This article covers a sample solution about Transitions for patient with chronic illness.
Sample Question – Transitions for patient with chronic illness
Unfolding case study of Red Yoder
A person with a chronic illness goes through many transitions while living with the disease. In this writing Assignment you will write a paper that discusses a patient with diabetes. In your essay paper you will discuss the patient’s illness transitions at three different times:
- Soon after diagnosis
- The time of an acute illness
- Post hospital discharge
Sample Answer – Transitions for patient with chronic illness
People suffering from chronic illness undergo various transitions while living with the medical condition. This is due to the disruptive nature of chronic illness, which requires drastic mental, social, psychological and lifestyle adjustment for the patient. Patients suffering from diabetes make various transitions, which could involve changing careers and sudden lifestyle changes. For elderly and geriatric patients with chronic illness such as diabetes, increased vulnerability to various comorbid conditions increases transitions across their lifespan in their various stages of illness (Pfaff, 2002). This paper examines illness transition of Red Yoder, an elderly patient suffering from diabetes at three different phases, namely soon after diagnosis, during acute illness and post hospital discharge.
Soon after Red Yoder diagnosis with diabetes, he has to make various transitions in his life to enable proper management of the condition. He has to adjust his diet, and avoid taking sugary foods. In regards to work, he has been compelled to reduce his involvement in the running of the farm. Another challenging transition that Red Yoder faces after diagnosis is seeking help from his son and daughter in law because of his reduced capability to take care of himself effectively. He is also concerned that he might not be able to socialize as much as he need to with his friends due to reduced mobility.
There are several strengths that Red Yoder possesses. First he has a good sense of humor, which is accompanied by a positive attitude about his life. The positive attitude and humor is crucial because it enhances socialization with other people, including the healthcare provider. Moreover, the positive attitude is important to enhance his mental wellbeing (Bury, 2008). Secondly, he is able to take care and manage his diabetic condition. He is actively involved in searching for information about managing the condition and sore on his foot and taking insulin medications. Thirdly, Red Yoder is not socially isolated and he is actively involved in the farm and social activities with his friends. Moreover, Red has the benefit of having family support from his son and Judy, his daughter in law. Judy’ experience as a nursing assistant is crucial in taking care of Red’s health needs. Red is also mobile and can easily move about without any difficulty. This makes it possible to exercise his body and keep physically fit, an important aspect of people suffering from chronic conditions such as diabetes (Coleman & Berenson, 2004). Moreover, Red is mentally sound and has a good memory in addition to having a good appetite.
Some of the problems that Red has soon after diagnosis include a wound on his big toe. This presents a major issue of health concern because of poor outcomes involving wounds in diabetic patients (Pfaff, 2002). Another problem is that Red has sleeping disorder, which makes it impossible for him to rest. The sleeping disorder compels him to take beer in order to fall asleep but it is not working. Taking beer is not also healthy for him. Another problem is that he has a craving for sugary foods, especially cake, which is not recommended for a diabetic.
Assessment needs of the patient include sleep disorders, problems with eating and feeding, incontinence, mental condition, evidence of falls and skin breakdown (Fulmer, 1991). The assessment tool applicable in this case is Fulmer’s SPICES a tool for older patients, which is aimed at obtaining information about common syndromes affecting elderly and geriatric patients (Fulmer, 1991). These syndromes include sleeping disorders, problems with feeding or eating, incontinence, confusion, evidence of falls and skin breakdown. By using Fulmer SPICES tool, the patient has several syndromes, which include, sleeping problems and evidence of skin breakdown, which is demonstrated by the wound on his big toe.
After the initial assessment, a visit was scheduled two weeks later to follow up on Red Yoder’s progress in his home, during a period of acute illness. Several findings were deduced after home visit to check on Red Yoder’s condition two weeks later during a period of acute illness. After an initial assessment Red Yoder demonstrated several strengths. He was actively self-managing his condition by monitoring blood sugar. Moreover, he is constantly checking the progress on his wound but is not following wound care instructions as directed by the home nurse, especially in regard to taking antibiotics to prevent infection on his wound. Red Yoder is also mentally sound and alert in regard to his health condition and issues around him. The notable problems he is experiencing includes, isolation from his friends because he cannot manage to go to meet them, reducing appetite and the wound has become infected, affecting the entire foot. Moreover, he is anxious because of being isolated from his friends, the effects of the diabetes particularly the high blood sugar levels and about his wound getting worse.
Using Fulmer (1991) SPICES assessment tool, the patient demonstrates various geriatric syndromes, which include problems in eating, forgetfulness and skin breakdown, resulting from the infected wound on his foot. Moreover, the patient has sleeping disorders but there is no evidence of falls and incontinence. In this regards, Red Yoder’s transition in time of acute illness is characterized by a sense of denial regarding his high sugar levels. Failure to accept that he is diabetic has played a significant role in influencing his ability to self-manage the condition. For instance, he is not willing to take insulin in spite of his blood sugar being high and does not take antibiotics to prevent infections on his wound. Complications on his wound resulted to his admission in hospital due to sepsis. Following his discharge from hospital, the third stage of Red’s transition is crucial to prevent him from developing more health complications.
Patient with chronic illness transition between different care settings, in accordance with their changing health needs (Coleman & Berenson, 2004). The patient could be transferred from home to hospital setting, from hospital to nursing home and could be taken back to hospital. These changes in setting present unique challenges to both the healthcare providers and the patient. After Red is discharged from hospital due to sepsis, it is crucial to assess his wound to ensure that it is not re- infected. For this reason, it is important to ensure that the wound remains dry and monitor any signs of urine incontinence. His blood sugar should also be monitored closely, as well as assessing signs of dehydration, malnutrition and sleeping disorders.
Red’s living arrangement at his home is advantageous to him because he can access medical support from his daughter in law, a former nurse assistant and social support from his grandchildren. However, he does not want to stay with his son, a situation that could stress him up and worsen his condition if he stays at the farm. To keep him healthy at home to avoid hospitalization, the patient and caregivers should be educated on effective ways of preventing being infected, benefits of taking insulin, and monitoring blood sugar. Moreover, he should be trained on eating appropriate meals, and ways of promoting mental health. To enhance communication between the patient and the nurse, the healthcare practitioner should be attentive, non-judgmental and good listener. Moreover, the nurse should involve Red’s family while developing his care plan.
Chronic illness is a major disruptive event that necessitates transition for the affected patient, family and friends. Elderly patients with chronic illness undergo many transitions, particularly due to their increased vulnerability to other comorbid conditions. During the various transition stages, patients respond differently as they transition from independence to dependence on other people for care. It is important for care providers to be cognizant of the psychological, physical and emotional wellbeing of the chronically ill patients as they undergo various stages of transition.
Bury, M.(2008). Chronic illness as biographical disruption. Sociology of Health and Illness, 4(2):167-181.
Coleman, E., & Berenson, R.(2004). Lost in translation: challenges and opportunities for improving the quality of transitional care. Annals of Internal Medicine, 140:533-536
Fulmer, T. (1991). The Geriatric Nurse Specialist Role: A New Model. Nursing Management, 22(3), 91- 93.
Pfaff, J. (2002). The Geriatric Resource Nurse Model: A culture change. Geriatric Nursing, 23(3), 140-144.