Article | MANAGING CHRONIC DISORDERS.

Running Head: MANAGING CHRONIC DISORDERS 1
MANAGING CHRONIC DISORDERS
Name
Institution

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Introduction
Mr. M is a 73-year-old retired engineer admitted to a hospital medical ward, Mr. M lives
with his wife in an apartment on a fourth floor, and has two adult children who live nearby. He is
diagnosed with type II diabetes, cardiovascular disease, and has been experiencing dyspnea,
frequent cough and edema in the legs over the last five weeks. For this reason, M is prescribed to
take Furosemide 250 mg BD to reduce the level of lung edema. During the previous five years,
M is said to have been infected by myocardial infarction, forcing him to sleep his head elevated
on three pillows. He has been experiencing high blood pressure and is instructed to take
Perindopril 8 mg daily to improve the condition. Moreover, M's kidney problem has been so
severe, leading him to a vascular surgeon referral and pre-dialysis multidisciplinary clinic.
Therefore M chronic disorders need urgent attention.
Dyspnoea, frequent cough over the last five weeks and Skin cool and diaphoretic
M had fluid in the lower lung fields, and the last five weeks, he had dyspnea and frequent cough
and a cooling skin with over sweating. From the mentioned signs, M may be suffering from
Pulmonary Edema. Pulmonary edema is an accumulation of fluid in the lungs, which usually
happens when excess fluid builds up in the alveolus, increasing the gap between oxygen and
carbon dioxide molecules, taking longer to transfer the respiratory gases to the bloodstream.
Increasing fluid in the air sacks, it grows in pressure in the air sacks beyond the normal range of
10mm Hg. Correspondingly insufficient oxygen in the bloodstream leads to shortness of breath
and respiratory distress by the patient ("Pulmonary edema - Symptoms and causes," 2019) M has
breathing distress in the ward, and he requires Oxygen 6 L/min which his lungs cannot produce

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until helped by Hudson mask. Pulmonary edema is associated with heart problems; it is unable to
pump blood to the blood vessels leading some of the heart problems such as heart attack,
hypertension, and even kidney failure (Ijaz & Adrish, 2015). Last five years, Mr. M had a
myocardial infarction. Also, in the objective data, there is a feeling of a heart murmur as a result
of heart failure, which later resulted in pulmonary edema.
Edema in Legs over the Last 5 Weeks
Legs edema is a presentation nephrotic syndrome, a conscious manifestation of kidney disease.
Reduction of oncotic suppression causes over filtration intravascular space fluid to space in the
interstitial, leading to excess sodium retention, hypervolemia, and impairment of renal
autoregulation. Continuous overfilling of the fluid leads to excess sodium retention, causing
edema (Siddall & Radhakrishnan, 2012). Referring to the diagnostic study from Mr. M, the
Creatinine level is 390 μmmol/L indicating clearly that his kidneys are unable to remove the
excess Creatinine in the body. Besides, serum test results suggest that the body is dehydrated due
to a high concentration of sodium concentration. Nephrotic syndrome causes a decline of protein
synthesis albumin, which is responsible for removing extra fluids in the body; therefore, albumin
reduction in the body causes fluid accumulation in the body and leads to swelling of the legs
(NIDDK 2019).
Venous leg ulcer on the left ankle and bloated abdomen
A venous foot ulcer is one of the common complications that occur in infected diabetic
individuals if not well controlled. It is due to poor glycemic control associated with neuropathy
and known to cause osteomyelitis and amputation of the foot. Ulcers occur after continuous
trauma and pressure exerted on the foot that occurs in three stages. The first stage is callus

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development resulting in neuropathy (Madmoli et al., 2019). Neuropathy is the leading cause of
foot ulcers in diabetic patients seeing that neuropathy loses nerves sensation when the pressure is
exerted on foot, causing foot micro-trauma or breakdown of the foot tissue. Neuropathy may
affect sensory nerves for detecting pain and temperature; therefore, no pain is felt when the skin
tissue is torn or worn out, leading to a motor imbalance of extensor muscle, causing foot
deformities like claw toes and metatarsal heads (Forsythe & Hinchliffe, 2016).
Gastrointestinal (GI) complication, which causes bloating, is most common to people
with a prolong diabetes complication though not easily noticed. When the smooth fibers in the
esophagus are affected continuously by neuropathy found in diabetes patients, it causes
peristalsis, contraction and reduces esophageal sphincter tones. Continuous contraction of soft
tissues results in esophageal dysmotility and gastroesophageal reflux (Krishnan, 2013).
Symptoms of gastrointestinal complications may be bloating and bowel syndrome. Bloating
occurs as a feeling of accumulated gas in the abdomen, full belly, and upset abdomen. Mr. M
may have been experiencing poor appetite and getting full quickly when eating which may be as
a result bloating.
The disorders mainly occur in diabetes mellitus patients. Diabetes type 11 is a chronic
disorder caused by persistence hyperglycemia or inadequate insulin secretion from the pancreas
leading to irregular levels of glucose in the blood (Jialal & Singh, 2018). Hyperglycemia and
other metabolic abnormalities cause damage to the organ system leading to health complications
such as neuropathy, retinopathy, and Osteoarthritis. M is instructed to take Atorvastatin 10mg
daily to reduce the level of fats and cholesterol and fats in the body. Cholesterol and fats are
associated with obesity in the body. Obesity in diabetic individuals increases insulin resistance
and B-cells malfunctioning. Therefore fat people are less insulin sensitive and reduced B- cell

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modulation. A decrease functioning of B- cells worsens diabetes patients (Algoblan, Alalfi &
Khan, 2014)
Complexity Care for Chronic Patients
Seeing that Mr. M is suffering from three major severe chronic diseases, urgent health care is
needed in order to manage the illness. Using the Grembowski model of caring for complex
chronic conditions may help in providing a solution that will escalate health demands from Mr.
M. The following strategies may be implemented in managing M’s chronic illness.
Health Systems.
Mr. M, in the past years, has been suffering various chronic illnesses, supplemental to that; his
condition has been deteriorating day by day. The condition may be worsening due to a lack of
information on how to manage the illness. Nurses and physicians have a defined role in
educating patients to have a positive health care outcome. Nurses' and physicians' patient's
interaction should be motivated and enthusiastic in that it should respond to the patient's needs
and advise on better management of health disorders. Self-efficacy has played a significant role
in clinical intervention, especially in chronically affected individuals such as heart disease,
rheumatoid arthritis, and hypertension (Paterick, Patel, Tajik & Chandrasekaran, 2017). Self-
efficacy helps in changing altitude on the view of various health challenges, therefore changing
one’s approach to health care management. Mr. should have been advised using the strategy and
could have mitigated the effects of chronic illness he is passing through.
For excellent management of chronic disorders, proper health systems have to be
implemented within the health organizations. Health care leaders have a daunting task in
managing the quality of health services for chronic condition not only in providing services to

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the patients but also ensuring government incentives are not compromised, but reach to the
intended organizations Government incentives ensure patients affected by the chronic disorders
get medical attention at lower costs, with excellent efficiency since there are adequate trained
care providers in the health centers (Smolowitz et al. 2015) . Improvement of care for people
suffering from chronicle illness occurs when if the leaders prioritize and make it a practice in
providing the necessary resources that are most crucial in chronic management. Community
leaders have to clearly understand the updated health systems to renovate and innovate provide
and effective care strategies based on practical evidence. On the same, sufficient qualified
personnel is sure-fire in succeeding in a sound health system, which will undoubtedly contribute
to improved health facilities such as screening facilities for those affected by diabetes and
cancer. Mr. M has been living with diabetes type II for quite some time. This indicates that he
may require frequent screening services to see the extent of diabetes infection, which sometimes
is very rare in health centers. Screening may be done in the early stages of diabetes to
asymptomatic individuals in the criteria assessment of diabetes mellitus. American association
further recommends screening for diabetes for individuals who are more than 45 years of age in
each year so that early treatment of diabetes can be enhanced before conditions worsen (Li,
2016). Uncontrollable diabetes leads to blindness, limb amputation, and other heart disorders;
hence, proper health plans should be implemented to reduce the effects of diabetes diseases. This
can be done by educating people on the factors that accelerate diabetes, such as new smoking,
increased obesity, and sedentary behaviors.
The government incentives may also be used to build more health centers in ensuring that the
patients' Additionally easily accesses health services there should be mobile health practitioners
who are should be responsible outreach as many chronic victims as possible, which can be

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initiated by providing excellent infrastructure for health practitioners, and adequate medicine
(WHO 2006). By this, government incentives contribute a lot in managing chronic diseases.
Community Mobilization
Due to the prevalence of chronic diseases among most aged individuals like Mr. M,
community mobilization may be one of the cost-effective methods of reducing burdens of
constant management. Community health delivery systems are primarily reactive and can
respond to emergency care needs. The community group focused on determining the type of
health care needed to particular individuals and also dividing roles among different member’s
teams to ensure the chronic patient gets attention in a better and planned interactive way. M, who
is in his old age, requires intensive care due to his condition both from his family members and
health care providers for comfort and support. He may also need psychology therapy, as he may
also be experiencing some stress and depression. Mr. M joining the team may be recommendable
since there is a guarantee of follow up even after hospitalization; therefore, M will have a
company that will be making casual visits after leaving the ward ("Delivery System Design::
Improving Chronic Illness Care," 2019). The community mobilization advantage is that they
have organized intervention which is focused on the needs of the patient consequently by
coaching them on healthy behavior, adherence to medication, and skills of managing chronicle
illness. M, who is a victim of various chronicle disorders, is suitable for this type of program,
which has proved a positive outcome in providing care of related diseases.
Self-management.

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Self-management is recommended to those infected with chronic illness.Mr. M is a
patient suffering from three central chronicle diseases, which are Kidney failure, Diabetes type
II, and Pulmonary Oedema. Therefore M needs urgent health management actions to coup up
with the disorders and controls his condition. Self-management interventions are proven
effective in improvement in patient-level outcomes. Self-management systems are actions taken
by sick individuals to meet their psychological social and emotional needs aimed at preventing
further live health accidents and caring for their present health conditions. People learn about
their chronicle illness, understand their health care needs, and perform various health care tasks
and skills such as managing their body responses, keeping doctor's appointments, and health care
promotion activities. Active participation of M and coordination with clinician contributes to the
success of self-care management. By this, the individual should completely understand the
health situation to take reasonable precautionary measures (Reynolds et al., 2018). Mr. M should
have full knowledge of his condition and able to deal with the symptoms and disability. Assisted
by the caregivers, he should be able to follow medical prescriptions along with the proper
dietary. At the moment, M has to keep his blood glucose near normal range by balancing the
food intake with physical activity. Psychological therapies are also recommendable since he may
also be experiencing depression caused by diabetes and related disorders. By receiving a
continuous recommendation from the health care providers, M can modify his dairy guidelines
and change his lifestyle habits.
M adapting to both social and psychological demands and healthy interactions with caregivers
gives him more chances to learn more of his condition together understanding with the physical
indicators on self-management which are aimed at improving individual health status regardless
of the chronic disorders, since they are related and manageable at the same time (Anekwe &

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Rahkovsky, 2018). On the same issue, Nurses have a significant role in self-management system
implementation based on every illness, both in the hospital or a home care setting, depending on
the patient's needs. Additionally, they have the responsibility of educating patients on proper
self-management system and encouraging the patients on the importance of following medical
prescriptions instructed by the health practitioners. They have to engage the patients in all the
decision they make on the patient and providing researched proved practices for self-care
management (Grady & Gough, 2014). To increase continuous support to Mr. M, physicians
should assist in setting goals, advising on better strategies in solving problems, and connecting M
in various management programs. Providing information, support, and compassion from both the
physicians and family members to M is essential for successful self-health care. By learning and
correcting essential skills on self-management, M will competently manage the chronic disorders
he is experiencing.
Clinical Information Systems.
Clinical information systems are used to track cases of a given disease or condition from an
individual targeting the changing of behavior. It provides information necessary for monitoring
one’s health status and reduces complication ("Clinical Information Systems: Improving Chronic
Illness Care", 2019)Access of timely and well organized information is known to improve care
for chronic patients through identifying individuals affected by the disorders, keeping a track
record of how the disease is being managed, tracking management procedures and examining the
most effective in controlling the illness and giving the final feedback to the care provider .
(Rahimi, Safdari & Jebraeily, 2014) On the same aspect, this information system may be used in

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monitoring Mr. M’s healing progress and keep records for his health and therefore come up with
health improvement strategies. The files from Mr. M maybe also to get other health
complications that he may be experiencing and used in treatment decisions.
Patient applications such as patient portals, PHRs, and integrated voice systems may educate
Mr. M on his chronic condition, medications, and better medication strategies to adopt (Pasricha
et al., 2012). Clinical information systems may be used to educate health care personnel’s on
better treatment methods to use when dealing with chronically infected people. Physicians,
doctors, and nurses should be provided with IT learning programs to help them adapt to the new
technology and ensure proper documentation, quality health care, and personal health care. In the
same view, Mr. M has been referred to as the pre-dialysis multidisciplinary clinic for individual
health care. Clinical information systems may equip health care providers in the same institution
with pre-dialysis skills in managing severe chronic kidney disease. Learning can also be done
through preparatory or enhanced e-learning based principles which may provide the in-service
type of education ("Educating Clinicians on New Elements Incorporated into the Electronic
Health Record," 2013)
Delivery System Design
Delivery Health care design illustrates how health care is carried out and how the health
organization operates. It involves several professionals coming together in their dairy
responsibilities to plan, care, manage, and prevent all chronic related infections. Chronic ill
patients can receive the treatment they need from a qualified health practitioner. The system
allows care to be well planned by providing all the resources and mechanisms of ensuring all
health plans are followed and are proactive. Mr. M needs a long term care expert even though he

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may be practicing self-management care. Due to the complexity of his chronic illness, he
requires several health practitioners, including nurses, pharmacists, Nutritional therapists, health
educators — physiotherapists, and social workers, to work collaboratively as an organized team
to improve his health condition. Though the division of tasks may vary depending on
practitioners' qualifications, nurses may be mostly involved in providing care support for M due
to his care urgency while pharmacists, on the other hand, have to ensure that M follows the
medical prescriptions and self-management advice. Health care providers may also visit M home
even after discharge to have regular contact with him to observe the progress and providing
continuous management education to the family as well.
Decision Making
Shared decision making is the process by which health practitioners have to pass through
various decision-making phases by sharing treatment prevalence and come to an agreement on
the best choice of treatment. Shared decision making is recommendable as it enhances quality
decision made by both patient and caregiver that are more informed and practical (Desroches,
2010)
The procedure done to the chronic patients has to be based on thoroughly researched and
proven by health practitioners such as physicians in ensuring the patients receive quality medical
care. Guidelines taken by health care providers should be discussed with the patient to help them
understand each every principle physicians are undertaking in their health management (Woo,
Yang, Lee & Kang, 2014). In the same way, nurses who are caring for Mr. M in the ward should
involve him in every treatment decision they undertake, which enhances the positive outcome of

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the care management. M has to analyze their symptoms and make wise decisions on their
adherence behavior by following the clinical guidelines provided by the health care providers.
Diseases like diabetes require complex regimen medication and a complete lifestyle change in
that dairy decision made by the patient have a significant impact on disease management.
Conclusion
Grembowski's framework structure intends to improve ambulatory care for chronically
affected individuals. When one considers both social and contextual health factors affecting
chronic victims, the model may to developing health care systems that will meet their complex
needs. Equally, I will adopt the same strategy in prioritizing health management and providing
an effective care plan to people living with multi chronic conditions. Grembowski frame has also
enlightened me on various challenges people living with chronic diseases face, and on the same,
the model has given solutions and strategies to use to overcome the difficulties of chronic
disorders in my future practice.

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