Nursing Patients with Chronic Illness
Part One
It is likely that Jason Chen has arrhythmia complications. Arrhythmia is a cardiovascular complication resulting from an irregular heartbeat (Antzelevitch & Burashnikov, 2011). The patient has had a Transient Ischemic Attack, which has led to his hospitalization in an acute care facility. The patient’s father died due to cardiac complications, which may predispose Jason to similar complications. This is due to the fact that cardiac complications are likely to have a genetic link (Knowles & Ashley, 2018). The misuse of alcohol and cigarettes is also likely to influence the patient’s cardiac stability, which may worsen his arrhythmia. It is likely that the arrhythmia is as a result of his failure to take hypertension medication. When diagnosed with this complication, the patient is likely to develop issues with their mental health and have to change his lifestyle. Also, there would be an increased economic burden on his family due to the cost of treatment. Jason may also be laid down from work due to his complications, increasing the strain on the family. This would probably escalate the wife’s depression and require the son to take on the parent’s burdens.
Jason may also be diagnosed with obesity. While it may not be a major chronic condition by itself, the cardiac issues highlighted above make obesity a great risk factor for the patient. According to Jason’s body weight and height, he has a BMI of more than 40. A BMI of more than 30 points is considered obese (Chang et al., 2018), which means that Jason is way above the threshold for obesity. Jason would have to attend lifestyle management lessons to enhance his ability to deal with obesity and try to reduce his weight. In case the obesity becomes limiting, the patient may have to undergo other procedures like gastric bypasses to put his weight in check (Dargan et al., 2018). For the family, this may mean the adoption of a different lifestyle to enable Jason to eat meals that are low in fats and carbohydrates as well as fast food. This would require a contribution from Jane and the son to provide and cook proper home meals for Jason. This may also be a bit more expensive compared to their normal food prices. The economic burden on the family would therefore increase.
It is also likely that the patient is suffering from pulmonary complications as a result of his smoking habits. In this case, the patient is using more than two packets of cigarettes, probably for a few years now. This puts Jason at the risk of developing cardiovascular as well as pulmonary complications such as Chronic Obstructive Pulmonary Disorder (COPD) or bronchitis (Oh et al., 2013). Seeing that the patient is already producing some thick phlegm from his lungs, it is likely that the condition has already intensified. If not addressed soon enough, the pulmonary complications may cause Jason to be hospitalized. This would lead to an increased economic burden since Jason will not be productive, and the family would have to cater for the medical expenses.
Part two
Jason already declares that any systematic treatment referrals would not suit his situation as he does not think he will attend the sessions. It is, therefore, important that the healthcare workers can empower him to come up with self-management solutions for the problems that he is facing. It is crucial to note that the patient’s conditions are a result of lifestyle problems with a likelihood of genetic predisposition. Care and self-management strategies should, therefore, aim to encourage lifestyle changes while using medication to treat complications that limit the patient.
Obesity should be the primary issue that the patient requires to manage (Woo, Lim, & Tam). This would require that the caregivers first establish the rationale for the management of obesity to enable Jason to deal with his increased weight. Patient education should, therefore, focus on making sure that the patient understands the need for him to reduce his weight. Solutions to obesity should be sought collaboratively with the patient. This would involve establishing bad habits such as poor eating habits, lack of physical activity, and alcohol consumption that enhance Jason’s obesity (Lee et al. 2016). The patient is then involved in developing strategies to eat a balanced diet and adopt healthy eating habits and take up physical activity. This will help Jason in dealing with cardiovascular complications as well as the pain problem.
Jason should also be encouraged to reduce his smoking habits and adopt a system to gradually reduce the consumption of cigarettes. This would be through behavioral approaches where the patient learns about their negative behavior, and the caregivers enable him to come up with alternatives to such behavior. Caregivers can recommend nicotine patches or other forms of therapy for the patient (Sakakibara, Kim, & Eng, 2017). Providing Jason with treatment manuals for his problems would enable him to discover how to go about self-management. The literature on smoking and any smoking cessation approaches should, therefore, be made available to the patient.
Self-management should also be aimed at developing stress management and stronger interpersonal skills for the patients (Rakhshan, Najafi, & Valizadeh, 2019). The caregivers should make sure that they insist o the importance of developing proper relationships, especially with the family members. In this step, caregivers should ensure that the patient sees the importance of good relationships in encouraging behavior change. This step can also involve the wife to improve the ability of the family to cope.
The last step in establishing self-management for the patient should aim at establishing a follow-up routine. This can be established through telephone calls, journaling, or visits from social workers and caregivers. According to Namrata et al. (2016), follow-ups enhance the ability of the patient to stick to the goals and achieve them. This is crucial to Jason as it will enhance the treatment outcomes.
Part Three
To:
PhysioActive Singapore
Camden Medical Centre
11-05 Singapore 248649.
4th May 2020.
Dear Sir/Madam
I hope this finds you well. I am a nurse that has been in charge of providing therapy for Jason. Thank you for agreeing to offer care to Jason. He is a 42-year old car driver from Bukit Timah who has a cardiovascular problem escalated by his obesity.
History
The patient has a history of cardiovascular disease from the father. The father died at 67 years after cardiac complications that arose following a transurethral resection of the prostate (TURP) surgery. His mother died at the age of 51 following metastatic ovarian cancer. The patient currently suffers from arrhythmia and has hypertension and has pain in his right knee.
Jason is 115kgs and is 1.65 meters tall, with a case of obesity. He has a family he takes care of through his taxi job. His wife is on treatment for depression. Initially, the patient had difficulties cooperating with the medical team since he thought he should blame his wife for his problems but is now receptive to care.
The patient smokes two packets of cigarettes each day and consumes at least two Tiger beers. He is on medication for hypertension, although he does not take the medication regularly. Jason also administers pain killers to deal with his knee pain.
The patient produces thick phlegm from his lungs and has been previously on a physiotherapy program to improve his airways since he is a regular smoker. He, however, indicates that he does not think that he will attend any rehabilitation programs since he was already on such a program, and he quit. The need to provide for his jobless wife and son also affects his ability to attend any rehabilitation program.
Required Services
I contacted your organization since I am aware that you offer private sessions for clients in their homes. The client would benefit from such a service as it would allow him to work and take care of his family while still receiving treatment.
I write to request that you would come up with a plan to enable Jason to get rid of his excessive weight and provide a continuous monitoring program for his smoking habits. This would assist the patient in dealing with both the cardiac problems and his pain problems as well as reduce his smoking tendencies. I would be interested in your analysis of the patient’s situation and his requirements. I am also concerned about his potential for concordance. I have already discussed the need for a gastric bypass for the patient and would be willing to recommend it to the patient following your review.
I am available for any inquiries or further information through my personal and office lines.
References
Antzelevitch, C., & Burashnikov, A. (2011). Overview of Basic Mechanisms of Cardiac Arrhythmia. Cardiac electrophysiology clinics, 3(1), 23–45. https://doi.org/10.1016/j.ccep.2010.10.012
Chang, X., Dorajoo, R., Sun, Y., Han, Y., Wang, L., Khor, C. C., Sim, X., Tai, E. S., Liu, J., Yuan, J. M., Koh, W. P., van Dam, R. M., Friedlander, Y., & Heng, C. K. (2018). Gene- diet interaction effects on BMI levels in the Singapore Chinese population. Nutrition Journal, 17(1), 31. https://doi.org/10.1186/s12937-018-0340-3
Dargan, D., Dolgunov, D., Soe, K. T., Er, P., Naseer, F., Lomanto, D., So, J. B., & Shabbir, A. (2018). Laparoscopic sleeve gastrectomy for morbidly obese adolescents in Singapore. Singapore medical journal, 59(1), 98–103. https://doi.org/10.11622/smedj.2017086
Knowles, J. W., & Ashley, E. A. (2018). Cardiovascular disease: The rise of the genetic risk score. PLoS medicine, 15(3), e1002546. https://doi.org/10.1371/journal.pmed.1002546
Lee, Y. S., Biddle, S., Chan, M. F., Cheng, A., Cheong, M., Chong, Y. S., Foo, L. L., Lee, C. H., Lim, S. C., Ong, W. S., Pang, J., Wang, J. (2016). Health Promotion Board-Ministry of Health Clinical Practice Guidelines: Obesity. Singapore medical journal, 57(6), 292–300. https://doi.org/10.11622/smedj.2016103
Namrata, H., Xinyue, F., Weifen, L., & Soong, Y. K. (2016). Evaluation of a chronic disease self-management program in Singapore. Ann Chron Dise. 2016; 1 (1), 1001.
Oh, Y. M., Bhome, A. B., Boonsawat, W., Gunasekera, K. D., Lee, S. D. (2013). Characteristics of stable chronic obstructive pulmonary disease patients in the pulmonology clinics of seven Asian cities. International journal of chronic obstructive pulmonary disease, 8, 31– 39. https://doi.org/10.2147/copd.s36283
Rakhshan, M., Najafi, H., & Valizadeh, G. A. (2019). Lifestyle of Patients with Atrial Fibrillation Following Self-Management Interventions: a Randomized Clinical Trial. Journal of caring sciences, 8(2), 83–88. https://doi.org/10.15171/jcs.2019.012
Sakakibara, B. M., Kim, A. J., & Eng, J. J. (2017). A systematic review and meta-analysis on self-management for improving risk factor control in stroke patients. International journal of behavioral medicine, 24(1), 42-53.
Woo, B., Lim, W., & Tam, W. (2018). The Translation of Knowledge into Practice in the Management of Atrial Fibrillation in Singapore. Heart, Lung and Circulation. doi:10.1016/j.hlc.2018.02.024