Coping With A Chronic Health Condition

The student nurse took care of a 59 year-old Caucasian female on September 11, 2018. The patient was admitted to the emergency department with a diagnosis of ascites. The patient had a history of diabetes, cirrhosis, hypertension, kidney failure, splenomegaly, and major depression. The patient complained of abdominal pain and swelling. The paracentesis was done on Monday, and seven liters of fluid were removed from the patient’s abdomen.

The patient told the student nurse that a paracentesis normally takes out nine liters of fluid not just seven liters, and she has had to have a paracentesis done frequently since May 2018. After talking to the patient and looking at the patient chart, the student nurse concluded that teaching about how to cope with a chronic health condition would help the patient to manage her health. The student nurse chose this topic because this patient has many chronic problems such as: hypertension, diabetes, cirrhosis, and major depression also. The patient also has had to get paracentesis done multiple times to remove fluid from her abdomen. The patient also stated that she’s very tired and sick because of her illnesses. Learning how to cope with her chronic conditions and deal with stress are very important to this patient.

Outcomes

1. By the end of this teaching session, the patient will be able to state what a chronic health condition is.
2. By the end of this teaching session, the patient will be able to list what three examples of chronic health conditions are.
3. By the end of this teaching session, the patient will be able to list two of the four steps to cope with a diagnosis of a chronic health condition.
4. By the end of this teaching session, the patient will be able to verbalize at least two of the five ways to manage stress.

Content

Upon assessment at the beginning of the shift, the patient was alert, oriented x3. Fall score was 70 and Braden score was 23. The patient opened her eyes spontaneously and spoke appropriately. Patient rated pain 6/10 on left side of the upper back. Her breath sounded clear over anterior, posterior and lateral fields. The patient’s heart sounded clear, and S1, S2 were heard clearly; her heart rate was 86. The patient’s abdomen was swelling, hard. Her abdomen had a lot of striae and a vertical scar above the umbilicus. The patient’s blood pressure was 96/49, pulse was 86, respirations were 18, oxygen saturation was 98%, and temperature was 36. 9. Her skin was light yellow, warm, and dry. Patient stated that her last bowel movement was on Monday morning. She reported that she did not have any difficulty voiding, but she did not void much. The patient had a saline lock with 20 Gauge on her right antecubital side.

What is a chronic health condition? A chronic health condition is a condition that develops slowly and is persistent. According to Krames on Demand: “If you have a chronic health condition, you have a problem that may not go away over time (Krames, 2018a)”. That means if the patient has a diagnosis of a chronic problem, the patient will have to deal with it for a long time. “Chronic illness diseases that are prolonged, do not resolve spontaneously, and are rarely cured completely (Greenberg, 2017)”. Once patient has a diagnosis with a chronic problem, the patient will have to follow a long treatment regimen, and the chance for reversible is low. Some chronic conditions are heart disease, asthma, arthritis, and diabetes (Krames, 2018a).

There are many reasons why people have chronic conditions such as: not enough physical activity, bad eating habits, tobacco use, or alcohol consumption (Greenberg, 2017). A chronic health condition can affect a person’s quality of life, limit their physical activities, and their working abilities (Greenberg, 2017). When the patient is diagnosed with a chronic health condition, what should the patient do? First of all, the patient should learn to cope with his or her diagnosis. The patient could be angry, depressed, or afraid about that diagnosis. But, to cope with that diagnosis, the patient should know about his or her disease. The patient can look at some medical books, ask his or her healthcare provider for more information, use some accurate online resources, or the patient can contact local groups that focus on the patient’s problem (Krames, 2018a). Accepting change is the second step to cope with a patient’s diagnosis.

The patient may have changes in his or her physical and mental health. The patient has to learn to control diet and change the way of his or her work. By the way the patient recognizes his or her changes, determines how the patient will accept those changes and control them (Krames, 2018a). After the patient accepts changes, the patient will learn how to control those changes like the patient learns to control his or her diet, physical activity, mood. The patient can talk with his or her healthcare provider about the treatment plan to control the disease also (Krames, 2018a). The last step to help the patient with coping with his or her diagnosis is moving forward. The patient should decide what is the goal to improve his or her health such as: be active, quite smoking, control the patient’s weight, stop drinking alcohol, change the patient’s eating habit. Counseling is a good place for the patient to talk about his or her trouble, sadness, or frustration (Krames, 2018a). After the patient deals with his or her chronic conditions for a while, stress is the patient’s main problem. So, how can the patient deal with stress? First, the patient should get enough rest and sleep should be appropriate for the patient’s age. Stress can also affect patient’s sleeping, so patient can try to relax before sleep by not exercising too close to bed time, listen to music, deep breathing practice…(Krames, 2018b). Another way to manage stress is making time for himself or herself. That means the patient can take time and focus on his or her hobbies such as: cooking, drawing, singing, shopping (Krames, 2018b). The third way is eating right.

A lot of diseases are affected by foods, so figuring out what the patient can and cannot eat is very important (Krames, 2018b). The other way is nourishing the patient’s spirit. The patient should ask the question “what is the most important thing in my life?” Sometime the patient should forget his or her chronic conditions, and focus on what the patient wants to achieve in his or her life (Krames, 2018b). The last way to manage stress is staying on the move: “Exercise helps burn off the negative energy of stress (Krames, 2018b)”. Being active and doing whatever that patient likes are the best way to manage stress. The patient can walk, jog, swim, or dance to improve his or her health, and these activities can also be used to deal with stress. A patient who has a chronic disease diagnosis should ask his or her healthcare provider in which exercises the patient can participate (Krames, 2018b).

Resources/ Visual Aid

The patient was given two handouts about how to deal with stress. The first handout is “Manage Stress with a Healthy Lifestyle” which includes five steps to help the patient manage his or her stress. The second handout is “Coping with Your Diagnosis of a Chronic Health Condition” which explains what a patient should do with a diagnosis of a chronic condition. This handout also explains what a chronic health condition is, and it gives some examples of chronic health conditions. These handouts were retrieved from Krames on Demand at the hospital. EvaluationThe patient sat on the chair during the teaching session, and her husband was interested in the teaching session also. The patient’s husband turned off the TV and told the student nurse to turn the light on. They were very active and willing to learn. The student nurse wrote five questions on the paper and handed it to the patient, and the student nurse also read it out loud, so the patient’s husband could be involve. The patient’s responses were:1. What is a chronic health condition?Patient response: “can’t cure”2. State three examples of a chronic health condition. Patient response: “Diabetes, heart failure, liver failure”3. State two of the four steps to use to cope when you have a new diagnosis of a chronic condition. Patient response: “I do not know, just get it, I guess”4. State two ways to manage stress. Patient response: “listen to music, sleeping”Patient got three questions right, and it equal 75%. After teaching session, the patient and her husband were willing to answer post-test questions. The purpose of the post-test was to evaluate the teaching session. The patient stated: “I know I have many chronic conditions, but I never think about how to cope with those illnesses. I’m glad you told me about that. ” The teaching session lasted about 15 minutes. The results of the post-test were:

1. What is a chronic health condition? Patient response: “Slowly develops and is persistent. ”
2. State three examples of chronic health condition. Patient response: “Diabetes, heart failure, chronic liver failure. ”
3. State two in four steps to cope with when you have a newly diagnosis of a chronic conditionPatient response: “Accepting change and moving forward. ”
4. State two ways to manage tressPatient response: “Listen to music, sleeping”

After teaching session, the patient and her husband got four out of four answers right. The score was 100%. This means the teaching session was successful, and the patient understood the information that the student nurse was teaching. The student nurse also gave two handouts which were highlighted the important information by student nurse for the patient.