NRSG372: Chronic Illness and Disability Assessment Answer

Introduction

The interviewee who is present named Alice has interviewed a patient, and after interviewing the person it has been noted that the patient is diagnosed with Cervical Dystonia. The patient is a 45-year-old man, and hence he should be assessed carefully and his medical history needs to be evaluated. The condition named Cervical dystonia is also known as spasmodic torticollis, it is a painful condition in which the neck muscles contract involuntarily and this leads to twisting or turning of head to one side. The two care priorities which are present in this condition are: the patient is in a lot of pain, hence, steps need to be taken to control the pain. The next care priority is to help the patient in maintaining mobility. In this condition it has been noticed that the patient is unable to carry out actions of mobility, hence, it should be worked on. The first education area that needs to be covered is patient education, when the patient is educated it will allow effective steps to take place so all needs of the patient are taken care of. Another education area that needs to be targeted is physiotherapy, it is essential as it will allow free movement of the neck, and pain is also controlled. This paper discusses SMART goals that are required to achieve the outcomes. In the later part of the paper, the role of the nurse is discussed, and how it will help to achieve the SMART goals established.

Patient Overview

The patient is a 45 years old male and upon diagnosis, it has been concluded that the patient is diagnosed with Cervical Dystonia. The patient is from Nepal and understands limited English. The patient has stated that there is pain in the neck side and along with it some involuntary neck muscles move towards the right side of the neck. At certain times the patient is in a lot of pain. It is a rare neurological disorder that originates in the brain. It is highly common in the form of focal dystonia. The major characteristic is the involuntary muscle contraction in the neck and this leads to abnormal movement and posture of the neck. The severity of the condition needs to be considered as it will lead to significant pain and discomfort (Supnet et al., 2019). This condition mainly begins to develop in middle age, and in very rare conditions it will begin in teenage years. Although the cause is unknown, genetic susceptibility can be one of them. When the biographical data of the patient is considered, it has been noted that the patient is a male and 40 years old. This condition is although a rare condition, however, it is highly common in middle-aged people and more common among women when compared to men (Kongsaengdao et al., 2018). The symptoms usually develop when the treatment which is required is not received. In Australia, a fair number of people are affected by this condition. It has been observed that about 3 in 1000 people are affected by this. When all the numbers are summed then it accounts for about 70,000 people in Australia. It is essential to control the number because it will decrease the incidence of this condition and hence, effective measures are adopted to control it. The behavioral pattern of the patient needs to be discovered, and the changes need to be done accordingly. Since it has been mentioned that the patient understands only limited English, hence, the treatment process is hampered and there will be some challenges faced while providing treatment (Raju et al., 2019).

Pathophysiology of Cervical Dystonia

 The pathophysiology of Cervical Dystonia has been described, the major and principal cause of dystonia is due to dysfunction of the basal ganglia. This has mainly emerged due to the concept of basal ganglia which is the region of the brain and it aids in motor control. If there is absence of neurodegeneration in primary dystonia, then lesions can be observed in the brain region other than basal ganglia. This condition also affects the motor system and it is mainly a disorder rather than a disease of motor structure. Several studies have provided evidence of dysfunction in about every region of the brain. It also included the central nervous system and how it is involved in motor control, sensorimotor, and spinal cord which also includes the brainstem and cerebellum (Groth et al., 2021). Standard MRIs have been conducted, however, it has not been successful in revealing the structural pathology, tensor imaging, and any other abnormality which might be present. DTY1 mutation has been identified, and it reduces the fractional anisotropy (FA) in the sub-gyral white matter of the primary sensorimotor cortex, left superior cerebellar peduncle, and pons. There are several abnormalities observed in the lentiform nucleus and along with it, in the white matter which is adjacent to the nucleus in the patient with focal dystonia. Other than this, several neurophysiological studies are presented and they demonstrate consistent changes with the abnormality in the inhibitory control, brain plasticity, and sensorimotor integration (Castelão et al., 2017). The EMG which has been carried out demonstrates dystonia and along with it, also shows co-contraction of antagonist and agonist muscles, and prolonged bursts and overflow of muscles are observed. Along with this, dopamine signaling is also involved in the pathophysiology of the condition. Dopamine signaling is involved in the pathophysiology of CD. The studies demonstrate that there is a decrease in the binding of labeled ligands for D2 dopamine receptors in the patient. The priority of care is to reduce the pain in the neck. This needs to be addressed because it causes discomfort among the patient, hence, it should be addressed immediately (Rosales et al., 2018).

First SMART Goal

The first SMART goal which has been identified is to reduce pain. It has been mentioned in the case study that the patient is in pain. Pain is in the neck side, there is involuntary movement of neck muscles and it moves towards the body and neck. Several measures can be adopted to reduce the pain. The pain which arises directly radiates towards the neck and shoulder, this leads to huge amounts of discomfort. It hampers the quality of life and the care process is hampered. In addition to it, the signs and the symptoms which are observed get worse over time and stress has a huge impact on this (Loudovici-Krug et al., 2022). The patient should be educated about how they should manage the pain, when the pain is managed, the quality of life is increased. With adequate patient education, early intervention steps can be adopted and this will decrease the severity of the symptoms. Patient education empowers the patient, and it will also improve the health status of the person. Whenever the patient is involved in care, there is a high likelihood they have been involved in the intervention, it also increases the chance of positive outcome. In addition to it, it also promotes patient-centered care, and also adherence to medication and treatment is increased (Contarino et al., 2017). The RLT model of care needs to be adopted, these are biological, environmental, psychological, politico-economic, and socio-cultural. In the SMART goal which is designed, all these components need to be taken care of. In the case of a study, the patient is in pain, hence, measures need to be adopted to control the pain, and some medication needs to be administered. The mental state of the patient is affected hence, mental support should be provided, and the family members should be involved to smooth the purpose of treatment. The patient does not understand English, hence, the care process should be such that English should not become a problem and it does not hamper the quality of care (Supnet et al., 2020).

Role of Nurse in Patient Education

Nurses play an important role in the treatment process and in providing relevant health education. The patient should be educated about coping strategies for pain management as this will help them to take the precautionary measures which are needed. It also allows the patient to stay ahead of the pain. The primary commitment of the nurse is to be committed to the welfare, health, safety, and comfort of the patient. Knowledge and self-awareness of pain and pain assessment are highly important as they will act as a standard of care for pain. It also enhances the ability of the nurse so they can advocate and assure that effective pain management is carried out (Fawkes & Moore, 2019). The primary role of the nurse is to maintain the health and well-being of the patient. The caregiver should be such that the patient should be able to manage the physical needs, it helps to prevent any illness and all the health conditions that need to be treated. To achieve it, the nurse must monitor and observe the patient and any relevant information needs to be predicted effectively. There are several ways which can be adopted to educate the patient, some of these steps are: brochures should be provided, these brochures will help the patient to understand certain topics, it will also allow them to learn certain things which are necessary and required (Fereidouni et al., 2019).

Second SMART goal

The second SMART goal which needs to be adopted is to ensure that anxiety and depression of the patient with cervical dystonia should be cured. Anxiety and depression affects the health of the people.. The goal of the nurse is to control depression and anxiety patients. Several steps can be adopted to ensure depression is cured, first is to practice counseling and adopt several non-pharmacological approaches, this will allow the patient to take care of their mental health and freely carry on all the actions. This goal might require some time to achieve. About 45-60 days will be required. However, if adequate sessions are attended by the patients there are high chances that depression will be taken care of. To achieve this goal, it is essential that the patient needs to be educated about the approach which needs to be followed while attending therapy. Nurses should educate the patient about the advantages of therapy and how it will help to improve mental health (Javed & Davis, 2022).

Nurse's Role in Educating the Patient

Nurses play a vital role in educating the patient about the advantages of therapy and how it will help the patient to cure depression. Patient education will help to facilitate the patient's knowledge to make sense of their plans. It will also help them guide towards more effective and ongoing self-management. Several strategies need to be developed and all these strategies will guide the patient to maintain their well-being and health. Nurse education should be such that it should be patient-centered and it should be aimed towards increasing adherence to medication and also treatment (Constantin & Dahlke, 2018).

Conclusion

This case study is about a patient named Alice and after interviewing the person it has been noted that the patient is diagnosed with Cervical Dystonia. The patient is from Nepal and understands limited English. A major problem faced by patients is pain in the neck side and along with it some involuntary neck muscles which move towards the right side of the neck. The pathophysiology of Cervical Dystonia has been described, the major and principal cause of dystonia is due to dysfunction of the basal ganglia. It has mainly emerged due to the concept of basal ganglia which is the region of the brain and it aids in motor control. The first SMART goal is to reduce pain, and the second SMART goal is to control depression and mobility. Nurses play an important role in educating the patient, and they will provide regular assistance to the patient.

References

Castelão, M., Marques, R.E., Duarte, G.S., Rodrigues, F.B., Ferreira, J., Sampaio, C., Moore, A. P., & Costa, J. (2017). Botulinum toxin type A therapy for cervical dystonia. The Cochrane Database of Systematic Reviews, 12(12), CD003633. https://doi.org/10.1002/14651858.CD003633.pub3

Constantin, S., & Dahlke, S. (2018). How nurses restore and maintain mobility in hospitalised older people: An integrative literature review. International Journal of Older People Nursing, 13(3), e12200. https://doi.org/10.1111/opn.12200

Contarino, M.F., Van Den Dool, J., Balash, Y., Bhatia, K., Giladi, N., Koelman, J. H., Lokkegaard, A., Marti, M.J., Postma, M., Relja, M., Skorvanek, M., Speelman, J. D., Zoons, E., Ferreira, J.J., Vidailhet, M., Albanese, A., & Tijssen, M.A. (2017). Clinical practice: Evidence-based recommendations for the treatment of cervical dystonia with botulinum toxin. Frontiers in Neurology, 8, 35. https://doi.org/10.3389/fneur.2017.00035

Fawkes, K., & Moore, J. (2019). Newly registered nurses' experiences of delivering patient education in an acute care setting: an exploratory study. Journal of Research in Nursing : JRN, 24(8), 556–567. https://doi.org/10.1177/1744987119869770

Fereidouni, Z., Sabet Sarvestani, R., Hariri, G., Kuhpaye, S.A., Amirkhani, M., & Kalyani, M. N. (2019). Moving into action: The master key to patient education. The Journal of Nursing Research: JNR, 27(1), 1–8. https://doi.org/10.1097/jnr.0000000000000280

Groth, C.L., Brown, M., Honce, J.M., Shelton, E., Sillau, S.H., & Berman, B.D. (2021). Cervical dystonia is associated with aberrant inhibitory signaling within the thalamus. Frontiers in Neurology, 11, 575879. https://doi.org/10.3389/fneur.2020.575879

Javed, M.J., & Davis, D.D. (2022). Assisting patients with mobility. StatPearls. Available from: https://www.ncbi.nlm.nih.gov/books/NBK559100/

Kongsaengdao, S., Maneeton, N., & Maneeton, B. (2018). Long-term quality of life in cervical dystonia after treatment with abobotulinum toxin A: A 2-year prospective study. Neuropsychiatric Disease and Treatment, 14, 1119–1124. https://doi.org/10.2147/NDT.S152252

Loudovici-Krug, D., Derlien, S., Best, N., & Günther, A. (2022). Physiotherapy for cervical dystonia: A systematic review of randomised controlled trials. Toxins, 14(11), 784. https://doi.org/10.3390/toxins14110784

Raju, S., Ravi, A., & Prashanth, L.K. (2019). Cervical dystonia mimics: A case series and review of the literature. Tremor and other Hyperkinetic Movements (New York, N.Y.), 9, 10.7916/tohm.v0.707. https://doi.org/10.7916/tohm.v0.707

Rosales, R.L., Cuffe, L., Regnault, B., & Trosch, R.M. (2021). Pain in cervical dystonia: Mechanisms, assessment and treatment. Expert Review of Neurotherapeutics, 21(10), 1125–1134. https://doi.org/10.1080/14737175.2021.1984230

Supnet, M.L., Acuna, P., Carr, S.J., Kristoper de Guzman, J., Al Qahtani, X., Multhaupt-Buell, T., Francoeur, T., Aldykiewicz, G.E., Alluri, P.R., Campion, L., Paul, L., Ozelius, L., Penney, E.B., Stephen, C. D., Dy-Hollins, M., & Sharma, N. (2020). Isolated cervical dystonia: Management and barriers to care. Frontiers in Neurology, 11, 591418. https://doi.org/10.3389/fneur.2020.591418

Supnet, M.L., Acuna, P., Carr, S.J., Kristoper de Guzman, J., Al Qahtani, X., Multhaupt-Buell, T., Francoeur, T., Aldykiewicz, G.E., Alluri, P.R., Campion, L., Paul, L., Ozelius, L., Penney, E.B., Stephen, C.D., Dy-Hollins, M., & Sharma, N. (2020). Isolated cervical dystonia: Management and barriers to care. Frontiers in Neurology, 11, 591418. https://doi.org/10.3389/fneur.2020.591418

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