Can Chronic Conditions Co-exist with Being Healthy - HIV - Research Paper Example

? Can Chronic Conditions Co-exist with Being Healthy: HIV/AIDS Introduction Chronic Conditions could co-exist with being healthy, especially in the case of HIV/AIDS. Health as a word originated from Old English meaning the state and condition of being sound, not only with the physiological functioning but with mental, moral soundness and spiritual salvation. However, the resent years have witnessed definition of health formed into three different concepts due to the advancement in the fields of medicine, science, sociology, psychology and politics. The three definitions of health are divided into traditional medical concept, World Health Organization concept and the ecological concept. Traditional concept defines health as lack of disease, symptoms or problems (Geyman, 2007). This concept concentrates on illness as health but neglects the individual as a whole. World Health Organization concept on the other hand defines health as a state of complete physical, mental and social wellbeing and not merely as the absence of disease or infirmity. Lastly, Ecological concept defines health as an adequate functional capacity which allows the individuals to carry out their duties and responsibilities or a certain quality of life which enables individuals to live happily, successfully, fruitfully and creatively (American Association of Retired People Public Policy Institute, 2009). Analysis Although definition of illness consists of components related to improper functioning and deviation from normality, it is also diverse in definition just as health since it might be difficult to establish what constitutes proper functioning and what characterizes a deviation from normality. The definition has been grouped in children, adolescents and adults, but they all center on the fact that illness refers to an alteration in an individual’s functioning (Price & Wilson, 1997). Optimum health can be defined as the unity of body, mind and spirit to function well and in full capacity in every day-to-day life. Optimum health bases its concepts on the fact that one should live in harmony with the natural environment, keep a stress free mind and a joyful spirit and have a balanced body type (Kalnins & Love, 1982). Chronic conditions can be defined as a condition that consists of the following criteria; have a duration that lasts for at least six months and above, have a pattern of recurrence or deterioration, have a poor prognosis and lastly produce consequences that impact on the individual’s quality of life. Chronic conditions consists of non-communicable conditions like cardiovascular diseases, diabetes, chronic respiratory and cancer and infections conditions like HIV, hepatitis B and tuberculosis and lastly mental health conditions like depression, schizophrenia and substance addiction. In this paper, tuberculosis as a chronic condition is highly discussed to establish its etiology, path physiology and its medical treatments (Price & Wilson, 1997). Tuberculosis is an infectious communicable disease that is caused by mycobacterium tuberculosis. It remains a major health problem in terms of chronic conditions and should be properly diagnosed to prevent further infection transmissions. It mostly affects adults in their productive age group and although it affects children as well, it is still not seen as a threat among the children. It is an infectious disease that could be passed to children from the adult sputum positive pulmonary TB cases excreting tubercle bacilli. This has made it difficult to control TB in children since it has to be detected and properly treated in adults. The most affecting agent of TB in human is Mycobacterium tuberculosis. It is an air-borne infection transmitted to a substantial population when patients suffering from TB discharge bacilli in their surrounding during coughing or sneezing (Kalnins & Love, 1982). On the part of the children, the TB is acquired through inhalation of the tubercle bacilli that is spread by the adult infections. In relation to this, the portal of entry to the body is the lungs and the infection disease can be caused with as few as 1-5. The disease is not that common because of Mycobacterium bovis since there exist in practice of boiling pasteurization of milk before consumption. With exposure of children to the TB infections, most of the children are exposed to the disease in what is known as primary infection and eventually can develop signs of the disease in lungs, lymph nodes, meninges, and bones in their lifetime. The primary infection occurs within the lungs and the bacilli begin to spread with some being carried through the lymphatic to the nearest lymph nodes. The basic complex constitutes the primary focus, the regional lymph nodes and the intervening lymphangitis. Its natural defense mechanism develops and becomes active in about 6-8 weeks and in most cases does contain the bacilli. In the event of complete healing, a few bacilli may become dormant in the healed lesions but may become active after many years of impaired host immunity. In the event that the primary infection is not contained, the disease becomes progressive, involving adjacent structure also known as progressive primary disease. When there is exogenous reinfection or endogenous reactivation of the dormant bacilli then that stage is known as post primary disease (Price & Wilson, 1997). In the unexposed person, the site of bacillary implantation creates inflammatory response with polymorphonuclear which is then followed by infiltration with monocytes and epitheloid cells. Eventually Macrophage infiltration continues in the second week resulting to caseation in the center and enlargement of tubercle. In the event of healing, it occurs by fibrosis and calcification where calcification may disappear by reabsorption. The same may occur in the lymph nodes and distant seedlings apart from a few cases where the lesion continues to progress resulting to symptoms and clinical signs (Kalnins & Love, 1982). This is mostly dependent on extension of primary focus and haematogenous seedlings in distant organs. Mostly there would be pleural effusion after rapture into pleural cavity because of the fact that primary focus is sub-pleural in nature. At time though effusion becomes purulent forming an empyema and at times the enlarging lesion ruptures into the adjoining bronchus and primary cavity is formed. Also a progressive lesion in regional nodes may erode adjoining bronchus causing either a complete obstruction with collapse of the distal portion of the lung or partial obstruction that could result to hyperinflation of the distal portion of the lung. Aspiration of caseous materials in the lung distal to the level of erosion leads to consiladation which after Broncho-pneumonia follows and in the area of collapse; Bronchiectasis occurs (Geyman, 2007). In the process of formation of primary complex, bacilli are disseminated through blood steam do different body parts like the lungs, brain, bones and kidneys among others. These lesions also heal like the primary complex. In other cases where subcortical tubercle ruptures into subarachnoid space, there follows TBM while on the other hand, a caseous node may rapture into a blood vessel and in the process disseminating tubercle bacilli into different parts of the body resulting to miliary TB. Both the TBM and military TB occur within two years after infection and it happens mostly where the host’s resistance is suppressed. The younger the child at the time of infection, the greater the chances of disease development while the higher the age at which primary infection occurs, the dissemination risk is reduced and the disease tends to be localized in the lungs (American Association of Retired People Public Policy Institute, 2009). Treatment of TB as a chronic condition is a big medical breakthrough since its one of the most infectious deadly disease that affects both the children and the adults. In the TB treatment, only standard regiments of specific durations are to be used (Kalnins & Love, 1982). Mostly the TB should be concentrated and treated in adults so as to break the chain of infection from the adults to the children. In treatment of TB in children, there are various pharmacologic drugs that are used. The drugs include; Isoniazidi: (H), Streptomycin: (S), Rifampicin: (R), Pyrazinamide: (Z), Ethambutol: (E) and Thioacetazone: (T) (Geyman, 2007). Isoniazid (INH) is the least toxic, most potent and less expensive effective drug. It is recommended to give 5 mg/kg/day of Isoniazid on the basis that plasma and serum levels are frequently 50 to 100 times more than the minimal inhibitory concentration required oral doses are used. This allows drug to be well distributed in the body fluids and tissues. Streptomycin (SM) on the other and is bactericidal against multiplying bacilli and it penetrates meninges when inflamed. Since it cannot be absorbed through gastro intestinal tract, it is not given orally. Its usual dosage is 15 to 20 mg/kg/day given intramuscularly. Rifampicin (RMP) is a bacteria drug that acts quickly and is given in a dosage of 10 mg/kg/day and it has characteristic of rendering body fluids red including urine although it’s harmless. Pyrazinamide (PZA) works on intracellular bacilli in an acidic PH and its recommended dose is 35 mg/kg/day. Ethambutol (EMB) on its part is a bacteriostatic drug and is capable of producing retrobulbar neuritis. It is given in a dose of 25 mg/kg/day for the first two months then followed by 15 mg/kg/day. Lastly, Thioacetazone (T) is also used in treatment of TB and it is given in the dose of 4 mg/kg/day. With Chemotherapy of Tuberculosis, children who suffer from primary TB get six month regime of INH, RMP, PZA with or without SM or EMB depending on the age for two months the it is followed by four months of INH and RMP. In the case of Tuberculous Meningitis and Miliary Tuberculosis, three drugs are used in the initial intensive phase for duration of two moths then followed by two drugs for the ten month period (Schneider, et al., 2009). The resent biomedical and nursing behavioral management has made it possible to substantially increase the ability and more so effectively prevent and control the chronic conditions that are commonly affecting people. In collaboration with nursing practice, there has been evidence that when a chronic condition patient receive effective treatments, gets self-management support and gets regular follow up from the nursing practice personnel, they can do better. It should not necessarily be the health worker’s care but organized systems of care that involves the entire community since this gives the patient more support for a positive outcome (Boruchovitch & Mednick, 1999). Although most chronic conditions are being handled at primary health care, it is becoming evident that the primary health cares should be boosted by health nursing program so that they do not become irrelevant in chronic handling of conditions. Also to improve health care on chronic conditions entails focusing on adherence for long term therapy. Despite patients being prescribed drugs for chronic conditions management, they should also adhere to long term treatment through health care that supports and provides appropriate information, support ongoing surveillance and follow up hence improve adherence and in turn improves the quality life of the affected patient. Decision makers on the part of the government and health nursing sector can improve the lives of the affected individuals with the chronic conditions. This can be through formulating policies that also favors the patients in terms of finance, health care systems and their economies. This should also include teaching programs that should both educate the patients as well as the people around them on how to be able to cope with the situation (Warshaw, 2006). It is also the responsibility of the health care providers to offer qualified personnel who can integrate openly and with the required skills for managing chronic conditions, offer better communication abilities, offer behavior change techniques as well as counseling skills that in the long term would help in the line better health care. It is important to also know that management of chronic conditions requires lifestyle behavior change hence it is the role of the patient also to play a central role and take responsibility for own health care. In terms of the community, nursing health care should go beyond the hospital or clinic but to the community that co-exists with the patient so as to harmonize the patient, family’s needs and the entire society. The society as a whole plays an important role to the patient and the family of the patient. By accepting the chronic condition and understanding how to cope with the situation within the society gives the patient moral support that is of essential to improving chronic condition of an individual. Apart from treating chronic conditions, the nursing health care should put more effort in preventing measures as much as in the treatment measures. Most of the chronic conditions are preventable and with proper education and knowledge, they can easily be avoided and prevented or handled at an early stage before they get to an advanced stage where they will cost more both to the patient and in economic ways. The strategies that could be implemented include early detection, increasing physical activity, reducing tobacco use and limiting prolonged unhealthy nutrition. This information should be well passed by the nursing health personnel on every interaction to the patient and the society at large (Department of Health and Human Services, 2011). To best deal with chronic conditions, it is important for the nursing health management to be aware of the challenges that comes along with the chronic conditions. It is known that chronic conditions are more persistent and hence need special attention to handle them (Geyman, 2007). They share some fundamental themes that include; chronic conditions are throughout the world and no country is immune to their impact, chronic conditions do challenge the efficiency and the effectiveness of the current health care system and does challenge the abilities of the medical fraternity to organize itself to surpass the current challenges, chronic conditions engender increasingly at a high rate serious economic and social consequences in all region and threaten heath care resources in every country and lastly, chronic conditions can be curtailed but only if both leaders in the government and healthcare departments embrace change and innovation in relation to medical issues. Both parties should be willing to do what it takes in terms of adopting new technology and having more qualified personnel in the healthcare departments. With proper understanding of the above factors, the healthcare stakeholders are able to assess the situation on chronic conditions and take necessary step that will see to it that either there is prevention of chronic conditions or there is proper treatment of the existing chronic conditions (Kalnins & Love, 1982). Conclusion Indeed chronic conditions have for the resent years been on the rise in almost every country and hence increasingly put more lives of individuals at risk. On the other hand, it should also be acknowledged that the medical stakeholders are doing all they can to either prevent or treat the chronic conditions that are arising together with those that have been in existence. This has been seen through the break in treating some of the chronic conditions that previously have been without cure or immune. However, a lot of effort is still required on the part of the health management to be able to fully handle the chronic condition and claim victory over it. This can easily be achieved through a proper coordination of the health and government departments so that the necessary resources could be allocated for research work to be done and for the public education to create awareness of chronic conditions to the public at large so as to prevent rather that treat (Boruchovitch & Mednick, 1999). References American Association of Retired People Public Policy Institute, (2009) Chronic care: a call to action for health reform. Retrieved on 9th April 2012, from: http://assets.aarp.org/rgcenter/health/beyond_50_hcr.pdf Boruchovitch, E. & Mednick, B. R. (1999). Causal attributions in Brazilian children reasoning about health and illness. Revista de Saude Publica, 35 (5), 484-90. Department of Health and Human Services (US) (2011). HHS initiative onmultiple chronic conditions. Retrieved on 9th April 2012, from: http://www.hhs.gov/ash/initiatives/mcc/index.html Geyman JP. 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