Introduction to Chronic disease management
The chronic disease management is based on the following parameters such as: care planning, evidence-based practice, clinical information systems, community resources, etc. Chronic diseases are broadly conditions that effectively last for 1 year or more and it even limit ongoing daily activities. There are following examples of chronic diseases such as: type 2 diabetes, stroke, heart disease, depression, arthritis, osteoporosis, etc. As per the World Health Organization, chronic diseases are long duration and generally slow progression. Moreover, there are six primary elements related with the chronic care model such as: community resources, health system, self-management support, delivery system design, decision support and clinical information systems. A chronic disease management plan is also known as enhanced primary care plan (EPC) (Health.gov.au, 2014). Top three chronic disease are as follows: heart disease, cancer and diabetes. For this essay, the selected disease is heart failure. As per the data issued by the Singapore Heart Foundation, every day 19 people die from cardiovascular disease (heart diseases and stroke) (Singaporeheartfoundation, 2021). As per the Singapore Heart Foundation, cardiovascular disease is accountable for 31.7% death in the year 2020. It means that 1/3 deaths in Singapore is due to heart diseases or stroke (Singaporeheartfoundation, 2021). In the year 2018, around 21,282 deaths were recorded and 21,446 deaths were recorded in the year 2019 due to cardiovascular disease (Singaporeheartfoundation, 2021). Apart from this, as per the data issued by World Health Organization, around 17.9million people die each year from cardiovascular diseases (Who.int, 2022). Moreover, most common causes of heart failure are as follows: coronary artery diseases, high blood pressure and previous heart attack. Congestive heart failure arises due to high blood pressure and longstanding alcohol abuse.
Heart failure is a chronic and progressive condition in which heart muscle is become unable to pump enough blood to fulfil body’s need for blood and oxygen. In the case of heart failure, it can be analysed that heart cannot keep up with its workload. Heart failure can affect left or right side of the heart or it can affect both sides at a same time. It can be either for an acute (short-term) or it can cause long-term issues. It is important to understand that heart failure incorporate various symptoms such as: fatigue, sudden weight gain, abdominal swelling, shortness of breath, leg and ankle swelling, etc (Yan, Zhang, Zang & Pu, 2019). Apart from this, it is important to understand that there are modifiable and non-modifiable risk factors related to cardiovascular disease. Non- Modifiable cardiovascular risk factors are those which cannot be changed such as: person’s age, genetics, family history, ethnicity, etc. Modifiable cardiovascular risk factors are those which can be reduced or controlled such as: smoking, high cholesterol, being overweight, hypertension, etc (Ada.com, 2021). It is necessary that people should be aware about the symptoms or different associated causes of the heart failure. If anyone experience any symptoms of the heart failure then they should immediately report the issue with the local hospital or clinic (Groenewegen, Rutten, Mosterd & Hoes, 2020). Apart from this, this essay will incorporate discussion regarding the pathophysiology of the heart failure, one symptom will be selected (such as: shortness of breath), discussion about assessment tool will be made and recommendations will be marked.
Heart failure and its causes
Physiology is the study of ways to measure about factors on how the body works. It effectively describes the chemistry and physics behind basic body functions. It is sub-section of biology which effectively covers range of different aspects such as: organs, anatomy cells, etc (Newman, 2017). Pathophysiology is the term which is used to describe changes at cellular level causes by disease or injury (Mullens, et. al., 2020). Heart failure is the pathophysiologic state and its pathophysiology the condition of heart failure results from injury to the myocardium from a variety of different causes including ischemic heart disease hypertension and diabetes (Dumitru, 2022). In the health failure pathophysiologic there are 8 common aetiologies such as: cardiomyopathies, valvular disease, myocarditis, infections, systemic toxins, and cardiotoxic drugs (Bromage, et. al., 2020). Heart fails to pump blood at a rate which is required for the metabolizing tissue. In this condition, heart fail to provide sufficient blood flow to effectively meet with the metabolic requirement or to accommodate systematic venous return. When heart fails then patients showcase following symptoms such as: rapid or irregular heartbeat, reduced ability to exercise, swelling of the belly area, fatigue weakness, shortness of breath, etc (Jaarsma, et. al., 2021). Apart from this, pathophysiology of heart failure that results in impaired cardiac output resultant are primarily due to cardiac and vascular changes. For example: changes in the cardiac function are associated with heart failure which eventually resultant in decrease cardiac output. Declining in the stroke volume due to systolic dysfunction and diastolic dysfunction. Moreover, the pathology of heart disease is also called coronary artery disease or ischemic heart disease. It suffers from inadequate supply of oxygen-rich blood to the heart muscle due to narrowing or blocking of a coronary artery by fatty plaques. The state of insufficiency or non-performance is also an adverse impact (Lippi & Sanchis-Gomar, 2020).
As, systolic dysfunction with a reduced ejection resultant in fraction and failure syndrome. It is important to understand that when heart failure arises then number of compensatory mechanisms are activated such as: frank-starling mechanism, catecholamines, activation of the renin-angiotensin system and release of atrial natriuretic peptides (Pappano & Wier, 2018). Apart from this, in reality, it can be analysed that many adult ages group (age between 35 to 45 years) also faces various heart disease due to two primary reasons such as: they tend to abuse alcohol or drugs intake and they refuse to focus on regular exercising schedule. In order to avoid heart diseases and other diseases it is important that every age group people should always follow their exercising schedule and they should avoid adverse lifestyle practices (such as: consumption of alcohol, tobacco and drugs) (Boorsma, et. al., 2020).
Heart failure occurred at the time when the heart does not pump blood. The blood often backs up and fluid builds in the lungs, causes shortage in the breath. Furthermore, various heart conditions which includes narrowed arteries in the heart as well as high blood pressure make the heart too weaker gradually (Chua & Kuan, 2017). The patients in Singapore suffers from the symptoms of shortness in the breath, weaknesses and swelling in the legs. Furthermore, the older person face from the symptoms of chest pain. In this the “shortness of breath with activity or at the time of lying down” symptom is selected and discussion is made on revealing the impact of this symptom on the patient (Seferovi?, et. al., 2020). If an individual is observing or feeling any of the symptoms such as: chest pain, severe weakness, irregular heartbeat, severe shortness of breath then they should contact their doctor for getting diagnosis. Although, other symptoms which can help in understanding about worsening heart failure are as follows: weight gain (more than 5 pounds in a week), chest congestion, unusual swelling in legs, feet or abdomen, etc. In such cases, ejection fraction can be utilized to classify or analyse heart failure condition.
Symptoms and risk factors associated with heart failure
The shortage of breathing while activity and performing other task such as lying down influence the quality of patient life. The proper management of the quality life is considered highly important for the patient survival (Yap, et al., 2019). The shortage of breathing reduces the ability of the patient to perform the physical as well as social activities. Moreover, it also reduces the ability of the patient to maintain happiness. For example, patients in Singapore reduces their happiness because of lack of capability for performing the routine and social activities (Li, et al., 2020). Therefore, through the discussion it is revealed that shortage of breathing reduces the engagement of the patient to perform the recreational activities (Levy-Lambert, et. al., 2020). Furthermore, due to lack of participation in the activities and inability to lying down increase other psychological problems among the patient. It is important to mobilize the resources for improving the quality of life (Lawson, et al., 2018). Furthermore, the shortage in the breathing and lying down symptom change the overall lifestyle of the patients such as in Singapore, the patient restricts their diet, fluid intake and exercise because of shortage of breathing problem. So, it can be analysed that patients who are dealing with cardiovascular diseases experience physiological as well as psychological issues which adverse impact their quality of lifestyle. For example: if someone is suffering from cardiovascular diseases then it can create fatigue or sleeping difficult or edema (edema is swelling which is caused by fluid trapped). It can resultant in limiting their physical and social activities which leads to poor quality of life. The other issue which patient suffer is the weight monitoring and this influence the overall behaviour of the patient. Apart from this, an individual can intake certain key measures for managing their condition of heart health such as: heart-healthy diet which are based on fruits and whole grain. An individual should consume diet which should be low in cholesterol, sodium, saturated fat, etc. A person should focus on maintain their weight because being overweight direct impact on enhancing their risk of heart disease (Mayoclinic.org, 2022).
The selected tool for assessment is “The QRISK®3 calculator”. It is a formal risk assessment method which can be used to effectively assess cardiovascular diseases (CVD) risk among the patients who lies in the age group of 25 to 84 years of age. This assessment tool calculates the risk of CVD among people by considering following key factors such as: patient age, sex, diabetes, their smoking status, stages of their chronic kidney diseases (CKD), rheumatoid arthritis, systemic lupus erythematosus, mental illness, HDO cholesterol level, etc (Jarvis, 2020). There are following advantages and disadvantages of this assessment tools which are as follows: it covers over wide range (30-84) instead of 35-74 years which means it better meet QF requirements, additional variables can be added in this tool such as: obesity, social deprivation, patient’s treatment with antihypertensives, etc. Although, the major disadvantage of this tool is that if all the relevant factors are not well inserted in this tool, then it can showcase irrelevant figures. Currently, it is developed for the UK population however Singapore health association and related agencies can also develop their own QRISK®3 calculator for the general people in the effective way.
Pathophysiology of heart failure
The nurses can adopt the strategy of providing training intervention to the patient for addressing the shortage of breathing issue among the heart failure patient. The chest wall vibration decreases the discomfort in the breathing. The nurses can also spread awareness for controlling the blood pressure. As higher blood pressure is become the main risk for increasing the heart disease (Sevilla-Cazes, et al., 2018). It is important for the healthcare institutions in Singapore for checking the blood pressure in regular basis at least one year for all the adults. As high blood pressure increases the problem of shortage of breathing among the adult. For the self-management the patient can take the necessary steps by changing their lifestyles this can become one of the main efforts for controlling the higher blood pressure among the patients. Moreover, nurses also play an important role in providing care treatment to the patients. For example: cardiac nurses can effectively help patients in the prevention, diagnosis and treatment of heart diseases. They (cardiac nurses) can help patients in fighting against heart disease by guiding patients for adapting good lifestyle choices. The intervention of nurses for patients with heart failure focus on the following factors such as: goal of optimizing fluid volume, administer medications, assess to the patient’s response, etc (Spitrey, 2022). Nurses can also promote self-management concept among patients. According to Alam, Thampi, Saba & Jermyn, the self-management is important because it reduces the shortage of breathing symptoms while performing the activity and lying down (Alam, Thampi, Saba & Jermyn, 2017). From the self-management perspective, the patient should check their cholesterol and manage their lifestyle accordingly, it helps in controlling the overall heart failure among the patient. In the adults the healthy weight is become one of the major problems for staying healthy and reducing the breathing problem. In Singapore, being overweight increase the risk of obesity and affects the patient from the high level of issue related to the breathing shortage.
The DASH diet is highly recommended to the patient for reducing the breathing issues and at the same time increase the capability of the patient for engaging the activities and can perform other related tasks (Kadri, et al., 2018). DASH diet stands for Dietary Appraoches to Stop Hypertension. This diet is design to help people to prevent hypertension related issues. The DASH diet includes foods that are rich in potassium, calcium and magnesium. It also limits food which are high in sodium and saturated fat (Mayoclinic.org, 2022). The nurses can also provide information to the patients regarding the limitation in alcohol and smoking. As majority of the patient suffer from the heart failure issue due to abuse of alcohol (Sadhu, et. al., 2018). This awareness can improve the knowledge of the patients regarding the long-term impact of breathing shortage because the psychological condition of the patient also gets influenced by not taking part in the recreational activities (Xu, et al., 2018). The regular exercise is also one of the strategies which provide various benefits to the patients such as strengthening the heart through making improvement in the circulation. Furthermore, it plays an important role in maintaining the healthy weight and reduce the problem of dyspnoea (Wongboonsin, et al., 2019). The nurses can provide exercise routine to the patient weekly aerobic exercise for pumping of the heart. The proper medications with changes in the lifestyles reduce the breathing shortage and make patient more active to participate in the activities (Griffin, et. al., 2020).
Compensatory mechanisms and impact of heart disease
From the perspective of emotional ground, it can be analysed that government of Singapore and Singapore health authorities are making consistent efforts in creating awareness among the people regarding which adverse impact of negative lifestyles. For example: The National Tobacco Control Programme (NTCP) aims at smoking control to reduce the smoking rates in Singapore. As, the NTCP utilises a multi-pronged approach to highly combat smoking habits among young generation (Healthpromotionboard, 2018). The aim of this program is to empower youth for stopping or reducing their tobacco dependency because in majority of the cases, long-term tobacco dependency can resultant in various health related issues. In reality, government and health institutions in Singapore are fulfilling their duties responsibly but it is necessary that youth of Singapore should start focus on developing healthy lifestyles habits instead of getting stuck to those habits which are eventually creating adverse impact at the psychological and physiological level (Jhund, et. al., 2021).
From the perspective of physical ground, it can be analysed that in the above section, the selected symptom of heart failure is related with the shortness of breath. Now, it is necessary that people should make sure to practice yoga and breathing exercise so that proper oxygen will flow in their body. As per the article published by the Journal of Cardiopulmonary Rehabilitation and Prevention claims that yoga is known to effectively reduce HR, BP and HF among patients. Certain yoga exercises create modulatory effects on the autonomic nervous system of the patients which reduce risk of HF, BP and HR (Guddeti, Dang & Williams, 2019). In reality, it can be observed that majority of the people in Singapore are aware that they should commence exercise daily and majority of the people even make various commitment with themselves to follow strict exercise schedule from a certain date. However, majority of the people fails to follow their commitment about exercise due to the lack of discipline and in such cases, the answer is that people are required to put efforts from within because external authorities (such as: government, health authorities, self-development books, etc) can only create awareness within them regarding positive and negative practices. In the end, people are required to put efforts from their own and they need to understand about the negative associated complications related with practicing negative lifestyle habits (Napoli, Benincasa, Donatelli & Ambrosio, 2020).
Nurses can help patients for managing their heart related issues in the following ways such as: rapid triage to create appropriate environment for safe clinical care, nurses also conduct objective monitoring for change in signs and symptoms, referral to multidisciplinary disease management, analysing anxiety levels of the patients, nurses also play their role in ensuring about consistent communication between patient and multi-disciplinary team members (Riley, 2015). From the perspective of social grounds, it can be analysed that external influence is the primary reason which pushes an individual into following adverse lifestyle schedule. In this case, people are required to analyse that what kind of common habits people those around them are following? For example: if a person consistently revolves around those people or friends who take drugs regularly then they are higher chances that he/she will also tend to start taking drugs or tend to starts practicing common behaviour habits which is present in their community. As, external forces have huge potential to influence others in following positive or negative behaviour habits in the effective way (Lopes, et. al., 2020). Moreover, from the perspective of patient safety standpoint nurses act as a medium to communicate all the necessary information about patient’s health to their families or caretakers. Nurses also enlighten families or caretakers to follow necessary steps in ensuring proper well-being of the patient.
Portfolio entry 3
Modifiable and non-modifiable risk factors for heart disease
Innovation and technology can effectively change nursing practices in the future. From the future perspective, it can be analysed that innovation is the fundamental element for ensuring and developing the care process, quality of treatment, protect health, prevent diseases, etc (Raphael, et. al., 2020). Apart from this, it is suggesting that in future nurses should focus on developing personalized treatment process. In future, the demand for personalized treatment will tend to increase and it is necessary that future nurses should be highly empower with this practice (practice of providing personalized recommendations with an appropriate use of innovation methods). Personalized medicine or treatment method is the tailoring medical treatment to the individual characteristics of each patient. Artificial Intelligence (AI) can help nurses to understanding about unique molecular and genetic profile which can help nurses or doctors in the development of personalized treatment. From the perspective of future nursing practices, it is recommended that they should focus on innovation and technology in the field of nursing for treating patients with heart failure diseases and all other kind of disease (Yan, Zhang, Zang & Pu, 2019). In future, nurses will need to automate and streamline various process in order to process quality treatment to the patients. It will further lead to help nurses in becoming adapting creativity in pioneering tools and devices that can lead to improve patient’s care situation in the effective way (Mayoclinic.org, 2021). It is suggested that in order to empower future nursing practices, medical associations should focus on educating healthcare professional on the following topics such as: cloud technology, virtual ICU, virtual reality, inpatient telehealth through specially equipped in-room televisions, etc. Educating healthcare professional and students on these topics will resultant in creating awareness among them related to the next generation technology in the effective way (Foronda, et. al., 2016).
Conclusion
From the above, it is concluded that heart failure is the dangerous disease which increases other problems among the patients such as high level of blood pressure and increase the risk of other chronic disease. In Singapore the adequate treatment is provided to the patient for the stress management, weight reduction and for decreasing the issue related to obesity and diabetes. In Singapore, the patient face from the symptoms of swelling and chest pain. As selected shortage of breathing reducing the capability of the patient to perform all the activities and can involve in other recreational activities this also reduce the stress among the patients. The shortage of breathing reduces the quality of life and does not allow the patient to move towards their expectations and outcomes. The causes are increase in age, changes in the care and lack of awareness which reduces the shortage of breathing problem among the patient. The is the selected tool is QRISK®3 calculator. This tool is the formal risk assessment to access cardiovascular diseases among patients. Therefore, it is recommended to the patients for adopting the self-management practices by involving in exercises and doing yoga in regular manner. The healthcare staff members can spread awareness to reduce the shortage of breathing symptom. Apart from this, it is recommended that healthcare professional and students should be educated about the innovation in the nursing so that they can provide personalized recommendation to the patients.
Awareness and prevention of heart disease
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