Chronic Conditions And Implications To Patients And Families

A. Chronic Condition

B. Signs & Symptoms

C. Pathophysiology and Quality of Life/Independence

a. Type 2 Diabetes Mellitus

· Increase thirst

· Fatigue

· Blurred vision

· Slow hearing sores

· Frequent urination

· Increased hunger

· Sores heal slower

In the affected person, the beta-cell dysfunctions and therefore the insulin secretion is decreased which limits the ability of the body to maintain normal levels of glucose (Galicia-Garcia et al., 2020).

Diabetes can lead to anxiety, depression, reduced life satisfaction, social isolation and stigma.

b. Osteoarthritis

· Loss of flexibility

· Stiffness in your muscles

· Bone spurs

· Swelling

· Tenderness

· Affected joint pain

The pathogenesis of the Osteoarthritis involved the gradual degradation of the cartilage and the remodelling of the bone which occurs due to the active responses of the chondrocytes in the articulate cartilage (Sacitharan, 2019). The inflammatory cells in the surrounding tissues.

The individuals with Osteoarthritis have difficulties in completing daily functional activities due to pain. They perceive to have a low quality of life.

c. Peripheral Vascular Disease

· Numbness in the legs

· Coldness on the lower foot or leg

· Sores on the toes and feet or legs

· The sores take time to heal

· Painful cramping

· Change in colour of legs

· Weak legs in the legs and feet

PVD occurs due to the blockage of arteries supplying blood to the lower limbs. The lower limb is often secondary to atherosclerosis.

People with PVD have issues in completing their daily activities of life due to the reduced mobility of limbs. Often a loss of limb is associated with PVD which can cause the individual to be bound to the wheelchair. Depression and stigma can follow with PVD.

d. Chronic Obstructive Pulmonary Disease

· Wheezing

· Tightness in chest

· Fatigue

· Shortness of breath

· Respiratory infections

· Unintentional weight loss

· Swelling in feet, legs and ankles

· Chronic cough that may produce mucus

COPD might be related to the latent adenoviral infection. EIA proteins that bind with the associated DNA strands and this EIA proteins occur mostly in the lungs of the smokers making them susceptible to COPD (Agustí & Hogg, 2019).    

The quality of life deteriorates considerably with the severity of the disease. Fatigue can interfere with the ability to perform daily activities (Ahmed et al., 2016). Wheezing and shortness of breath can interfere with physical activities.                                                                                                                                                                                                                                           

d. Peripheral Neuropathy

· Sharp jabbing, throbbing and burning pain

· Extremely sensitive to touch

· Weakness in muscles

· Paralysis if the motor nerves are affected

· Absence of coordination and falling

In peripheral neuropathy, the peripheral nerve cells and fibres manifest secondary to a wide range of pathologies. The nerves include cranial nerves, never root, ganglia and trunks and division and the nervous system.

The [patients with PN can experience emotional distress, depression, lack of energy, pain and lack of physical mobility, etc.

Implications to Patient and/or family and loved ones

A. Social

People with chronic illnesses often have to face discrimination and social isolation and the family members of the individuals also have to face stereotypes that the affected individual is a burden on the family or the individual is incapable of engaging in social interactions (Sokas et al., 2021).

B. Emotional

The person affected with chronic illnesses face psychological distress, feelings of directionlessness, worthlessness, pessimism, feelings of inadequacy and incapability.

The family members are also in emotional distress about the distress of the affected person. The care burden can be fatiguing, distressful and depressive for the caregivers (Chivukula, Kota & Nandinee, 2018).

C. Physical

People affected with chronic illnesses might have to face typical physical issues associated with the chronic illnesses. Issues in mobility can cause the affected person to feel physically bound and hamper their natural physical movements and daily activities of life. The family members of the affected person might feel fatigued causing physical issues like diabetes, high pressure due to the tension and worry inevitable in the caregivers.

D. Psychological

Cognitive abilities of the affected person can be hampered like judgement, decision making, attention abilities and other executive functions due to the chronic illness or as a side effect of the chronic illness. Depression and feelings of helplessness will be prevalent in the caregivers and family members.

E. Financial

The affected person might suffer from financial crisis due to extended period of financial expenditure (Essue et al., 2018). The family members might suffer from loans, debts and mortgage issues.

Strategy / technique / equipment

Benefit

Multidisciplinary Team Member / s

Encourage daily physical activities

Light to moderate daily physical activities will help strengthen the client’s muscles and the physical exercises can be light as walking which would empower and make the clients feel independent.

Lifestyle activity therapist, health psychologist, registered nurse, occupational therapist

Provide supportive tools to improve independence

The environment of the client should be rearranged to enhance the mobility of the client. The bed should be supported with handrails and the bathroom should have bathing chairs and handrails to promote better movement.

Nurses, social workers, doctors and physiotherapist

Use of contemporary therapies

The use of music therapy, massage, aroma therapy or acupuncture can play a role in the promotion of recovery and independence. These contemporary therapies will be more useful in cases of clients with side effects of pharmacological approach.

Occupational therapists, registered nurses, aroma therapists, acupuncture therapist and physiotherapists.

Support with mobility equipment

He can be provided with mobility assistive devices like walking aids, wheelchairs, etc. The client should be encouraged when they are able to accomplish the daily activities by themselves.

Registered nurses, social workers, doctors and occupational therapist

Mood enhancing techniques

Feelings of low mood and disconnectedness can be reduced by encouraging him to take part in hobbies of his preferences that does not require him to make extensive movement, for example, painting, gardening and listening to music.

Mental health registered nurse, occupational therapist

Technique

Technique Use

a) Hydrotherapy

The techniques that are used in hydrotherapy are as follows (Hammill et al., 2018):

· Cold plunges

· Baths in hot tubs

· Jet massages

· Whirlpool baths

· Hot showers

· Sitz bath

b) Pilates

The techniques used in the Pilates are alignment, bathing, flowing movement, centering, stamina, concentration and co-ordination (Fernández-Rodríguez et al., 2019) 

c) Art therapy

The techniques used in art therapy are as follows (Czamanski-Cohen et al., 2019):

· Painting  

· Colouring

· Collage making

· Oil painting

· Clay art

· Stripling

· Doodling and scribbling

· Photography

d) Prosthetics

The techniques used in prosthetics are as follows:

· Ball rolling

· kicking balls

· throwing and catching

· balance board

Nursing diagnosis

Planning – (Nursing intervention)

Multidisciplinary team member to provide support

Link to personal needs

Expected Outcome

1. Instability in blood glucose level

– Monitor blood glucose level at 2 hours of interval

– Assess the temperature of extremities

– With the supervision of RN

Registered nurse and endocrinologist  

Need for a healthy nutritional diet and a physically fit routine

The blood glucose

level will come

down to a normal

level

2. Risk of impairment in mobility

– Perform physiotherapeutic exercise

– Provide reduced assistance with activities of daily lives

Registered nurses, physiotherapist, occupational therapist

The progressive endurance of the client, independence and self-esteem will be improved

Patient is able to

demonstrate

Independence in

Performing

3. Wheezing and shortness of breath due to COPD

– Aligning the patient to a forward leaning position to enable optimal breathing

– Practice breathing techniques

RN, pulmonologist, physiotherapist

Proper breathing will help reduce fatigue and help manage symptoms of COPD.

Improvement of

breathing and better

blood circulation.

Disease/Chronic Health Condition

Clinical Manifestation

Chronic Asthma

The clinical manifestation of Chronic asthma are as follows:

– Chest pain or chest tightness

– Inability to breath properly (feelings of suffocation and shortness of breath)

– Wheezing sound while exhaling

– Disturbed sleep due to coughing, suffocation and wheezing

– Attacks of coughing and wheezing spells

Asthma that is worsening has the following symptoms:

– Increased difficulty in breathing with chocking sensations

– Symptoms appearing more frequently

– Symptoms interfering with the daily functioning of the individual

Exercise induced asthma can get worse with in cold and dry environment. Allergy induced asthma is triggered by airborne substances like mold spores, pollen, pet hairs, etc (Mims, 2015).

Chronic pain including back pain

The signs and symptoms of chronic pain including back pain are as follows:

– Sensation of pain in localized parts of the body. The pain can be aching, burning, shooting, squeezing, twisting, stiff, stinging and throbbing in nature.

– Chronic pain can lead to other symptoms like fatigue, lack of energy, irritable mood, anxiety, etc.

– Decreased range of motion

– Inability to move, stand and sit

– Back pain may radiate down to the leg

– The pain worsens while bending, twisting, lifting, standing or walking

– Daily life functioning is disrupted due to the pain

Chronic renal failure

Usually in the early stage of renal failure, individuals do not experience significant symptoms. However, symptoms emerge during the gradually advanced stage of failure.

Symptoms of chronic renal failure includes the following:

– Urge to frequently urinate

– Pale and foamy urine

– Hypertension or high blood pressure

– Swelling of legs

– Poor appetite

– Nausea and vomiting

– Loss of weight

– Muscle twitches and cramps

– Blood in the stool

– Easy bruising

– Development of brown spots on skin in the advanced stage of failure

– Extreme fatigue

– Drowsiness and lack of consciousness

– Increased susceptibility to infection

Congestive heart failure

The symptoms of congestive heart failure are as follows:

– shortness of breath when engaging in activity or lying down

– weakness and fatigue

– swelling in the legs, ankle or feet

– swelling in the abdomen

– irregular heartbeat

– rapid heartbeat

– lack of appetite and nausea

– persistently coughing

– wheezing with pink-tinged blood in mucus

– rapid gaining of weight from build-up fluid in the body

– extreme chest pain in case the heart failure is caused by heart attack

In severe cases:

– Chest pain and fainting

– Severe weakness in body

– Foamy mucus and unconsciousness

Eczema

The following are the symptoms of Eczema:

– Itching

– Redness of skin

– Rough, patchy and scaly skin (Gerbens et al., 2016)

– Inflamed or discolored skin

– Raw and sensitive skin

– Small raised bumps which might leak fluid and have flakes when scratched

– Brownish grey patches in various parts of the body including feet, ankles, upper chest, eyelids, eyebrows, elbows, knee and scalp.

– Exposed, wounded, sensitive and raw skin from excessive scratching

– Severe urge to itch the patches

– Excessively dry skin

– Scales detaching from the skin and exposing raw skin

Incontinence

The following are the symptoms of urine incontinence:

– Walking up frequently in the middle of the night to urinate

– Sudden and uncontrolled urges to urinate

– Urinating during sleep

– Urine leakage while sneezing, exercising, coughing and laughing

The symptoms of urine incontinence, therefore, range from inability to control the urge to urinate to uncontrolled and involuntary leakage of urine in sleep and during work. The symptoms can be severe in case of women who had their menopause. The four different types of incontinence – functional, urge, overflow and stress-induced, has different symptoms.

Neurological injury

Physical symptoms:

– Nausea and vomiting

– Loss of balance

– Dizziness

– Speech issues

– Extreme fatigue

– Seizures (Hennessy & Smith, 2018)

– Inability to awaken from sleep

Cognitive, psychological and behavioral symptoms:

– Loss of consciousness for few seconds or minutes

– State of confusion and disorientation

– Delirium

– Feelings of low mood and anxiety

– Disrupted sleep

– Problems in memory

– Lack of concentration

Sensory symptoms:

– Blurred vision, ringing sound in the ears

– Unusual taste in mouth

– Inability to smell

– Sudden sensitivity to sound and light

– Dilation of the pupils (either both or one)

Long-term unconsciousness

The symptoms of long-term unconsciousness are as follows:

– closed eyes

– irregular breathing

– lack of response to painful stimuli, except for certain reflex movements (Firsching, 2017)

– lack of response of limbs, excluding some reflexes

– lack of awareness about the surroundings

– the individual may exhibit spontaneous body movements

– Shaking and jerking abnormally

– Breathing, excretion and other natural bodily processes may be impacted by the unconsciousness

Parkinson’s disease

The following are the symptoms of Parkinson’s disease:

– Tremors (Radhakrishnan & Goyal, 2018) – the tremor usually begins in the limbs, for example, in the thumb, forefingers, etc.

– Bradykinesia – slowed down movements of different parts of the body. Due to this the individual might find it difficult to complete daily activities of life

– Rigidity in muscles – muscles stiffness can make movements painful and reduce the range of motion

– impairment in balance and coordination  – the posture may become stooped and cause issues in balance while walking

– changes in speech – speech might become slurred, quick and incoherent

Rheumatoid arthritis

The symptoms of Rheumatoid arthritis  are as follows:

– joint pain and aching (Tedeschi et al., 2017)

– loss of weight

– weakness

– fatigue

– joint swelling and tenderness

– stiffness in more than one joints of the body

– appearance of same symptoms on both sides of the body

– difficulty in movement

– reduce ability to walk, bend and twist

– feelings of low mood

– sweating

– high body temperature

– dry eyes as a result of inflammation

– loss of appetite and weight loss

Stroke

The following are the symptoms of Stroke:

– sudden numbness  o weakness in different parts of the body including limbs, face, leg and especially on one side of the body

– sudden trouble in speaking, slurred speech, confusion regarding understanding the speech of others (Yew & Cheng, 2015)

– suddenly trouble in seeing in one or both eyes – blurred vision in both or one eye

– sudden trouble in mobility

– sudden confusion

– sudden and severe headache

– suddenly trouble in walking

– feeling dizzy

– loss of coordination and balance while walking

– fatigue and angina

– sweating

Systemic lupus erythematosus

The following are the signs and symptoms of Systemic lupus erythematosus :

– fever

– joint pain and stiffness (Leuchten et al., 2018)

– skin lesions

– chest pain

– shortness of breath

– dryness in eyes

– the individual’s fingers and toes can turn white or blue when they are exposed to stress and cold temperature

– loss of memory, concentration and confusion

– rashes in the shape of a butterfly on the bridge of the nose and face.

– lesions on the skin worsen when exposed to sunlight for prolonged period of time

The above symptoms might appear suddenly or develop slowly over time.

Breast cancer is one of most common cancer in the Australian female population. The breast cancer occurs when the cells lining the breast lobules and are inflamed and abnormal cell growth is prolonged (Waks & Winer, 2019). The breast cancer might also begin in the glandular tissue known as the ducts. Researches indicate to lifestyle and environmental factors as increasing the risk of breast cancer in females. There is a significantly high chance of the abnormal cell growth spreading to different regions of the body.

Prostate cancer is the 2^nd most common cancer in Australian male population (Rawla, 2019). In prostate cancer, there is a uncontrolled abnormal cell growth that initiates in the prostrate which leads to the formation of a malignant tumour.

Melanoma is a common type of skin cancer which develops in the skin cells known as melanocyte (Davis, Shalin & Tackett, 2019). This usually occurs in the part of the skin which is over exposed to the sunlight. In Australia, the 3^rd most commonly diagnosed cancer was Melanoma in 2021.