Essential Nursing Care Chronic Obstructive Pulmonary Disease

Question: Discuss about the case study of Essential Nursing Care for Chronic Obstructive Pulmonary Disease. Answer: Introduction The assignment is a case study report on Luigi, an Italian man who is living in Australia since 40 years. He has worked as an accountant before his retirement. The purpose of this report is to identify the chronic ailment in patient and discuss the pathophysiology of the diagnosed illness in the patient. It will also give detail on the manifestation of each diagnosed illness in the patient. It will also give information about the complexities of the patient's condition. It will identify the interaction between patient's co-morbidities and how it can have an impact on the patient's family. Pathophysiology of disease The case study is on Luigi, a 77-year Italian man living in Australia. His health has declined over the years due to poorly controlled type 2 diabetes. He takes Metformin for controlling his diabetes. Although he is overweight, he does not pay attention to his diet and leads a sedentary lifestyle. His vision is blurring, and his ankles are swelling. He also has high blood pressure and protein in the urine. Further investigation revealed that he suffers from chronic renal failure. This section is a discussion of pathophysiology and clinical manifestation identified in the patient. Two significant chronic conditions diagnosed in the patient were type 2 diabetes and chronic renal failure. Type 2 diabetes is associated with the inability of the body to produce adequate insulin to meet the demands of the body. Patients with Type 2 diabetes develops insulin resistance where muscle and liver cells may fail to respond to insulin. It will result in an abnormal rise in the blood glucose level. The disease is also aggravated by obesity and physical activity (Scheen, 2014). So, Luigi's type 2 diabetes might have been poorly controlled because of his obesity and sedentary lifestyle. The dysfunction in the body is characterized by hyperglycemia resulting from inadequate insulin production and excessive glucagon secretion. Type 2 diabetes is asymptomatic, but clinical manifestations include polyuria, polyphagia, polydipsia, weight loss, and blurred vision and yeast infection. Luigi also had blurred vision due to type 2 diabetes. Type 2 diabetes occurs due to complex interaction of genetic and environmental factors. Therefore two primary defect pathophysiological abnormalities in type 2 diabetes are the -cell failure and insulin resistance (Kahn et al., 2014). The glucose regulation pathway is dependent on insulin secretion and insulin sensitivity. The progression of Type 2 diabetes occurs due to a continuous decline in -cell function. Insulin resistance in patients develops due to the elevated level of proinflammatory cytokines in plasma and fatty acids. Diabetes develops in those patients who cannot increase insulin secretion to balance insulin resistance. -cell dysfunction is a major factor in diabetes development, and it may develop in the early stage of the pathologic process. -cell fail to compensate insulin resistance. The -cell function is dependent on -cell mass and its secretory capacity. Therefore loss of -function might be due to lipotoxicity, insulin resistance and pre-existing genetically determined risk. Firstly, normal glucose tolerance proceeds to abnormal glucose tolerance. Then fasting hyperglycemia develops due to the failure of hepatic gluconeogenesis. Insulin resistance develops mainly due to obesity. The risk of diab etes is also high in patients with high plasma concentration of 3 amino acids (Meier Bonadonna, 2013). Luigi was finally diagnosed with chronic renal failure after urine and blood test. The symptoms are not visible until severe damage to the kidney. Common symptoms of chronic renal failure include increased urination at night, cloudy urine, edema (in hands and feet), high blood pressure, fatigue, shortness of breath and loss of appetite. Luigi also had high pressure and swelling in the leg which is a manifestation of chronic renal failure. Severe complications include anemia, hypertension, brittle bones, edema, the risk of bleeding and seizures. Luigi might have developed renal failure due to his poorly controlled Type 2 diabetes. Poor control of glucose gradually damages the function of kidneys. High blood pressure is also a leading cause of damage to the kidney (Popolo et al., 2013). IgA nephropathy is a cause for end-stage renal failure. Diabetes and high blood pressure destroy the small blood vessels in the body. Pathologic features of renal failure are fibrosis, loss of renal cel ls and infiltration of renal tissue by monocytes and macrophages. Proteinuria, hypoxia, and Angiotensin II production all lead to kidney failure. Angiotensin II is responsible for glomerular hypertension thereby damaging the kidney (Levey Coresh, 2012). The predisposing factors of the chronic condition are aging, congenital kidney defect, family history of renal failure, an autoimmune disorder. Precipitating factors like exposure to a toxin and particular medication, sedentary lightly and high residue diet is also responsible for manifestations of the disease condition (Gansevoort et al., 2013). Discussion on chronicity and complexity of condition Patient with diabetes is at increased risk of comorbidities like hypertension due to change in cardiac structure, nonalcoholic fatty liver disease and dyslipidemia. Patients like Luigi who have poor diabetic control may develop the risk of vascular complications. Diabetic control is poor in adolescent in spite of active follow up treatment. The progression of the disease is faster in obese children mainly due to the accumulation of lipids visceral compartment resulting in insulin resistance and reduced sensitivity of -cell. Several studies on patients with comorbid conditions like depression and type 2 Diabetes have also shown that mortality in such patient is high compared to a patient with diabetes alone (Luijks et al., 2012). As Luigi was finally diagnosed with chronic renal failure too, it has made his condition more complex and chronic. The common comorbidities associated chronic kidney disease are cardiovascular disease, anemia, malnutrition, depression, bone disorder and decreased functional status. Patients like Luigi are at more risk of dying due to the cardiovascular disease-related condition. Blood pressure control and glucose control is a vital factor in managing the comorbidities. However Luigi's blood pressure was also high and his diabetes was also poorly controlled. So, his condition was extremely complex in which immediate medical attention was necessary. It is also needed for Luigi to maintain his diet, increase physical activity and pharmacologic therapy. These activities will help him in controlling low-density lipoprotein cholesterol which is important to prevent cardiac disorder. Several patients with chronic renal failure develop anemia due to the improper synthesis of erythropoietin b y kidneys (Albrecht et al., 2016). Interaction of comorbidities Type 2 diabetes is a chronic illness for which continued medical attention and knowledge about preventing acute complication is necessary to minimize lifetime risk. Most patients with chronic kidney disease have been found to have one or more comorbidities that interact with each other. The first and second most significant conditions that have to lead to chronic renal failure in patients are diabetes and high blood pressure respectively. Luigi also had poorly controlled type 2 diabetes and high blood pressure. These conditions were also responsible for his renal failure. Patients with type 2 diabetes are at more risk of cardiovascular morbidity and mortality than patients without diabetes. These risk further augmented by other factors like hypertension, dyslipidemia, and obesity in patients. This also suggests that it is critical for Luigi to maintain his weight and reduce obesity (Look AHEAD Research Group. 2013). It is evident that patients like Luigi with comorbidities often take multiple medicines. Therefore Luigi will have to manage his medications properly and do regular health check-ups because his poorly controlled diabetes was only the reason for his chronic renal failure. High blood sugar level can damage many parts of the body. In type 2 diabetes, pancreas synthesizes insulin, but the body is unable to use it properly . Due to diabetes, small blood vessels get damaged. Due to this, the kidney cannot clean blood purify blood properly. It leads to more retention of water and salt contributing to weight gain and ankle swelling. It becomes apparent now why Luigi was obese and had swollen foot. It also leads to more protein in the urine ( Similar condition also found in Luigi). Diabetes also damages nerves in the body which has an effect on the function of the bladder. When the bladder is not emptied, pressure resulting from full bladder injures the kidney. This explains the reason why a patient with type 2 diabetes is at more risk of developing kidney disease (Perkovic et al., 2013). This section will discuss the relation between diabetes and cardiovascular system. Blood is an essential part of the cardiovascular system whereas diabetes is a condition in which level of blood glucose rises. So, it is evident that there must be some link between the two. Diabetes and cardiovascular system disease are related to each other due to insulin resistance syndrome. The National Diabetes Surveillance system report also revealed that among 20 million people with diabetes in U.S., 5-6 million of them have the cardiovascular disease too. The commonly diagnoses cardiovascular disease included stroke, high blood pressure, and coronary heart disease (Look AHEAD Research Group. 2013). Now based on the interaction of two ways by which comorbidities interact, it is necessary for such patients to manage treatment procedures properly. Luigi will have to follow suitable diet according to doctors advice. It will be necessary for him to have an open dialogue about his health with the physicians (Dunkler et al., 2013). Several modifications in risk factor will help Luigi to maintain health despite comorbidities. He will have to maintain his blood pressure and keep the BMI less than 27 to control his overall health condition. For proper maintenance of health, he will also have to do an annual urine test; retinal dilation test and biannual foot examination for sensation testing and pressure check (Copeland et al., 2013). A regular visit to the doctor should be his priority so that his improvement can be tracked by the doctor. Proper medication and advice from doctors will help Luigi in the long run. Lifestyle changes like increasing physical activity will be a crucial facto r in managing his diabetes. His treatment plan will include multiple drug therapy to reduce all the risk factors. Different types of insulin shots are available, and physician will help Luigi in choosing the best type for him. Since Luigi as developed renal failure, he will require a higher dose of insulin. Oral diabetes medication will assist in lowering blood glucose (American Diabetes Association, 2013). Older adults with diabetes are at more risk of cardiovascular disease. Lipid and blood pressure control will be an essential factor in reducing the risk of cardiovascular disease in Luigi. It will also depend on his overall health and frailty. Comprehensive education in self-management will also be necessary for him. The major component for self-management in Luigi will include self-monitoring of blood glucose, medical nutrition therapy, doing exercise regularly, Physiologically dependent insulin regimens or oral medications and periodic assessment of treatment goals. Metformin is also a common medicine prescribed to diabetes patients which Luigi was also taking (Inzucchi et al., 2014). It improves the sensitivity of body tissues to insulin and lowers glucose production in the urine. Other medications include Sulfonylureas, Meglitinides, Thiazolidinediones, DPP-4 inhibitors, etc. will also stimulate pancreas to secrete more insulin. Luigi will also need to do regular exercise like ae robics for 30 minutes every day. Stretching and strength training will also be beneficial for him. Luigi should take low glycemic index food after consultation with a registered dietitian that will fit his health goals (Kohan et al., 2014). The chronicity will also have an impact on Luigis family member. Family members also live with the disease and has to manage their disease. It is necessary for family members to support them and take care of their diet. A patient who involves their families can share their emotional concern with them, and they are less risk of stress. Emotional support by family members also has an effect on adherence to treatment regimen. Diagnosis of diabetes contributes to anxiety for family members as the comorbidities are difficult to manage initially (Mayberry Osborn, 2012). However, once family members are aware of the condition, they will be able to make lives better for their closed one by making them adhere to treatment regimen. Conclusion The case study report has summarized the chronic condition of Luigi. It identified the major disease that the patient was suffering from and gave detail about the pathophysiology and clinical manifestation of each diagnosed illness. It has explained the chronicity and complexity of patients condition. It identified two possible interactions of comorbidities and gave detail about the impact of these comorbidities on patients and family members. It provided detail about the possible treatment and medications required in such patients. Once the patient has knowledge about ways of managing their clinical condition, they can improve their health after following a treatment regimen. Reference Albrecht, J. S., Park, Y., Hur, P., Huang, T. Y., Harris, I., Netzer, G., ... Moyo, P. (2016). Adherence to Maintenance Medications among Older Adults with Chronic Obstructive Pulmonary Disease: The Role of Depression.Annals of the American Thoracic Society, (ja). 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