A Case Study of a Patient Suffering with a Long Term Health Problem

The aim of this study is to provide a detailed account of the nursing care for a patient who is experiencing a breakdown in health. One aspect of their care will be discussed in relation to the nursing process. The model used to provide an individualised programme of care will be discussed and critically analysed.

The Department Of Health (2009) describes long-term conditions as chronic illnesses that can limit lifestyles. In

The nurse’s role would be to evaluate first the patient’s level of understanding of their disease. It is important to also include a patient’s support system when teaching. The nurse must give the patient information about his or her condition in a form he or she can easily understand so the patient can develop a genuine comprehension of the disease process. After the patient has a good comprehension of the disease, he or she can then apply this knowledge to his or her own situation. When this knowledge is applied to a patient’s own situation, the patient is then able to ask questions and form a new way of thinking about living with the disease. When these steps are accomplished, the patient will then be able to create a plan that would help in achieving his or her goals in regards to living with the disease process. As nurses caring for patients with chronic illnesses, recognizing where patients are at in their journey with learning about their chronic illness, and meeting them where they are will help when educating and guiding them to the next step.

Parkinson 's disease is a progressive neurologic degenerative disease of the Central Nervous system. The brain produces Dopamine and Norepinephrine, which are chemicals needed for smooth muscle movement and coordination, heart rate, and blood pressure. Dopamine and Norepinephrine are released by basal ganglions that are produced in a bundle of nerve cells in the brainstem called substantia nigra. In Parkinson 's patients, the substantia nigra are destroyed and neither of the chemicals can be released into the body. (3) The decrease in Norepinephrine causes heart arrhythmia and low blood pressure, causing the person to get dizzy upon standing or tire easily. The lack of Dopamine, the smooth muscle movement and coordination controller is now gone, or significantly decreased, resulting in the first signs of Parkinson’s disease, pill-rolling, a one handed tremor and a decreased appetite. (2)

The aim of this essay is to define a long term condition (LTC) and explain why this is important for nurses. Common symptoms may accompany many LTC’s and how these are treated, along with the impact on patient and carer will be considered. The patient chosen for this case study shall be referred to as John to

J.N., a 65-year-old Caucasian female with a history of anxiety and depression, presents for diagnostic testing at Saint Mary Medical Center in Hobart, Indiana to confirm or deny a diagnosis of Parkinson’s Disease, after presenting with recent onset of upper extremity tremor affecting both sides and facial masking. Patient history also includes bradykinesia, restlessness, fatigue, muscle weakness, and poor balance and coordination, all of which are common in a diagnosis of Parkinson’s Disease. J.N. was referred to the Neurology Department of Saint Mary Medical Center after a routine appointment with her Cardiologist, who noted the recent onset of additional signs and symptoms. J.N. is my mother and my inspiration for this assignment.

Long Term Conditions (LTC) are illnesses for which there is no cure, yet can be managed with the correct medications and treatments. Common LTCs include high blood pressure, chronic obstructive pulmonary disease and arthritis (The King’s Fund 2015). The following essay will discuss LTCs and their prevalence in today's society, by first looking at statistics and the government policies that were developed as a result of said research. Secondly, this essay will examine different methods of developing a care plan for an individual following a biopsychosocial model. Lastly, a Long Term Condition will be examined that was experienced when interacting with a patient from a previous community placement; this individual was living with Chronic Heart Failure and this essay will critically evaluate CHF, including the ailments, causes and the various

This essay will define what long term conditions are and how they impact on individuals, families and the community. It will recognise the social impact in relation to stigmas, the economic impact in regards to financial concerns or costs overall to the individual, their family and the community, and the political impact and how legislations and policies are developed to address, prevent and educate. This essay will examine the New Zealand health strategy, the primary health care strategy and the influence these strategies have in the allocations of funding and initiatives developed to support long term conditions. It critically analyses and discusses primary health care and primary health care nurses, identifying how nurses in these organisations connect and work with patients and the importance of cultural safety in regards to nursing care and support of patients. Long term conditions (LTC), or chronic illnesses, are life changing and have a major impact on people’s lives.

Long term condition (LTC) is a health problem that cannot be cured, at present, but can be managed by medication or therapies’ (Snodden., 2010: p1). There are more than 15 million people in England that are suffering from long term conditions (Department of Health., 2013). Long-term conditions are more common in older people. The percentages of people of over 60 having a LTC is 58 per cent compared to under that is 14 per cent (Department of Health, 2012). LTC is also more predominant in more deprived groups, such as the poorest social class as it has 60 per cent higher prevalence than of those in the richest social class. (Department of Health, 2012).

This assignment with look at long term conditions and the associated multiple pathology and the impact both physically and the financial burden placed on the NHS. It is reported that globally over 36 million deaths every year are accounted to long term conditions (World Health Organisation, 2013). The most common LTCs are reported to be Mental health problems, Diabetes, Hypertension, Musculoskeletal problems, Heart disease and Asthma. (Department of Health, 2012). The DH state that one third of the population are reported to have one or more long term conditions, these are described as conditions that cannot be cured but can be managed. (The Kings Fund, 2012)

Long-term conditions (LTC) are defined as “any ongoing, long-term or recurring condition that can have a significant impact on people’s lives” (National Health Committee NHC, 2007, p. 116). Two out of three adults within NZ have or have had a LTC, resulting in the most prominent cause for hospital admissions, premature deaths and an increase in health expenditure (Auckland District Health Board, 2013). This assignment will cover Olivia’s (pseudo name) experience of living with a LTC and how this has impacted her life. A reflection on learning about LTC will be included as well as a discussion on the implications I may encounter in my future practice when caring for a LTC patient will conclude the assignment.

Many may not know Parkinson’s disease is the second most common neurodegenerative disorder in the world. This disease is most seen in the elderly starting at 62 years of age although, younger individuals can still have the disease it isn’t common. Parkinson’s make it difficult for its victims to carry out everyday activities that might have once been easy for them. As the disease progresses it makes it hard for the patient to do things like walk, stand, swallow and speak. A great deal of people don’t realize how helpful therapy can be when dealing with such disease!

Despite technological and medical advances today, chronic disease and resultant co-morbidities are prevalent in the Australian Healthcare System. As a result, patients, especially in the acute care setting, have more complex care needs. The management and care of patients with these complex care needs present a challenge for the contemporary nursing professional. Positive patient outcomes will be dependent on a number of factors, such as the assessment of the patient’s condition, the identification of potential risks for the patient, the planning of appropriate care and the management of the subsequent interventions that may be required.

Charcot examined a large group of patients within Salpetriere Hospital in Paris, he had developed a way to observe tremors in action and at rest. “He noted that the patients with action tremor had accompanying features of weakness, spasticity, and visual disturbance. In contrast, those with rest tremor differed in having rigidity, slowed movements, a typical hunched posture, and very soft spoken.” (Goetz 2011) Charcot early tremor studies helped to establish Parkinson’s Disease through his very high publicized findings that neurological entity could be confidently be diagnosed. In 1957 a Swedish scientist Arvid Carlsson found out that dopamine in the brain region that is important for movement control. He showed that the levels of dopamine can be reduced in animals to cause symptoms of Parkinson’s Disease and also by giving the animals levodopa (L-dopa) to reverse the symptoms of PD. PD is second most common neurodegenerative after Alzheimer’s Disease and the most common movement disorder. Over 60,000 people here in the United States are diagnosed every year but they say the numbers can be much higher with undiagnosed people out there but over one million people live with Parkinson daily.10 million people worldwide live with Parkinson’s Disease and April 11th is World Parkinson’s Day. On April 11th, 2017 marked 200 years since James Parkinson publicized his essay.

Parkinson disease (PD) is a progressive neurodegenerative disorder characterized mainly by physical and psychological disabilities. This disorder was named after James Parkinson, an English physician who first described it as shaking palsy in 1817 (Goetz, Factr, and Weiner, 2002). Jean- Martin Charcot, who was a French neurologist, then progressed and further refined the description of the disease and identified other clinical features of PD (Goetz, Factr, and Weiner, 2002). PD involves the loss of cells that produce the neurotransmitter dopamine in a part of the brain stem called the substansia nigra, which results in several signs and symptoms (Byrd, Marks, and Starr, 2000). It is manifested clinically by tremor,