Caring for a Patient with Long Term Condition - Article Example

Nursing: Caring For a Patient with Long Term Condition Introduction Long term conditions are any medical complications that are on going, for a longer period of time or they are recurring conditions that have a critical blow on an individual's normal working life. In common language or dialect these conditions are usually referred to as chronic medical conditions or chronic illnesses/diseases. Some of the common conditions that present themselves as long term conditions include; chronic pain from cancerous states, cardiovascular diseases (hypertension and Angina), respiratory disorders, endocrinology conditions such as diabetes, Parkinson's disease, Alzheimer's disease, and arthritis; bipolar disorders, infection by viruses especially the HIV/AIDS virus, drug and alcohol dependence among other conditions. Some definitions of long term conditions differ around the globe in relation to the duration an individual will suffer from the disease condition, others vary depending on the causal agent of the medical condition while other consider more on the impact of the condition on the victim or their families. The Management of Long Term Conditions There are several programs put in place that help to reduce the negative impact of the long term diseases conditions on individuals lives. Self care is the common method that is advocated for those peoples who are not seriously ill or bedridden to enable them o take care of their responsibilities in terms of health and the general well being, Department of Health. (2001). Any patient suffering from long term condition should be allowed access to high quality information that has tangible evidence of success in order to help in the management of the conditions more efficiently as a patient with informed consent. The causes of the conditions, symptoms, and management of the condition are very important factors. In the United Kingdom, there are several programs that are put in place to care for individuals with long term condition, Lorig et al (1999) they include; 1. The United Kingdom Health scheme 2. Proposed Model for delivery of improved medical services 3. the Long term Conditions - a National Health Service Policy 4. local implementations 5. new approaches with success evidences The NHS Policy envisages a medical care system for long term conditions in terms of three stages of management, DOH (2005) i.e. a case management for victims of multiple and complicated medical conditions, disease management applies to those individuals who present the risk of developing the disease and it is based on some established guide lines (program) in the primary care and a self care support program that is advocated for use by those victims who present low risk of developing the disease condition (Lorig et al 1999). The Expert Patients Programme (EPP) which is part of the department of health in England was established in 2001 to support the self care programme that was being run by the National Health Service (NHS). The EPP adopted some of the feature of Chronic Disease Self Management Programme (CDSMP) that is in operation in the USA, Lorig et al. (1999). The Incident: Cervical Cancer As student nurse I had a very serious and delicate situation taking care of a cancer patient (Miss Magy) suffering from cervical cancer. This could be a very painful condition in the abdomen when it's left unattended an may even cause some bleeding, however in early stages one cannot easily notice or tell that the tumour is cancerous. This patient explained to me that her condition begun with a small lump in her abdomen, which one could easily assume that it's normal or rather something that would disappear on its own, Dept of Health. (2001). After having that lump in her abdomen for close to seventeen months, she decided to go to the doctor since she had been living in denial but the discomfort being caused by the lump could not be neglected. Magy thought that all she needed to do was to eat right and take her medicine with hopes that everything would turn out just right little did she know that the condition would turn out to be a deadly one. This conception was because of the fact that she could carry out her daily chores without any problem. One day Magy's Doctor sought help from another doctor. When she begun treatment with the new doctor she was so shocked when the new doctor revealed to her that she had cancer. She claimed that it was hard for her to actually accept that the mass in abdomen was malignant! She actually went into shock and she could not be allowed to go home, preparations to get her admitted begun immediately. Magy's condition could have been easily treated or manage without any cause for alarm. The doctor performed a Computer Tonorgraphy scan (CT scan) which revealed that everything was not alright and the palpitation indicated a large mass. The Reflection Cervical cancer is a malignant cancer that affects the cervix and uterus and may cause bleeding at some point; however the symptoms are not clear until at advanced stages (Almendral & Gisela 1981). If her condition could have been discovered earlier by the use precancerous diagnostic methods like the Pap smear screening, the treatment or management could have been possible by use of high grade means hence preventing the development of cancer. Pap smear screening can actually detect precancerous states, Dept of Health. (2001), the name of the test to establish the possibility of cervical cancer is called Pap smear screening; this is because the causal agent for the cervical cancer is the Human papillomavirus (HPV). The human papillopmavirus is an oncogenic virus and causes changes to the cervical tissues' DNA and the result is uncontrolled multiplication of the cells (Almendral & Gisela 1981). The risk factors for developing cervical cancer include previous infection with the HPV virus, numerous sexual partners, early sexual intercourse encounters, the use oral contraceptives and cigarette smoking, DOH (2005). Academic Reflection Diagnosis Magy was very scared to face the surgery since the doctor scheduled her surgery in two days time. This made me to think about the importance of early diagnosis of the cancerous states. The Pap smear is an effective way of diagnosis and not a confirmatory test for the pre cancerous test, DOH (2005). After detecting the possibility of developing cancer, a confirmatory test has to be done and this involves a biopsy which is done through colposcopy (United Nations 2005). This is the use of a dilute acetic acid and a magnified visual examination of the cervix and uterus to check out abnormal cells. Another diagnostic process involves the use of Loop Electric Excitation Procedure (LEED) and conization in which the lining of the cervix is isolated for pathological examination (Almendral & Gisela 1981) The lump in Magy's abdomen was so big that the surgeon was also worried that may be she might not make through the surgery. She went into the surgery room singing doxology and everybody around was so scared, one nurse prayed with her. And the surgeon locked the doors as we watched in frustration. The surgery was carried out successfully despite the fact that the mass was so big. The doctor explained that he could not believe that she had actually made it safely, the cancer had shifted from the uterus to her colon and attached to the wall of the abdomen and the surrounding organs including her ovaries, United Nations (2005) All of the affected parts were removed and she lost about 11 inches of her colon. Due to these experience, Magy suffered several other sicknesses including Hypertension. Risk Factors HPV is transmitted by sexual intercourse, unprotected sexual contact and having multiple partners are the main risk factors of infection. Cigarettes contain some chemicals that may interact with the cervical cells and develop precancerous changes that can develop into cancer after some time, DOH (2005). Oral contraceptive increases the chances of developing cervical cancer especially following a long term use. The international Federation of Gynaecology and Obstetrics (FIGO) take the responsibility of staging based on clinical inspection and not according to the surgical findings. Under these strategies, only few diagnostics are used to determine the stage. They are palpitation, Computer Tonorgraphy scan, colposcopy, cystoscopy, proctoscopy, intravenous urography, X-ray and endo-cervical curettage (United Nations 2005). Treatment There are several methods of treatment of cancer if detected in early stages and these are; surgery, chemotherapy, immunotherapy, radiation therapy, photodynamic therapy and antiangiogenesis, DOH (2005). Magy's case called for surgery and when the day came she was very frightened. The surgeon had to go through the CT scans, make decisions on who was to carry out the surgery and who was to be her oncologist. Malignant cancers are very dangerous compared to benign ones (Rohan & Shah 2004). Having undergone a successful surgery was not a guarantee that Magy was healed, the cancerous states recurred and this second bout it was a metastatic colon on the lining of her abdomen and breast cancer. This was after seven months of chemotherapy. Medically, the breast cancer developed as a result of the hormone therapy she was undertaking to counter hot flushes (Rohan & Shah 2004), doctor's judgment was that she could not survive the next 18 months. After the surgical removal of the uterus and cervix, medically termed as Hysterectomy, women should not undergo screening for cancer except if the surgery didn't involve the removal of the cervix, the surgery was done for cancer or pre-cancer or if she was exposed to (DES) diethylstilbesterol through her mother's pregnancy. Conclusion Long term conditions can be very devastating and risk factors for any of them have to be addressed. The adoption of care such as the NHS and the social care has to be provided to everybody who presents the risk. As the old adage goes prevention is better than cure. So far the Expert Patient Programme (EPP) by adopted NHS is doing very well Prevention of HPV vaccine is currently available and is used to prevent infection by the HPV virus. The vaccine is safe and very effective. Avoidance of other risk factors like avoidance of sexual contact or use of condoms is beneficial, plus mutual monogamy can be partial protection from the risk. Cessation of smoking is very important if the victim was a smoker as HPV and smoking increases high grade lesions two to four fold. References Almendral A.C & Gisela D (1981). Cervical Cancer Springer-Verlag Department of Health. (2001) The Expert Patient. A new approach to chronic disease management in the 21st Century. The Stationery Office. DOH (2005) Department of Health- Great Britain. Supporting People with Long Term Conditions. An NHS and Social Care Model to Support Local Innovation and Integration. Department of Health Lorig. K, et al. (1999) Evidence suggesting that a chronic disease self-management programme can improve health status while reducing hospitalization. Med Care 1999; 37(1):5-1 Rohan T.E & Shah .K.V (2004) Cervical Cancer: From Aetiology to Prevention Springer. United Nations (2005) Factors and Conditions of Long-term Growth. Stationery Office Books Read More