Healthcare Essay 2022

Running head: HEALTHCARE
HEALTHCARE
Name of Student
Name of University
Author’s Note

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Introduction
The main objective of this essay is to demonstrate the knowledge and understanding of
core pathologies and describe their impact on occupational performance. The understanding is
done by describing the impact of Rheumatoid Arthritis and Bipolar Disorder, which Lydia in the
given case study is suffering from. However, apart from these impacts Lydia is also suffering
from the extensive poverty because of her unemployment. All these impacts are pushing Lydia
into depression, ultimately making her feel lonely.
Section 1
Rheumatoid Arthritis
A chronic inflammatory disorder, which affects the joints of the human body, sometimes
even leading to damaging the eyes, blood vessels, lungs, skin and heart, is known as rheumatoid
arthritis (Kurkó et al., 2013). It usually occurs by the mistakenly attacking the tissues of the body
by the body’s immune system, thereby it is an autoimmune disorder (Kaur, White and Bartold,
2013).
In the given case study, Lydia (35 years old), was diagnosed with Rheumatoid Arthritis in
her late twenties and is currently suffering from severe flare up of the disorder.
Symptoms of Rheumatoid Arthritis
 Tender, swollen joints, warm
 Joint stiffness, which is usually worse after inactivity and during the mornings

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Tender, swollen joints, warm
In this particular symptom, the patient’s smaller joints, like the metacarpophalageal joints
and the metatarsophalangeal joint (MCP) which are present in the fingers and toes, are firstly
targeted, resulting in causing tenderness and swelling of the joint. In the given case study, Lydia
faced problems with making tea for her friends; this is because in order to make tea, she has to
use her hands to hold the pot or to add the ingredients (Van Nies, et al., 2015). However, Lydia is
suffering from Rheumatoid Arthritis, her grip strength have decrease and she is experiences
fatigues in the proximal upper extremities, which is limiting the movements of her hand and
making her incapable of making tea (Koziel, Mydel and Potempa, 2014). The grip strength of
Lydia had decreased and the stiffness of the joints have increased. Lydia’s decreased proximal
interphalageal joints and the wrists and decreased MCP flexion has brought about this functional
disability in Lydia, that has de creased his fine motor skills like grasping and holding. In
addition, the disorder has resulted Lydia in losing her ability to balance things with her hand, for
which she will not be able to hold the pot of tea. The fine motor skills of Lydia has been
vanished because she is not able to pick up things from her fingers, in addition she is not able to
use the different tools and instruments of the kitchen, which is required while making tea.
Therefore, the skills and movement of hands required to make tea are no longer available in
Lydia along with the disorder her financial conditions are also not very stable, for which she
feels embarrassed and do not welcome her friends when they arrive by not opening the door.
Joint stiffness, which is usually worse after inactivity and during the mornings
It is the symptom, which involves pain whenever the joint is moved, thereby reducing the
motion and the range of motion, in a patient with Rheumatoid Arthritis. Sometimes the stiffness
of the joints is so intense that the patient feels that their hands or legs are stuck by means of

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superglue or something. In some cases, the patients are able to perform rage of motions but it
requires extra force and energy. Lydia, is suffering from Rheumatoid Arthritis, from almost 15
years and the symptoms have become more of a disorder themselves. Like the joint stiffness, has
worsened in the past years, causing difficulties in the locomotion of the hands and the legs. This
has affected the endurance of the limbs and is also causing difficulties in the daily activities of
living. (Matcham et al., 2013). Even a slightest discomfort to their hands will generate immense
amount of pain in the patient. The motor skills of balancing also require additional effort due to
the stiffness in the joints. However, while making tea, Lydia has to hold the pots and the tea bags
and then serve the interesting cups she got, to her friends, which will require immense amount of
effort. For a normal and healthy individual, it seems simple to hold a teapot, but for patients like
Lydia, it is almost equivalent to holding a big massive rock, because of the dysfunctioning due to
the stiffness of the joints in their body, especially hands and legs. Due to the severe symptoms of
the Rheumatoid Arthritis (Matcham et al., 2015), Lydia is not being able to make and serve tea to
her friends, for which she feels embarrassed and lonely.
Section 2
Bipolar Disorder (Mental Health Condition)
The case study revealed that Lydia had been suffering from bipolar disorder, which might
be another cause of her inability to prepare tea. Since, people suffering from bipolar disorder
have tremendous mood swings, which can affect the daily activities of living in people with
bipolar disorder. People suffering from bipolar disorders have distinct brain structures that
affects the concentration of individuals. Preparation of tea requires certain amount of
concentration for adding the correct amount of sugar or milk. In correspondence to the current

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neurobehavioral theory in psychiatry, the theory links to abnormal motivation leads to abnormal
behavior, causing depression and mania as two extremes of the reward driven processes (Gonen
et al., 2016). Such changes does not motivates the subject to carry out the daily chores of life.
Frequent depression periods and abnormal elevation of mood periods are the conditions
of a mental disorder, known as Bipolar Disorder (Grande et al., 2016). Mania or hypomania is
the term referred to the abnormal elevation of mood. Crying, negativity and low self-confidence
are the prominent components of the depression. Substance use disorder and anxiety disorder are
the other mental health disorders, which are associated with the bipolar disorder. The reason
behind this disorder can be both environmental and genetics (Phillips and Kupfer, 2013). Long-
term stress and abuse in the childhood history are the elements of environmental factors. The
patient who have suffered with one mania episode is diagnosed with bipolar I disorder and the
patient with one hypomanic episodes along with one depressive episode is diagnosed with
bipolar II disorder. In the given case study, Lydia has been diagnosed with Bipolar disorder. The
symptoms are
 Mania Episodes
 Depression Episodes
Mania Episodes
In this particular symptom, the patient is hyperactive active and has feelings of euphoria,
creativity and high energy. The patient sleeps for less time and remains active for long and they
feel invincible. In the beginning, the patients enjoy the mania episodes, but the tendency of these
episodes to spiral out of control is a drawback and this is where the problem begins (Geddes and
Miklowitz, 2013). The patient often behaves ghastly and recklessly, they might gamble away

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their entire savings or are engaged in sexual activities, which are not appropriate. Lydia in the
case study, suffered from the manic episode when she spent her entire savings on useless things
instead of buying the necessary items for herself. This led her to bankruptcy and thus she was not
able to pay her electricity bills on time. The poverty line of Lydia was further enhanced towards
extreme poverty because of her mania episode (Zeschel et al., 2015). Lydia even spent her
money, with which she was supposed to pay off her debts, leading her to the depth of intense
debts. Because of this episode, she lost all her money on non-necessary things, which resulted in
inability to buy medicines for her. With no electricity and money, Lydia was not able to serve tea
to her friends, which lead her to further embarrassment and depression episodes.
Hypomania Episodes
In this symptom, the patient experiences one mania episode along with one depression
episode. There are chances, where the conditions become severe resulting in psychotic
depression where the patient loses the contact with reality and therefore suffers from greater
problems in social functioning. Feeling sad, empty, guilt, hopeless, irritation along with the sleep
problems and memory problems are other basic elements of mania episode, which is faced by the
patient. Lydia because of her bankruptcy due to mania episode loses her friends due to the
disability of her to serve tea to her friends. Lydia becomes extreme embarrassed and depression,
as her friends were the only source of social functioning in her life and now even they were
gone. Hanging out with her friends used to give her motivation towards her life and would help
her to concentrate on her life, but due to her bipolar disorder, she ended up losing them. Lydia
also suffered with long periods of moderate depressions, because of which she became alone
(Whitton, Treadway and Pizzagalli, 2015). The depression symptoms include the feelings of
insomnia, irritability, anxiety and other harmful thoughts of suicide if not medicated properly.

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Lydia’s condition was very vulnerable because of her mania episodes and hypomania episodes
along with her Rheumatoid Arthritis disorder, making her life difficult (Gignac et al., 2015).
Section 3
Impact of Poverty
Poverty had a major impact on the life of Lydia. She became unemployed two months
back and had to experience significant poverty. Because of the poverty, she was not being able to
buy medicines for her Rheumatoid Arthritis disorder, which led to the severe conditions of the
disorder (Mani et al., 2013). An individual’s occupation or job gives a meaning to their life, it
gives them purpose in life by which one is able to move forward in their life and are able to face
the daily challenges efficiently (Carper, 2017). The unemployment phase of Lydia resulted in
changing the identity of Lydia, because earlier she was working but after her unemployment her
identity of working women was lost, which is another way that pushed Lydia into depression.
Her job was also not that great, she used to receive minimal benefits. The benefits were so low
that with that much of money she was not being able to buy the basic stuffs. In addition, she had
debts, which she was not being able to clear because of her low salary. Moreover, due to the
mania episode, she further spent her entire savings on unnecessary items. She did not have
money to even buy the basic items or to pay her electricity bill. According to the framework of
Doing-Being-Becoming, which is used in the practice of occupational therapy, these three
elements helps the individual to develop their own identity, to make them believe in themselves
and enables individual to see and prioritize their future (Ennals et al., 2016). All these elements
are important for enhancing the potential for self-actualization and growth of the individual.
Lydia was unable to meet the aspects of these elements. Due to not paying her electricity bills as

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per her pre-payment meter, her apartment was out of electricity. She felt embarrassed because of
her conditions and decide not to open the door when her friends arrived. Another occupational
concept, Model of Human Occupation, which is a client-centered model, is a framework that
governs the engagement of an individual in daily activities (Taylor, 2017). Lydia, with no money
to even buy medicines, fails to engage with her environment by getting demotivated and losing
all self-confidence, which was helping her to give a meaning to her life. Spending time with her
friends, Lydia used to feel good, motivated and concentrated in her life; she used to forget her
worries while sharing a cuppa in her funny and interesting mugs, with her friends. With no
money, she was not able to get treatment for her arthritis disorder, which became severe. She
suffered from joint stiffness and joint swelling in her hands and legs, because of which she was
not able to prepare tea, as preparation of tea requires additional effort like holding the pot and
serving the tea to her friends. With the unemployment and the two disorders, life of Lydia
became very difficult (Holz et al., 2015). She had developed anxiety issues and faces severe
depressive episodes. She is not being able to provide herself with effective a deficient treatment
for her disorders. She did not had the guts to call her friends and tell them about her issues,
which ultimately lead her into being lonely, affecting her life severely. The impact of poverty
had a vital role in the life of Lydia, as does not even have the money to buy the ingredients of
tea. Her medical conditions further became severe because of lack of medications.
As Lydia’s health conditions were severe, her occupation was also being affected by it,
because she was not being able to devote herself fully to her job. The model of Person-
Environment-Occupation emphasizes on the fact that the performance in an individual’s
occupation is governed by the person’s domain of health cognition, self-concept, personality,
sensory capabilities, physical performance and cultural background (Ivanoff, Iwarsson and Sonn,

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2006). In the given case, Lydia’s unemployment can be due to her health conditions leading to
poverty. The impact of poverty results in disrupting the mental health of an individual causing
severe depression and suicidal thoughts in the individual. Lydia anyways, was suffering with
depression episodes, but due to poverty, the intensity of depression episodes increased leading to
severe bipolar disorder (Garg et al., 2015). The fact that she was not able to use her hands and
legs efficiently because of Rheumatoid Arthritis, she was not able to involve range of activities
and motion in her life, causing her life to be stiffed as her joint bones in hands and legs. It is not
like that, these disorders are not treated, they are, but the treatment requires huge amount of
money and Lydia did not even had money to pay her bills. The major participation of the poverty
in the life of Lydia was the unemployment and the mania episode, due to which she ended up
spending her entire savings on useless stuff (Amin et al., 2014). She could have used the money
to pay her bills but the mania episode is like this only, where the patient gambles away their
money due to their feeling of being hyperactive. With the loss of her friends, the only hope and
support in her life, she further fell into the pool of depression and then ultimately became alone
throughout (Sharkins, Leger and Ernest, 2017). In terms of money, she only had her flat where
she lived; apart from this, she only had debts. The bipolar disorder of Lydia could have been
treated, if only she would have spent some time with her friends and told them about her
conditions. Her friends would have helped her and would have taken her out of depression, but
she was too embarrasses to even open the door when her friends arrived.
Conclusion
To conclude, occupational performance refers to the capability of an individual to
perform necessary tasks, activities and roles of living and different health ailments can result in

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the onset and progression of occupational performance issues. An analysis of the case study
suggests that Lydia had been affected with bipolar disorder and rheumatoid arthritis, which
created a significant impact on her proficiency in conducting activities of daily living. In
addition, poor socioeconomic condition also created an influence on her, and acted in the form of
an impediment in her recovery. This calls for the need of implementing occupational therapy, in
order to facilitate development, recovery, and maintenance of meaningful activities. It will not
only increase active participation of Lydia in different activities, the therapy will also prove
effective in enhancing her mobility. Furthermore, the therapy will also facilitate development of
emotional and social wellbeing, prevent the manifestation of negative behavior, and improve
abilities of the individual in conducting daily activities. It will also assist Lydia to work on her
fine motor skills, enhance hand-eye coordination, and address the physical disability.

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