Self Management Nursing Report 2022

Running head: NURSING
NURSING
Name of the student
Name of the university
Author note

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Part one:
The symptoms and the history of Jason indicates the possibility of Transition
ischemia attack caused by a clot in a brain artery. The blockage of the artery can arise due to
a ruptured plaque induced by atherosclerosis or arterial hardening. Downstream debris from
shrunk carotid arteries or blood clots frequently develop in the heart and come to the brain
artery followed by a blockage (Tutwiler et al., 2016). The medical history of Jason also
support the probable disease condition. Jason was previously taking Ibuprofen for the
hypertension. Several reports indicated clear association regarding hypertension and transient
ischemic attack, which resulting in short-term occurrence of stroke. Jason also has extreme
body weight that add on with the risk of the disease (Webb et al., 2018). Jason also reported
to smoke at least two packets of cigarette in a day with adequate consumption of alcohol. The
lifestyle and eating-drinking habit of Jason also serve as a major factor in poor physical
conditions. Cerebrovascular disorders are the first source of female deaths, and the second
source of male death in developed nations. Smoking cigarettes is a significant indicator for
both men and women of cerebrovascular disorder. The risk of having ischemic stroke for
smokers is 1.92 times higher than non-smokers. Smoking raises the likelihood of thrombus
development in small arterial channels and leads to an elevated prevalence of plaque
atherosclerotics. Smoking also enhances the blood viscosity, the accumulation of fibrinogen
as well as platelets. It reduces the high-density lipoprotein (HDL) cholesterol that triggers
endothelial damage directly and also leads to higher blood pressure (Arboix, 2015).
Jason and his family will be in great trouble concerning the financial, emotional and
medical problems they will face for the transition ischemia attack (TIA). Jason has a son but
he is not agreed to take financial help from his son. Jane, the wife of Jason also lost her job
recently and struggle to achieve any job now. The treatment of TIA is not one time

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investment and need to continue the medicines and therapies to eliminate risk of stroke. Jason
already diagnosed with atrial fibrosis and TIA , which adds up with the possibility of stroke.
The financial burden is huge in Singapore with the medication cost almost $200 per month
and more for the advance treatment like bypass surgery or percutaneous coronary
intervention (Moh.gov.sg, 2020). The financial trouble is not the only problem the family will
go through. Depression is another factor that the family will face due to the health
consequences. Post stroke depression is correlated with increased post stroke mortality.
However, there is not investigation about the impact of certain mental health problems on
post-stroke mortality which can clearly state the link. Post stroke depression exists in around
one-third of all patients of ischemic stroke and has been connected with poorer clinical
performance, delayed healing, and poor quality of life (Karamchandani et al., 2015).
Part Two:
The self-management framework for Jason need certain modification as per his
unique need, lifestyle and education. Guidelines for secondary stroke prevention suggest
prescribing and commitment to treatment, active education, and clinical therapy on potential
factors and lifestyle. Positive behavior must be embraced and sustained as a behavioral
preference to reduce repeated vascular accidents, and involving potentially proactive
improvement in behavior and self-management strategies can be effective to acquire that
(Salinas & Schwamm, 2017). International best practice guidelines for secondary prevention
of cardiovascular diseases propose multimodal approaches. It discusses prescribed
pharmaceutical items in combination with appropriate knowledge delivery. Jason, is a school
drop out and worked in various occupations to sustain. The educational background indicates
that there may be clear lack of his knowledge about the disease (Vaughn et al., 2014). The
approach fill the gap by educating him that can help in eliminating future risk factors. In

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order to increase efficiency and enforcement, it is important that multimodal approaches be
guided by the philosophy of behavior change and integrate strategies of behavior change
(Lawrence et al., 2015). There are three key explanations for implementing theory-based
approaches. First of all, therapy is more probable to be successful if it addresses
improvements in actions and behavioral root determinants. Secondly, the intervention
methods are well tested and evaluated. Lastly, the interventions are based on the culture and
the community. They understand the culture and community, analyze them and implement in
the theoretical intervention. Hence, the multimodal approach will be best fit for Jason, but
still it need modification concerning the eating habit of Jason. The self-management
framework need to incorporate the healthy lifestyle habits to his life. This include elimination
of smoking habit and drinking habit and incorporation of exercise in his life (Wood & Neal,
2016). Jason also found stressed due to the financial burden of rehabilitation center.
Studies has shown that several behavioral improvements can support blood pressure
reduction and therefore reduce the likelihood of reoccurrence of strokes and strokes. Body
weight loss with associated decrease of blood pressure claims to have a direct association.
Diets high in vegetables, fruit, and no/ low fat dairy foods, like the DASH diet, and non in
saturated fat and total fat are separately successful in lowering blood pressure. . Reducing
sodium and rising potassium consumption are effective in lowering of blood pressure and the
likelihood of strokes. Furthermore, there is a clear statistical association between alcohol and
blood pressure, with the maximum blood pressure decrease happening while alcohol
consumption is restricted to one and two drink for respectively women and men. With
increasing alcohol intake, the advantage of lowering blood pressure by the diet plan can be
compromised (Satterfield, Anderson & Moore, 2012). He need to demonstrate the techniques
like yoga and music therapy to reduce stress in a cost effective way. Emotions are elicited by
assessments of incidents according to the theory of appraisal. Musical preference is reported

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to be more valuable than arousaland in relaxing people with stress and depression. This can
be attributed to the strong association between music preference and the degree of perceived
joy and peace (Jiang et al., 2016).
Task Three:
Recipients Name
Address line
State, ZIP code
Subject: Referral of Jason to Respiratory physiotherapy
Dear (Recipient name),
I am a registered nurse in the emergency department of XYZ hospital. Recently I am
facilitating the discharge of one of my patient Jason, and writing to you as per the need of his
health services.
I would like my patient Jason to you for heal services. Jason Chen is Bukit Timah's GRAB
Car driver whose age is forty two. Taking into account Jason's clear comment on his poor
probability of conformity with referrals. The interdisciplinary team agreed to the system
of self-management as the most suitable approach for his continued treatment after he suffer
from a Transient Ischaemic Attack (TIA). Jason also stated that he was advised to take
pulmonary rehabilitation owing to his elevated development of dense phlegm from chronic

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persistent swelling of his airways. However, he did not continued the therapy as he had to
join his work.
The medical history and the family history of Jason is also not very good. Jason's father
passed away at age 67, after a transurethral prostate resection (TURP) operation, leading to
heart complications, while his mother died in metastatic ovarian cancer at the age of 51.
Jason’s lifestyle is also not healthy. He consume high amount of alcohol with intake of two to
three packets of cigarette every day. With the cardiac problems Jason is also suffering from
hypertension and for its maintenance took sporadic medication often. The job loss of jason’s
wife and hospital admission of him also add on with the poor mental health of Jason.
The medical assessment of Jason states that he has the Transient Ischaemic Attack (TIA)
caused by a blood clot which formed in the heart and travelled to the brain artery causing a
brain blockage. The irregular heart rhythm can be caused by the atrial fibrosis that is
commonly co-related with TIA and hypertension. The excess body weight can also be
responsible for the condition with the history and lifestyle of Jason.
Jason and our team talked about the condition of him and available health services that can be
beneficial for him. With the concern of the both party we decided to give him a self-
management care. He need help from you for getting the service of respiratory physiotherapy.
Our team believes that Physiotherapy will increase airway clearing in hypersecretion-related
respiratory problems of Jason. Driven expiratory procedures are the most effective forms of
care for enhancing airway clearance in short term. Jason and our team agreed on the
incorporation of the respiratory physiotherapy associated with other self-management factors
will improve the condition of the Jason. I am confidant that your organisation will give
excellent care and service to Jason and your team is perfect as well as experienced to give
adequate care to the patient (Sahealth.sa.gov.au, 2020).

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Please do accept him with your care. I am hereby attaching the contact details of my hospital
for any further communication, if needed.
Sincerely
ABC
Registered Nurse
Emergency Department, XYZ Hospital
Address line
State, ZIP code

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References:
Arboix A. (2015). Cardiovascular risk factors for acute stroke: Risk profiles in the different
subtypes of ischemic stroke. World journal of clinical cases, 3(5), 418–429.
https://doi.org/10.12998/wjcc.v3.i5.418
Jiang, J., Rickson, D., & Jiang, C. (2016). The mechanism of music for reducing
psychological stress: Music preference as a mediator. The Arts In Psychotherapy, 48,
62-68. https://doi.org/10.1016/j.aip.2016.02.002
Karamchandani, R., Vahidy, F., Bajgur, S., Vu, K., Choi, H., & Hamilton, R. et al. (2015).
Early Depression Screening Is Feasible in Hospitalized Stroke Patients. PLOS
ONE, 10(6), e0128246. https://doi.org/10.1371/journal.pone.0128246
Lawrence, M., Pringle, J., Kerr, S., Booth, J., Govan, L., & Roberts, N. (2015). Multimodal
Secondary Prevention Behavioral Interventions for TIA and Stroke: A Systematic
Review and Meta-Analysis. PLOS ONE, 10(3), e0120902.
https://doi.org/10.1371/journal.pone.0120902
Moh.gov.sg. (2020). MOH | Fee Benchmarks and Bill Amount Information. Moh.gov.sg.
Retrieved 15 April 2020, from https://www.moh.gov.sg/cost-financing/fee-
benchmarks-and-bill-amount-information/Details/SD812H--1.
Salinas, J., & Schwamm, L. (2017). Behavioral Interventions for Stroke
Prevention. Stroke, 48(6), 1706-1714. https://doi.org/10.1161/strokeaha.117.015909
Satterfield, G., Anderson, J., & Moore, C. (2012). Evidence supporting the incorporation of
the dietary approaches to stop hypertension (DASH) eating pattern into stroke self-
management programs: a review. Journal of Neuroscience Nursing, 44(5), 244-250.
DOI: 10.1097/JNN.0b013e3182666248. https://scholar.google.com/

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Vaughn, M., Salas-Wright, C., & Maynard, B. (2014). Dropping out of school and chronic
disease in the United States. Journal Of Public Health, 22(3), 265-270.
https://doi.org/10.1007/s10389-014-0615-x
Webb, A., Mazzucco, S., Li, L., & Rothwell, P. (2018). Prognostic Significance of Blood
Pressure Variability on Beat-to-Beat Monitoring After Transient Ischemic Attack
and Stroke. Stroke, 49(1), 62-67. https://doi.org/10.1161/strokeaha.117.019107
Wood, W., & Neal, D. (2016). Healthy through habit: Interventions for initiating &
maintaining health behavior change. Behavioral Science & Policy, 2(1), 71-83.
https://doi.org/10.1353/bsp.2016.0008