Healthcare Priorities: Peripheral Neuropathy and Hypertension
This interview is with Mrs. Rachel Robbin (which is a pseudonym). She is a 59 years old woman who came to Australia in the year 2007 from India. In 2007, when she and her family migrated to Australia, she was diagnosed with Non-insulin Diabetes. As she had a full-time job and two kids growing up, she was unable to manage her diabetes. In 2013, she was diagnosed with Type 1 diabetes mellitus and commenced on insulin. Her past medical history includes Peripheral neuropathy, Hyperlipidemia, High blood pressure, deficiency of iron, deficiency of Vitamin D, GORD, Mild microalbuminuria, and Moderate non-proliferative retinopathy (Referred to the case). This paper will discuss two health care priorities for Rachel which are peripheral neuropathy and hypertension. Both the priorities will be explained using RLT paradigm. The Health behaviour model has been used to help Rachel to manage her conditions. In case of Type 1 diabetes, the pancreas produces no or very little amount of insulin. The body recognizes insulin as a foreign substance and starts destroying it. It is an autoimmune response (DiMeglio, Evans-Molina & Oram, 2018). Diabetic fatigue is much more than a weary emotion and can contribute to exaggerated despair. Hypertension often referred to as high blood pressure, is a major contributor to cardiovascular disease (CVD) around the world. In high blood pressure, poor adherence to medication is prevalent. There is frequently a lack of a uniform model for assessing such aspects (
The Health Belief Model (HBM) is a cognitive and intrapersonal health behaviour model. This health model was first created in the 50s and then in the period of 1980s, it was updated (Green, Murphy & Gryboski, 2020). The concept is based on the assumption that a patient’s proclivity to change their health-related practices is largely driven by their health-related beliefs. The views of a particular individual towards their health and health issues, as per this paradigm, perform a part in deciding the activities that are related to their health (Green, Murphy & Gryboski, 2020). The HBM is a “value-expectancy” model. It aims to describe and estimate health-related behaviours by concentrating on people’s and communities’ mindsets and thought processes. This model is made up of 6 domains which are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and modifying factors. It is widely regarded among the most impactful models in the history of the health promotion profession, and it has demonstrated effectiveness in forecasting health-related behaviours by many populations with or at threat of developing peripheral neuropathy and high blood pressure (Luquis & Kensinger, 2019).
The first priority is the management of peripheral neuropathy. Rachel was diagnosed with Type 2 diabetes mellitus and commenced insulin. As mentioned in her interview, her past medical history includes peripheral neuropathy. Peripheral neuropathy is damage to the nerves caused by diabetes and persistently elevated blood glucose levels. There are a number of reasons for peripheral neuropathy such as high blood sugar preventing the reach of important nutrients to the other body organs like feet and legs. Further, it causes numbness, impairment of sensation, and discomfort in the feet, legs, or hands (Agarwal, 2018). The RLT paradigm has been extensively created to account for a patient’s psychological, biological, and social requirements in an effort to offer a comprehensive strategy for therapy (Williams, 2017). The RLT paradigm is made up of twelve everyday tasks: keeping a healthy atmosphere, efficient communication skills, breathing, eating and drinking, excretion, bathing and dressing, regulating temperature, movement, working and playing, expressing sexual orientation, sleeping, and death. In Rachel’s case, she works in a PCA aged almost 5 days a week. She was not able to eat a healthy diet as she has always been busy with her work and raising her kids. She has to do all her work. She hardly has time to work out as Rachel is fatigued after a long day of work and fell asleep (Holland & Jenkins, 2019).
Using RLT Paradigm for Therapy
If this condition is not controlled, it can result in hypoglycemia unawareness. Rachel might not be able to notice the signs of low blood sugar levels. Reasons for leg amputation in people with diabetic neuropathy are due to loss of sensations they do not notice small cuts and lesions which if left untreated can cause infection in the legs which can eventually lead to gangrene. It can also result in low blood pressure all of a sudden. It can also lead to issues with digestion as well sexual dysfunction (Bodman & Varacallo, 2021).
The nurse should educate Rachel about the ABCs so that she can take action to prevent the condition that she is having. She needs to believe that if she will not manage her condition, it can have some serious complications (Abedzadeh Zavareh & Sayehmiri,). A stand for the A1C blood test. A1C is a blood test that will reveal Rachel’s average level of sugar in the blood over the last few months. B indicates blood pressure. Rachel needs to believe that regulating her blood pressure is exactly as crucial as managing her glucose levels because she has diabetes. Her high blood pressure puts her in danger of myocardial infarction, a stroke, and renal damage (Delahanty, 2021). C stands for cholesterol Rachel’s past medical history indicates Hyperlipidemia, which is another risk factor that can increase the risk of many serious issues. Rachel needs to aim for A1C levels to be below 7 percent, blood pressure to be below 140/90 or even lower, and the level of LDL cholesterol to be below 100 (Delahanty, 2021).
Health belief model will help Rachel in monitoring her life style and lead a better life. Rachel should monitor her level of sugar in the blood on a daily basis if she believes in leading a healthy lifestyle. Rachel should believe on the choices she makes regarding the food that she consumes and the way she leads her life have a very big influence on her overall health. She should make healthy dietary choices such as consuming lots of fruits, vegetables, whole grains, and dairy products that are low in fat. She should limit her consumption of meat or food that is fried and rich in fat. She should be active and work out for at least 30 minutes three times a week. She needs to take proper care of her feet. She should wash it frequently and moisturize it properly. She should cut her toenails and must wear clean and dry socks (NIDDK, 2016).
The second priority for Rachel is to manage her high blood pressure. Her past medical history of Rachel includes high blood pressure and she is consuming Metoprolol for regulating her blood pressure. In case of Diabetes blood arteries gets damaged due to situation of high level of blood glucose which makes them stiff, this results into atherosclerosis. If this situation is not managed at the correct time, it can lead to high blood pressure which can result to complications such as damage to the blood vessel, heart attack, retinopathy, and renal failure. The RLT consideration of the second priority is that Rachel is able to converse successfully, hearing and speaking without the use of any assistance or challenges. She also attends community services to talk with older people as after lockdown most of them are scared to be out of their houses due to covid cases increasing There was no evidence of shortness of breath, no indicators of respiratory failure, and no reports of pain while breathing. She likes singing, cooking food for her children, and loves Indian wear. She was not able to eat a healthy diet as she has always been busy with her work and raising her kids. She hardly has time to work out as Rachel is fatigued after a long day of work and fell asleep.
The Health Belief Model to Guide Health Behavior
High blood pressure puts too much pressure on the walls of arteries, which can harm both the blood vessels and the organs. The higher the blood pressure and the longer it is unmanaged, it causes the greater amount of damage. High blood pressure can promote artery stiffness and thickening also known as atherosclerosis, which can result in a heart attack, stroke, or other issues (Fuchs & Whelton, 2020). Aneurysms can happen when the blood arteries degenerate and enlarge as a result of high blood pressure. If an aneurysm bursts, it can be fatal. It can lead to heart failure. It can also cause the weakening and narrowing of veins and arteries in the kidneys. Blood vessels in the eyes that are thickened, constricted or torn because of the high blood pressure. This can lead to eyesight loss (Riley, Hernandez & Kuznia, 2018).
In terms of care-seeking and adherence to treatment, a hypertensive patient’s capacity to see a doctor and adhere to a therapeutic plan is influenced by a number of factors. These comprise the patient’s personal understanding, benefits and views, altering circumstances, and behavioral signals (Khalil & Tartour, 2017). Hypertension can be controlled with dietary changes and, in certain cases, medication. Rachel should have this belief that she needs to develop a strategy to bring her blood pressure back into a normal range. She should consume a diet that is rich in fiber and potassium content. Her diet should be low in sodium, fat, and added sugar. Rachel should consume a variety of fresh fruits and vegetables. She should consume whole grains including whole-wheat pasta, brown rice, and whole-grain bread. She must consume dairy items that are low in fat. She must avoid fatty meat portions, cooked or preserved meats, birds with skin, and pre-made and prepared meals. Rachel should maintain a body weight that is considered as healthy. If she is overweight or obese, she should lose weight. She should be active and work out for at least 30 minutes three times a week. She should include exercises that can strengthen her muscles. She should not use any kind of items that has nicotine or tobacco in them. She needs to control her long-term health conditions such as diabetes and hyperlipidemia. She should manage her stress and indulge herself in activities such as yoga, meditation, and so on (Gabb, et al., 2016). Through this model Rachel will understand the severity of the condition and how important it is to manage it.
In conclusion, it can be said that chronic conditions such as diabetes and hypertension can result in many health issues such as cardiovascular diseases, kidney problems, and so on. Proper nursing interventions and education can help her in managing her conditions and lead a healthy life. The nursing staff and the healthcare providers will discuss the significance of self-care in diabetes and hypertension as the next step. Topics such as monitoring the level of glucose, adherence to the medicines, regular exercise, eating healthy food, and managing the weight should be discussed. The education provided on these topics will manage the HbA1C level of the patient as well as the level of blood sugar. It will help the patient in maintaining a healthy weight as well as staying physically fit. This will also help in managing the high blood pressure as well as high blood sugar level and enhancing the life quality.
References
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