Georgie Smith, Essay Example

Introduction

This essay focuses on a case study surrounding a patient Georgie Smith and her husband John Smith. Georgie has been diagnosed with diagnosed with rheumatoid arthritis just over 10 years ago. This 64 year old woman has been suffering from heart failure for 5 years now. Also she has cataract removed from her left eye three months ago. Her most recent diagnosis was type 11 diabetes and was placed on Insulin. It was observed that her blood glucose levels (BGLs) have been consistently high. Subsequently she was referred to the community health service for follow up care and management of her health issues.

From the case study report there are five major health issues, which require intense management. It was further reported that John was reluctant in cooperating with the request of administering insulin to this wife. As such, this essay offers a management intervention encompassing identifying and prioritizing clinical issues in a concept map; conducting a comprehensive client assessment; identifying impact of health issues on Georgia and John; assessing the impact of their level of independence regarding functioning in the community along with designing nursing care strategies that will support and educate Georgia and John to facilitate independence.

Comprehensive client assessment

In conducting this comprehensive client assessment the four- corner matic approach advanced by Carla J. Berg (2009) of Department of Medicine, University of Minnesota Medical School will be adapted. The focus of this approach is to establish a more client centered evaluation embodying the hope concept as a major awareness criterion in the assessment process. Precisely, the consultant argues that comprehensive assessment must include the individual as well as the setting. Therefore, the four corner approach is very effective in achieving this goal. (Berg, 2009).

Mrs. Georgie’s assets and weaknesses in relation to her environment will be assessed applying the four-corner matrix, which is attached below this information.   Valence is the first phase of the matrix involving two subsets the specific client’s assets and weaknesses.  Source is the second phase assessing factors within the client and factors within the client’s environment. Consequently, a 2 (valence: assets vs. weaknesses) X 2 (source: within Client vs. within environment) (Berg, 2009, p. 10) matrix is created with four quadrants:-

• Quadrant 1: assets; within client
• Quadrant 2: assets; within environment
• Quadrant 3: weaknesses; within client
• Quadrant 4: weaknesses; within environment

(Berg, 2009, p. 10)

Hope theory is applied with the four corner matric in conducting a comprehensive client assessment. It has proven very useful from the premise that it contains three essential elements applicable to profound evaluation of a client’s strengths and weaknesses when the individual entity as well as the environment is taken into consideration. First it forges goal directed thinking which enables facilitates the assessment process as well subsequent interventions. Next it stimulates pathways of thinking, which helps the individuals create achievable goals. Thirdly, is agency being the philosophy of utilizing the goals emerging from pathways of thinking to further assits the client’ asset and weakness (Snyder, 2004).

A major advantage of combining the four- corner matrix with hope theory in this comprehensive client assessment of Mrs. Georgie Smith was that it created a rather relaxed atmosphere during the interview since the focus was not on her health problem; rather it provided a scope for self-assessment as to how the individual could contribute towards their well-being.  It shifted the responsibility from entirely the nurse/ consultant towards a cooperative effort of both nurse/ consultant and client  In this way analysts have predicted that the techniques offers more accurate data  regarding the problems facing clients since more expression is allowed(Snyder, 2004).

Summary of Comprehensive client assessment

In Mrs. Georgie Smith’s interview the four corner matrix was applied in determining her assets and those within her environment. This data was retrieved by further synthesized theoretically by adapting the hope theory expressive strategy allowing Mrs. Smith to express goals she wished to achieve knowing what her health issues are. These expressed goals initiated a pathway thinking mechanism that ultimately revealed that Mrs. Georgie Smith would require special interventions first in gaining her husband’s support. Importantly there are five health issues she considered crucial towards functionality within her environment and community. They included blood glucose monitoring; insulin administration; weight control; pain management; mobility; impairment of vision and breathlessness. These are embodied in health condition diagnoses heart failure; rheumatoid arthritis; type 11 diabetes, cataract and obesity

Identifying impact of health issues on Georgia and John

Five major health issues have been identified from the comprehensive client assessment. In order of priority heart failure; rheumatoid arthritis; type 11 diabetes, cataract and obesity are listed in order of priority. They impact differently on the client, Georgie, and her husband, John. From data retrieved through the client assessment Georgie knows very little about the health dysfunctions she is experiencing. Therefore, to begin explaining what is required of her to control the blood sugar levels; relive breathlessness and pain during mobility  a nurse/consultant have to begin by education using the most simplistic strategies.

Heart failure

Heart failure is linked to severe mental/physical impairment and ultimately poor quality of life. The condition becomes worse as the person gets older. There is an annual mortality rate of 10%. Consequently, breathlessness producing difficulty in moving from one place to the next impacts walking and affects mobility seriously. John who wants to be a supportive husband would have to contend with either helping Georgia walk or push her in a wheel chair when they have to attend functions , visit friends; go shopping.at 64 she could still be sexually active and this impairment could affect their marriage and John ability to function effectively as a sex partner (Neubauer, 2007).

Rheumatoid arthritis

Rheumatoid arthritis is a disease of the autoimmune system and even the course varies among individuals from mild to severe it progresses throughout the person’s life. Some 20%–30%  of persons affected develop  subcutaneous nodules, which has a very poor prognosis. However, pain during mobility promotes great discomfort. In Mrs. Georgie Smith situation an associating heart failure adds to this mobility discomfort. Scientists have linked heart failure to Rheumatoid arthritis progression. Obvious impacts of this disease on Georgie and John are similar to the heart failure. In addition there are painful joints complicating movement

Type 11 diabetes

Type 11 diabetes emerged later in Georgia Smith’s life and could be considered an unfortunate form her very active hard working husband. Diabetes in itself is a very debilitating disease, numerous complications emerge especially, when blood sugar levels are not controlled.

Some complications include loss of vision, heart failure and stoke. Statistics reveal that 90% of deaths in diabetics is due to coronary artery disease manifesting as heart failure (Smyth & Heron, 2006).

Impact on Georgia and John relates to taking blood glucose levels at least daily along with self-administration of insulin. John is reluctant to comply with giving his wife insulin since he believes that, this is the role of a health care practitioner. Similarly, Georgie does not feel capable of sticking herself either to test her blood neither give herself the insulin treatment.

Cataract

Cataract causes clouding of the lens and impairment of vision. Even though Georgie had cataract surgery there is no guarantee that her vision would be restored to normal (Bollinger & Langston, 2008). Importantly, it is only three months that surgery was conducted. With other as serious health conditions this would impact negatively on her mobility and interaction with other. Besides, the psychology of illness embracing all these dysfunctions could retard the restoration of her sight. Now she has to depend on someone also to help in moving from one place to then next. Impaired vision created from cataract now imposes another difficulty impacting her independence and pressure on a hard working John who is relatively healthy.

Obesity

Georgie weighs 110kg, which is approximately 245 pounds. Her height is 170cm tall approximately 5ft 5 inches. According to the body mass index assessment she is obese. Obesity is one of the leading causes for diabetes. Scientists have classified them the twins. Theoretically, obesity is also associated with heart failure  (Hunskaar, 2008). It would appear that one health issue is impacting the other since diabetes, obesity heart failure, rheumatoid arthritis are linked to the same source. For John this is a challenge living with someone who is very ill. The impact on Georgie is that she has lost much of her indolence while John has now more responsibilities than just a provider of economic resources.

Impact of their level of independence in functioning in the community

Heart failure, rheumatoid arthritis, type11 diabetes, cataract and obesity when evaluated individually and collective limit functionality in the community greatly. For example, mobility is seriously challenged through painful joints, impaired vision from cataract, exertion on minimal activity due to heart failure and difficulty carrying around excessive with from which the heart is incapable of keeping abreast with.

A study conducted by John A. Dodson, Suzanne V. Arnold and Kimberly J. Reid (2012) investigating ‘Physical Function and Independence One Year Following Myocardial Infarction: Observations from the TRIUMPH Registry’ revealed that specific strategies must be designed to assist pateints with heart conditions to maintain their independence as long as possible because loss of function is compatible with loss of independence at home and in the community (Dodson, Arnold & Reid, 2012)

Conclusion

Nursing care strategy utilized in this section will reflect the hope theory assumptions of goal directed thinking; pathway thinking and Agency (Frank, 2008).

References

Berg, C. (2009). A Comprehensive Framework for Conducting Client Assessments: Highlighting Strengths, Environmental Factors and Hope. Journal of Practical consulting, 3(2); 9-13

Bollinger, K., & Langston, R. (2008). What can patients expect from cataract surgery?. Cleveland Clinic journal of medicine, 75 (3); 193–196, 199–196

Dodson, J. Arnold, S., & Reid, K. (2012) investigating ‘Physical Function and Independence One Year Following Myocardial Infarction: Observations from the TRIUMPH Registry. Am Heart J.  163(5): 790–796.

Frank, J. (2008). The role of hope in psychotherapy. International Journal of Psychiatry, 5, 383–395.

Hunskaar S (2008). A systematic review of overweight and obesity as risk factors and targets for clinical intervention for urinary incontinence in women.  Neurourol. Urodyn. 27 (8); 749–57.

Neubauer, S. (2007). The failing heart – an engine out of fuel. N Engl J Med 356, (11); 1140–51.

Reed, P. (2009) Inspired knowing in nursing: Contemporary Nursing Process. Springer Pub

Smyth, S., & Heron, A.  (2006). Diabetes and obesity: the twin epidemics. Nature Medicine 12 (1): 75–80

Snyder, C. R. (2004). The psychology of hope: You can get there from here. New York: Free Press.

Turesson, C, O’Fallon, W. Crowson, C. Gabriel, S., &  Matteson, E (2003). Extra-articular disease manifestations in rheumatoid arthritis: incidence trends and risk factors over 46 years. Ann. Rheum. Dis. 62 (8); 722–7