Multiple and Complex Chronic Conditions - Case Study Example

Multiple and Complex Chronic Condition Name Institution Date Introduction Mrs. Johnson is a 68 years old patient facing a multiple chronic health. She started developing medical complications at the age of 62 years when she suffered from myocardial infarction. This health complication is treatable if the medication is administered on time. The disease is due to some of the lifestyle practices such as failure to exercise and excessive consumption of food with high fat contents. Three weeks ago, she has been experiencing an increase in dysponea. The situation has further been complicated by frequent coughs and oedema in her legs. This situation has disrupted her normal life and she has to sleep in an elevated position on three pillows. This can be quite uncomfortable considering her age and it may also trigger other complications that may affect her morbidity. However prior to these symptoms, she was able to perform most of the normal activities including cooking and shopping and cleaning. This is considering that she lives alone and has two adult children. She was diagnosed with type 2 diabetes, hypertension and chronic kidney disease. The combination of the diseases has thus made her condition chronic. The increasing dysponea on exertion is the condition that has forced her to be admitted. According to Schoo, (2010), the combination of the health complications requires different interventions for the purposes of managing each of the chronic condition. Poor management of the condition has often resulted to the death of the patients. The paper thus discusses the concepts of multiple and complex chronic heath condition in relation to Mrs. Johnson. Signs and Symptoms The complex nature of the multiple chronic conditions that is being witnesses by Mrs. Johnson could be as a result of one of the chronic condition or all the chronic conditions facing her. According to Ismail-Beigi, (2010), the major signs and symptoms of type 2 diabetes includes increased thirst, hunger and weight loss among the patients. Fatigue and low blood pressure is also a symptom of type 2 diabetes. Type 2 diabetes also causes poor circulation in the limbs due to the imbalance in blood pressure. Mrs. Johnson is experiencing some problems on her feet and this could have been contributed by type 2 diabetes which is responsible for such complications. In some instances, the people with diabetes 2 are usually forced to have amputations on their limbs in extreme cases. Fatigue is also a symptom that is associated with type 2 diabetes. This could also be contributing to the problems being faced by Mrs. Johnson. The frequent fatigues hinder the ability of the individual to carry out exercises which may improve the situation. High blood glucose is also one of the main symptoms of type 2 diabetes. This imbalance also has effects on the blood pressure. In some of the instances, the high blood pressure has an impact on the breathing rate of the patient (Shoelson, 2009). Although the breathing problem is not common among the people with type 2 diabetes, it could have contributed to thee breathing problem that Mrs. Johnson is facing. This is because of the combination of the other complications that she is also facing. Hypertension is also a chronic medical condition that is characterized by high blood pressure. This condition elevates the blood pressure above the normal range which is between 100mmHg and 140mmHg. The blood pressure for Mrs. Johnson is 160mmHg which is the first symptom of hypertension. A frequent headache is also a symptom of hypertension. Mrs. Johnson is experiencing dysponea on exertion and this could be contributed by hypertension. This is because hypertension forces the heart to work harder than normal. Weyand, (2011), argues that the action interferes with the normal functioning of the heart which is responsible for controlling the circulation of oxygen in the body. The heart beat also increases when the heart is overworked. The heartbeat is closely associated with the breathing pattern taken by an individual. Difficulties in breathing therefore results as demand for oxygen cannot be met by the body. The supply of oxygenated blood to the body is also hindered due to the condition and hence resulting to dysponea. The condition may be serious and the patient may start experiencing frequent breathlessness which may be fatal incase immediate medical intervention is not sought by the patient. The frequent coughing by Mrs. Johnson is due to the lack of adequate air which forces her to gasp for breath. It is thus important for hypertension to be managed so as to prevent the individual from experiencing dysponea on a frequent basis. Anxiety is also a symptom that is mainly associated with hypertension and it also affects the heartbeat of the patient (Després, 2009). The chronic kidney disease is characterized by the los of renal function. According to Coresh, (2012), fluid overload is one of the symptoms of chronic kidney failure and it is usually accompanied by production of vasoactive hormones. This increases the blood pressure and it ma also result to hypertension as experienced by Mrs. Johnson. The chronic kidney diseases could have resulted to hypertension. The fluid overload is also associated with the chronic kidney disease. This usually results to oedema. Mrs. Johnson has also been diagnosed with oedema and swelling of the feet. This is directly linked to the chronic kidney diseases. Oedema is can sometimes be fatal if the medical attention is not sought immediately. This is especially common in the case of pulmonary oedema. The morbidity of the individual with oedema is usually reduced due to the swelling of the feet as is with the case of Mrs. Johnson. This further complicates the situation and hence impacting negatively on the management of the other conditions. The chances of contracting cardiovascular diseases are also high among the people suffering from chronic kidney diseases. Mrs. Johnson also has a history of myocardial infarction which could also be linked to the chronic kidney diseases. The management of the condition is required for the purposes of avoiding fatalities due to more complications that are caused by the condition. The combination of the chronic condition for Mrs. Johnson therefore presents a lot of risks in terms of her health. This is because any of the chronic condition may trigger other complications that could be life threatening (Toto, 2009). The frequent coughing and difficulties in breathing could also be as a result of respiratory distress. Labored breathing is one of the symptoms of respiratory distress. The inability to adequately ventilate is a clinical symptom of respiratory distress. According to Ferguson, et al, (2009), the causes of respiratory distress varies and in some of the incidences it may include injuries to the lungs. However, the situation being faced by Mrs. Johnson could not have resulted from the injuries to the lungs. The combination of the multiple chronic conditions is responsible for difficulty in breathing. It is also due to this reason that she is being admitted to hospital. The combination of hypertension and chronic kidney disease has the potential of causing respiratory distress. This is due to the increase in blood pressure that affects the breathing pattern of a patient. When the breathing pattern is interfered with, the individual may end up experiencing dysponea accompanied by coughing. The management of the condition will also be dependant o the underlying causes. This is because respiratory distress is only a condition that is caused by other factors. The condition may lead to respiratory arrest if medical intervention is not undertaken on time. This is a serious condition and it could also result to fatalities. It is thus important to ensure that the appropriate measures are taken immediately in order to save the life of the patient (Gattinoni, 2010). Key issues Mrs. Johnson needs to ensure that all the three multiple complications related to the chronic illness are addressed so as to prevent the complications that she is facing that includes oedema and high blood pressure. Since the symptoms indicate that some of the complications like the chronic kidney disease is almost at an advanced stage, it is important to ensure that home hemodialysis is administered to the patient. This process is a method that is effective in terms of renal replacement therapy among the patients. However, it will require the services of some specialized medical personnel apart from the nurses. According to Wolf, (2011), a nephrologist is required for the purposes of writing daily reports and prescription. The nephrologists will also work closely with the community nurse who will be required for the purposes of educating the patient on how the condition can be managed effectively. It is also important to ensure that the patient is able to control their own treatment process for the purposes of increasing the efficiency of the treatment process. Since Mrs. Johnson also has other conditions that needs to be managed, it is important for the short daily home hemodialysis to be administered five to seven times a week and it will involve two to four hours per session. The use of this method is advantageous to the patient as it also offers a better way to manage the blood pressure which is also a problem that he patient is facing. The process also reduces the chances of the patient developing cardiovascular diseases which is also a complication that may be caused by chronic kidney disease (Goicoechea, 2010). The home hemodialysis can also be conducted successfully at Mrs. Johnson’s home as she lives a lone and it will not inconvenience anyone. The visits by the community nurse will also play an important role in terms of helping the patient to manage the other chronic health diseases that she is facing. More education about the other conditions of the patient will also be conducted by the community nurse. According to Hueb, (2009), the proper management of type 2 diabetes will also play an important role in terms of managing the blood pressure that is also responsible for hypertension. This should be done with the help of the general practitioner and the advice from the community health nurse. The main focus for managing this condition will involve the change in lifestyle. The community nurse should educate her on the diet that is safe for her condition. Advice on how she should carry out exercises will also be important as it will enhance the circulation of blood and hence reduce some of the complications that she is facing. A diabetic diet should be recommended to her so as to ensure that her situation can be managed. The anti-diabetic medication should also be administered. However, it is important to ensure that only the recommended medication is taken. This is because she is facing other chronic conditions and the use of different types of medication may lead to further complications due to side effects. Self management of blood glucose level and blood pressure will also play an important role in terms of improving the condition (Liu, 2010). Since she has a severe problem in terms of dysponea, the management of hypertension will be required for the purposes of improving the condition. The treatment of dysponea is also dependant on the underlying cause. It is thus important for Mrs. Johnson to be educated regarding the matter so as to ensure the management of the condition is effective. The community nurse should educate her on the body position and the ventilation patterns. These measures are however primary as she is also facing other chronic conditions that have negative impact on her health which also contributes to dysponea. Lifestyle modification will be required in order to manage the condition. Dietary changes should be initiated as it will also play an important role in terms of managing type 2 diabetes. On the other hand, exercises should also be encouraged. However her age factor should also be considered as it may hinder her ability to perform strenuous exercises. According to Pimenta, (2009), the diet should also be low in sodium as it is effective in terms of reducing the blood pressure. It is also important to ensure that the recommendation of the doctor is followed so as to avoid affecting the diabetic diet which may result to more complications. The use of medication to manage hypertension should also be carried out after the recommendation of the doctor. The community nurse will also have to play an active role as she is living a lone and the chances of skipping the medication could be high. The proper management of hypertension will also reduce the heart murmur that she is experiencing (Smulyan, 2009). The management of respiratory distress is an important process that will improve the condition of Mrs. Johnson. Immediate hospitalization is required in order to deal dysponea. The hospitalization will also play an important role in terms of ensuring that that the breathing process is regulated. According to Taccone, (2009), the administration of CPR should be done as the first step to ensure that the condition is stabilized. However, it is important to ensure that stomach bloating is prevented through the entry of air. The respiratory distress will also require the management of hypertension and high blood pressure. This is because the high blood pressure has contributed to respiratory distress that the patient is facing. Its is also important for the community nurse to be involved in the process of educating Mrs. Johnson. This is because the respiratory problems may occur at any time. The failure to manage the condition can result to an acute respiratory distress which may prove to be fatal. The use of drugs to manage the condition is also important but this will depend on the recommendations of the doctor (Christiani, 2010). Further complications may arise incase of using multiple drugs. The family of Mrs. Johnson must also be informed of her condition and educated about it so that they can easily offer the necessary help when required to do so. The general practitioner, the community nurse and the doctor are required for the purposes of ensuring that the condition of Mrs. Johnson can be managed effectively. Care recommendation The multiple chronic conditions that is facing Mrs. Johnson requires a lot of management practices as the treatment at this stage cannot completely eliminate the problem. It is recommended that she should first be educated on her condition. According to Peugh, et al, (2009), creation of awareness is important so as to enable the patient to understand the importance of engaging in management practices. This should be done by the doctors and the community health nurse. She should be educated on the methods that can be used to regulate her blood pressure. This is because the high blood pressure is responsible for most of the complications that she is facing. Mrs. Johnson should be taught how to measure her blood pressure and also the blood glucose du to the type 2 diabetes problem. The management of the blood pressure and blood glucose will avoid some of the complications like dysponea that she is currently facing. It is also recommended that she modifies her diet. This is because the consumption of some of the food is directly related to the worsening of her condition. She should not consume fatty foods, food rich in sodium and alcoholic substances. Her intake of sugar should also be regulated. However the consumption of vegetables should be features in her diet. A diabetic diet is however the most suitable for her condition. It is also important for the community nurse to educate Mrs. Johnson about the dietary issues adequately so as to avoid the complications. However, this does not mean that the patient with multiple chronic conditions should be restricted to a specific food only (McCulloch, 2010). It is also recommended that Mrs. Johnson should involve her family members in the course of managing her condition. Living alone is not recommended but instead she should have a career. This is because she may not be able to perform some f the tasks and the complications can arise at any time. This is also considering that most of the complications that she is facing may be life threatening incase medical intervention is not sought immediately. She should also be encouraged to carry put physical exercises. The physical exercises play an important role in terms of enhancing the blood circulation in the body and hence improving the body conditions. On the other hand, it is recommended that she should take her medication at the correct time. However all the medication should be recommended by the doctor regardless of its nature. This is for the purposes of avoiding complications du to the use of a variety of drugs at the same time. The renal replacement therapy should also be carried out from time to time in order to enable the management of the chronic kidney disease. It is also recommended that she should visit the hospital from time to time for the purposes of medical check ups (Heisler, 2010). This will enable her to manage her condition better. It is also recommended that Mrs. Johnson should be subjected to the treatment of normalizing the hemoglobin for the purposes of improving the quality of her life. Conclusion In conclusion, it is evident that the multiple chronic heath conditions results to multiple complications. The complications may be fatal incase immediate medical attention is not taken. However, the proper management of the condition may prevent the occurrence of the conditions. The chronic kidney disease contributes to oedema due to the accumulation of fluids in the body. On the other hand, hypertension results to high blood pressure and irregular heart beats which also contributes to dysponea. The chronic respiratory distress affects the breathing of the patient and it could also result to fatalities if medical interventions are not put in place. Type 2 diabetes also results to complications that may lead to the amputation of the limbs. It is evident that most f the chronic health conditions are as a result of lifestyle practices. Modification of the diet is important in terms of managing the conditions. It is also evident that physical exercises are beneficial in terms of managing multiple chronic conditions. The education and awareness of the conditions by the patient also plays an important role in terms of encouraging self management by the patient. The quality of life can be improved incase proper management measures are put in place. References Schoo, A. (2010). Supporting self-management of chronic health conditions: common approaches. 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