Care of the Patient with Complex Care Needs

This research essay discusses the care needs of a 68-year-old man with heart failure and the nursing services required for his recovery. It also explores the use of the Roper-Logan-Tierney model in prioritizing nursing care.

CARE OF THE PATIENT WITH COMPLEX CARE
NEEDS
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In contemporary scenario, health care needs of people are changing due to different
health dimensions; however at the same time it is essential in terms of adding new services in the
health care sector. Thus, in this respect, the present research essay is discussing about Bob Evans
who is a 68 year old man and who was admitted in the hospital because of decomposed heart
failure (Skelly and et.al, 2016). As per the clinical history, Job has ischaemic heart disease for
around 20 years and along with that, he has coronary artery bypass graft which is a compete
heart block. The patient is taking several medications such as Furosemide, Enalapril, Warfarin,
Simvastatin and Lactulose. Thus, considering the heart issues, it is clear that the patients’ needs
should have a specific treatment; hence that is being discussed in the present research study.
Moreover, in this context discussion has also been included regarding the care and nursing
services which are essential for Bob to get recover. After developing the plan, it will be suitably
implemented so as to get the desired outcomes.
At present, the patient is admitted because of heart failure which also leads to gross
peripheral oedema and painful legs. Therefore, the patient requires inotropic support. Similarly,
his renal function is also changing; hence he is becoming hypotensive. After discussing the entire
matter, Mr Evans has shown interest in being at home at the time of dying (Braunwald, 2016).
Thus, considering his medical condition the family members and care practitioners have decided
to deliver palliative care services at home. For the care needs, the community nursing team will
continue to manage the health care needs with GP and palliative care team as this is also useful
in treating the patient in effectual way.
Therefore, considering the situation of Mr Evans, it can be said that nurses can make use
of Roper-Logan-Tierney activities to categorise the major nursing care priorities. Chronic
Obstructive Pulmonary Disease is typically one of the major causes of mortality in UK and it is
also known as a chronic illness that is often caused by smoking. Since, Mr Evans is habitual of
smoking and drinking; therefore he has the issues of COPD. The disease is a life-long illness and
it can also affect a person’s life (Shortness of Breath without Chest Pain Can Signify the
Presence of High Risk Heart Disease, 2005). Therefore, as per the model, chief focus will be laid
on aspects of care related to berating, eating, drinking and motioning a safe environment. These
aspects are also useful in terms of delivering the best care for the patients.
Instead of having several changes in the health dimensions, Mr Evans continues to smoke
and drink alcohol on social basis. Because of such health issues, he has taken early retirement
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from the job (Vasudevan and et.al, 2017). His family members are very much concerned about
his health dimensions; hence considering the same they have decided to give appropriate health
care services to the patients. Mr Evans is required to have proper medical treatment about heart
failure, pain management and wound assessment as his health conditions are getting changed
frequently. At present, Mr Evans is getting services from community nursing team as his care is
managed by the Community Matron and Specialist heart failure Nurses in the community.
Appropriate nursing care management is essential since that could help the patient to get
recovered as early as possible. Therefore, as per Roper-Logan-Tierney, changes are required to
be made in the eating and daily life schedule of the patient so that health prospects can be
improved accordingly (Yin and Hsiung, 2016). With the help of this model, proper treatment can
be delivered to Mr Evans so that his health prospects can be enhanced. This nursing process is a
systematic tool which is useful in ascertaining the needs of individuals. At the same time, it also
works in giving better services to the patients. COPD is considered as the 5th most common cause
of morbidity and mortality which enhances the number of patients in the country.
Henceforth, as per the identified problems of Mr Evans, the main aim of nursing is to
solve her problems by preventing the worst conditions which is occurring with her. At the initial
stage, it is crucial for the nurses to make the patient breathe comfortably so that other health
issues can be improved accordingly (Braunwald, 2016). Specific attention is required to be given
on heart problem and kidney disease which are major aspects of a person’s health. Along with
medication, suitable therapies are also required to be given so that Mr Evans can move forward a
happy life.
It is also crucial for the nurses to ensure that Mr Evans is leaving his sedentary lifestyle;
since, then only he will move forward towards a healthy lifestyle. Along with community nurses,
it is also crucial for the health care practitioners to encourage Mr Evans to move forward towards
a healthy life (Rizik and et.al, 2017). The model states that there are varied factors that impact
the health care services; hence it is crucial for the nurses to consider all such dimensions. Nurses
and health care practitioners are required to keep balance between social and cultural values as
that also holds more importance in encouraging service dimensions. Further, nursing services
will also be enhanced through meeting all the requirements of patients. For instance- Mr Evans
wishes to be at home in his last days; therefore while delivering palliative care services, it is
crucial for the nurses to keep all the cultural and social values.
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It is also analysed that Mr Evans is very much frightened especially during nights and as
a result it becomes difficult for him to sleep properly. He is also having bilateral pitting oedema
with leaking fluid from both legs. This happens due to the presence of gross peripheral oedema;
thus it also brings pain in the legs (Oellgaard and et.al, 2016). Therefore, in this regard it can be
said that suitable medicines are ought to be given to Mr Evans so that he can have healthy life.
The amount of energy is also getting down as Mr Evans has no appetite; henceforth he eats very
less. Therefore, according to these situations, Mr Evans is required to focus on suitable
medication and healthy habits.
After accessing the case of Mr Evans, it is ascertained that there are two major health
issues which are prevailing such as breathing problems and gross peripheral oedema. Therefore,
as per the health problems, proper services will be delivered to Mr Evans so that his health
aspects can get changed (Nioi and et.al, 2016). Ischemic heart disease is also known as Coronary
Artery Disease which affects the supply of blood to the heart. In this situation, blood vessels get
blocked and as a result, it reduces the supply of oxygen and nutrients to the heart muscle. Any
defect in the heart affects the supply of oxygen to the vital organs like brain, liver and kidneys.
This also leads to the death of tissues and eventually it leads to death in many cases.
Mr Evans is having such problem; therefore fatty diet and sedentary lifestyle should be
avoided as these are the major causes of ischemic heart disease. While dealing with such cases,
nurses are required to control cholesterol and hypertension (Skelly and et.al, 2016). Shortness in
breath usually occurs at the time of having cardiac symptoms and most often it also leads to
development of cardiac pain. It also increases lung disease especially in the patients who have
cardiac risk. In most of the retrospective study, it is mentioned that there are varied patients who
have coronary disease usually experience shortness in breath. Similarly, this also brings chest
pain and as a result it encourages overall health complications.
Further, Mr Evans is also having gross peripheral oedema which is an accumulation of
interstitial fluid. Apparently, the volume of fluid in the interstitial space is 20% of the normal
body weight; however leakage from capillaries and lymphatic drainage can aid in keeping the
balance in the fluid (Preibsch and et.al, 2016). This usually occur due to enhance plasma volume,
due to reduced plasma oncotic pressure and also because of lymphatic drainage. Oedema is also
called pitting at when it is pressed on the affected skin. This is also regarded as a classic type of
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oedema that is caused because of fluid accumulation. Therefore, in this context it is evident that
non-pitting oedema occurs in conditions such as lymphoedema and myxoedema.
Therefore, stating about the causes, it can be said that pitting- dependent oedema can
increase fluid pressure from venous stasis and it also increases fluid pressure from sodium water
retention (Sapontis and et.al, 2017). However, on the other hand it leads to develop issues
because of right heart failure. Hence, it can be said that because of this oedema, Mr Evans is
having pain in the legs. Other symptoms are also observed such as lack of appetite, no energy in
the body and lack of sleep. It also increases capillary hydrostatic pressure due to pulmonary
hypertension. Therefore, according to the health issues, it is crucial for the nurses to adopt
suitable nursing intervention so that health aspects of Mr Evans can be managed accordingly.
Roper’s model is applicable in this situation because it is a model of nursing care that
helps the person to live healthy life. It is the most widely used nursing model in the UK and it is
based upon the activities of daily life. Thus, as per the model, there are several areas wherein Mr
Evans has to bring changes so that to proceed towards a healthy life. At the same time, the
original purpose of the model is to assess the patient’s care and also to deliver suitable services
to the patient in overall health care provision (Helgadottir and et.al, 2016). This model could be
used for Mr Evans for the purpose of assessing how much the life of patient has changed due to
this illness or after admitting in the hospital. Therefore, the overall impact on the quality of life is
required to be analysed accordingly. The model will be including varied aspects of patient’s
overall life dimensions.
Activities of life plays a crucial role in ascertaining how a person manages all the aspects
of life. This includes the way of promoting maximum independence through carrying out
complete assessment of all the nursing intervention. Therefore, in this respect it is vital for nurses
to consider that Mr Evans is having controlling on all his activities as then only his health values
could be maintained (Cury and et.al, 2016). In activities of life, nurses should work on
maintaining a safe environment so that while delivering palliative care services, safety and
security aspects could be maintained. In this respect, communication also holds much importance
because it could direct Mr Evans to discuss all those issues which he is facing. Nurses should
also work on managing breathing aspects as due to ischemic heart disease, the frequency of
breathing gets changed. Further, according to the health condition, diet chart can also be
prepared subsequently in which Mr Evans will be recommended to have healthy diet.
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According to the current analysis, it is identified that Mr Evans eats less; hence that
develops other health issues and because of anxiety and lack of concentration, he is unable to
sleep as well. At the same time, the model also includes all such factors that influences activities
of living; therefore herein major consideration is required to give on smoking and drinking
habits. Since, the patient has severe health conditions; therefore it is essential for the nurses to
inform the patients about the ill impacts of sedentary lifestyle (Williams, 2017). Therefore,
nurses should focus on biological, psychological, environmental and sociocultural aspects which
affects the life of an individual in many domains. Along with the same, the model also includes
how life span of a person changes in different situations. The model also emphasizes on
educating the patient so that the quantity of fluid intake can assist in preventing water. Patient
education is necessary in this case as Mr Evans has serious health consequences which needs
immediate treatment.
Therefore, it is evident that appropriate nursing intervention and care plan is required to
be developed for Mr Evans. Apart from patient education, chief emphasis is required to be given
on proper use of techniques so that proper functioning of all the body parts can take place.
Anxiety is a state in which a person gets unconscious and does not understand what is required to
manage the overall health values (Smith, 2016). In the same way, Mr Evans is also anxious;
therefore it is essential for the nurses to consider the same thing into account. As per nursing
diagnosis, it is clear that suitable medicines should be given to Mr Evans so that he can change
his eating and sleeping patterns. The concept of end life care also exist in the present case
because Mr Evans desires to die at his home in last stages of his life. Thus, palliative care
services must be given to the patient while assessing his health care requirements.
Assessment Nursing
diagnosis
Goal Interventions Rationale Evaluation
Breathing
According to
Roper’s
framework,
safe
environment
is required to
Proper
analysis of
respiratory
system
(Minster and
Williams,
To maintain
suitability in
respiration
system
Analysing
blood gas and
also through
noting pH and
HCO3 level
This is
essential in
terms of
managing
oxygen
intake
Irregular
breathing can
create issues;
hence
suitable
monitoring
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be
maintained
2016) capacity. and
controlling is
required.
Analysing
respiratory
depth
changes
Proper
analysis is
essential so
as to
ascertain
breathing
pattern
To change
ineffective
breathing
pattern
Focus on
managing
COPD on
regular basis
This is useful
since it can
aid in
managing the
flow of air in
the lungs
(Mitchell,
McCormack
and
McCance,
2016).
This can also
help Mr Evan
to identify
the impacts
of smoking
and drinking.
Gross peripheral oedema
Treatment on
the basis of
causes
Several tests
such as renal
function,
CXR and
ECG will be
carried out
(Kahanpää
and et.al.
2016).
The main
goal is to
reduce the
level of pain
in the legs.
Proper
medicines
and therapies
will be
applied
accordingly.
It is useful in
analysing
chronic pain
in the
systems.
Therefore,
this can help
in managing
proper
functioning
of the heart.
Empirical
treatment
with diuretics
Clear
diagnosis is
required to
identify the
main issue.
The main
goal is to
change the
way through
which body
parts
manages
Medicines are
required
along with
changes in
lifestyle.
This is useful
in reducing
other
problems
such as
cardiac and
renal.
Health issues
can be
diminished
accordingly.
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their
functions.
Therefore, on the basis of above defined care plan, it can be said that nurses need to
ensure that suitable intervention are being added in the care provision (Bradshaw, 2016). This is
also useful for the purpose of managing Mr Evan’s health conditions in the most suitable
manner. Thus, along with such changes suitable consideration should be given to all the habits
and activities of Mr Evans.
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