Impact of long term condition on health of the individual:

Impact of long term condition on health of the individual:

Introduction

The long term condition is a condition that cannot be cured but can be managed with treatment or medicines. The long term conditions not only affect the health of the individual but also it affects the family, financial, the job and the education of the individual. The examples of the long term conditions are arthritis, asthma, diabetes, high blood pressure, chronic kidney diseases (Coulter, et al, 2015).

Impact of long term condition on health of the individual:

Those individual who take the responsibility of managing the disease along with the doctor show better health outcomes. When the person knows about the different options of treatment available for the management of the disease then the confidence level of the patient increases and the patient also have the notion where to ask for help in crisis condition. The management of the disease becomes easier for the patient when the person is involved with the treatment making decisions from the early phase of the disease. All the relevant information about the disease will be available from any of the source such as the online information, information provided by the concerned physician, health care service providers and voluntary organisations. This aspect of care is called self management which comprises of the tools and techniques to manage the health condition during the crisis moment in the daily life of the patient. Individuals suffering from the long term conditions are often associated with higher risk of mental health related problems but due to the lack of the awareness the patient may not undergo the treatment process. It is also observed that the patients of chronic diseases are likely to suffer 7 times more from depression in comparison to the normal individuals (Harrison, et al, 2015; Gately, et al, 2007).

Impact of long term condition on Social cultural factors:

The social and the cultural factors deal with the attitude of the people towards their illness. It also comprises the habits of individual that can significantly impact their health. The behaviour of the person suffering from any long term health conditions affects the surrounding where they work, i.e., their community so this aspect is also taken care under this division. The different parameters such as the culture, the environment, the geographical origin, the financial condition of the patient affects the health of the patient. According to the World Health Organisation, the life style of the people influences about 60 percent of the health related problems and the quality of the life. The different bad habits of the individuals such as malnutrition, smoking, consumption of the unhealthy diet, drug abuse and stress can have immense effect upon the health conditions of the people and can also contribute to the formation of long term health conditions. The spatial location plays a significant role for different risks associated to the environment and can adversely impact the health of the individual. Risk factors associated with the environment can affect the health of the individual showing varied levels of complexity and severity in the clinical outcomes such as cancer can be induced by many factors of the environment. The person who is experiencing a crisis in their financial condition is under more perceived level of stress and this impacted the poor condition of health. The gender of the person may also affect the health of the person for example men are more prone to develop coronary artery related diseases much earlier in their life in comparison to the woman partners though they have the same risk factors for the development of the heart disease such as smoking, unhealthy food habits and alcoholism, high blood pressure and cholesterol. Ageing is associated with several health conditions. Common long term health conditions associated with age are chronic obstructive pulmonary disease, diabetes, depression, osteoarthritis and dementia (Serour, et al, 2007; Koyama, et al, 2000).

Policy Framework for the long term health conditions:

Several policy frameworks have been developed for supporting individuals suffering from any long term health conditions. It does not highlights about the prevention and the health promotion issues rather it concentrated upon the factors such as how these people can be supported to live a healthy and quality life . The organisations such as the NHS England and the Public Health of England have recently taken the responsibility of improvising the health services for the people with long term health conditions. Therefore, to support the independent living of the people Telecare electronic equipment, sensors and aid are installed within the home of the individuals. Individuals may were personal alarm around their neck so that bad sensors would be able to detect any unexpected movements, door alarms and food alerts. Telehealth is an electronic equipment which can be used to evaluate the vital signs of the patient such as the oxygen level of the blood, pulse and weight of the patient, respiration rate of the patient. Any signals will be automatically transferred to the clinicians or the monitoring centre from where the staff will be monitoring the health of the person. The staff will monitor the person everyday so that any kind of worsening in the health of the person can be quickly detected and immediate action can be taken. Telemedicine involves the remote consultation of the individual where the person may contact with the clinician over the phone or may send pictures of his condition to the doctor for a advice. In this way the load of the hospital admissions can also be alleviated (Beard, et al, 2016).

Chronic Kidney Disease (CKD)

The term chronic kidney disease is long term damage to the kidney which usually gets worse with the passage of time. The kidney may stop working if the degree of the damage increases. The conditions results in either kidney failure or end stage renal diseases (ESRD). Kidney is an important organ of our body which helps the whole body to work properly. When the individual suffers from chronic kidney disease the other organs of the body may also show disturbances. Few associated comorbidities with the chronic kidney disease are anaemia, diseases related to bones, heart disorders, high level of potassium and calcium in the blood and accumulation of fluid in the body.

The chronic kidney disease is described in the five different stages. The starting condition is very mild and the ending stage is the complete failure of the kidney. The different stages of the kidney disease are related to the functioning capacity of the kidney, i.e., how effectively the kidney can filter the waste materials and extra fluid from our body. During the early stage of the disease the kidney can perform its function properly but in the later stage it becomes very hard for the kidney to carry on the function and may also stop working. The clinicians estimate the functioning capacity of the kidney based on the estimated glomerular filtration rate (eGFR). The value of eGFR is determined by the level of creatinine which is a waste product in the blood. Based on the value of the eGFR the kidney disease stage is assigned such as when the value of the eGFR is 90 or greater denotes the stage 1, value ranging between 60 -89 denotes stage 2, the value between 30 – 59 denotes stage 3, value between 15 -29 stage 4 and when the value within 15 it denotes stage 3 of the CKD. The following tests indicates about CKD such as the eGFR value, the urine test which examines the presence of protein and blood in the urine, the assessment of blood pressure as high BP indicates about kidney disease (Levey, et al, 2012; Jha, et al, 2013).

Physical Risk factors associated with Chronic Kidney Disease (CKD):

The condition of chronic kidney diseases may affect anyone. But people affected with certain conditions are at greater risk of acquiring the disease. The conditions includes the following: diabetic condition, people suffering from high blood pressure (hypertension), individuals suffering from any cardiovascular disease, if any member of the family suffers from kidney disease, normoalbuminuria, macroalbuminuria, if the individual is of African-American origin, Hispanic or native American or Asian in origin and if the individual is above 60 years of age.

Social factors responsible for the Chronic Kidney Disease (CKD):

Lifestyle or the social factors that contribute to the disease includes addiction to tobacco and alcohol, reduced level of physical activity, stress induced due to the crisis in the financial conditions, lower strata in the society.

Psychological factors associated with the Chronic Kidney Disease (CKD):

The mental health problems such as the depression, lower level of social support, anxiety, anger and hostility, stress are considered as the potential risks associated with the disease.

Control measures of CKD:

Diabetes and hypertension are the common cause of CKD. Living a healthy life can control all of these conditions and thus in turn can also control chronic kidney diseases. Few life style changes are advised to control kidney disease such as: the individual should follow a low salt and low fat diet, physical activity should be practiced for at least 30 minutes every day, need to have a regular health check up by a doctor, cessation of smoking and avoid drinking alcohol (Levey, et al, 2003; Lee, et al, 2014; Kao, et al, 2009).

A Case study:

The patient is a 56 year old male of African –American origin. The patient has left the job due to his compromised ability and his medical condition. The financial condition of the patient is also not so good and the social life of the patient is also hampered. The patient also reported to intake uncontrolled amount of fluids in his daily diet intake. The patient was also reported to suffer from mental health problem depression as evident from the behavioural aspects though he claimed not to consult any physician and intake of any medication regarding this aspect before.

The clinical manifestation of the patient:

The patient reported about the shortness of the breath, swelling observed in the lower parts of the body. The patient also reported about his nauseating tendencies, vomiting and often occurrence of diarrhoea, his altered sense of taste. The patient was reported to produce decreased urine output. At present the patient was admitted to the emergency service of the hospital and complained about the nausea and vomiting habits for the past 2 months. He was again suffering from the shortness of the breath for the past few days and altered sense of taste. The swelling of the lower extremity worsened from the previous conditions. The other complaints associated are the blurring of the vision, diarrhoea and extreme level of weakness. The past medical records reported about the condition of type II diabetes mellitus and high blood pressure for the past 10 years. There was no history of significant surgery in the medical records of the patient. The life style of the patient is close to normal as there is no history of tobacco addiction, no use of intravenous drug but consumes alcohol occasionally.

The vital signs of the patient are as following:

Temperature: 97.7 •F; the respiratory rate: 20 / minute; pulse: 90 bpm; blood pressure 177/90 mmHg The physical examinations confirmed the oedema condition of the lower extremities continuing up to the knees along with the presence of very minute levels of white crystals in the form of patches in the neck and head region of the patient.

The major laboratory findings of the patient are:

The RBC count of the patient lies between is 2.5 (reference interval 4.5-11.0 × 109/L), haemoglobin is 7.1 (reference interval 12.0-16.0 g/dL), hematocrit 20.8 (reference interval 37-47%) Sodium 140 (reference interval 136-145 mEq/L), Potassium 4.5 (reference interval 3.6-5.0 mEq/L), Chloride 115 (reference limit 98-107 mEq/L), Carbon dioxide 10 (reference limit 22-30 mEq/L), Albumin 3.0 (reference limit 3.2-5.5 g/dL), BUN 210 (reference limit 6-20 mg/dL), Creatinine 25 (reference limit 0.5-1.2 mg/dL), eGFR 3 (reference limit >60 mL/min/1.73 m2).

The possible answers based on the findings of the patient are:

The most striking features of the patient based on the laboratory and the clinical findings:

The presence of the minute snow like flake particles on the head and neck region of the patient, the increased level of the urea nitrogen in the blood (BUN), the elevated level of the blood creatinine and the significant decreased observed in the estimated glomerular filtration rate (eGFR) along with the carbon dioxide level indicates about the path physiological condition of the end stage renal disease along with the uncontrolled level of diabetes and diarrhoea. The eGFR value of the patient is indicative of the stage V of the chronic kidney disease.

The condition of the skin of the patient is known as uremic frost which occurs due to the accumulation of the urea and other nitrogenous waste in the sweat which might have crystallised after evaporation. This is a significant manifestation of the condition of the untreated uraemia among patients suffering from the advanced stage of the chronic kidney disease. It is often noticed among those patients who have high level of urea nitrogen in the blood (BUN) exceeding the value of 200 mg/dL.3. The theory matches with the laboratory findings of the patient. Though it has been observed in few cases of patients with high level of uraemia and higher levels of BUN (> 200 mg/dL.3) do not develop uremic frost. The researchers also could not provide enough evidence behind these unusual findings of the patient. The condition of the uremic frost is an interesting feature of the dermatological conditions and should not be mistaken with any other skin conditions.

The doctor prescribed the renal replacement therapy such as haemodialysis and peritoneal dialysis in the present condition of the patient. Regular follow up of the patient showed the disappearance of the uremic frost from the head and neck region of the patient. The patient was also advised to follow a strict diet and fluid intake as per the renal dietician, practice mild level of physical activity and to monitor the BP (John, et al, 2011).

The care pathway – NICE pathway

According to the NICE guidelines to deal with the chronic kidney disease, the person with the condition should be monitored and assessed of his condition. The renal replacement therapy of the patient is suggested for the stage 4 and 5 chronic kidney disease. They should be provided with the relevant information and support to manage the disease such as the contact details of the healthcare professional who will take care of the renal disease before the onset of the conservative management, joint decisions should be taken for the treatment options such as the Renal Replacement Therapy (RRT) or the conservative management along with the family members of the patient stating clearly about the expected quality of life and the predicted life expectancy. The assessment phase includes the patient and their family in the shared decision making about the path of treatment to be followed. It includes the following step such as the clinical preparation, evaluation of the psychological condition of the patient and ready to give support to the patient, the opinions of the patient about the RRT treatment procedure and when to start the course, what will be the impact of the treatment on the health and life of the patient. Further advice from a clinical psychologist is needed for the patient undergoing the transplantation process. The individual undergoing the dialysis procedure should be offered with a choice of dialysis modalities in the home or in the centre and it has to be ensured that the choice should be taken based on the clinical considerations and the preference of the patients. The patients who are undergoing the peritoneal dialysis should be given a choice of CAPD (Continuous Ambulatory Peritoneal Dialysis) or APD (Automated Peritoneal Dialysis). The haemodiafiltration (HDF) should be considered in comparison to the haemodialysis (HD) if the process is taking place in the hospital care setting. NICE has also published guidelines for the insertion of the catheter via laparoscopic method during peritoneal dialysis with the usual arrangements of the clinical governance and consent taking of the patient. There is also published briefing on the U – drain for those people requiring the night drainage of the dialysis fluid or urine. When the peritoneal dialysis is planned via the catheter insertion mediated by the open surgical technique, the access should be created prior 2 weeks of the dialysis as suggested. In case of haemodiafiltration via the arteriovenous fistula, the fistula should be planned before 6 months of the dialysis process allowing proper maturation. The dialysis should be started based on the uraemia observed in the daily life of the patient and also depending on the laboratory findings of the eGFR value and overloading of the fluid. Care should be given to the patient to reduce the effect of the disease in the day to day life. Special renal dietician should assess the full dietary intake of the people which should include the following parameters: weight of the patient, the fluid intake by the patient, the level of the sodium, potassium, phosphate, protein in the body and also the calorie intake of the patient. The individual undergoing conservative management should always be asked about any kind of symptoms and other ongoing treatments. The patients should also be making aware of the associated symptoms and how the treatment can help to alleviate them. The stopping of the treatment and the other associated information on future risks should be offered to the patient (NICE, 2018).

The self management of chronic kidney disease includes the following: maintenance of the blood pressure, the blood glucose level of the patient has to be controlled as the patient is diabetic, adherence to the medicines prescribed by the clinician, the patient should consider the diet meal pattern mentioned by the specialist dietician, the patient should also participate in some kind of physical activity, should get enough sleep and the fluid intake of the patient is restricted as per the dietician. Smoking and drinking of alcohol is restricted for the patient (Washington, et al, 2016).

Several studies have reported about the role of health information technology (IT) which is a tool for monitoring, training and self management of the chronic kidney disease with the improved outcomes. The use of the health IT to engage the patients with CKD are varied in number. Individuals with CKD would be able to access the complete therapy plan and the medical histories issued by the clinicians on their personal devices such as in mobile which will maintain the confidentiality and will provide the ease to access the data. Simplicity of the tool health IT would be considered as an ideal feature to be applied in the CKD. Though it can provide multiple facilities still it cannot replace the provider and patient relationship (Diamantidis, et al, 2014).

Role of Nurses:

The primary nurses play a major role in the management of the chronic kidney disease patient. The patient should be made aware of their condition of the health and the implication of the long term treatment. The patient should be encouraged to practice the self management of the disease. The nurses should monitor the blood pressure of the patient and they should also educate the patient about the risk of high blood pressure which is a indicative of the CKD. The glycemic level of the body should be controlled to slower down the progress the CKD and this information should be passed on to the patient. Moreover, the patient should also be advised by the nurse to perform healthy exercise. The nurses should show a positive attitude and caring attitude to the patient. The nurses should also provide the timely accurate information to the patient regarding the treatment. This aspect of the nursing attitude can help to deal with the emotional and psychological crisis of the patient (Walker, et al, 2013; Thomas-Hawkins, et al, 2005).

Conclusion

Among the varied long term conditions, the chronic kidney disease is considered to be a crucial long term condition. The long term condition can affect the patient’s life from all spheres and hampers the day to day life of the patient due to the compromised ability of the patient. The patient also suffers from a lot of psychological issues due to the disease. Chronic kidney disease (CKD) worsens with the passage of time and results in renal failure or end stage renal diseases (ESRD). The other associated comorbidities with the disease anaemia, diseases related to bones, heart disorders, high level of potassium and calcium in the blood and accumulation of fluid in the body. Varied level of physical, lifestyle and psychological factors are associated with the disease. Here the patient is suffering from the chronic kidney disease stage V and is also showing the symptoms of uremic frost. All the clinical symptoms of the patients were analysed in detail and the lifestyle associated factors were also considered for the treatment procedure. Based on the laboratory findings and the symptomatic features the clinician confirmed the disease and the patient was prescribed to undergo the renal replacement therapy. The NICE pathways were followed for the treatment process and the patient was informed everything about the treatment procedure and the outcomes of the treatment with respect to the quality of life and the predicted life expectancies. Informed consent was taken prior to the treatment and the nurses monitored the patient at regular intervals. The patient opinion about the treatment process was also considered and a shared decision making approach was taken for the treatment. The clinician advised the patient for the specialised diet intake prepared by a renal dietician and asked the nurses to educate the patient about the self management techniques involved for the long term chronic kidney disease.

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