Family Health - Case Study Example

Case History Introduction Autoimmune diseases are diseases characterized by the invasion of the body tissues and organs by the body’s own immune mechanisms and cells. Lupus erythematosus is one such disease that occurs when the body’s immune system attacks connective tissues such as the joints and other organs such as heart, kidneys, lungs and the even the blood cells. Although the exact cause of Lupus is still unknown, extensive research has revealed that there is a higher occurrence of the disease in women than in men. Lupus is the general term given to the four types of the disease. According Hejeer, H. (2001), there are four types are: systemic lupus erythematosus, discoid lupus, drug induced lupus and neonatal lupus. The most severe and most is the systemic lupus erythematosus; it can affect many parts of the body but in most cases it affects the skin, joints and blood vessels. Drug induced lupus just as the name suggests is caused by use of certain types of drugs over a long period of time, the symptoms are similar to the ones observed in systemic lupus. However the symptoms can be reversed once the use of the causative drugs are discontinued. Discoid lupus erythematosus is characterized by extensive and recurrent sores on the face; ears head scalp and other parts of the body. The last form of lupus is the neonatal lupus which is not as prevalent as the previous three. This type lupus occurs to newborns during the first few years of birth due to the passage of some of the mother’s immune cells to the baby during birth. These immune cells do not recognize the newborn’s tissues and are therefore capable of destroying the baby’s tissues such as skin, heart and blood. Lupus is evenly distributed across all age brackets but research has established that the risk of developing lupus increases by a factor of eight in older women. Lupus is characterized by alternating periods of active symptoms followed by remissions. The periods of active disease can emanate to fatal instances but the symptoms are always controlled by the use immunosuppressive therapy. Active periods may also lead permanent irreversible damage leading to permanent physical or mental damage. Therefore it is important that lupus is diagnosed as soon as possible. Since lupus is a disease of the connective tissues it usually falls under the field of rheumatology among other diseases such as arthritis. (Uramoto, K. 1992). History of presenting compliant Lupus is a very difficult disease to diagnose because it shares most symptoms with other diseases. Therefore it might take a considerably long time before the correct diagnosis is made and treatment started. The long period of time together with the pain and discomfort caused by the disease may put both the patient and the patient’s family in a challenging situation. Therefore psychosocial issues form an important part of patients living with the disease. This case study is about a female Caucasian patient of 53 years old married with four children and one grandchild. The first time the patient visited the hospital she complained of pain in the joints and the back. The patient was coming for regular doctor’s appointment after having undergone a surgery to remove lymph nodes in the neck which had been infected by pneumonia. It is very important to note that lupus diagnosis is always further compounded by the variations in symptoms from one individual to another. The patient had complained of extreme fatigue during the visit and after observation the doctor had recommended more rest time for the patient. The patient was a kindergarten teacher and her daily schedule was characterized by many involving activities so the doctor thought that rest might provide some relief. However after three days the patient was back again, this time with swollen joints and mild fever. During the physical examination the doctor realized that the patient had skin rashes all over her chest that extended to her armpits. In some instances lupus causes photosensitivity and since the patient spent most of her time with children outdoors, the doctor considered lupus as an option. The patient had also complained of bouts of recurrent fever. Laboratory tests revealed that the patient had an abnormal urinalysis which showed that the kidneys were not functioning properly. The tests also revealed that the patient had polyserositis which is a general term used to describe inflammations of the heart lining or pericarditis, inflammation of the lungs or pleurisy, and inflammation of the abdomen or peritonitis. Analysis of the blood cells revealed that there were an abnormally low number of red blood cells. Chest examination revealed the presence of lung infiltrates. The period of examination of lupus is always long considering that a number of tests have to be performed to rule out other related diseases. Uramoto, K. (1992). During the frequent visits to the hospital the patient showed signs of confusion and frustration mostly directed at the doctors and the nurses because she complained that nobody cared of the pain that she was going through and that the doctors were incompetent. Although the doctors were to some degree sure that it was lupus they could not tell her until conclusive results were obtained. The situation was further worsened by the fact that the patient’s husband believed that the patient was suffering from psychological trauma as a result of the past operation. The patient’s children had their own families and had little time and therefore were less supportive. However the nurses were able to establish a strong relationship with the patient by explaining to her that doctors were trying really hard to establish the cause of the symptoms she was experiencing. The patient was able to calm down in most instances during the diagnosis period. Before the diagnosis was made the patient’s situation worsened and now her legs were swollen that she could hardly walks. At one time the patient was rushed to the hospital after she experienced violent convulsions while at home. At this point the hospital was forced to admit her. After performing a number of regular clinical tests the doctors finally concluded that the patient was suffering from systemic lupus erythematosus. Past Medical History The patient had experienced a traumatizing medical history and it was disheartening to the patient that no one within her family was supportive. The patient had been born with a congenital heart problem characterized by a hole in her left auricle. The problem was subsequently corrected via surgery. As a result the patient avoided strenuous activities during childhood and could only engage in less strenuous sports such as bowling. One year before the lupus diagnosis the patient had travelled to Africa to deliver some aid to HIV patients. During the journey the patient contracted a dangerous form of pneumonia that had extremely affected her lymph nodes at the neck. Due to the severity the doctors were forced to surgically remove the lymph nodes. Family History The family history revealed that two of the patient’s maternal relatives had died of ovarian cancer. The history also established that the patient had lost one child as a result of neonatal lupus. This presented a very interesting discovery considering that since lupus may be a genetic disease, it raised the question as to the reason it took so long to present the symptoms in the patient and what could have been the most likely trigger. Discussion Lupus patients together with their families experience a challenging period considering that the diagnosis takes so long to be established leaving room for speculations and anxiety. During this period it is the responsibility of the hospital staff to ensure that the patient is given attention. Most importantly the family members should be encouraged to remain supportive and show the patient empathy. During the time before conclusive diagnosis of lupus the anxiety experienced by patients causes them to be irritable and in most instances they tend to blame the doctors or nurses of incompetence. The patients in the case study experienced recurrent symptoms that would go away for some days and then suddenly reappear. Due to the recurrent symptoms most patients tend to believe that it may be a psychological problem presenting itself physically and some even go to the extent of consulting psychiatrists. Recurrent symptoms also make it difficult for the family members to believe that the patient is actually in pain especially if the patient has had previous psychological history. Lupus presents symptoms which at times cause much pain and trauma to the patient, therefore psychosocial aspect of a patient living with lupus is very important consideration to health practitioners. The practitioners need to be conversant with the various aspects of the disease in order to provide quality care to the patient. Lupus is a chronic disease with alternating periods of symptoms and lack of symptoms and with each period the patient may develop some psychosocial problem and the medical practitioners need to be well prepared to deal with these issues. ( Nuria, N. 2007). The fears associated with lupus such as death, disability and losing of job are mostly apparent during and the early stages of treatment. However, the fears may resurface later in life when the symptoms become more intense and the realization of disability of even death dawns on the patient. (Uramoto, K. 1992). According to a research conducted by oxford online journal of Rheumatology (2009) it was established that women suffering from lupus had a higher degree of developing coronary artery calcification which may lead to heart problems as compared to women without lupus; this is due to the adverse psychological effects associated with lupus. Lupus is characterized by many physical, emotional, Social and psychological changes that might sometimes overwhelm the patient. These changes are observed from the time before diagnosis throughout the course of the disease. Unexplained fatigue is one of the symptoms that may reduce the physical capacity of the patient. The fatigue is always accompanied with pain. These changes can affect the patient’s day to day life including important aspects such as social, life, career and hobbies. The most observable symptoms of lupus are the sores and scarring that may appear in different part of the body including the face and the arms. The medicines used to treat lupus may also sometimes change the appearance. The corticosteroids used to treat the inflammatory symptoms may also lead to increase in weight, swellings in the body and hair loss. Furthermore the corticosteroids can lead to mood disorders, anxiety and changes in personality. The patient, the family members and friends should be aware of and understand the consequences of such medicine so that they would be supportive of the patient’s side effects. Although it has been an assumption that lupus is a women disease, research by the Lupus Foundation of America (2007) that the disease can actually affect men regardless of age. However the disparities between female and male patients increases with increase in age: before puberty the ration of male to female is 1:3, the ratio increases during adolescent to 1:10 and dramatically decreases after the age of fifty to 1:8. The most probable suggestion for the decrease during old age is the fact that older women show lower response to hormones. The research also established that the emotional impact of the disease on men and women are the same. Lupus patients are always advised to take the disease seriously especially in terms of taking of medications however mild the disease may seem to be. A keen medical attention is always required to monitor the progress of the disease. Patients are also advised to always share their fears and concerns with their doctors. Sharing of information may assist the doctor in recommending additional psychological help from the hospital if need be. Feelings such as those of death, fear of losing jobs, guilt and anxiety are completely normal for patients who have just been diagnosed with chronic diseases and patients are always advised to give themselves time with proper counseling to get over the feelings. Patients are also always advised to join groups of other people with lupus so that they can benefit from the sharing sessions. A patient is advised to seek professional counseling if the feelings persist for abnormally longer time. Patients are always advised to: find out as much information as possible about lupus, the patients are encouraged to understand that they might encounter various emotions. During this period the patients are advised to adopt a positive attitude. Patients are also advised to dig into their sources of strengths such as families, friends and hobbies. (Pisetsky, D. 2001). The patient in the case study confessed to relief after she was told that what was ailing her was actually lupus. Initially she was very optimistic and even wanted help in making plans on how to deal with the situation. However the optimism was short lived after the symptoms worsened. The reality of the real situation dawned on the patient when she realized that she still bore the responsibility of disclosing the news to the family. The psychological situation the patient is placed in especially when there is little or support from the family is difficult. In most instances when there is a family member accompanying the patient to the hospital visits it is much easier for the health professionals to prepare the family members and they may even assist the patient in disclosing the nature of the disease. However in situations such as the ones experienced by the patient in the case study the most that the health practitioners can do is to prepare the patient on the various responses they might get from family members, friends and even employers. In some instances patients have been known to keep the diseases they are suffering from a secret either by pretending they are okay or by claiming that it is a more mild disease. The denial may be due to guilt that the family member might feel for the financial pressure and emotional pressure the disease might place the entire family in. Some patients also develop an urge to find out as much information about the disease as possible; they urge may be positive because the health practitioners can take advantage and supply the patient with as much information as possible on issues concerning the management of the disease, how to live positively with the disease, the kind of lifestyle to adopt and the best nutrition. However for some patients the urge may be negative and they may go on to find out information from other not so reliable sources such as the internet. The information they find from these sources may be dismal and it is important that the patient is discouraged from depending on these sources. It is mostly difficult for other people to understand what a patient suffering from a chronic disease might be going through. In most instances people suffering from lupus and have not had access to proper medical care or counseling due to ignorance or financial reasons may experience elevated psychological and emotional distress. The distress may cause the patients to be irritable and unstable and therefore socially unapproachable. The psychological results of lupus and the medications used develop from a number of mechanisms. The mechanisms include the emotional reaction to the various physical effects of the disease. The quality of life of the patient may also be compromised especially when the patient does not get specialized health care and support. Depression mostly starts occurring before the disease is diagnosed, because the symptoms are extremely varied and occur intermittently. A survey conducted by the Lupus Association established that half of the patients had experienced the symptoms for more than three years before conclusive diagnosis was made. Most of the symptoms are not quantifiable and in most instances they could pass for symptoms of psychological distress. As a matter of fact most physicians give diagnosis as psychologically related and this may cause the patient to go through emotional distress. The patient in the case study confessed that when she discovered that she had lupus the greatest challenge was not the realization that she was not going to die, but how she would survive with the disease. As is common with most chronic diseases the reaction and approach of the immediate family members is an important factor towards the psychosocial stature of the patient. In most instances the medical practitioners do not have control over the reactions or response of the family members; however the practitioners can prepare the patient for the various responses they are likely to receive and encourage the patient to develop a positive attitude. For instance some family members may be overly smothering to a point where the patient may feel irritated or offended. Since lupus is a genetic disease some family member may feel responsible. For instance, in the case study the patient might have felt guilty since her baby had died of lupus. Although it is a reality that lupus is a genetic disease, a patient should be discouraged from feeling guilty as this might further weaken the already compromised immune system. Any form of stress or depression should be discouraged or deal with as soon as possible. Family members should therefore work together with the health professionals to ensure that the patient is comfortable at all times. The patient together with the family members may also develop concern and anxiety over issues concerning the future. The situation mostly happens with chronic diseases because future planning is always difficult on issues concerning jobs and family life. Planning is difficult because most of the symptoms o lupus are unpredictable therefore it is difficult for a patient to plan for the future not knowing whether she will be well or unwell. A lupus patient may be overly dependent on others physically and even emotionally but this does not mean that the patient needs smothering. (Denburg 1997). Spouses play a very important role when taking care of a patient living with lupus because the patient trusts so much in them and expects them to support them unconditionally. However most spouses rather than being supportive, they may experience strong emotions just like the patient. Such spouses may experience feelings of anger and grief due to the changing physical condition of the patient. Some spouses may also experience a period of denial as demonstrated by the husband of the patient in the case study who refused to believe that his wife could have been showing symptoms of a chronic disease. Lupus may also lead to a considerable degree of mobility and flexibility which may cause a patient to lose their jobs. In the instances where the patient was the sole breadwinner or contributed considerably to the family upkeep it may force the family to reorganize the finances, a situation which may lead to conflicts and confusion. Conclusion Lupus can have adverse effects on a patient’s mood and general view of life. This condition can be triggered by the side-effects of the medication or the psychological challenges associated with the disease. Lupus is caused by an overactive immune system and the treatment always revolves around returning the immune system to normal. Stress or depression can trigger or worsen lupus but there is no conclusive evidence to support this. However the most important thing is that the patient has access to specialized health care and support. (John, W., 2008). The society has responded positively to lupus and lupus patients regardless of the fact that it mostly affects women. The Lupus Association is a worldwide organization with the aim of advocating for a lupus free world through support and research into a possible cure. Unlike other diseases such as fistula that affect women and have therefore encouraged debates on gender issues, lupus has otherwise stayed out of the gender debates. In Australia alone Lupus Association has over one thousand members. The organization provides various services to those who have been newly diagnosed with lupus and those who have been living with the disease. The organization has an official website that provides resourceful information on issues concerning lupus. Furthermore the organization also provides counseling and training services to the family members of lupus patients. The societal response to lupus has helped the patients deal more positively with the disease and even gain some hope for the future due to the researches being conducted. It is important that after a patient discovers that he or she has lupus, that the patient gains as much control of their life as possible. The easiest way to accomplish that is for the patient to get enough education and counseling which encourages the patient to talk freely about her reactions to the illness and the side effects. Aspects such as positive health habits may also be important so that the patient can manage the disease effectively. It is important for the patient to keep in touch with the doctors so that they can learn such facts and even learn how to engage in safe activities such as meditation sessions. (Hejeer, H. 2001). Lupus is just one of the chronic illnesses affecting people that need specialized health care for proper management and to alleviate the pain and discomfort caused by the symptoms. Lupus diagnosis takes a considerably longer time to diagnose and this fact compounds the situation both for the patient and the health professionals. There are many other chronic diseases that may have similar symptoms and the lack of knowledge as to which one the disease is may cause anxiety. After the diagnosis the patient may experience some form of temporary relief. The relief goes away after the patient realizes the severity of the symptoms. (Denburg, 1997). References Bethseda, A (1997), Handout on Health: Systemic Lupus Erythematosus. Retrieved on 7th September 2009 from www.niams.nih.gov/hi/topics/lupus Daniel, J. (2008). The Lupus Book: A Guide for Patients and their Families, 4th edition, Oxford University Press. Denburg (1997). Journal of Rheumatology, Psychological Aspects of SystematicLupus Erythematosus. Hareyan (2007). Emax Health: Effects of Lupus and Lupus Medications on the Mood. Mental Health Articles. Hejeer, H. (2001). Epidemiology of the Rheumatic Disease: Systemic Lupus. 2nd edition Oxford University Press. John, W. Barnhill (2008). Journal of Hospital for Special Surgery:The Effects of Lupus and Lupus Medication on Mood. Cornell Medical College. Lawrence, C. (2008). National Lupus Workgroup. Estimates of Prevalence of Lupus. National Lupus Workgroup. Linda, D (2002), The Female Patient: Coping with Systemic Lupus Erythematosus Retrieved on 7th September, 2009 from www.femalepatient.com. Lupus Foundation of America. (2008) Men and Lupus: Gender Differences in Lupus. Retrieved on 7th September, 2009 from www.lupus.org/webmodules Luttz, W. (2009), Psychosomatics Journal. Suffering and Posttraumatic Growth in Women with Systemic Lupus Erythematosus: A Qualitative/ Quantitative Case Study. Academy of Psychosomatic Medicine. Nuria, N (2007), Science News Journal. Controlling Stress Help Fight Chronic Diseases such as Lupus. University of Granada. Retrieved from www.prensa.urg.es/prensa/research Oxford Journals (2009),Rheumatology: Association between Depression and Coronary Artery Calcification in Women with Systemic Lupus Erythematosus. Oxford University Press. Retrieved on 7th September, 2009 from www.rheumatology.oxfordjournals.org Pisetsky, D. (2001). Systemic Lupus Erythematosus: Primer on Rheumatic Diseases. 12th edition. Arthritis Foundation of Atlanta. Uramoto, K. (1992). Trends in the Incidence and Mortality of Systemic Lupus Erythematosus. Varda, M (2007). Women Over 50, Psychological Perspectives, 1st edition, Springerlink Publishers. Read More