Running head: CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH

THE DISEASE 1

Chronic Illnesses and Transitions, While Living With the Disease

Name

Institutional affiliation
CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH THE DISEASE 2

Chronic Illnesses and Transitions, While Living With the Disease

Generally speaking, the chronic diseases are those which stick out for long time and lasting

more than 3 months. Furthermore, the chronic diseases can be prevented by the vaccinations

or cured by the medications. Almost, chronic diseases used to become more common with the

passage of age. The, common chronic diseases include arthritis, diabetes, stroke, blood

pressure and diabetes. More or less, it is not uncommon to be diagnosed with the chronic

illnesses in the old age however; the person who is suffering from the chronic illnesses faces

a range of experiences. Schulman-Green, et al., (2012) have aggrandized that chronic

illnesses are the most prevalent and costly diseases. Moreover, the chronic diseases are the

foremost concern for that the adults seek health care. Overall, these are the leading cause of

death and disability among old age people (p. 2). So, the chronic illnesses are affecting the

people of old age not only physically but also, physically, emotionally and socially.

Mr. Red Yunder is an 80 years old male who is living alone on his farmhouse which

is 20 miles away from town. Furthermore, he had been widower from 10 years and having

one son and grandchildren. He was diagnosed with Diabetes 6 months ago and was on

tablets. However, his fluctuating glucose levels shifted him from tablets to the insulin. In the

present age still he was an active man who used to do some work of his farmhouse. He was a

social person and used to spend a lot of time with his friends sitting in coffee shop and having

chit chat with them on the recent news of the world. Despite of diagnosis of diabetes he used

to eat sweet because he was thinking that he is not to live forever on this world. Moreover, he

was having no other comorbid and chronic condition other than diabetes. According to

Weinger, Beverly, & Smaldone, (2014), the older adults with diabetes are presenting

themselves with full continuum of health ranging from excellent or good health. Additionally,

they are not with poor cognitive abilities and social health as well (p.2). So, Mr Red was
CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH THE DISEASE 3

having strengthening points regarding his health and management of diabetes. He was also

involved in the decision making process in the family and for his own.

The nursing assessment in this situation is needed because the uncontrolled diabetes

mostly leads towards a number of complications. According to Brunner, Smeltzer, Bare, &

Cheever, (2010), the complications of the diabetes which leads towards the increased risk of

diabetic foot and limited activities along with the increase chances of infection are; Sensory

neuropathy which leads towards the less sensations of pain and fissuring of the skin, the

vascular disease which leads towards the less supply of blood to the extremities thus,

lowering the healing process and lastly the immunosuppression that decreases the immunity

and allowing the infections to invade in the body easily (p. 1236). The same problem was

with Mr. Red when had a sore on his foot and ignored it. This limited the activities of him

and he was going through the sleep problems. Furthermore, he was with urinary incontinence

and the current condition of his foot was making him feel low.

In the same way Mr, Red was worried and wanted to talk to his grandson but due to

his condition he was not able because he was worried about his wound and his home nurse

was caring for his wound. For the assessment of Mr. Red’s condition the following tools can

be used. First of all, Fulmer SPICES: An Overall Assessment Tool for Older Adults can be

used to assess the Sleep disorders, problems with eating and feeding, incontinence, confusion,

evidences for fall and skin breakdown and skin’s condition. Secondly, Katz Index of

Independence in Activities of Daily Living assessment tool can be used to see the daily

activities of Mr. Yunder Red. These include bathing, dressing, toileting, continence and

feeding. This is appropriate tool that is used to measure the daily activities of the elderly

people with chronic illness. Lastly, the Pittsburgh Sleep Quality Index (PSQI), which

includes the assessment of the sleep patterns among elderly patients.

CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH THE DISEASE 4

Thus, the findings of these assessment tools will help in management of Mr. Red in

the early diagnosis period. As a nurse it is the duty to teach Mr. Red about healthy activities,

healthy eating, monitoring the blood glucose level, taking medications and adherence to the

insulin plan, and reducing the risks related to the diabetes.

Mr. Red after two weeks had developed a sepsis. As the immunity is decreased the

infection has progressed and limited the activities of Mr Red. He was advised to take

medication however, he didn’t took the antibiotics and the wound gotten infected. He was

also having flue and due to his current condition he was not able to go the café for a cup of

coffee with his friends. He was with low appetite and was not willing to eat. Though he was

eating less the blood glucose levels were uncontrolled and he was not understanding whether

to take insulin or not. With such a condition he was taken to the hospital for further

management.

The positive points of Mr. Red were that he was willing for the treatment and he

eagerly wanted to know either the medication should be taken or not in such condition. He is

also aware that the sepsis is due to his own negligence and he should have taken the

medication. The nurse should assess for the eating patterns, social pattern, physical condition,

urinary incontinence and blood glucose levels. Thus, the infection is associated with the

diabetes and causing the deaths around the globe. Therefore, Mr. Red was admitted in the

hospital. The geriatric syndrome was present and it was necessary to admit Mr. Red in the

hospital for further treatment and management of the diabetes. The typical presentation of

sepsis includes the absence of fever, confusion, anxiety and apprehension. Therefore, the

doctors advised the admission of Mr. Red in the hospital to manage the further complications.

The whole condition as communicated to the professional team by the home health care

nurses. According to Nasa, Juneja, & Singh, (2012) the risk for sepsis is increased in the

elderly who are having the chronic illnesses such as diabetes and cancer. Additionally, the
CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH THE DISEASE 5

decreased nutrition and immunity also play a vital role in infection pathogenesis (p. 24). So

the sepsis is present with a typical symptoms thus, making it is difficult to diagnose the

sepsis.

Hence, Mr. Red was recovered and was advised to discharge from the hospital. His

son wanted to take Red at his home but Mr. Red refused and wished to stay at his own home

in the farm because he was able to manage his own situation. The current condition of Mr

Red is not good and not allowing him to stay alone at home. He was with agitated mood, poor

diet and increased levels of glucose in the blood. According to him he was able for self-

management of diabetes. According to Schulman-Green, et al., (2012), self-management is

the interactive and daily process that helps in the engagement of the person in the activities of

management of chronic illnesses. Moreover, a person gets involved in the community, family

and treatment modalities at home as well (p.2). Undoubtedly, Mr. Red was active enough yet

he was having diabetic foot, limited activity levels and less social activities after discharge

from the hospital. The assessment that is needed in this time by the home health care nurse

includes the compulsory head to toe assessment, ambulation assessment, nervous system

assessment, daily activity assessment, blood glucose assessments, assessment of the sleep

patterns, nutritional intake assessment and management plan, exercise and its limitation and

the routine follow up visits with the doctor.

The benefits of the living alone are less as compared with the risks. The benefits

include the more activities whereas; the risks include, dizziness, diabetic coma, fall, injury

related to fall, fluctuations in the sugar levels, no plan of diet and exercise. The risks of the

home living alone include the following issues; firstly there are chances of glucose levels

lowering in the night. Thus, it is necessary to check glucose levels before going to bed and

must eat something as insulin lowers the glucose levels. Additionally, if Mr . Red had
CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH THE DISEASE 6

exercise in day time then he must be educated to keep an alarm in the night to recheck the

glucose levels.

The present needs of Mr Red include the proper assessment of the wound and

dressing along with physical assessment. Proper financial support and family care along with

the professional health care team support. In future, Mr, Red needs proper checkups and

routine and regular care by the home nurse. For the effective communication with the other

health care professionals the home health care nurses must use some kind of effective

strategies. SBAR tool kit is a very effective way to communicate in patient’s care. SBAR

stands for the situation, background, assessment and recommendation. It is actually providing

a frame work when the information is transferred to the other team members. This is used to

explain the current situation of the patient to the other health care professionals in a very

effective and predictable way that is well known to them. Furthermore, the black and white

report of the patient also helps in effective communication.

The Strategy to communicate with the patient and family is the use AIDET. By and

large AIDET is used by nurses, physicians, technicians, food service, administrators, and all

staff involved in patient and family encounters at the bedside and across the continuum of

care. The acronym includes acknowledge, introduce, duration, explanation and thank you.

This communication strategy has been used to improve the customer’s perception and

provision of proper information transfer. The next communication strategy is I PASS THE

BATON. This include the introduction, patient, assessment, safety, situation, background,

action, timing, ownership and next. Moreover, this is used to talk to the patient, family and

with the other health care professionals.

In short, the chronic illness like diabetes and its management is a collaborative

process that is between patient, family, nurse and doctors. A person with chronic illness goes

through many transitions where he/she tends to overcome the situation. However, the
CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH THE DISEASE 7

physical, mental and social always needs attention of the family and health care

professionals.
CHRONIC ILLNESSES AND TRANSITIONS, WHILE LIVING WITH THE DISEASE 8

References

Nasa, P., Juneja, D., & Singh, O. (2012). Severe sepsis and septic shock in the elderly: An

overview. world journal of critical acre, 1(1), 23-30. doi:10.5492/wjccm.v1.i1.23

Schulman-Green,, D., Jaser, S., Martin, F., Alonzo, A., Grey, M., McCorkle, R., &

Redeker, N. S. (2012). Processes of Self-Management in Chronic Illness. Journal of

Nursing Scholarship, 44(2), 1-14. doi:10.1111/j.1547-5069.2012.01444.x

Weinger, K., Beverly, E. A., & Smaldone, A. (2014). Diabetes Self-Care and the Older

Adult. Western Journal of Nursing Research, 36(9), 1272-1298.

doi:10.1177/0193945914521696

© 2008-2017 Citefast: Your speedy solution to citation confusion. Questions?

Brunner, L. S., Smeltzer, S. C., Bare, B. G., & Cheever, K. H. (2010). Brunner & Suddarth's

textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Wolters

Kluwer/Lippincott Williams & Wilkins