Chronic Care Across the Lifespan A 

The chronic disease is the disease which stays for a prolonged time and usually has a long-lasting effect on human beings. These types of conditions last for more than three months up to a lifetime of the patient (Beal et al., 2016). There are many chronic conditions like arthritis, heart attack and stroke, diabetes mellitus type 1 and 2, cancer and so on. The chronic conditions are the result of poor health behaviours like excessive alcohol intake, no physical exercises, more intake of cigarettes and tobacco and poor eating habits. The chronic conditions have a lasting effect on the physical and mental well- being of the affected individuals. This essay is based on the case study provided that identifies a chronic condition in the patient and gives a detailed description of its pathophysiology, symptoms that present the current issue in the patient. This essay also outlines the relevant diagnostic and ongoing tests that are associated with the patient’s chronic condition. The developmental, cultural and health literacy considerations are also mentioned for the patient with a chronic condition. The three priorities for nursing management of the patient’s chronic condition are discussed that require immediate nursing interventions for the current management practice of chronic condition.

This is the case of a 45-year-old female nurse who works in a rural hospital. She has injured herself in a workplace injury while assisting a bariatric patient who had fallen. Raelene the patient has been complaining about the pain and swelling in her hands from a long time that as affected both her hands. She has recently been diagnosed with a chronic condition called rheumatoid arthritis (RA) as a result of which she suffers from joint pain and pain in her hands and back. The second chronic condition that is related to her history is chronic depression. The presenting issue is the constant back pain which is related to the chronic condition of rheumatoid arthritis (RA) and she has a medical history of another chronic condition that is chronic depression. Her partner is worried about her mental health and states that his partner is in depression but this patient is reluctant to see any doctor. The chronic condition of rheumatoid arthritis (RA) is an inflammatory disorder that affects the joints of the patient. There are varied symptoms and this patient has also presented with one of the major symptoms that are swelling and persistent pain in her joints of the hands. The chronic conditions of a patient do not just affect the physical health of the patient but also affects mental health and this patient already has a medical past of chronic depression.

The current condition with which the patient has arrived is the constant back pain which has developed after the workplace injury. She was earlier diagnosed with arthritis and chronic depression. The Pathophysiology of arthritis that is associated with back pain includes a description of osteoarthritis. The spine has a three-joint complex which includes vertebral osteophytes (OST), disc space narrowing (DSN) and facets joint OA (FOA) (Goode et al., 2019). There is an adequate nerve supply in all of these parts which are capable enough to produce LBP. The synovial joints are the vertebral facet joints (zygapophyseal joints) and FOA is a multifactorial process that produces the degenerative changes which are highly similar to those that are seen in the synovial joints. Osteoarthritis is a clinical outcome of a disorder that is the result of structural and functional failures of the synovial joints.

In arthritis, the synovial joints results in pain and similar is the case in osteoarthritis (Lindsey & Dydyk, 2020). The spine degeneration is associated with the low back pain and this is the main reason for the back pain in people with arthritis. There exists a significant relationship between disc space narrowing and vertebral osteophytes and lower back pain. This patient who works in a rural hospital was assisting a bariatric patient who was falling. There are high chances that the patient has developed pain in her back either due to disc space narrowing or due to back injury. There is an association between arthritis and degraded mental health of the patients (Kameda et al., 2020). The partner of this patient fears that she is in a depression so there is a requirement for addressing the issue of mental health that is depression. This patient with a physical illness that causes significant limited physical activities like limitations in doing basic things like sleeping affects the mental health of the patient.

The relevant diagnostic tests that are associated with the patient’s conditions are blood test that is related to rheumatoid arthritis. The diagnostic tests include physical examination like careful observation of the ongoing inflammatory areas, swelling, warmth, redness and reflexes (Takase-Minegishi et al., 2018). This gives a better insight of muscle strength and the physical examination is a key that helps in the diagnosis of rheumatoid arthritis. This chronic condition is known to target small joints of the hands, wrists and feet. The patient Raelene is also having similar symptoms like pain and swelling in her hands and finger joints. After the workplace injury, she has developed a persistent pain in her lower back which implies that her condition has worsened now. Family history plays a very important role in examining this chronic condition because genes also have a certain role to play in developing rheumatoid arthritis in the patients (Deane et al., 2017).

The people who have a family history of RA are at high risk of developing this chronic condition. Certain blood tests are helpful in the diagnosis of this condition that tests for markers that signifies inflammation that is a common symptom of this condition. Some of the main blood tests that are used to diagnose this condition include rheumatoid factor, anti-cyclicc citrullinated peptide, C- reactive protein (CRP), erythrocyte sedimentation rate (ESR) and antinuclear antibody (ANA) (Ahmadi et al., 2017). The patient is at higher risk of the worsening condition of her depression so there is a necessity to perform a diagnostic test for depression also. The diagnostic test for depression, in this case, would be based on diagnostic criteria that are given by DMS-5. The symptoms will be checked with the patient and her family members and then a diagnosis will be made for chronic depression.

The potential problem that is associated with arthritis is the development of pressure ulcer. The patient is unable to perform various activities and is bedridden. There are high chances that she may develop pressure ulcers because of not being able to perform various activities and being in bed for long. The pressure ulcers develop due to pressure or shear forces over a bony prominence in the presence of this major risk factor that is arthritis (Young, 2019). The second potential complication that may arise is osteoporosis which mainly occurs due to the medication that is used to treat the patient with RA. These medicines weaken the bones and make them more prone to fracture (Liu et al., 2018).

The developmental considerations that can be applied in this case comply with Erickson’s psychosocial theory of development. This patient falls under the stage seven that is generativity vs. stagnation (Dunkel & Harbake, 2017). The patient is unable to perform daily activities and has also not been working from the past four months. This disease has led to stagnation due to which her mental health is affected. She might see herself as a failure because she is well educated and has high health literacy but the social life is affected as a result of which her life has become stagnated. The contribution to society and performing for the benefit of people was her main work as a nurse but now she is stagnated and is unable to contribute to society because of RA (Knight, 2017).

The priorities of nursing management for this patient include pain management, addressing her mental state to improve depression and giving appropriate positioning training so that the back pain can be managed. The patient is under extreme pain in her lower back and other joints of the hands so pain management can be done by administering medication for pain management (Shenker, 2019). The patient is being given medication so the nursing intervention would be the administration of the medicines. The mental health can be addressed by giving her appropriate counselling sessions so that she can talk to the nurse and feel better to be back with the work (Sharpe, 2016). This will help in being normal from the state of depression. The third priority is patient education related to positioning. The lower back pain is not allowing the patient to sleep so appropriate positioning can help the patient with sleep.

The conclusion drawn is that there are many chronic conditions like arthritis, heart attack and stroke, diabetes mellitus type 1 and 2, cancer and so on. This patient is suffering from chronic RA and depression due to which she is unable to carry out daily activities. The nursing interventions are applied for pain management, addressing her mental health because she is depressed and also by providing appropriate positioning training so that she can sleep.

References for Chronic Disease

Ahmadi, H., Jamshidi, A. R., Mahmoudi, M., Cuzzocrea, S., Fattahi, M. J., Barati, A., & Mirshafiey, A. (2017). The potent inhibitory effect of β-D-mannuronic acid (M2000) as a novel NSAID with immunosuppressive property on anti-cyclic citrullinated peptide antibodies, rheumatoid factor and anti-dsDNA antibodies in patients with rheumatoid arthritis. Current Drug Discovery Technologies, 14(3), 206-214.

Beal, S. J., Riddle, I. K., Kichler, J. C., Duncan, A., Houchen, A., Casnellie, L., ... & Corathers, S. D. (2016). The associations of chronic condition type and individual characteristics with transition readiness. Academic Pediatrics, 16(7), 660-667.

Deane, K. D., Demoruelle, M. K., Kelmenson, L. B., Kuhn, K. A., Norris, J. M., & Holers, V. M. (2017). Genetic and environmental risk factors for rheumatoid arthritis. Best Practice & Research Clinical Rheumatology, 31(1), 3-18.

Dunkel, C. S., & Harbke, C. (2017). A review of measures of Erikson’s stages of psychosocial development: Evidence for a general factor. Journal of Adult Development, 24(1), 58-76.

Goode, A. P., Cleveland, R. J., Schwartz, T. A., Nelson, A. E., Kraus, V. B., Hillstrom, H. J., ... & Golightly, Y. M. (2019). Relationship of joint hypermobility with low Back pain and lumbar spine osteoarthritis. BMC Musculoskeletal Disorders, 20(1), 158.

Kameda, M., Tanimae, H., Kihara, A., & Matsumoto, F. (2020). Does low back pain or leg pain in gluteus medius syndrome contribute to lumbar degenerative disease and hip osteoarthritis and vice versa? A literature review. Journal of Physical Therapy Science, 32(2), 173-191.

Knight, Z. G. (2017). A proposed model of psychodynamic psychotherapy linked to Erik Erikson's eight stages of psychosocial development. Clinical Psychology & Psychotherapy, 24(5), 1047-1058.

Lindsey, T., & Dydyk, A. M. (2020). Spinal Osteoarthritis. In StatPearls [Internet]. StatPearls Publishing.

Liu, L. C., Lu, M. C., Wang, S. Y., Livneh, H., Lai, N. S., & Tsai, T. Y. (2018). Association of use of rehabilitation services with development of osteoporosis among patients with rheumatoid arthritis: a nationwide population-based cohort study. Osteoporosis International, 29(8), 1897-1903.

Sharpe, L. (2016). Psychosocial management of chronic pain in patients with rheumatoid arthritis: challenges and solutions. Journal of Pain Research, 9, 137.

Shenker, N. (2019). I134 Results from the first UK audit of pain management in inflammatory arthritis: EULAR recommendations examined. Rheumatology, 58 (Supplement_3), kez109-133.

Takase-Minegishi, K., Horita, N., Kobayashi, K., Yoshimi, R., Kirino, Y., Ohno, S., ... & Emery, P. (2018). Diagnostic test accuracy of ultrasound for synovitis in rheumatoid arthritis: systematic review and meta-analysis. Rheumatology, 57(1), 49-58.

Young, T. (2019). Rheumatoid arthritis and its impact on ulceration and healing. Wounds UK, 15(4).

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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