this type 2 diabetes are advised to improve their lifestyles after which therapist can be applied.

The dietician is the urge to deriver professional advice that is sensitive to the beliefs and culture of the patient. In Bertha’s case, she can lose weight and do physical excises to be initiated. However, the report that was cited by professionals’ consultants signifies the barriers to provide sufficient support. The patient’s physical disabilities could also affect blood glucose tests and insulin injections (Brigitte, 2017). The blood group sugar meters that are electronic has also been reported to improve healthcare and provide the privacy and security of the patient (Nice 2015). The developed group support and educate the appropriate professionals to equip Bertha with self-monitoring, hypoglycemia management, and self-care.