Care of Patients With Complex Condition

Introduction:

People with complex health conditions such as diabetes and heart disease are more vulnerable to mortality and morbidity as compared to healthy people. This is because the complex health condition not only affects the target organs but also can attack the functions of other body system thereby causing severe deterioration of health. Therefore, patients with complex health conditions need systematic and personalised care that assist the care professionals to manage the symptoms of the health condition thereby eliminating the associated risks.

This study aims to discuss the care of two patients with complex health conditions. One patient suffers from one complex health condition, Chronic obstructive pulmonary disease [COPD] and another patient suffers from two complex health conditions such as type 1 diabetes and Coronary Artery Disease (CAD). This study will present two separate case study in which it will discuss the patient's current health condition, lifestyle, demographic factors and the impacts of the complex health condition on the physical and psychological wellbeing of patients. After giving a brief discussion of the case study of each patient, this study will deal with each case in which it will evaluate the complex health condition of the patient [to discuss the probable causes, pathophysiology and impacts in this health condition on the patient. This study will discuss that whether the complex health condition of the patients develops any secondary health issues. After that, the study will discuss the separate care plan for each patient, based on the patient's complex health condition/conditions. In this case study, the study will discuss how the three-health conditions can be managed and how the risks associated with each health condition such as infection can be reduced. Under NMC (2015), this study has changed the real names of each patient in terms of maintaining the confidentiality of the patient's identity (NMC, 2015).

Case study of the patient with COPD:

Daniel is a 67 years old man, had been admitted to the emergency ward with severe breathing difficulties, chest tightness and episodic shortness of breathing. He is a retired bank manager, a regular smoker who lives with his wife. They have no children. For the last five years, he suffers from chronic obstructive pulmonary disease (COPD). He does not have any other complex health condition. However, he has a history of psychological illness such as depression, anxiety and dementia. His wife informed him that, he loves to play golf, play the guitar and he was a good cook who cooked special dishes for his wife each weekend. Since the last four years, his health condition has been deteriorating with frequent breathing issues, poor respiratory function and severe lung infection that made him highly depressed and inactive. He also has a history of irregular lifestyles such as skipping meals and medicines (inhalers), fasting, high consumption of junk foods and cold drinks that cause lung inflammation and lack of exercises. For the last 48 hours he suffers from shortness of breath and the condition deteriorates in the last 10 hours with chest tightness with his inability to take a breath. After watching this deterioration of his health condition Daniel’s wife calls the ambulance and after reaching the hospital, he had been immediately transferred to an emergency ward.

After the admission, the physical health assessment had been carried out in which nursing professionals check Daniel’s BP, breathing rate, heart rate, oxygen saturation level and pulse rate. Different tests had been carried out based on the symptoms shown by Daniel such as spirometry, High-Resolution Computed Tomography test (HRCT test), Red Blood Corpuscles [RBC] counts test and Pulmonary Function Test [PFT test]. Based on the test results it is clear that Daniel has COPD with a severe lung infection (85% blockages in the lungs). His oxygen saturation level is 87% (normal: 95-100%) and his breathing rate is 25 breaths per minute. From analysing his pre-medical history, it is clear that he does not have any genetic history of pulmonary illness. His overall physical test shows the following report:

Complex condition 1: COPD (Chronic obstructive pulmonary disease)

What is COPD:

Chronic obstructive pulmonary disease or COPD is a chronic (incurable) lung disease in which there is the inflammation on the inner walls of the bronchiole and lung alveoli thereby causing severe obstruction in the normal airflow inside them (Maddocks et al. 2017). This is considered a complex health condition as it is incurable and make patients vulnerable to the risk of morbidity, even mortality (if left untreated). However, by following a systematic diet and medication, Daniel can manage this health condition. COPD has many symptoms such as breathing difficulties, episodic shortness of breathing, chest tightness, heavy cough, mucous production, chest pain and wheezing (Bringsvor et al. 2018). Patients with COPD like Daniel are highly vulnerable to the risk of developing different additional health condition such as lung cancer, heart disease and other health condition (Jolly et al. 2018). Chronic bronchitis and emphysema are the two common health condition that is associated with COPD (Jenkins et al. 2017). People suffering from COPD often experience episodes in which the symptoms associated with this health condition worsen. These episodes of worsening symptoms are known as exacerbations (Jenkins et al. 2017).

How COPD develops:

The actual causes of COPD are still obscure (Hillebregt et al. 2017). Clinical evidence suggests tobacco smoking can be one of the potential causes of developing COPD in patients (Kessler et al. 2018.). People who are regularly exposed to fumes from the burning fuel during cooking or heating in a house that is poorly ventilated are more likely to develop COPD than people who are not exposed to fumes (Sandelowsky et al. 2018). As argued by Jolly et al. (2018), there are many cases in which regular smokers having a smoking history for several years have reduces lung function but the condition cannot be called COPD. Despite the criticism, it is acknowledged that tobacco impacts adversely on the airways and lung alveoli. Tobacco damages the cilia that are located inner wall of airways. According to Van der Molen et al. (2017), cilia that are located on the inner wall of the airways play crucial roles in restricting the entry of the debris and the harmful foreign particles that are present in the air. Therefore, cilia allow the fresh air to enter into the airways. Due to continuous smoking, tobacco causes severe inflammation in the inner walls of the airways by damaging the cilia which then accumulate mucous on the inner wall thereby narrowing the inner diameter of the airways.

In the case study, care professionals must evaluate the possible reason for COPD in the case of Daniel. As he is a regular smoker, therefore tobacco smoking can be the potential reason behind the development of this complex health condition. In addition to this, an aspect that care professionals need to consider while preparing his care plan is Daniel's eating habit, food choice, lifestyle, medication and pre-medical history.

Pathophysiology COPD:

While it comes to discuss the cause and outcomes of COPD, it is important to analyse the pathophysiology of this health condition. In normal airways there is non-interrupted airflow through the trachea, then bronchioles and then to the lung alveoli (Sigurgeirsdottir et al. 2019). In the lung alveoli there occurs the gaseous exchange with the blood flowing in the surrounding blood vessel. Here the oxygen from the alveoli enters into the blood in the blood vessels and then transported to all the body parts through the blood. The process of mixing of blood to the oxygen is known as the oxygenation of blood (Sandelowsky et al. 2018). The process through which the oxygen enters into the alveoli and then enters into the surrounding blood vessels through diffusion process is known as the inhalation. On the other hand, carbon dioxides from the blood enter into the lung alveoli, which then pass-through airways and exit from the body. The process through which the carbon dioxides enters from the blood vessels into the alveoli and then eliminated from the body into the external environment is called the exhalation (Hillebregt et al. 2017).

In the case of COPD patients, like Daniel, the airways are inflamed which cause a severe obstruction of the airflow through the airways (Ogunbayo et al. 2017). There are two health condition that contributes to developing COPD such as emphysema and chronic bronchitis (Khan et al. 2017). In the case of emphysema, severe inflammation is caused on the inner wall of the bronchioles. This inflammation occurs when the inner lining of the bronchioles (cilia) become damaged thereby reducing the elasticity of the airways (Sandelowsky et al. 2018). Due to the reduced elasticity of the inner wall of the airways, the airways cannot recoil during exhalation thereby making it difficult to exhale carbon dioxides (Jenkins et al. 2017). On the other hand, in the case of bronchitis, due to damage of the inner lining of the airways, there is high mucous production and accumulation in the inner wall of the bronchioles thereby reducing the inner diameter of the airways (Khan et al. 2017). When air enters into the narrower passage it gets obstructed and a poor amount of oxygen is then transported to the lung (Hillebregt et al. 2017). This is the reason behind the episodic shortness of breath and breathing difficulties in Daniel. The chest tightness and chest pain in Daniel trigger his risk of having severe lung infection. Pathophysiology of COPD suggests that as the lung is inflamed it is unable to get more oxygen to the body which causes the body to pose stress on the respiratory tract located in the chest region to get more oxygen. The chest tightness in a COPD patient is caused due to the pressure that the body exerts on the lungs to get the extra oxygen to meet the oxygen demand of the body (Guimarães et al. 2018). This may the potential reason behind the chest tightness chest pain that Daniel experience.

Risk associated with COPD:

As Daniel suffers from COPD for more than three years and does not follow the correct medical regimen, he is highly vulnerable to many additional health issues such as heart diseases, lung malignancy and heart stoke (Khan et al. 2017). Here Daniel’s depression and anxiety are associated with his COPD which causes psychological distress in him. COPD poses adverse impacts on normal lifestyles and quality of living of Daniel as mentioned in the case study, due to his poor physical health, Daniel is unable to perform his regular activities. Due to his poor lung capacity and breathing issue he can do limited walk or limited work that his body permits.

Care plan and Management of COPD:

Assessing the holistic needs of patients: [PESSO COLA assessment tool]

After evaluating the cause and outcomes of COPD, it is important to discuss the process of managing the symptoms of this health condition. As mentioned by Jolly et al. (2018), although COPD is a chronic illness that can not be permanently cured, its symptoms can be well-managed through following a systematic lifestyle, healthy diet and proper medications. In the case of Daniel, the management of COPD includes proper clinical support, lifestyle change, regular and systematic medication as prescribed by doctors, vaccinations and self-management.

Appropriate clinical support is important for Daniel to carry out his necessary health assessment and clinical intervention of the illness. As mentioned by Guimarães et al. (2018), while dealing with a patient suffering from complex illness such as COPD, care professionals must use such care plan that can promote the holistic wellbeing of the patients. In the case of Daniel, care professionals can use the PEPSI COLA tool that will assist them not only in managing the symptoms of COPD but also it improves the overall quality of Daniel’s life. The elements that care professionals consider through using this tool are as follows: Physical Emotional Personal Social support Information and communication Control and autonomy Out of hours Living will illness Aftercare

Through using this tool, care professionals can determine and meet the personalise holistic needs of Daniel such s his physical, emotional and social needs (Plaza et al. 2017). Under NMC (2015), while managing any health condition, care professionals must treat a patient as an individual and meet his or her personalise needs accordingly ([NMC, 2015)]. Daniels physical needs areis to improve his breathing condition and oxygen saturation level. Here SABA or salbutamol is administered to Daniel. Salbutamol is associated with mediating the increasing numbers of cyclin adenosine monophosphates in the smoothest muscle cells of the airways (Jolly et al. 2018). This relational of the smooth muscles thereby causing the bronchodilation through dilating the small airways salbutamol increases the airflow through airways thereby increasing the oxygen supply to the lung (Kessler et al. 2018),

Additionally, the long-acting muscarinic antagonist (LAMA) is also used in the case of Daniel, in terms of improving his oxygen saturation and breathing condition. This medicine acts against the bronchoconstrictor impacts of the acetylcholine on the M3 muscarinic receptor located on the smooth muscles of the airways (Ogunbayo et al. 2017). Therefore, LAMA leads to smooth muscles relation of the airways thereby causing vasodilation thereby improving the oxygen supply to the lungs. In these ways, the overall oxygen saturation level, breathing condition and lung function of Daniel can be improved within 12 hours (Jolly et al. 2018).

In terms of meeting the emotional and social needs of Daniel, nurses need to provide mental and emotional support to Daniel by using friendly, polite and empathetic attitudes and behaviour towards him (Ogunbayo et al. 2017). Here nurse and care professionals will motivate him to be optimistic and encourage him to take a positive decision.

Through developing effective communication with b Daniel, care professionals can easily understand whether he experiences any additional health issues after administering medicines. Through clear and empathetic communication nurses and doctors can improve the self-confidence and mental strength of Daniel (Sandelowsky et al. 2018). Through communicating with Daniel, about his health condition, treatment and care, care professionals can engage him in the overall care process. Throughout the care process care, professional must respect the autonomy, dignity and right to the confidentiality of Daniel. Patient’s autonomy needs to must be protected and respected to provides them with high-quality care (NMC, 2015). Care professionals will be considered Daniel’s preference, choice and autonomy while applying any treatment for COPD. As mentioned by cCare profession must ensure that the treatment and care strategies that are applied for managing symptoms of any health condition are highly appropriate based on the health needs of the patients

Lifestyle change:

Daniel must avoid smoking otherwise his lung infection will deteriorate and the percentage of inflammation in the airways will increases thereby enhancing his risk of mortality. As mentioned by Sandelowsky et al. (2018), tobacco smoking is associated with severe mucous formation and accumulation in the inner wall of airways thereby causing severe airways inflammation Daniel must. Daniel, must not skip meals and medicine. He has to follow the diet strictly that is prescribed by the doctors and nutritionist in which he must avoid the food that can cause allergies or always inflammation such as nuts, cold drinks and junk foods. He must do aerobic exercise regularly that will improve the oxygen supply to his lungs. He must follow healthy habits such as early rising and early sleeping to have a sufficed sleep.

Vaccination:

Vaccination is important as well as crucial for managing COPD (Ogunbayo et al. 2017). Therefore, doctors must keep Daniel aware of all the up-to-date information regarding the pneumococcus and influenzas vaccination. Under Primary Care respiratory Society and British Thoracic Society UK, it is the duty of pulmonologists to provide proper information regarding vaccination to COPD patients like Daniel such as the time of administering the vaccines, the duration between two vaccines and the persuasions need to take by Daniel during vaccination.

Self-management:

Self-management skill is important for COPD patients to manage that health condition (Plaza et al. 2017). Daniel will be advised about his self-management plan such as how he check or monitor his symptoms, how he determines his oxygen saturation level, the secure pack of salbutamol, antibiotics and steroids that he must keep with him. Care professional will provide health education to Daniel to improve his knowledge on what precaution he would take to avoid the worsening of his health condition and the strategies he used to improve his oxygen supply to lung.

Case study of patients with type 1 diabetes and CAD:

Merry, a 37 years old lady had been admitted to the A&E with severe dehydration through frequent urination, chest pain, shortness of breathing and a fast weight loss of 10 kg in the last 2 days. From assessing her medical history, it is seen that she has a history of Type 1 diabetes for the last five years. In last year she is also diagnosed with Coronary arterial Disease (CAD)she works at a private consultancy company. From the last three days, she experiences severe breathing difficulties, episodic shortness of breathing along weight loss and hyperglycaemia. After her admission, the physical assessment has been carried out. Under this physical assessment, doctors have carried out A1C test, fasting blood sugar test, glucose tolerance test and GFR test (Glomerular Filtration Rate). The test result shows that merry has a fasting glucose level of 275 mg/dl. For determining the percentage of blockages in the coronary artery doctors have performs ECG, Echocardiography, intravascular ultrasounds and coronary angiography. From the test, it was clear that Merry has 78% blocks in her coronary artery which is the reason for her episodic shortness of breathing.

Complex condition 2: (CAD)

Pathophysiology of CAD:

Coronary arterial disease (CAD) is the condition in which cholesterol deposition (plaque) is accumulated into the inner wall as of the coronary artery. The coronary artery is the network of blood vessels that wrap the heart from the outside thereby supply oxygen and nutrients to the heart muscles (Guimarães et al. 2018). Heart muscles need continuous oxygen to perform the function. Previously CAD was considered as the cholesterol storages disorders but recent clinical intervention shows that CAD develops due to atherosclerosis which is an inflammatory disease. Clinical evidence suggests that coronary disease occurs due to the atheromatous narrowing as well as subsequent occlusion of the coronary arterial vessels (Honigberg et al. 2020). The cholesterol deposition that is accumulated into the inner wall of the coronary artery is known as the plaque. When the endothelium of the coronary artery encounters some bacterial products as well as risk factors such as the vasoconstrictor hormones of the inflammatory cytokines, the cells of the endothelium cause augmentation of the expression of the adhesion molecules on the endothelium to get attached to the blood leucocytes in the inner surface of artery walls. Leucocytes then interact with the smooth muscle cells of the endothelium of artery walls (Andre et al. 2021). A lipid core is then released from the leucocytes which then migrates to the intima thereby ingesting the lipid. A connective tissue matrix is then developed from the smooth muscle that migrates to the intima thereby creating a wide layer of connective tissues in the inner walls of the artery walls. Therefore, the inner diameter of the artery wall gets narrower which obstructs the blood through inside it (Giza et al. 2017). Due to the reduction in the blood flow through the coronary artery, insufficient oxygen and nutrient are supplied to the smooth muscles of the heart. Due to the lack of sufficient oxygen smother muscles of the heart cannot perform their functions systematically which also pose adverse impacts on the function of the heart. This is why patients with CAD have a high risk of heart attack or cardiac failure, if left untreated, the patients with CAD can form full blockages inside the coronary artery, in which there is no passage to flow blood and oxygen through the coronary artery (Mathews and Mathews, 2020.). At this stage, there is no oxygen and nutrients supply to heart muscles because the heart cannot perform its function thereby causing a heart attack.

Risk associated with CAD:

CAD has several physical and psychological impact on patients. The major physical impact of this complex condition is breathing issues in the patient. As there is a reduced oxygen supply to heart muscles, the heart is unable to perform its function of transporting blood and oxygen to different body parts (Giza et al. 2017). This is why Merry experiences breathlessness and episodic shortness of breath. On the other hand, patients with CAD have a risk for heart attack and cardiac failure. In the case of Merry, she has 78% blockages in her coronary artery, which points out that she is highly vulnerable to the risk of heart attack if proper treatment is not delivered to her. CAD pose psychological impacts om Merry such as she may develop depression, frustration and reduced self-confidence due to her poor physical condition.

Care plan and Management of CAD in the case study:

Coronary artery disease is a chronic illness that cannot be cured, but by following a prescribed medication regimen and a healthy as well as systematic lifestyles, people can manage the symptoms of this health condition (Xie et al. 2018). Management of CAD in the case of Merry consists of two main aspects following a prescribed medication regimen and an effective lifestyle change. As Merry has 78% blockage in her coronary artery it is not possible to improve her blood supply as well as oxygen transportation through the coronary artery without carrying out surgery. Therefore, she is advised to undergo an angioplasty after which she will be discharged after carrying out a follow up (Patel et al. 2018). In her current medication regimen, aspirin is administered that prevents the formation of furthers deposition in the artery walls. She is also provided with other medicines such as ACE (angiotensin-converting enzyme) inhibitor, beta-blockers and nitro-glycerine (Guimarães et al. 2018). Nurses regularly check her BP, oxygen saturation, heart rate (ECG) and blood sugar level.

Along with medication, she needs to follow a systematic and healthy lifestyle by avoiding smoking and alcohol consumption. She needs to follow the diet that is prescribed by her doctors. Merry recommends consuming low-fat foods that are enriched in protein (Merry cannot consume foods that are enriched in carbs due to she is diabetic). Merry also need to do regular exercises that can improve her blood cumulation and oxygen supply to the lungs. She must learn and use some stress management techniques such as deep breathing that will eliminate the chances of developing hypertension (Guimarães et al. 2018). She must check her blood sugar level regular wise and try to follow a proper clinical regimen to maintain a normal sugar level.

Complex condition 3: Type 1 diabete4s

Pathophysiology of Type 1 diabetes:

Type 1 diabetes is associated with an autoimmune response of the body, in which the body's immunise system destroys the insulin-producing beta cells of the pancreas (Garg et al. 2017.). The pancreas has two types of cells situated in the Islets of the Langerhans region, the alpha cells that secrets glucagon and the beta cells that secret insulin. Insulin hormone plays crucial roles in glucose-homeostasis by maintaining the blood glucose level at the normal range. If blood glucose is higher than the normal range in the circulation then the beta cells are stimulated thereby secreting the insulin hormones (Lennerz et al. 2018). Insulin then works on the excess glucose to convert it into glycogen which is then absorbed by the muscle and tissue cells and stored into them for future use. In the case of patients like Merry who are diagnosed with type 1 diabetes, the insulin-producing beta cells are damaged by the immense system. Therefore, the excess glucose cannot be converted into glycogen increasing the sugar level at faster rates in the blood. Merry experiences ketonuria which is the common symptoms of type 1 diabetes. As stated by Danne et al. (2019), in ketonuria, ketone bodies are formed from the breaking down of the body’s muscles and tissues. This is why Merry loses her weight at a faster rate in the last three days due to the breaking down of her muscles and tissues cells. Merry also experiences polyuria which is another common symptom of type 1 diabetes, in which the excess glucose is eliminated from the body through urine.

Risk associated with type 1 diabetes:

Type 1 diabetes pose adverse impacts on the physical and psychological health of patients. Merry experiences many physical issues such as polyuria, ketonuria and weight loss that hamper her quality of daily living. On the other hand, due to frequent urination, she may feel shy and embossed in her professional field. Due to these physical issues, she feels inactive, exhausted and depressed that make her unable to perform her regular function.

Risk associated with type 1 diabetes:

Type 1 diabetes pose adverse impacts on the physical and psychological health of patients. Merry experiences many physical issues such as polyuria, ketonuria and weight loss that hamper her quality of daily living. On the other hand, due to frequent urination, she may feel shy and embossed in her professional field. Due to these physical issues, she feels inactive, exhausted and depressed that make her unable to perform her regular function.

Care plan and management of Type 1 diabetes in the case study:

There is no particular medicines and surgical procedures to cure type 1 diabetes permanently (Chiang et al. 2018). Merry can manage this health condition by following a healthy and systematic lifestyle, proper medical regimen, regular exercise and self-management. Merry needs to take the medicines that are prescribed by doctors. She must consider that she has two complex conditions, type 1 diabetes and CAD. Therefore, while following a diet she must ensure that her diet is enriched in low carbs and low fat (Hilliard et al. 2018). She must not avoid carbs completely because it can lead to sugar faults. She also needs to do regular exercises. Here she must do the aerobic exercises that will benefit her in two ways such as improve her blood circulation and increase her blood supply (Riddell et al. 2017). She must be provided with proper health education so that she can monitor her sugar level, BP and symptoms at her home. She must be trained in developing self-management skill, that will assist her to control her health and wellbeing.

Conclusion:

From the overall discussion, it can be concluded that complex health condition poses adverse impacts on the physical, emotional and psychological; wellbeing of people. Most of the complex illnesses are chronic that cannot be cured presently but their symptoms can be managed through systematic lifestyles and relevant clinical regimen. Care professionals mist provides higher quality personalised care to patients with a complex health condition to promote their holistic wellbeing, additionally, they need to provide health education to people with complex illness to improve their self-management skill.

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