Chronic Disease Essay: Analysing Clinical Situation Of Shaun
Question
Task: Shaun is an 86-year-old male, with type 2 diabetes and he has foot ulcers. Shaun has had a long history with resistant to heal diabetic ulcers on his feet caused through shoe trauma. On discharge the infection had abated however the foot ulcers had not healed. When taking down his dressings today, the visiting wound care nurse noted a pungent odour, his foot ulcers were visibly deteriorating with bright green exudate and large amounts of slough in the base of his ulcers. His wound margins were inflamed and his skin surrounding the ulcers is red and hot. Shaun has also been losing weight, a total of 6kg in 3 weeks. He has not been feeling like eating much recently, and the visiting nurse is concerned about him becoming depressed.
In this chronic disease essay you will analyse the above case study giving a brief description of the chronic condition and the presenting health issues for the person.
Answer
Part-A Scenario -3 Case study
Introductionto the case scenario of chronic disease essay
Health care is a systematic approach that is related to the mental process called clinical reasoning, which comprises calculation, evaluation of the state of the patient, proper diagnostics, and management of the patient's situation. Clinical reasoning is the central concept for successful clinical nursing. In this chronic disease essay, the critical clinical situation of Shaun, an 86 years old diabetic patient will be discussed. Type 2 diabetes made him struggle with feet ulcers caused by shoe trauma. The clinical status of this disease, symptoms as well as the medication procedures will also be discussed.
Analysis
Chronic disease is a kind of disease that usually persists for a long period in the human body and as the disease has long term presence in the body, some additional health issues occur with the primary issues. And sometimes the disease stops showing symptoms and it is considered that the disease disappears from the body. But, in the actual case, no symptoms never mean to the disappearance of the disease. Still, chronic diseases can be controlled or prevented. In scenario-3, Shaun reached the age of post eighty and is dealing with the milder effects of type 2 diabetes. Among the two types of diabetes, this type 2 is predominantly observed in the case of aged peoples(diabetes & diabetes, 2020). A statistic on diabetes notifies that in the world, more than 415 million people are facing diabetes problems and among them 193 million people in an undiagnosed state of diabetes(Chatterjee, Khunti & Davies, 2017). Most of the cases of diabetes (90%) in the case of type 2 diabetes(diabetes & diabetes, 2020). On the feet of Shaun, there is an open shore and the patient has a good recovery record from this Diabetic Ulcers. The use of insulin magnifies the risk of foot ulcers from diabetes and in this case, shoe trauma is the reason behind the Ulcer(Kim, 2020). Due to diabetes, some of the microvascular as well as macrovascular complications occurred and these are the reason behind the complications of the for ulcer from diabetes(Chatterjee, Khunti & Davies, 2017). In the present condition of the foot ulcer condition is not in a stable state as without proper treatment and hygienic treatment the ulcer becomes worse and gets infected. Though the infection recovered the bad smell comes from the ulcer as helicobacter pylori drive the ulcer to exert bad smell. Hence, the disease is not fully cured yet and the bacterial infection persists in the ulcer.
It is the most sensitive issue identified in this chronic disease essay related to diabetes’ patients as it is related to the soft bone infection or tissue infection under the malleoli. It often leads to hospitalization and extremity amputation. It is frequent and diagnosable in case of the diabetic patients. Considering the case of Ulcers, it is diagnosed by identifying the two most common symptoms. These two common symptoms are purulence, and inflammation(Gemechu et al., 2020).loss of the sense of pain is another important sign (diabetes & diabetes, 2020).This problem with the diabetic foot ulcers is divisible into three steps and these steps are moderate, severe, and mild. In most cases of diabetic foot problems, the infections are polymicrobial. This chronic disease is caused by the pathogen, staphylococcus and it is one kind of gram-positive cocci. The severity of this disease is increased by the complications of osteomyelitis it may lead to the surgical situation from this simple stage of the ulcer. It is seen in the pathological analysis that is about more than 25% cases, Staphylococcus, the Methicillin-resistant bacteria cause a dangerous infection to the foot(Gemechu et al., 2020). As the relevant pathogen to this disease is a gram-negative, it can be found in the necrotic and also in the ischemic foot rashes and infections. But the treatment of this issue of Diabetic ulcer can be treated by applying simple antibiotics, even when the case is in a severe situation. But the wound and the nature of the infection needs to be judged first as it is important to judge the state of the patient. When the erythema extends from 0.5 cm to 2.0 cm and also with no systemic symptoms of inflammation and the inflammatory resonance from the local infection, it can be considered the mild infection spreads(Gemechu et al., 2020). When the erythraemia extends more than 2 cm, the ulcer and the infection are no more in a mild state and it is the sign of moderate infection. Despite the local infection, when the regular inflammatory response is observed, the situation becomes severe infection as it is seen is the case of Shaun. His ulcer surroundings also red and hot, it indicates the situation is critical and the infection reaches the severe state(Gemechu et al., 2020). Though the use of antibiotics is mentioned as the system to tackle the disease, the treatment process is solely dependent on the severity of the infection. Mild infection can be treated with simple antibiotics, wound care. But when the situation turns out as severe, patients need to be hospitalized and intravenous antibiotics need to be applied and even the critical situations demand surgery.
To identify the Diabetic foot ulcers several diagnostics approaches, need to be taken. Before testing the diabetes ulcers, the A1C test needs to be performed to diagnose diabetes type 2. As in this test, the sugar level in the blood for the past two or three months is identified with this test. Diagnostics approaches to identify the Diabetic foot, pulse volume recording and blood tests need to be performed as the primary criteria and then the ultrasonography, computed tomography, bone scans, magnetic resonance imaging, angiography should be performed to diagnose. The ankle-brachial index also needs to be found to approach the ulcers(Rowe, 2020).
It is evident in this chronic disease essay that diabetic ulcers possess a major threat to human psychology and the first and most important complication that is caused by the foot ulcer is Neuropathy. It is a disease that indicates damage or dysfunction of nerves and it leads to less sensitivity, numbness, muscle weakness, tingling, and so on. Gangrene and amputation as well as retinopathy are some severe threats of Diabetic ulcers(Publishing, 2020). Gangrene is a state when the tissues and cells damage for lack of oxygen. And this is the reason for amputation that may lead to death. This is the severity of this disease. And retinopathy is a mild problem of eyesight that is caused by the damage of blood vessels inside the eye and also the damage of the light cells called Retina("Diabetic retinopathy - Symptoms and causes", 2020). Not only diabetic ulcers but also these are some common threats that are related to diabetes.
It is known to all; every physiological disorder brings some psychological obstacles and sometimes these psychological hardships result in serious damage. Hence, psychological assistance is important for every patient. In the case of diabetes, Emotional distress like depression is very common and it is also seen in the case of Shaun. But the main psychological problem occurs for young age people is that they do not want to acknowledge their problems, the result of the diagnosis. But Shaun has already been struggling with the problem and also become aged so that he does not have any problem acknowledging the fact("Taking control of your diabetes", 2020). But he is feeling depressed maybe for his adultery and is also feeling alone. Considering the given case study in this chronic disease essay, it can be stated that it is necessary to give him company and he needs some good conduct at the treatment as the symptoms of depression like fatigue or worthlessness feeling caused by ignorance and improper behavior to anybody("Taking control of your diabetes", 2020). If the depressed situation improves, the sugar level in the blood also increases. As he has been facing this problem for a long time, it can be assumed that he has prior knowledge of the problems and symptoms of diabetes. Still, the Shaun needs to be taught about some specific health concerns like education of footcare, use of prescribed footwear, Blood pressure, and glycaemic control, smoking cessation("Diabetic Wound Care | Foot Health | Patients | APMA", 2020).
Through the industrial revolution, the lifestyle has changed a lot and its complications of the diseases also increased day by day. Nursing and health care personnel are important for the detection of this disease. Active participation of a nurse to dress the wound and to educate the patient about the prevention of the diabetic foot and how to take care of the diabetic foot(Karri et al., 2016). A nurse has a responsibility to detect the changes in skin or foot and also take care of the sensation of foot and proper dressing. Sympathy for the patient can help to improve the psychological state of the patient(Kumarasinghe, Hettiarachchi & Wasalathanthri, 2018).
Conclusion
From the above discussion on chronic disease essay, it can be concluded that diabetic ulcers impacted the health of Shaun and this situation demands mental support. This is a very complex situation that possess several threats for the nervous system and gangrene can also be caused. Proper dressing and adequate knowledge about health care are essential in this case.
References
Chatterjee, S., Khunti, K., & Davies, M. J. (2017). Type 2 diabetes. The Lancet, 389(10085), 2239-2251.
diabetes, A., & diabetes, W. (2020). International Diabetes Federation - What is diabetes. Idf.org. Retrieved 4 September 2020, from https://www.idf.org/aboutdiabetes/what-is-diabetes.html.
Diabetic retinopathy - Symptoms and causes. Mayo Clinic. (2020). Chronic disease essayRetrieved 4 September 2020, from https://www.mayoclinic.org/diseases-conditions/diabetic-retinopathy/symptoms-causes/syc-20371611.
Diabetic Wound Care | Foot Health | Patients | APMA. Apma.org. (2020). Retrieved 4 September 2020, from https://www.apma.org/diabeticwoundcare#:~:text=What%20is%20a%20Diabetic%20Foot,or%20other%20ulcer %2Drelated%20complication.
Gemechu, F., Seemant, F., & Curley, C. (2020). Diabetic Foot Infections. Aafp.org. Retrieved 4 September 2020, from https://www.aafp.org/afp/2013/0801/p177.html#:~:text=Classification%20of%20Diabetic%20Foot%20Infection &text=*%E2%80%94Local%20infection%20is%20defined%20as,local%20warmth% 2C%20and%20purulent%20discharge.
Karri, V. V. S. R., Kuppusamy, G., Talluri, S. V., Yamjala, K., Mannemala, S. S., & Malayandi, R. (2016). Current and emerging therapies in the management of diabetic foot ulcers. Current Medical Research and Opinion, 32(3), 519-542.
Kim, S. (2020). Diabetic Foot Pain and Ulcers: Causes and Treatments. Healthline. Retrieved 4 September 2020, from https://www.healthline.com/health/diabetic-foot-pain-and-ulcers-causestreatments#:~:text=High%20glucose%20levels%20can%20slow,of%20feeling%20in%20your%20feet.
Kumarasinghe, S. A., Hettiarachchi, P., & Wasalathanthri, S. (2018). Nurses' knowledge on diabetic foot ulcer disease and their attitudes towards patients affected: A cross?sectional institution?based study. Journal of clinical nursing, 27(1-2), e203-e212.
Publishing, H. (2020). New thinking on peripheral neuropathy - Harvard Health. Harvard Health. Retrieved 4 September 2020, from https://www.health.harvard.edu/diseases-and-conditions/new-thinking-on-peripheral-neuropathy#:~:text=Nerve%20damage%20might%20be%20causing,distress%20without%20your%20knowing %20it.&text=Doctors%20have%20long%20known%20peripheral,in%20the%20feet%20and%20hands.
Rowe, V. (2020). Diabetic Foot Ulcers Workup: Approach Considerations, Blood Tests, Pulse-Volume Recording. Emedicine.medscape.com. Chronic disease essayRetrieved 4 September 2020, from https://emedicine.medscape.com/article/460282workup#:~:text=Patient%20workup%20for%20diabetic %20ulcers,% 2C%20bone%20scans%2C%20and%20angiography.
Taking control of your diabetes. https://www.apa.org. (2020). Retrieved 4 September 2020, from https://www.apa.org/topics/controldiabetes#:~:text=Psychologists%20can%20help%20patients%20change,other% 20diabetes%20self%2Dmanagement%20activities.
