Case Study Essay Online Tutoring

INTRODUCTION

This paper is a reflective study of the management of the complex and chronic needs in a patient. A thorough analysis of the case study format revealed the following information. Mr. Chen is a 79-year-old Buddhist male with a BMI of 39. He is a widower, has strong religious views and lives with his younger daughter, son-in-law and their kids. He was admitted in hospital for colonoscopy due to rectal bleeding. In addition, he was monitored to have high blood sugar, hypertension, mild dementia and ulcer around his ankle. His past medical history includes Type 2 diabetes, hypercholesterolemia and hypertension. He also suffered a Trans ischemic attack few years back and has a family history of cardiovascular and cerebro-vascular diseases. He has been taking medication for high cholesterol, and diabetes and was discharged with a drug for hypertension.

 This essay is a descriptive summary that directs the attention to such individuals who suffer from health complexities and require constant care. It also sheds light on the different barriers that supposedly hinder the proper care and effective solutions to tackle such issues.

 The aim of this paper is to enhance the reader’s knowledge about the significance of structured management, the beneficial part played by the multidisciplinary teams and the strenuous role of the nurse in aiding the patient to avail such care. It will focus on the globally acknowledged health concepts through sharing references and researches from various countries and regions.

 

 

CHRONIC AND COMPLEX NEEDS:

DEFINITION OF CHRONIC CONDITION:

Chronic needs are defined as the medical needs that target the long-term illnesses.

EXAMPLE:

Following are the chronic conditions most prevalent:

• Cancer
• Pulmonary disease
• Diabetes
• Hypertension
• Asthma
• Mental illness.

DEFINITION OF CHRONIC AND COMPLEX NEEDS:

Chronic and Complex needs can be defined as:

• Such conditions in a patient that requires treatment and management over a long period.
• The treatment includes social, environmental, physical and psychological dimensions of the patient.
• Where pharmacological and non-pharmacological approach is acquired.
• Multidisciplinary team members are needed
• Proper daily monitoring is done
• This type of care is costly and might require funding.

(Iglesias et al., 2018) In’ International Journal of Integrated Care’ explained the prevalence of chronic and complex needs through a cross-sectional population based studies. Iglesias et al., (2018) stressed the importance of awareness of the conditions that require complex care and its prevalence.

YES, MR. CHEN HAS COMPLEX CARE NEEDS

Because:

• He has chronic conditions that require complex care e.g. diabetes, dementia (Lin and Elizabeth, 2012).
• His feeding habits are unhealthy, which resulted in the deterioration of his condition. He therefore needs guidance.
• Due to the list of diseases, he requires a broad utilization of home based health services.
• He requires speech therapy and psychological care.
• His weight and height ratio targets him as an obese individual and requires proper therapy. Obesity has been found to have a direct relation with diabetes (Wang et al., 2005).

 

3 TYPES OF NEEDS AND RATIONALE FOR PRIORITIZING THESE NEEDS:

Mr. Martin suffers from a list of needs, but the most obvious and that requires our immediate attention are

• Diabetes
• hypertension
• dementia

 

RATIONALE FOR PRIORITIZING THESE NEEDS:

TYPE 2-DIABETES:

• Type 2 diabetes is a lifelong disease that affects the person extensively (Roupa Ζ et al., 2009). Roupa Z et al. (2009) enlighten the effect of diabetes and BMI on the fluctuation of mood and depression. The increase and decrease in blood glucose level influences the blood pressure, kidney function and the other major organs.
• Chen has been observed to have hyperglycemic state when admitted. Even though Metformin had been previously prescribed. The need to inject insulin tells us that the dietary and living condition of Mr. Martin doesn’t comply with the health standards.
• Diabetes also results in atherosclerosis in patients (Hurst and Lee, 2003). Mr. Chen having a history of Hypercholesterolemia is at a high risk for atherosclerosis which makes diabetes, a risk that needs to be immediately managed.
• It was also observed that an ulcer had been developed on the ankle of the leg foot. It can be assumed that the ulcer was due to venous hypertension or might be a diabetic foot ulcer. In both the cases, treatment of diabetes is imperative to bring about a change.
• Trans ischemic stroke is found to occur more in patients with diabetes type 2 due to cerebrovascular risk factors (Lee et al., 2007).

HYPERTENSION:

• According to the case study, Mr. Chen was admitted to the hospital with high blood pressure. He has a history of Hypertension, which might affect his heart if left untreated (Sowers et al., 2001). Sowers et al., (2001) defined in his article the link between hypertension and cardiovascular diseases in a diabetic patient.
• Hypertension is found to be an instigator of various problems. It elevates the incidence of cerebrovascular disease which in turn again results in trans ischemic stroke (Kario et al., 2004). Kario et al.,(2004) illustrated how a silent cerebrovascular disease is found in old patients with hypertension. His article focused on the morning surge of high blood pressure and its connection to patients with stroke. Mr. Chen has a family history of this disease and therefore precautions should be taken

DEMENTIA:

• Dementia requires complex care needs as its symptoms are problematic and cannot be handled easily (Fitzsimmons and Beuttner, 2002). Fitzsimmons (2002) provided results based on clinical trials how the aggression and depression in dementia patients was decreased after providing recreational therapy intervention i.e. cognitive, spiritual, physical and mental therapy
• Dementia is a progressive degeneration of the brain cells. There is a possibility that Mr. Chen might be suffering from dementia brought about by trans ischemic stroke (Kalaria et al., 2016). After the stroke, it progressed over the years and the symptoms became apparent. Although there is no treatment, it is imperative that we manage the illness for a better life care. The underlying cause of the degeneration should also be handled. Through management of diabetes hypertension and obesity, progression of dementia can be controlled.

MULTIDISCIPLINARY TEAM MANAGEMENT AND COMPLEX CARE NEEDS:

Mr. Chen has been found with complex chronic conditions that cannot be easily treated and therefore require professional management (Parekh et al., 2011). A whole range of multidisciplinary team members are present to deal with every issue that arises. They will be from medical profession such as physicians, neurologists, cardiologists, endocrinologists, nurses, psychiatrists, pharmacists etc or from non medical background such as social workers, dietician, physical trainers etc.

 

TYPE 2-DIABETES:

Elderly patients have been found to be most prone to type 2-diabetes and other chronic conditions (Centers for Disease Control and Prevention, 2020). As this is a life long illness therefore it requires a home based therapy and implementation for preventing institutionalization.

• MEDICATION NEED:

Patients with multiple diseases are prescribed a list of drugs that combat the diseases. Drug therapy is one of the most important steps for the management of diabetes. Diabetic patients should be vigilant and their care-givers should be attentive in giving them medicine on time.

ROLE OF THE PRIMARY PHYSICIAN/ ENDOCRINOLOGIST:

A primary physician is the main doctor in the multidisciplinary team. He interacts with the other team members to provide a safe and effective course of therapy. He keeps a proper check on the glucose level through tests every few months.

ROLE OF THE PHARMACIST:

One of the basic needs of the patient is a proper prescription of medicines. They should be effective, with minimum side effects, should not interact with other drugs, should be age-appropriate and the patient should not be allergic to it. Pharmacist plays an important role in this matter.

 

• MONITORING NEED:

Due to the serious health condition, Mr. Chen requires close monitoring. His body should be checked for signs and symptoms of any escalation of disease. His feet and hands should be observed for any sign of ulcer or blisters

ROLE OF DIABETIC NURSE EDUCATOR:

Special diabetic nurses called DNE (Diabetic Nurse Educator) play an effective role in supporting the patient. They are highly qualified in diabetic studies, screen the patient for any critical signs and inform the health practitioner about it.

• DIETARY NEED:

 Mr. Chen’s BMI proves that his dietary habits are quite improper. He survives on take-out food which is quite unhealthy and dangerous for his condition. He requires a low fat, low carbohydrate diet that controls the sugar level in his blood stream and needs to follow a proper schedule for meals. His weight needs to be controlled and should refrain from processed foods.

ROLE OF THE REGISTERED DIETICIAN:

A dietician will be able to guide Mr. Chen and will design a comprehensive food plan that will comply with his chronic conditions. He will discuss the patient’s physician and nurse to devise a plan that cater patient’s needs and keep the glucose within target range.

• EXERCISE NEED:

Exercise is another important need of a diabetic patient. A physical activity utilizes the sugar in the body and aids in functioning of insulin. Mr. Chen should be encouraged to resume his activity in the garden and light exercise that is age appropriate.

ROLE OF PHYSICAL TRAINER:

A physical trainer will plan an exercise regime for the patient based on the patient’s age, weight, health condition and will help Mr. Chen to lose weight in an active way.

HYPERTENSION:

• MEDICATION NEEDS:

Hypertension is one of the main causes of various cardio vascular diseases. It also affects the diabetic patient’s progress. Mr. Chen was found to have a history of Hypertension and was admitted with high blood pressure. Hypertensive medicines should be taken vigilantly to control the rise of this condition.

ROLE OF PHYSICIAN:

Physician plays an important role in controlling the hypertension. He assesses medical needs, lifestyle choices and symptoms. He orders tests and other therapies that will aid in controlling the blood pressure. He directs the pharmacological and non-pharmacological approach. Physicians may also include cardiologists.

• DIETARY NEED:

Mr. Chen requires low salty food for his management of hypertension. Food should have low level of spices, oil and fats to control the blood pressure. Dietitians believe in DASH (Dietary Approaches to Stop Hypertension) diet protocol for blood pressure all over the world. This includes minerals, soya beans and various other food items (DASH Eating Plan, n.d.).

ROLE OF REGISTERED DIETITIAN:

Dietitian will help chart the proper diet based on the health criteria. He will balance the diet based on the patient’s likes and requirement.  He will also assist the patient and his care givers in understanding the reason behind each requirement.

• MONITORING AND ADHERING TO THERAPY:

It is vital that the patient be monitored for any adverse effects such as palpitation, headache and shortness of breath.  High blood pressure may give rise to extreme conditions and therefore blood pressure should be checked. Mr. Chen had a high blood pressure and he was unaware of it. Monitoring at his age is extremely necessary.

ROLE OF NURSES:

Registered Nurses play an important part in providing the first line of care by supervising and analyzing every sign and reporting it to the concerned authority (Patterson et al., 2010).

ROLE OF SOCIAL WORKERS:

Social workers play an important part in connecting the patient and his caregivers to the other patients with similar problems, thus providing support and sympathy. They assist through conveying patient’s wants and needs to the medical professionals.

• PHYSICAL ACTIVITY:

Daily Physical activity helps the heart to become stronger and as a result to pump more blood with little effort. As the heart will work less the arteries will relax and lower the blood pressure down. But this choice requires continuity and promise. Constant three months of exercise will have a prominent effect.  Mr. Chen has an overweight structure that requires exercise. He needs aerobic activity that will keep him active and prevent hospitalization.

ROLE OF PHYSICAL THERAPIST:

Physical therapist is a health professional whose expertise lies in study of movement. He provides the exercise pattern based on the health issue. A good therapist will engage with other health practitioners and will write a low intensity endurance exercise that will not exert Mr. Chen. It will keep him healthy and will keep his sickness in check.

• STRESS MANAGEMENT NEED:

Stress management is one of the most important risks factors of hypertension. When a hypertensive patient takes stress, the hormones released affect the blood pressure and makes it high. This is dangerous for those patients who have a history of stroke and cardiovascular diseases. Mr. Chen was observed to be angry in hospital and had combative nature. His caregivers were equally worried and puzzled. Hypertension has been found to have a negative effect on the psychological being of an individual.

ROLE OF PSYCHOLOGIST:

A psychologist is a person that studies the normal and abnormal mental states, their cognitive brain function and behavior to others. He will assist Mr. Chen through talking and understanding his perspective and needs.

DEMENTIA:

Dementia is defined as a disease with overall decrease in memory, language skills, thinking and other capabilities. It is a disease with no treatment, but management can be done to slow down the progress. The basic care required for Mr. Chen is for his caregivers to understand and remain patient. Patients with dementia are already agitated and depressed. It is important to show compassion and help them in memory loss.

• MEDICATION AND THERAPY PLAN:

 Mr. Chen needs a proper diagnosis plan for management.

ROLE OF NEUROLOGIST/ GERIATRICIAN:

Neurologist or Geriatrician will use various cognitive assessments to diagnose the level of dementia. Based on this diagnosis, a prognosis will be established.

• BEHAVIORAL CARE:

The most important need for Dementia is a handling of behavior. Mr. Chen was reported to be irritated, combative and with sudden bouts of frustration. These concerns need to be addressed.

ROLE OF NEURO PSYCHOLOGIST:

A neuropsychologist is an expert in behavioral and cognitive response. He will also assist in ongoing therapy.

• MONITORING:

Dementia patient needs to be monitored 24 7 due to loss of memory. They have to be reminded for food, medication, exercise and other essentials.

ROLE OF NURSE OR ADMIRAL NURSE:

Admiral Nurses are special nurses that work alongside patients with dementia and their clients. They provide extreme support and bring about positivity and strength. Specialist Nurses are aware of the symptoms and provide immediate response.

• MOBILITY :

Extreme case dementia patients forget the basic routine steps and require assistance.

ROLE OF OCCUPATIONAL THERAPIST:

Occupational therapists are individuals that aid in providing a synchronized movements and schedule that helps the patient to stay independent and to prolong institutionalization.

 

• DIET AND EMOTIONAL STRESS:

Patient with dementia is bound to lose weight and suffer from confusion and depression.

ROLE OF NUTRITIONIST:

Nutritionist will provide a diet for Mr. Chen that will tackle all his existing problems and obesity

ROLE OF SOCIAL WORKER:

Social workers will aid in providing care and support. They will connect the family to various patients with dementia and help in understanding the situation. Social worker will also assist the patient and connect them to other Buddhist patients for a spiritual gathering. They can arrange visits to the Buddhist temple.  Mr. Chen’s psychological state can be helped in this way.

• SPEECH PROBLEM AND ROLE OF SPEECH THERAPIST:

Mr. Chen was observed to have a developing language problem due to the onset of dementia. Speech therapist will aid the patient in reacquiring his speech skills through a strategic approach.

 

OTHER NEEDS AND ROLE OF REGISTERED NURSES:

Nurses are the link that connects medical and non-medical staff. They are the main supervisor of patients and observe the diagnosis, prognosis and after effects.

AGED CARE ASSISTANCE:

Aged care assistance team is a professional team that is experienced in dealing with aged people with ailments that cannot be handled easily at home.  Mr. Chen is a patient of illnesses that require constant supervision. His children can opt for these services if needed. This team consists of medical professionals, nurses and other workers. Registered nurse can provide details for such associations and connect the care givers to it. Their excellent skills and critical thinking will work here (Patterson et al., 2007). They can assure the staff at ACAT about the condition of the patient and brief them.

DOMESTIC ASSISTANCE:

As mentioned in the case study that Mr. Chen’s family wants to go on vacation but are afraid to leave him alone at home. This issue can be resolved as there are places called residential aged care assistance. They provide domestic and complete care for the elderly. RN again plays an important role here as their job makes it possible for them to connect clients to the desired location.

FINANCIAL ASSISTANCE:

Nurses can aid the patient and his family through different resources (Iglesias et al., 2018). Example many pharmaceutical companies provide patient assistance for those who can afford it. Nurses can organize such appointments and can contact certain organizations that can fund the elders care.

 

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