Meeting Acute and long-Term Health Challenges
Chronic Conditions
Introduction
Chronic health conditions require intervention or management from nurses, doctors, and other healthcare practitioners to cure or control medical interventions, clinical operations, or therapies.
These long-term health conditions include type I and type II diabetes, e.g., hypertension, angina, Chronic respiratory, conditions, such as asthma, and COPD (chronic obstructive pulmonary disease), Tom Williams has been diagnosed with types 2 diabetes and hypertension.
Diabetes develops when the body becomes resistant to insulin, and this can ultimately result in blindness, kidney failure, and reduced circulation.
Hypertension is a high blood pressure illness. Tom’s diabetes is presently been managed with Metformin and glipizide. The combination of metformin and glipizide integrates two actions which assists the body manage high sugar levels and also stops liver from storing sugar.
Underlying long term illnesses can also develop into severe or acute diseases such as heart failure, myocardial infarction, and stroke. His diabetes could result in total blindness, while bilateral cataracts could be as result of Tom’s age (78 years).
The effects of hypertension and diabetes can be a risk factor to Tom’s well-being, impacting his social mental health.
Tom was an ex-tobacco smoker, which can pose a risk for angina or COPD, even though he stopped smoking. Tom family history has been assessed through his care plan.
We are considering the impact of Tom’s underlying health problems, on both his physical and mental well-being.
Generally people with chronic health problems may also have multiple health conditions, leading to other complication. When this is the case, the types of interventions or nursing approaches used for patients should be person-centred.
The biopsychosocial health factors on Tom’s life, such as diabetes and hypertension can lead to mental health and adverse wellbeing, which would require Tom to visit psychiatric nurse or mental health nurse, sometimes the patients are advised to follow mental wellbeing therapy.
The social implications of Tom Williams’ health condition
Effects on psychosocial impact on an individual or patient cannot be under-estimated. Tom’s social life was good before dwindling over the past few years.
The stress related to well-being and health promotion are inter-woven with the approaches used by practitioner to treat and manage patient. With reference to Tom, his autonomy must be respected and consented to when managing his health plan.
Anxiety can lead to the patient’s social isolation, and uncertainty. Similarly, Tom’s case is linked to social isolation due to diabetes’s exacerbated symptoms, hypertension and other destructive symptoms which might raise his anxiety levels and lead to social isolation.
Tom’s was diagnosed with type 2 diabetes with hypertension, is monitored with several medications.
The psychosocial implications of people who are hypertensive or living with diabetes are most common among some ethical background or race, due to their social-economic situation. stress or emotional wellbeing (Butler, 2017). Diabetes and hypertension are common among low-income countries. Some illnesses are common or present among race, geographical region, or ethnicity regarding dietary lifestyles. These cultures commonly consume high cholesterol foods, or food rich in fibre, resulting in chronic health problem.
Tom had an excellent social life with his wife in a small bungalow, this situation diminished over few years, they moved to a smaller apartment compared to what they previously enjoyed.
Tom may not be socializing like before, having withdrawn syndrome, and may have become less active, which is not helpful for someone who is living with diabetes 2 and hypertension.
The continual increases in Tom’s health assessment of care, and the impact of unemployment on the entire family can also be a major stressor effecting Tom’s well-being (Brooker, and Nicol, 2011). Their new home may be small, and not well ventilated like the former bungalow. The stress of socialising with activities, e.g., playing sports or other recreational activities, might have stopped due to financial concerns and this is another factor we considered.
Tom’s past history of smoking pose risk for COPD or angina. His family may also have a history of smoking.
The connection of chronic obstructive pulmonary disease (OCPD) and smoking is one predominant among some people. In this particular case Tom’s family background makes him more susceptible and heart disease.
National and internationally health condition impact?
According to Dellinger et al. (2013) type 2 diabetes can lead to the development of additional medical problems. Due to Tom’s type 2 diabetes diagnosis, he is also at-risk factor for blindness, kidney injury and heart failure.
Tom was readmitted to the hospital after 48hours when he discharged himself against the hospital approval, in this case, the nursing team would educate Tom about self-care management of his medications and make him more accountable for his self-medication and prompt him to communicate his health status on time.
The consequences of Tom’s not finishing his antibiotics had a serious impact on him during his readmission. It also had psychosocial effects on his family in general, because lack of timely treatment of diabetes can lead to depreciated social and economic assets among other challenges such as depression and eating disorders.
Weight management and a healthy diet are one of the global nursing promotions used to treat diabetes, Tom weight was at 109kg, we need to consult his care plan to check his height and establish his body mass index (BMI). An increase in BMI is directly linked to diabetes and increased vulnerability of acquiring other diseases. Most men have a higher probability of developing more complications than women.
Severe health problems, such as the ones Tom is experiencing now, can lead to death.
Changes in diet, exercise or even medications are very significant to health problems like diabetes, AKI, hypertension, cancer, and obesity are some of illness associated to some races like (BAME) Black and Asia minority ethnic groups (Cox, Schallom, and Jung, 2020).
Another good example is the COVID-19 vaccine, some patients reject the offer of getting the Pfizer/ Biotech vaccine but prefer to wait for the Oxford/AstraZeneca version as an example of nationalism. This goes against internationalism. Since individual with full mental capacity has the autonomy to decline or accept clinical intervention.
World health organisation (WHO) is also an example of international influences, when we consider worldwide health interventions.
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Summary of Tom’s Condition
An overview of Tom Williams’s critical concerns regarding his Long-term illness.
Nurses must have the competencies and nursing skills to assess, diagnose and recognise early signs of acute health problems.
Furthermore, regardless of age, sex, and ethnicity, nurses can manage health challenges, using the basic nursing processes of News 2; RCP, sepsis screening tools (sepsis 6 in cases of red flags).
When we assess Tom Williams’s background, we can generally assume that he may be having acute health complication from some underlying illnesses, e.g., Tom’s diabetes has been a long-term health problem, managed with metformin and glipizide.
Atrial fibrillation, the heart rate is fast, irregular and reduce blood flow to the heart, with symptoms such as shortness of breath, and fatigue, and Tom is susceptible to this, having experienced it in the past. Tom is awaiting surgery for bilateral cataracts for his impaired vision, a common condition for patients over 60 years of age.
The ABCDE approach and the NEWS 2 scores used mostly by health care practitioner worldwide. Regarding Tom, this score shows some ascending urinary tract infections, which can also lead to a neurogenic bladder, a condition which the brain is unable to transmit signal, due to injury, affect mainly the bladder and its neighbouring organs.
Tom’s present temperature was 38.6oC, but an auscultation air entry is heard in all the four quadrants of his lungs with crepitation heard in both bases.
An E-GFR of 48, is an indication that Tom needs urgent medical intervention, because GFR of 60 or higher is normal, while lower than 60 is an indication of kidney injury.
The concern of pressure sores around the sacrum, is common among patients over 70years, due to dehydration and illness like diabetes, it is also common during hospital admission because of mobility problems and confinement to bed, without hourly repositions of the patients (Butler, 2017). This leads to the possibility of incontinence of urine, faces and poor hygiene, which can potentially be why Tom has pressure sores that can lead to ulcer. Therefore, Tom’s condition seemed to be geared towards improvement due to current medication and the lifestyle changes that he makes in his life.
Identify and critically discuss Tom Williams’ care priority and care management.
Breathing assessment, one of the most important things to note during an ABCDE assessment ensures that patient airways are patent prior to breathing assessment by looking, listening, feeling, and measuring. In this particular case, Tom’s airway is patent because he is alert but reluctant to be in hospital.
We can assess Tom’s care plan and his present assessment. Clinical concerns would indicate why he was admitted to the hospital and the tests carried out to determine any long-term health challenges. We know the possibilities that Tom may develop an ascending urinary tract infection, which is the inability to expel urine. The risk of sepsis is crucial to Tom’s health and must be screened since one of the parameters of the NEWS 2 ABCDE also score 3 (respiration) since Tom has an impaired immunity (diabetes). In addition, his age of 78 years old indicates a Sepsis screening should commerce when patients show signs of unwell or has some physiology abnormality.
Tom’s blood glucose was 18.7mmol/L, a great difference from an earlier reading of 18.2mmol/L, and normal reading of 4-8mmol/L. We are of the impression that Tom confusion can be a result of ascending urinary tract infection or the side effects of his medications or the possibility of an underlying health problem like Acute kidney injury (AKI).
In order to attain multiple aims Tom’s medical delivery structures has to be aligned with his medical condition and the medication from the doctor. The care management emerges from primary ways of handling medical condition and designing ways of preventing emergencies. Defining the care management according to Tom’s condition will increase the quality of the medication.
Using an ABCDE assessment after Tom was readmitted at 19.00u: -20.00u.
Tom’s Background: -
- Type 2 diabetes for 20 years (prescribed metformin and Glipizide)
- Atrial fibrillation (prescribed digoxin and aspirin)
- Hypertension for which he has prescribed an ACE inhibitor (Ramipril)
- Awaiting surgery for bilateral cataracts
- He used to smoke but quit up several years ago.
Assessment from 19.00 u– 20.00u
Airways:
- Confused (2) Breathlessness.
- Airway maintenance okay
- Sits up in bed and comfortable,
- Feeling nauseated
Breathing:
- R = 32/min NEWS 2 score = 3
- Spo2 = 90% NEWS 2 score= 3
Circulation:
- HR = 98/min P= Irregular
- BP = 90 /63 NEWS 2 score = 3
Urine output: Urethral catheter inserted on admission drained 80mls.
CSU: sent for culture and sensitivity.
Complaints of nausea:
Tom has not passed urine for 14 hours; this is an indication of UTI.
Disability:
Blood Glucose = 17.4 mmol/L
Temperature: = 38.6oc News2 score = 1
Confused
Lethargic and slow to respond to verbal commands: This can be an indication of shock, stroke or UTI.
Exposure:
- Skin and mucus membranes dry and cracked.
- Pressure sore stage 4 on the sacrum
NEWS 2 = 10
Chart 2: NEWS 2 threshold and triggers due to an aggregate score 7 or more.
Clinical risk = High
Response = Urgent or emergency response
Situation, background, assessment, and recommendation (SBAR)
Clinically effective detection and management of patient are essential to their care and general wellbeing. In this case, Tom needs a medication tailored to meet his personal medical needs.
Respecting patent centred care and wishes, knowing your patient and having knowledge about their care and needs, would help the practitioners make informed decisions regarding Tom’s care.
If the trigger scores for Tom are in the high-risk range, then the outreach team should be contacted immediately and when relevant, evidence should be compared and contracted to supported intervention.
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Date and time of initial call: 14/01/2021 19.15u
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Information:
Patient’s name: Tom Williams Nurse’s Name:
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Date and time of response:14/01/2020 19.20u
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Name of person communicating with:
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Background: Relevant past medical, psychosocial, history, economic, spiritual/ ethical factors
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Background of Tom Williams: · Type 2 diabetes for 20 years (prescribed metformin and Glipizide) · Atrial fibrillation (prescribed digoxin and aspirin) · Hypertension for which he has prescribed an ACE inhibitor (Ramipril) · Awaiting surgery for bilateral cataracts · He used to smoke but gave up several years ago.
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Assessment
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Previous sign Time taken18.00u
R: 22/min
SPo2:97% P: irregular T: 38.2oc
GCS: 14/15
Blood Glucose: 18.2mmol/L Disability: Confused
NEWS scores: 5
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Current vital sign Time taken: 19.00u.
R: 32/min
SPo2: 90% P: T: 38.6oc
GCS:14/15
Blood Glucose: 17.4mmol/L Disability: Confused
NEWS scores: 10 between 19-20u |
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Others:
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Lactic Acidosis is the cause of metabolic acidosis among hospitalized patients and Tom was 2.9mmol/L which is high.
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Recommendations and response: · we are recommending extra fluids to keep the blood pressure from dropping dangerously low, which can cause shock. IV fluids, so that the organ can function and reduce damage from sepsis. · Commence antibiotics therapy for suspected urinary infection. · Access serum creatine and urea and electrolytes. · Insert a urethral catheter and send a catheter specimen of urine (CSU) for culture and sensitivity to antibiotic intervention.
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What we are requesting: Tom should be reassessed immediately by senior nurse, as we suspect deterioration in his physical health. His pulse rate is irregular, with elevated lactate and high creatinine of 630µmmol/L?
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What we are recommending: We would like Tom to be reassessed by a senior trained nurse and if possible, transfer to ICU. Ask Tom for consent or ask his family if Tom is unable to give consent due to his UTI. The NEWS2 score is outside the set parameter, we should think sepsis.
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Signature: |
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Evidence based Intervention.
Evidence based assessment is a way to interpret the patient’s present condition to ascertain any long-term potential risk, prevent health deterioration and access timely intervention. Evidence based intervention are reliant on Tom’s progression due to the assessment of the expected outcome. Due to the isolation of specific mannerisms.
This method has been effective in patients with same signs and symptoms as Tom (Gain, 2014). When a nurse identifies concern, they should seek immediate advice and support.
Keeping Tom safe during hospital admission by staying with him throughout
The major aim is to monitor and reassure Tom hourly, which including airways observations and, breathing, because Tom may go into shock, causing a stoke or occult sepsis. Dehydration is another reason to continue monitoring Tom. His urinary tract infection (UTI) can also lead to other health complications.
Tom should be encouraged to sit at a 45 degrees angle in his bed, unless there are spinal cord injuries and bed reposition hourly, because of Tom age, there is the possibility of infection and the catheter inserted also pose a risk of infection. Repositioning helps relieve pressure on his bottom and promote good blood circulation.
Hourly screening for Sepsis is very crucial to Tom’s health because if there is need for escalation of health treatment or if any concern is observed, more advanced health practitioner could be in the position make any necessary interventions or recommend transferring him to ICU.
It is critically important in the management of sepsis to act fast, if any red flag is present that is why we would recommend retesting and reassessing Tom as a high-risk patient. He should be monitored to determine the type of antibiotic to be administered to be and if it is achieving the goals.
Communication and reassurance are vital to every patient (Elwyn, and Fisher, 2014) due to the connection it has to shortening the recovery period. We must also seek consent before any clinical intervention since the patient is conscious and has the capacity to give consent. As we know from the report, that Tom was not happy with the face mask, therefore nasal mask was used instead.
Tom’s weight is another factor, as it is weight of 109kg, we cannot measure his BMI without knowing his height, but that information can be assessed from his care plan or hospital passport.
Plan to contact relatives in accordance with Tom’s preferences.
Every patient has information about how, when and who to contact in the case of emergency or end of life in their care plan, this makes it possible to involve family and friend, whether it for family engagement or empowerment (Elwyn, and Fisher, 2014). The presence of family is vital source of psychological stability for patient like Tom, it helps in quick recovery while maintaining a contact with family. More so, some hospital has a team of medical staff members who can give patients encouragement and a social life.
Conclusion
We conclude that Tom maybe having an episode of severe acute health complications caused by one or more his finding from his assessment using the ABCDE approach and NEWS2.
Using NICE guideline as reference, if we consider Tom in this case study, his data’s assessment indicates that maybe be at the risk of acute kidney injury because his health condition is deteriorating rapidly.
It is recommended that his serum creatinine be assessed hourly, by the handover nurses, while reassessing, while keeping Tom safe and reassurance in this vital stage. Family member should also be informed to be on standby.
There are various impediments to Tom’s health diabetes, as an ex-smoker COPD is liable to any chest pain, or angina, which can also lead to stroke or hypertension.
Tom should be referred to a nephrology team because we are uncertain of the cause of acute Kidney injury, but since chronic kidney diseases in adults like Tom show less than 60ml/min/1.732 of (eGFR) Tom may likely be at risk for following disease:
Diabetes, acute kidney injury, heart failure, liver disease, oliguria (when urine output is less than 0.5ml/1kg/hour) and hypovolaemia.
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