Managing Long Term Health Care Needs, Essay Example

Introduction

According to Okuyama, Coronary Heart Disease (CHD) is the disease of the heart, which causes the narrowing of the coronary arteries. Although there has been remarkable research on the psychosocial conditions and their implications on mental and physical health, there is still insignificant research work into the consequences of psychosocial marital circumstances on health. The link existing between psychosocial working conditions and Coronary Heart Disease is not as strong for women relative to men. Other researchers suggest that domestic and household factors play a critical role in the health of women (Okuyama 25).

This research paper seeks to establish the management processes of long-term health care conditions. The primary focus is in Coronary heart disease. This disease is a leading killer of hundreds of thousands of people yearly throughout the globe. The paper begins by considering the relevant pathophysiology of the conditions of Coronary heart disease and their causes. It also provides rationale (reasoning) for appropriate nursing and inter-professional and inter-agency interventions. Further description gives relevance to the medicines used, their effects, and risks and discusses appropriate medicines management. Finally, the legal, ethical, political, and economic context of care in the local community for people with the long-term condition also features under the exploration.

Patho-physiology of the Coronary heart disease and contributory causes

Krantz et al describe Coronary heart disease (CHD), sometimes referred to as coronary artery disease, as a disease that derives characteristics from the narrowing of coronary blood arteries, which are accountable for supplying blood and oxygen to the heart. Coronary heart disease is a long-term health condition that account for significant illness and death in the world (Krantz et al 350)

Atherosclerosis causes coronary heart disease. This is a situation where plaque, also referred to as cholesterol substances, gradually pile on the walls of the blood vessels. Continued accumulation of these substances causes the vessels to narrow down, hence resulting in limited flow of blood into the heart. In some scenarios, a clot may form thus cutting blood flow to the heart muscles entirely. This disease often leads to shortness of breath, angina pectoris (chest pain), myocardial infarction (heart attack) and many other symptoms (Marshall et al 147)

Angina is a painful chest discomfort or tightness that occurs whenever a region of heat muscles is receiving limited blood and oxygen supply. This condition occurs in the form of heaviness of the heart, pains at the neck, arms, shoulders, throat and jaws as well as symptoms of indigestion, heartburn and shortness of breath. Angina can broadly be categorized into stable (chronic), unstable and variant angina (Shem and Wachowiak 43). Stable angina unsurprising lasts for short spans, and associates with a feeling of gas or indigestion. On the other hand, blood clots cause unstable angina by, and it occurs surprisingly, lasts for a longer period, and may worsen over time if not treated. Finally, is the variant angina, which occurs when a blood vessel experiences a spasm that results to the narrowing and tightening of the artery? The result is the disruption of blood flow to the ear. Often, this condition results from stress, exposure to cold, smoke, medicine or cocaine use (John 65)

Where shortness of breath occurs, the heart and other body organs fail to receive sufficient blood and oxygen supply and the patient starts panting. Heart attack is the worst symptom of the disease. This results in the absence of sufficient blood supply to the heart muscles causing them to die. The condition also refers to coronary thrombosis, myocardial infarction or cardiac infarction. This condition is an emergency case as it can result to permanent damage of the heart or even death if not treated immediately (Schneiderman and Antoni 87). There are some risk factors, which relate with contracting coronary heart disease. Some of them are beyond the control of the victim. For instances, the risk of heart diseases increases as one advances in age. Secondly, men stand a greater risk of contracting the hearting disease than women who are still undergoing menstrual period. Additionally, the disease is links to genetics implying that one can acquire it through inheritance. Other risk factors that can be controlled include consumption of food bearing cholesterol, smoking, exercising and overweight (Franks et al 28)

Rationale for appropriate nursing and inter-professional and inter-agency interventions

Patients suffering from long health conditions such as Coronary heart disease undergo much of psychological, emotional, physical and medical complications. All this have their cause on the fact that the disease it there to stay and probably might be the primary reason for their eventual death. As such, these patients tens to suffer from a series of emotional breakdown if no proper care and attention exists to them. In fact, most of them may end up resigning to fate (Norman and Stamlern 76). Therefore, this is appropriate for nursing, interpersonal, and inter-agency interventions. The following are some of the reasons that ate attributed to these measures:

As already stated, patients suffering from Coronary Heart Disease tend to experience varied levels of emotional and psychological breakdown. These emotions eventually drive them into depression to the extent that they chose to ignore the accustomed medication. As such, if they lack the attention of a medical practitioner, they end up suffering from the negative side effects of the medication. (O’Malley 12). Appropriate nursing is crucial in ensuring that the patient adheres to the regular medication. Denise Wilmington, the 70-year-old woman in the case scenario is a perfect example of this situation. Her Cardiologist notes that she has probably been ignoring her medication. This trend is worrying and could eventually harm her health. Close attention by a medical nurse will play a pivotal role in ensuring that such a patient adheres to the medicine prescription.

Inter-professional services also play a critical role in addressing the challenges that patients suffering from long-term coronary heart disease face (Cohen 32). In the case scenario, the cardiologist attending to Denise Wilmington chooses to seek the services of a psychiatrist after realising that she might be suffering from depression. The decision is laudable because his effort to force her to continue with the medication could be detrimental if the psychological problem fails. Patients like Denise Wilmington need the services of a medical doctor and the ideas of a psychiatrist for the successful treatment of their diseases. Psychiatrist plays a crucial role in patients suffering from emotional and psychological breakdown. They give them reasons as to why they should not lose hope in life and medication (Krantz and McCeney 8)

Prevent complications associated with Coronary Heart Disease

Identify Undiagnosed People with Diabetes

Diabetes Mellitus is a disease identified as a serious risk factor to Coronary Heart Disease. The first step towards mitigating the complications that might result from CHD is proper and early diagnosis. This step is essential in the commencement of early treatment of the disease before it develops to uncontrollable level.

Appropriate Weight Reduction and Healthy Eating

Obesity is one of the factors known to exacerbate resistance to insulin and aggravate dyslipidemia, hypertension, and finally risk for Coronary Heart Disease. The key approach at this point is for the patient to carry out procedures and activities that lead to weight reduction. Small reduction in weight to the tune of 1015% of the original body weight results to greater improvements in insulin sensitivity, glycemic control, blood pressure, and circulating lipids. Therefore, patients should begin by setting realistic goals relating to weight loss. They have to desist from ideas of setting unrealistic weight loss programs that may end up frustrating them as well as to the health care team (Carrier 17)

The physiological aspects of weight loss tend to be straightforward. On the other hand, the behavioral changes and psychological considerations form one of the utmost challenges for many patients. The concept of weight loss is all about the consumption of less energy than whatever breaks down for body use. This implies that patients are keen on the diet they utilize. Fatty meals and lipids should be eliminated in diets at least for most of the time. In the event of an elevated very-low-density lipoprotein (VLDL) triglycerides and cholesterol, a boost in the monounsaturated fat content in the diet and a decrease in levels of alcohol and carbohydrates consumed, can produce significant improvement (Verrier, Tolat and Josephson 2229).

Exercise

Exercise is a one of the surest ways for achieving the desired loss in weight. Through exercising, a patient reduces plasma glucose levels as well as enhances glucose uptake and insulin sensitivity. Furthermore, exercising plays a critical role in ensuring that the excess glucose and fats break down during respiration process. This minimizes fat accumulation within the blood vessels (Charlson 47).

Reduce cigarette smoking

Cigarette smoking is another main cause of Coronary Heart Disease. Basing on the research work conducted by Kromhout, patients suffering from the disease must cease from using cigarette or smoking any other form of tobacco content that may prove infectious and detrimental to the lungs. Since cigarette interferes with the lungs, such smoke hampers gaseous exchange along the alveoli surface. In addition, because CHD associates with limited oxygen supply to the heart, cigarette smoking worsens the condition even further. As such, a patient stands greater risk of experiencing complications linked to heart attack. In order to prevent future occurrence of the complication, the patient should desist from using cigarette or any substance that tampers with the uptake of oxygen at the alveoli walls and into the blood for general circulation within the body (Kromhout 12).

Treat Depression

Patients of Coronary Heart Disease have also the responsibility of managing their behavioral and emotional states. Depression and anxiety are all associated with cases of hypertension. Research conducted by Schneiderman and Antoni indicates that emotional distress amongst patients suffering from Coronary Heart Disease (CHD) attributes to poor prognosis. For this reason, doctors need to assess the mood and refer CHD patients with emotional distress to further psychological treatment. George and Mann (64) assert that psychosocial intervention serves to reduce the risk associated with this disease. Cardiac rehabilitation seeks to promote optimal physical and psychological function. Further research in to examine the psychological effects of CHD is inevitable. The initial studies show that rehabilitation after myocardial infarction (MI) may lessen death by twenty percent to twenty-five percent. Unfortunately, research conducted so far in cardiac rehabilitation lack sensitive outcome measures and a broad variability in healing strategies (Schneiderman and Antoni 41).

The current studies indicate that the short-term psychological effect of cardiac rehabilitation can potentially affect long-term prognosis. This simply implies that those rehabilitation programs that prove successful in lowering emotional distress may help considerably with regard to reducing death than program without psychological effect. According to cognitive models of behavior, enhancing the patient’s sense of control serves to decrement negative effects. Franks et al claim that this promotes the upholding of changes in lifestyle that may propagate prognosis. Additionally, decrement in distress might change pathophysiological mechanisms closely linked to top stress-related cardiac events (Franks et al 12).

Additionally, further on the effects of reduction in prognosis distress, the intervention ought to be effective in reducing distress and made to work towards the needs of each patient. In this regard, the present studies put much emphasis on consideration of usage of sensitive measure as a way of evaluating a comprehensive rehabilitation program. The study mainly focused in testing the hypotheses that (I) reducing emotional distress is one technique that may clarify this useful effect of rehabilitation on prognosis and (2) cardiac rehabilitation works to lessen emotional distress in the short term and death in the long term.

Medication of Coronary Heart Disease

The treatment of Coronary Heart Disease requires various forms of medications. The classification of such medicines attributes to their implications on the causative agents of the disease and any other attributive features concerning the disease. The following is an outline of some of the medications as well as their effects and risks.

Medications used to modify cholesterol levels: they include fibrates, statins and bile acid sequestrants. They serve to reduce the deposited materials on the walls of the coronary arteries and lower the LDL levels (Verrier, Tolat and Josephson 2226).

Clot-busting medication and low-dose aspirin: these drugs assist in the prevention of blood clotting this minimizing the risk of heart attack or angina. However, these medications are unsuitable for those patients having bleeding disorders.

Beta blockers: These medications reduce blood pressure as well as the rate of heartbeat. Therefore, this implies that there is a reduction in demand for oxygen supply by the heart. Often, these medications reduce the risk of future attacks for those patients who have ever experienced a heart attack when used (Cohen and Whooley 915).

Nitro-glycerine: These drugs are in the form of sprays, patches, or tablets used to control chest pain by reducing the heart’s demand for oxygen and widening of the coronary artery. Angiotensin-converting enzyme (ACE) inhibitors: they serve to lower blood pressure and in the slowing down or stopping the progression of coronary heart disease. They also facilitate in lessening of the risk of future heart attack for those patients who have ever suffered from it before. However, patients using the medicine must not to stop taking them without the full consent of a medical doctor. Otherwise, it may pilot to the deterioration of symptoms.

Prevent unplanned hospital admissions due to a crisis

Coronary heart disease is one that requires sufficient monitoring of the patient to ensure his safety and health is not jeopardized. It is evident that in such a scenario it may sound ridiculous to assume that medical emergencies are not bound to come. If anything, these should be the central concerns for the patient or those around him. Since medical emergencies are bound to happen, it is worthwhile to find out a way through which the effects of such emergencies may be minimized as much as possible (Department of Health: Public health, adult social care, and the NHS). Unplanned hospital admissions are not the best since they cause a lot of chaos and may result in the patient not receiving medical attention as required.

A lot of research has been on-going regarding this issue and so far there are a number of ways through which unplanned hospital admissions can be prevented. First, there is the use of home health care, whereby skilled medical practitioners offer a system of care in the comfort of their homes with the instruction of physicians. These are useful in ensuring the independence of patients as well as to heighten their optimum level of wellbeing in addition to the major purpose of limiting hospitalization and other related issues and costs.

With the ever increasing advancement in technology, there is also massive integration of technology in the healthcare system to give health practitioners an easier time handling their patients. Computer models, commonly referred to as predictive models may also be used to help these practitioners identify people that highly risk being admitted in hospitals in the future. Through this system, such people may be identified and given additional support for maintaining their health and limiting unplanned admissions. Such support includes virtual wards through which such people may be taken care of in their own homes.

Promoting self-care in the community setting

The self-care program in the social care setting is very vital and suitable for especially in the context of community based health professionals. It is therefore, a worthwhile venture to deliver its awareness to the clinicians and other health professionals in the community. This eventually becomes practical when the health professionals employ it in the treatment of their patients (Department of Health: Public health, adult social care, and the NHS). They also have to be furnished with relevant resources such as information that they can share with their clients. It is also possible to make use of community projects and voluntary organizations which may assist in the flow of information both for the professionals and their clients.

Pychosocial impact and practical implications of the disease on the person, relationships, work and future

Recent research on the psychosocial impact of Coronary Heart Disease indicates that disquiet, social segregation and low perceived touching support, depression, hostility and work-related diseases are the pivotal contributors to the development of the heart disease. In addition, there is convincing evidence linking prognosis associations with social isolations and low perceived emotional support. Researchers often associate these psychosocial risk factors to undesirable lifestyle behaviors. Therefore, when psychosocial risk factors occur concurrently with CHD, there is a greater risk of further aggravation of the condition (Desmond and Shillingford 78).

Abnormal hypothalamic-pituitary-adrenocortical functioning derives significance from this aspect because it links to hostility, depression, and social isolation. This forms one of the early predictors of Coronary Heart Disease. Also, impaired vagal control is a feature that characterizes hostility and depression, and the activation of elevated sympathetic nervous system accompanies social isolation, hostility, anxiety, and work stress. In addition, hostility and depression directly link to the impaired platelet function. This information offers useful insight in the comprehension of how psychological factors contribute to the progression of Coronary Heart Disease.

Legal, ethical, political and economic context of care in the local community for people with the long term condition

Evashwick & Raidel (2004, p. 45) acknowledge that the treatment of a long-term health care condition is not an easy task. It results to financial strain, which are among the contributing factor of stress that most of the victims face. Most health facilities prioritize meeting their financial obligations rather than attending to the patient. As such, it becomes imperative that the government, in conjunction with the healthcare facilities to develop and invent certain programs that may help mitigate the financial challenges faced by the families and the patients suffering from the long term diseases such as Coronary Heart Disease. However, the effort undertaken so far by most governments are laudable. For instance, the healthcare reform that Obama subscribes to has been a relief to most families. This has served to make access to healthcare services affordable to all (OSHA Compliance Management 45).

Conclusion

From the study, a lot was learnt regarding patients suffering from long-term health complications. It is evident that they need the help of the society more than even the medication they use on a daily basis. It is undeniable that most of them suffer from psychological and emotional breakdown that calls for attention even before subjecting them to medication. Coronary heart disease is a principal cause of many deaths in the globe (Elsie 1). The key lesson that emanates is the fact that unless the society learns to attend to these patients, most of them will suffer more from depression, which aggravates their medical condition even further (Douglas 23). From the research, it was also learnt that long-term health condition such as CHD requires more of psychosocial attention, and behavioral adjustments to ensure long-term survival of patients. The society has to learn to embrace such people and cease from engaging in behaviors that add stress to these individuals (Tokumine 29).

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