CHRONIC ILLNESS
1
Introduction
A chronic illness refers to a long-term health ailment that might not have an appropriate cure and some common examples of chronic illnesses are asthma, cancer, diabetes mellitus, arthritis, ad heart disease (Falvo & Holland, XXXXXXXXXXChronic illnesses affect several regions of the body and are generally not responsive towards treatment, thus persisting over a long period. It has often been found that chronic illnesses are co
elated with relapse or remission where the illnesses temporarily disappears, or eventually reappears. While the major risk factors differ with gender and chronological age of the affected people, most common chronic illnesses are a direct consequence of lifestyle, dietary pattern and metabolic conditions (Joachim & Acorn, XXXXXXXXXXThis assignment will analyse the interview response of a patient suffering from type 1 diabetes, following which the pathophysiology and pharmacology of the illness shall be discussed. The Roper, Logan and Tierney nursing model and clinical reasoning cycle will also be used to define the care priorities.
Background
The interview was conducted with an adult female patient X (pseudonym). Her name will not be disclosed following the standards of maintaining confidentiality regarding patient personal information. X was suffering from type 1 diabetes (T1D) and health status was characterised by signs and symptoms of increased hunger, frequent urination, extreme thirst, fatigue, blu
y vision, unexplained loss of body weight, and mood changes. Her personal history consists of presence of T1D in her mother. Her cu
ent medications include NovoRapid that she is supposed to intake 15 minutes before meal. However, it was analysed from the responses that she often forgets to take the insulin and does not regularly measure her blood glucose levels, which is supposed to be checked thrice a day, before meal.
The pathophysiology of the condition involves the termination of lymphocytic infiltration and damage to the beta cells that are located in Islets of Langerhans in the pancreas. With a decline in the mass of the beta cells, there occurs a reduction in secretion of the insulin hormone, unless the insulin available is no longer sufficient for maintaining normal levels of glucose in the circulating bloodstream (DiMeglio, Evans-Molina & Oram, XXXXXXXXXXFollowing destruction of around 80-90% of the beta cells, there occurs the development of hyperglycaemia and diagnosis of T1D. This calls for the need of administering exogenous insulin to the patients, with the aim of reversing the catabolic ailment, reducing hyperglucagonemia (excess glucagon secretion), preventing ketosis, and normalising protein and lipid metabolism (Wewer Al
echtsen, Kuhre, Pedersen, Knop & Holst, XXXXXXXXXXNovoRapid is commonly used for management of T1D and comprises of the active substance insulin aspart that is a rapid-acting insulin (Kapitza et al., XXXXXXXXXXIt exerts effect after around 1-3 hours following a meal, and the effects last till 3-5 hours. The typical dose is XXXXXXXXXXunits/kilogram body weight/day. It acts in the form of replacement insulin, which although similar to the hormone insulin produced in the body, gets abso
ed at a rapid rate and helps in controlling the amount of blood glucose. However, evidences suggest that hypoglycaemia is the most common side effect of NovoRapid, though its health advantages are greater than the risks (Cypryk & Wyrębska-Niewęgłowska, 2018).
Discussion
The responses suggested that the diagnosis of T1D is a major stressor for her family and also creates problems in her association with her partner, since she remains more involved in disease management. Not only does the medication expense and cost of food create financial trouble, but X is also affected emotionally since she is not able to follow a diet plan according to her wish. She remains wo
ied about her health. Evidences suggest that the physical impacts of diabetes often result in anxiety, nervousness and confusion (Moskovich et al., XXXXXXXXXXApplication of the Roper, Logan and Tierney model of nursing helps in analysing the change
ought about by the illness on the life of the patient. Activities of Living (AL) is associated with promotion of thoroughgoing independence, through comprehensive assessment that eventually lead to management strategies for supporting independence of patients in regions that cannot be accomplished on their own (Williams, XXXXXXXXXXThe major activities of living in the model that are relevant in this case are namely, safe environment, communication,
eathing, sleeping, and elimination. One factor that might affect X’s safety is blu
ed vision and hypoglycaemic attack that would result in confusion, thus necessitating help from others, and increasing her dependence (Lelliott, Basu & Besser, 2019).
Though X does not report any communication problems but hypoglycaemic attack might cause slu
ed speech and lip tingling due to neuroglycopenic effect, thus increasing her vulnerability (Kataria, Fernandes, Lebastchi, Bravo & Sena, XXXXXXXXXXX is typically independent with
eathing, nonetheless might report i
egular pulse and respiration due to hypoglycaemic attack. Since diet has not been effective in controlling T1D, X was prescribed insulin. Skipped meals can be associated to poor dietary intake and this in turn increases risk of hypoglycaemic attack, thus calling for the need of assistance from dietician to adhere to a balanced diet (Faradji, Uribe-Wiechers & de la Maza, XXXXXXXXXXT1D might also lead to polyuria owing to the glucose concentration in glomerular filtrate. In addition, problems of polyuria or frequent urination might cause nocturia, thus affecting the quality and amount of sleep she gets (Weiss & Everaert, 2019).
Care priorities and goal setting
The responses provided by patient X helped in detection of two major issues that directly threaten the health and wellbeing of the patient that are namely, (i) poor health literacy and (ii) poor dietary management. Poor health literacy has often been co
elated with noncompliance to management and treatment plans and the prescribed medication regimen, high costs of healthcare, poor self-care and an increase in the risk of mortality and hospitalisation (Castle et al., XXXXXXXXXXA diet that is rich in calories, fat and cholesterol directly increases health risk of the patient. Not only does her habit of skipping meals worsen her health condition, but the poor diet during social gatherings and festivals also increase her chance of suffering from obesity, thereby making her more susceptible to como
id conditions like cardiovascular problems.
The Partnering with Consumers Standard identifies the significance of involving all patients in their health management and also highlights the importance of directly communicating with patients (ACSQH, XXXXXXXXXXThe first health education area of poor health literacy will be addressed based on action 2.10 that emphasises on communicating with patients, families, carers and consumers such that the information delivered is able to meet their needs and easy to comprehend (ACSQH, XXXXXXXXXXThe ability of a patient to read, comprehend, and implement health-related data creates a huge impact on the efficiency of both written and oral patient education. The first strategy will encompass usage of the ‘teach-back’ method where information about T1D, its impact, cause and management will be reviewed and repeated at the end of each session for reinforcing the major messages (Yen & Leasure, XXXXXXXXXXIt will involve inquiring the patient X to recapitulate in her own verses what is required for T1D management. She will be explained that multiple injections at same region often leads to fat deposit (Smith, 2017). Not only will she be taught the significance of deep subcutaneous insulin administration, but will also be taught strategies for managing hypoglycaemia using snack, cracker or glucagon injection.
The second care goal will be based on action 2.6 that focuses on delivering safe and high-quality care to patients by involving them in planning and deciding about existing and future care (ACSQH, XXXXXXXXXXX will be taught that meal timing is significant and must match the insulin doses. A diet chart will be prepared that contains complex ca
ohydrates like whole wheat, quinoa,
own rice, oatmeal and fruits. X will be advised to avoid food products and beverages like soda, trans-fats, simple ca
ohydrates, and processed food (Lennerz et al., XXXXXXXXXXThe importance of consuming protein-packed foods such as, eggs, legumes, peas, and lean meat will also be taught.
The care plan will also include adding Medite
anean diet to her diet plan owing to the fact that it contains nutrient-dense foods (Granado-Casas et al., XXXXXXXXXXThe patient will be asked to regular check body weight that acts like an assessment tool for evaluating the sufficiency of nutritional intake. Her bowel sounds shall be auscultated owing to the fact that fluid electrolyte distu
ance and hyperglycaemia often reduces gastric motility, thus affecting the intervention choice (Sharayah, Hajjaj, Osman & Livornese, 2019).
Conclusion
Thus, it can be concluded that the patient X who had been subjected to the interview was suffering from the chronic illness of T1D. Her interview responses suggested that she might have inherited the condition from her mother who was also diagnosed with the metabolic syndrome. T1D has affected her emotional, financial and cultural wellbeing. Not only does poor literacy about health condition make the patient X more likely to suffer from poor health outcomes, but also decreases her engagement with the healthcare providers and reduces comprehension of clinical information. However, poor adherence to dietary changes, skipped meals and i
egular insulin administration have further worsened her health status. Therefore, the two key priorities that will be addressed in this case are poor health literacy and poor dietary management. The Partnering with Consumers Standard will therefore be followed for the implementation of care strategies that will increase her awareness on diabetes management, and also decrease the imbalance in nutrition that she is suffering from.
References
Australian Commission on Safety and Quality in Healthcare XXXXXXXXXXPartnering with Consumers Standard. Retrieved from https:
www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard
Australian Commission on Safety and Quality in Healthcare XXXXXXXXXXAction 2.6. Retrieved from https:
www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard/partnering-patients-their-own-care/action-26
Australian Commission on Safety and Quality in Healthcare XXXXXXXXXXAction 2.10. Retrieved from https:
www.safetyandquality.gov.au/standards/nsqhs-standards/partnering-consumers-standard/health-literacy/action-210
Castle, M., Adams, N., Coriell, A., Buffinger, A., Crabtree, K., Liston, J., ... & Ehrhart, K XXXXXXXXXXImproving Health Literacy for Positive Patient Outcomes. https:
digitalcommons.shawnee.edu/cos/2019/day1/3
Cypryk, K., & Wyrębska-Niewęgłowska, A XXXXXXXXXXNew faster-acting insulin Fiasp®—do we need a new meal-time insulin?. Clinical Diabetology, 7(6), XXXXXXXXXXDOI: 10.5603/DK XXXXXXXXXX
DiMeglio, L. A., Evans-Molina, C., & Oram, R. A XXXXXXXXXXType 1 diabetes. The Lancet, XXXXXXXXXX), XXXXXXXXXXhttps:
doi.org/10.1016/S XXXXXXXXXX
Falvo, D., & Holland, B. E. (2017). Medical and psychosocial aspects of chronic illness and disability. Jones & Bartlett Learning. https:
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Faradji, R. N., Uribe-Wiechers, A. C., & de la Maza, M. E. S XXXXXXXXXXHypoglycemia: Diagnosis, Management, and