Chronic Schizophrenia with Co-Morbidity as Large Bowel Obstruction - Essay Example

? Chronic Schizophrenia with Co-Morbidity as Large Bowel Obstruction of   Introduction Co-morbidity refers to a situation in which a patient is diagnosed with two or more medical conditions. That is, these conditions are suspected or diagnosed after the initial diagnosis has been done. Such a patient thus, suffers from more than one condition at the same time. Notably, these co-morbid diseases may be entirely unrelated. However, this lack of connection among these diseases does not imply that they do not affect the treatment of and recovery of patient from the other. Thus, collectively, co-morbid conditions affect a patient’s life, implying that both conditions should be cared for in equal measure according to their seriousness (Bleichrodt et al., 2003). The care in this sense goes beyond the conventional medical models of investigating diseases; rather more emphasis is laid on promoting patient health and wellness. The health care needs arising due to co-morbidity make it imperative that nurses play their roles and undertake their responsibilities to meet and exceed client expectations. In the recent past, a lot of studies have been conducted to examine single co-morbidities with schizophrenia. Notably, most of these studies have been done on small and unrepresentative samples. In other words, many of these studies have failed to take a broader approach to the subject of the schizophrenia with single co-morbidities, instead focusing on the testing of hypotheses (Menezes et al., 2006). Nonetheless, there are a few cases of studies, which have explored thousands of discharge records from hospitals to ascertain the proportional morbidity ratios. Although many studies show that approximately 45% of co-morbidity is accounted for by behavior-related and psychiatric diagnoses. Studies also reveal that those diagnosed with schizophrenia and those with similar diagnosis in their families report that other diagnoses precede or follow schizophrenia diagnosis. Besides psychiatric conditions, schizophrenia patients are also reportedly being diagnoses with conditions such as obesity, cardiovascular conditions, type 2 diabetes, essential hypertension, chronic airway obstruction, hyper alimentation disorders, asthma, and acquired hypothyroidism. Researchers have noted that these conditions could actually be occurring at a greater rate in schizophrenia patients than they are found. Thus, endemic under-diagnosis is cited as the reason these co-morbidities are not detected. Second, schizophrenia patients also tend to receive low standards of medical care, resulting in the under estimation of their conditions and the treatment to accompany. This paper explores the concept of co-morbidity/complexity with reference to chronic schizophrenia co-morbidity with large bowel obstruction. In addition, the paper explores the role of the nurse when working with such as patient and their family in the community, considering. In particular, the paper outlines the health care needs for both chronic schizophrenia and large bowel obstruction for patients as well as their families and the immediate community. The possible nursing interventions with specific focus on person-centered approaches, client education, and empowerment are also explored in the paper. Chronic Schizophrenia with Large Bowel obstruction Co-Morbidity Many authors and researchers continue to research the subject of schizophrenia co-morbidities with psychiatric and non-psychiatric condition, seeking to determine whether it is spontaneous that psychiatric disorders such as schizophrenia are co-morbid with non-psychiatric medical conditions such as large bowel obstruction or diabetes. The other issue that researchers seek to address is whether lifestyle, behavioral factors are associated with chronic schizophrenia and whether there exists a biological connection between schizophrenia and non-psychiatric conditions such as large bowel obstruction. Importantly, the public health ramifications for the treatment of both chronic schizophrenia and co-morbid conditions are the other area of interest for researchers and authors (Warner, 2009). Schizophrenia refers to a psychiatric condition characterized by breakdown of one’s thought process and deficiencies in emotional responses. Its symptoms are disorganized speech and thinking, paranoid delusions, auditory hallucinations, and social or occupational dysfunction (Isaac et al., 2007). It is majorly diagnosed by observed behavior and the patients’ reported experiences. It is caused by genetics (hereditary), environment factors such as drug use and prenatal stressors, drug use, and developmental factors such as hypoxia, infection, stress, and malnutrition. That a schizophrenic patient is diagnosed with large bowel obstruction co-morbidity presents health care workers, especially nurses, with numerous new challenges, unlike the case of purely schizophrenic patients. For this reason, it is of the essence that the health needs of such patients are identified and appropriately attended. It is necessary that a nurse is well conversant with the nature, causes, and treatment of large bowel obstruction to professionally care for a patient suffering from such co-morbidity. A patient diagnosed with large bowel obstruction has the large intestine partially or entirely blocked, preventing the movement of gas, fluids, and solid foods along the intestine. Such a patient feels and on and off pain (Maglinte et al., 2001). The core causes of large bowel obstruction include narrowing and twisting of the intestine, scar tissue, and tumors. Other causes are hernias and Crohn's disease that twist or narrow the intestine (Abbas et al., 2005). Among the symptoms of this condition that health care professionals should be on the look out for are cramps, on and off pain around or below the belly button, vomiting, bloating, constipation, lack of gas in completely blocked intestines, and diarrhea in partly blocked intestines. The diagnosis of large bowel instruction is done by a CT scan of the belly. This technique assists doctors to ascertain if the blockage is partial or complete (Talley, 2006). Several nursing interventions are advised in case a schizophrenic patient is diagnosed with large bowel obstruction. These include medication and fluids through a vein (IV). To help a patient to feel comfortable, nurses are advised to insert a nasogastric (NG) tube through a patient’s nose all through to the stomach. The purpose of the tube is to remove fluids and gas from the intestine thus eliminating or relieving the pain and the pressure in the intestine. It is not advisable to give such a patient anything to eat or drink. Although most bowel obstructions get better by themselves, it is important to note that there are cases in which more and special treatment may be necessary. These extra treatments include the use of liquids or air (enemas) or small mesh tubes called stents to open up the blocked intestine. For completely blocked intestines, surgery is always recommended. In addition, surgery is performed when blood supply to some sections of the intestine is cut off. In more serious cases that require the removal of the affected portions of the large intestine, colostomy or an ileostomy is preferred after surgery. Once the affected part is eliminated, the remaining part is sewn to an opening in the skin through which stool passes out of the body (Fass & Pimentel, 2009). Just as a nurse will be taking care of the co-morbid large bowel obstruction, he or she will have to ensure that the schizophrenia needs of the patient are also taken care of. The presence of large bowel obstruction as a co-morbid disease in schizophrenics impacts patients’ quality of life, research, and clinical practices. Clinical and nursing practices are affected with regards to diagnosis, prognosis, treatment, and health care delivery. In this case, large bowel obstruction has its own impacts on the quality of the patient’s life and clinical effects on his/her well being (Zbar & Steven, 2010). Thus, the goals of all nursing and clinical interventions should be to control the courses of both diseases and maximize quality of life for the patient. The evaluation of how the two conditions affect the patients' health-related quality of life should mainly emphasize the index disease, considering the effect of co-morbidities to a lesser degree (Burns, 2009). Nonetheless, if emphasis is on the consequences such as mortality, complications, and the cost of medical care, co-morbidity becomes an important denominator. Conclusion Co-morbidity or coexisting diseases occur if two or more diseases are diagnosed in the same person. Thus, the existence of co-morbidity has all-encompassing effects not only on the quality of life but also on research, and clinical practice. Co-morbidities influence the two conditions’ diagnosis, prognosis, treatment and, health care delivery. The situation gets worse since each condition has its own implications and clinical effects on patients' sense of well-being. Assessing and diagnosing schizophrenic patients for co-morbidities helps not only in the prioritization of health care but also guides in the decision-making process in health care delivery. In particular, the assessment of co-morbidities should be done during waiting time just as it is essential to evaluate the ways in which co-morbidity may impact on the outcomes of joint replacement. Although chronic conditions such as schizophrenia negatively affect peoples’ quality of life, cause disabilities, and result in early death, co-morbidity makes the situation worse for patients and their relatives. Nurses are required to routinely address all the diagnosed conditions as part of patients’ well being and survivorship care. In addition, nurses should be well placed to educate patients and their families on the risks of both/all conditions suffered. This education and treatment of the co-morbidities should be done through evidence-based practice guidelines, treatment summaries, and care plan. The evidence-based practice guidelines are particularly useful in offering nurses the strategies for sharing with patients and survivors.   References Abbas, S., Bissett, I. P., and Parry, B. R. (2005). Oral water soluble contrast for the management of adhesive small bowel obstruction. Cochrane Database of Systematic Reviews. Bleichrodt, H., Crainich, D., and Eeckhoudt, L. (2003). The Effect of Co-morbidities on Treatment Decisions. Journal of Health Economics, 22: 820.   Burns, J. (2009). Dispelling a Myth: Developing World Poverty, Inequality, Violence and Social Fragmentation Are Not Good for Outcome in Schizophrenia. African Journal of Psychiatry, 12(3): 205. Fass, R., and Pimentel, M. (2009). Evidence- and Consensus-Based Practice Guidelines for the Diagnosis of Irritable Bowel Syndrome. Arch. Intern. Med. 161(17): 2088.  Isaac, M., Chand, P., and Murthy, P. (2007). Schizophrenia Outcome Measures in the Wider International Community. British Journal of Psychiatry Supplement, 50: s71. Maglinte, D. D., Kelvin, F. M., Rowe, M. G., Bender, G. N., and Rouch, D. M. (2001). Small-Bowel Obstruction: Optimizing Radiologic Investigation and Nonsurgical Management. Radiology, 218 (1): 39. Menezes, N. M., Arenovich, T., and Zipursky, R. B. (2006). A Systematic Review of Longitudinal Outcome Studies of First-Episode Psychosis. Psychological Medicine, 36(10): 1349. Talley, N. J. (2006). A Unifying Hypothesis for the Functional Gastrointestinal Disorders: Really Multiple Diseases or One Irritable Gut? Reviews in Gastroenterological disorders, 6(2): 78.  Warner, R. (2009). Recovery from Schizophrenia and the Recovery Model. Current Opinion in Psychiatry, 22(4): 380. Zbar, A. P., and Steven, D. (2010). Coloproctology. New York: Springer. Read More