NSG2NCI Nursing Patients with Chronic Illness | Free Samples

Part 1: What chronic illness is Liz at risk of developing? Explain by using details from the scenario.

Part 2: Identify the health services available in Australia that could help Liz selfmanage her risk of developing the chronic illness you’ve identified in part 1. Clearly describe what the services involve and who are the health professionals that can help? Discuss why you think Liz would benefit from having access to these.

Part 3: Reflect on the services you’ve identified in  Part 2. Discuss what challenges there could be for Liz to access the services you’ve discussed. What are the gaps in our healthcare services for people like Liz that could be addressed?

Answer:

Introduction

Patient Liz who is forty-nine old, 165 cm high and weighs 87 kgs was diagnosed five years ago with chronic bronchitis. Since the diagnosis, she has been trying to stop smoking cigarette. She has cut down her smoking to 3 cigarettes daily. She also drinks, occasionally and exercises for fifteen minutes by walking her dog around the neighborhood. She is on anti-hypertensive medication as she is hypertensive. Her cholesterol levels are also high. She has an abusive partner which made her relocate. Currently, she lives with her 22-year-old son who is a cook. Patient Liz is an Uber driver. She took this job to try and help out his son. Three days ago she experienced right-sided weakness and dizziness for over 6 hours. After being rushed to the emergency department, where blood tests, CT scans, and ECG was done. They revealed that she had a transient ischemic attack and an atrial fibrillation. The neurologists refrained her from driving the uber for the next two weeks. This made her regret visiting the emergency room and it also saddens her. this paper will focus on the chronic illness that Liz is predisposed to. secondly, Australia offers many services that could be beneficial to patient Liz. Two of these services will be identified. Thirdly, there will be a reflection on the services that patient Liz can benefit from. Lastly, there will be a summary of all that has been done above.

1.Heart failure resulting from the right ventricular failure.

Hypertension, bronchitis, high cholesterol levels, smoking habits, drinking habits, and her recent atrial fibrillation and transient ischemic attack, they predispose him to heart failure as a result of right ventricular failure. Laennec, 200 years ago stated that “for all the diseases that are severe and causes a prolonged period of dyspnea, they tend to cause heart dilatation/hypertrophy as a result of the constant efforts of the heart to perform. The heart tries to take blood through the pulmonary circulation that is to the lungs against the resistance opposing as a result of dyspnea. Therefore, there is a relationship between chronic obstructive pulmonary diseases (bronchitis) and heart failure. Kolb & Hassoun (2012) explains that there is pulmonary hypertrophy and the right ventricle is hypertrophied as a result of remodeling which results from the structural changes of the lungs parenchyma and the gaseous exchange abnormalities. There is an increased ventricular afterload. This is markedly defined by the hypertrophy of the right ventricle, preserved myocardial contractility, and cardiac output. This results from the disruption and chronic hypoxemia of the pulmonary vascular bed. Brown et.al., (2016) states that 26% of the mortalities in America is as a result of pulmonary hypertension. He continues to state that 30% to 70% of those with chronic obstructive pulmonary diseases, for example, bronchitis develops right ventricular failure as a result of pulmonary hypertension.

Chhabra & Gupta (2010) reported that the major cause of death of patients with the chronic obstructive pulmonary disease is cardiovascularly related rather than respirator related and to be specific it is as a result of heart failure. COPD is associated with the cigarette smokers. It is the reason for their morbidity and mortality. As mentioned above COPD causes structural abnormalities and functional abnormalities this is as a result of the chronic hypoxemia which is results from the cigarette smoke. As mentioned earlier the COPD causes right ventricular hypertrophy as the increased pulmonary resistance makes the heart work harder to achieve adequate perfusion. All this translates to pulmonary hypertension which further worsens the COPD (Rahman, Hann, Wilson, Mnatzaganian & Worrall-Carter 2015).

Moe, (2016) the structural changes as a result of COPD is right ventricle hypertrophy and dilation and the functional abnormalities include; an increased end diastole pressure, there is a reduction in the ejection fraction of the ventricles, the recoil/elasticity reduces and the negative intrathoracic pressure is reduced. The long-term effects include heart failure which results from the reduced cardiac output as a result of reduced ventricles dilation which results from the compression of the two ventricles. This reduces the preload and the cardiac output. Lastly, smoking cigarettes predisposes the patient to atherosclerosis which is a cardiovascular disease. In addition to this, the smoke destroys the air sacs, increases the neutrophils influx, causes mucus hypersecretion, causes systemic inflammation which in turns causes the inactivation of the anti-proteinase and there are proinflammatory markers whose expression is markedly seen.

2.Beneficial services to Patient Liz.

Miller & Wood (2012) states that in Australia cigarette smoking is a challenge as it is ranked as one of the highest cause of death/mortality and morbidity. Over a total of 3 million Australian who are 14 years and above they smoke and half a million are occasional smokers. They continue to report that many of them regret starting to smoke and they wish to quit. Many have tried to quit although they are reported to relapse as they are a dependency on tobacco is chronic. For patient Liz, she is struggling to cut down her smoking habit and currently she is at three cigarettes a day. This shows that to reduce her mortality risks and morbidity risks she needs to quit the smoking habit. In addition to this, her cholesterol levels were found to be high and her basal metabolic index (BMI) shows that she is obese. This further complicates her condition/cardiovascular system. She, therefore, needs to get fit and cut her weight and normalize the cholesterol levels.

The first beneficial service.

As stated above she requires to stop smoking so as to reduce her mortality and morbidity risks, therefore her first service that will be beneficial will be the smoking cessation programs offered in Australia. Vuong, Hermiz, Razee, Richmond & Zwar (2016) report shows that a variety of smoking cessation services are available in Australia. these include; the clinical, behavioral and pharmacological interventions to stop smoking. The clinical interventions can be minimal or intensive. The therapies provide include the aversion therapies, the group therapies, the individual or telephone counseling. Secondly, the behavioral interventions are through the self-help programs. The country provides quitting strategies through internet programs, a variety of leaflets and booklets. Lastly, the pharmacological interventions provided in Australia include; the nicotine replacement therapies and the use of the anti-depressants (Rahman, Hann, Wilson, Mnatzaganian & Worrall-Carter 2015). This will benefit patient Liz in her attempt to quit smoking so as to reduce her mortality and morbidity risks.

The second beneficial service.

Reeve, Humphreys, Wakerman, Carter, Carroll & Reeve (2015) research shows that primary health care is emphasized in Australia so as to ensure that a healthy population is obtained. There are strategies set by the Australian government to ensure that the society access these services. They are provision competent clinical care and good access to the secondary and the tertiary services and lastly, there is advocacy to the community for them to address the modifiable health risks and the social determinants. Shams, Ajorlou, & Yang, (2015), the risks of heart failure are reducible by modifying the risk factors. The patient is at risk for heart failure from the formation of an atheroma. This results from her high cholesterol and BMI values. This will further complicate the cardiovascular effects of his smoking habit. To achieve this the Australian government has made it possible by providing education on healthy dieting, healthy lifestyles, and exercising through self-help materials. In addition to this, there are national guidelines on how different genders and age group should eat (the nutritional requirements). Lastly, it has come up with campaigns so as to educate the population more on cardiovascular diseases, their prevalence, etiology, risk factors and treatment (Reeve, Humphreys, Wakerman, Carter, Carroll & Reeve 2015). This services will benefit patient Liz by modifying her risks factors for heart failure.

3.Reflection

Triandafilidis, Ussher, Perz, & Huppatz, (2018) states that high cholesterol levels, BMI levels that are high and cigarette smoking has effects on the cardiovascular system. They predispose the patient to heart failure. Patient Liz, is a smoker, she drinks alcohol, she is obese and her cholesterol levels are high. The Australian government has helped in tackling these effects by making primary, secondary and tertiary services available and accessible to the society. There is also advocacy on the reduction of health risks and on better and healthy lifestyles and exercise. This is made possible through self-education, clinical teaching, and the pharmacological intervention. For the case of Liz, she is receiving the smoking cessation services and the cutting her weight.

The challenges of meeting the two services above include inequitable health care resources. For a patient to receive medical support/service they pay 50% from their pockets. This makes it not to be affordable to the middle and the low-income earners (Macri, 2016). This is a challenge in the case of Liz as she requires frequent check-up visits for cardiovascular checkups and considering that she is a low-income earner this might not be affordable for her. Secondly, the healthcare fraternity is faced by discrepancies on which smoking cessation interventions is the best (Krahnke, 2016). This would affect patient Liz care as she might not be recommended for the best care. lastly, the care and the caregivers concentrate more on the acute issues when it comes to the chronic illness. Therefore, the risk of heart failure might not be addressed and this will disadvantage patient Liz

Conclusion

It is therefore clear that patient Liz is at risk of heart failure as a result of chronic obstructive pulmonary disease (bronchitis) as a result of smoking. On top of this, she is obese which further complicates her condition. To avoid the risks, the Australian government provides the smoking cessation programs and ways to cut weight. Lastly, these services are faced with challenges, for example, equitable service provision.

References

Brown, T. J., Todd, A., O'Malley, C., Moore, H. J., Husband, A. K., Bambra, C., ... & Nield, L. (2016). Community pharmacy-delivered interventions for public health priorities: a systematic review of interventions for alcohol reduction, smoking cessation, and weight management, including meta-analysis for smoking cessation. BMJ Open, 6(2), 270-295 doi: 10.1136/bmjopen-2015-009828

Chhabra, S. K., & Gupta, M. (2010). Coexistent chronic obstructive pulmonary disease-heart failure: mechanisms, diagnostic and therapeutic dilemmas. Indian J Chest Dis Allied Sci, 52(4), 225-238.

Kolb, T. M., & Hassoun, P. M. (2012). Right ventricular dysfunction in chronic lung disease. Cardiology clinics, 30(2), 243-256.

Krahnke, J. S., Abraham, W. T., Adamson, P. B., Bourge, R. C., Bauman, J., Ginn, G., ... & Champion Trial Study Group. (2015). Heart failure and respiratory hospitalizations are reduced in patients with heart failure and chronic obstructive pulmonary disease with the use of an implantable pulmonary artery pressure monitoring device. Journal of cardiac failure, 21(3), 240-249.

Macri, J. (2016). Australia’s Health System: Some Issues and Challenges. J Health Med Econ, 2 (2), 60-75. Retrieved 12 September, 2018 from https://health-medical-economics.imedpub.com/australias-health-system-some-issuesand-challenges.php?aid=8344

Miller, M., & Wood, L. (2012). Smoking cessation interventions: a review of evidence and implications for best practice in healthcare settings. In Smoking cessation interventions: Review of evidence and implications for best practice in healthcare settings. Commonwealth of Australia.

Moe, G. (2016). Heart failure with multiple comorbidities. Current opinion in cardiology, 31(2), 209-216.

Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., ... & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975.

Rahman, M. A., Hann, N., Wilson, A., Mnatzaganian, G., & Worrall-Carter, L. (2015). E-cigarettes and smoking cessation: evidence from a systematic review and meta-analysis. PloS one, 10(3), 244-270 https://doi.org/10.1371/journal.pone.0122544

Reeve, C., Humphreys, J., Wakerman, J., Carter, M., Carroll, V., & Reeve, D. (2015). Strengthening primary health care: achieving health gains in a remote region of Australia. The Medical Journal of Australia, 202(9), 483-487.

Shams, I., Ajorlou, S., & Yang, K. (2015). A predictive analytics approach to reducing 30-day avoidable readmissions among patients with heart failure, acute myocardial infarction, pneumonia, or COPD. Health care management science, 18(1), 19-34.

Triandafilidis, Z., Ussher, J. M., Perz, J., & Huppatz, K. (2018). Young Australian women’s accounts of smoking and quitting: a qualitative study using visual methods. BMC Women’s Health, 18, 5. doi:  https://doi.org/10.1186/s12905-017-0500-1

Vuong, K., Hermiz, O., Razee, H., Richmond, R., & Zwar, N. (2016). The experiences of smoking cessation among patients with chronic obstructive pulmonary disease in Australian general practice: a qualitative descriptive study. Family practice, 33(6), 715-720.