Nursing Case Study: Self-Management Framework for Jason Chen's Health

This nursing case study presents the case of Jason Chen, a 42-year-old Grab car driver, diagnosed with multiple chronic illnesses including atrial fibrillation, obesity, bronchiectasis, knee osteoarthritis, and a risk of ischemic stroke. The assignment details his health assessment, lifestyle factors (smoking, alcohol consumption, and medication non-compliance), and the impact of these conditions on his daily life and economic situation. Due to Jason's reluctance to fully comply with treatment, the interdisciplinary team opted for a self-management framework, which includes educating him about his conditions, encouraging a healthy lifestyle, medication reminders, and nursing interventions for diet and exercise. The case study also includes a discharge plan, which involves a referral to a smoking cessation program, and a sample letter to the health authority requesting follow-up and enrollment in the 'I Quit' group counselling program. The assignment emphasizes the nurse's role in facilitating patient discharge and ensuring continuity of care through effective communication and support for self-management strategies.

Running head: NURSING ASSIGNMENT- CASE STUDY
NURSING ASSIGNMENT- CASE STUDY
Name of the Student:
Name of the University:
Author’s Note:

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Part 1
From the case study, it was found that Jason Chen, a 42-year-old GRAB car driver,
may have agonised from the cardiac disorder, which is diagnosed as he had a Transient
Ischaemic Attack (TIA). At the time of hospitalisation, it was found that there is an
undiagnosed condition that involves ongoing irregular rhythming of the upper chambers of
the heart; this specifies that he might be suffering from atrial fibrillation. Boriani et al. (2018)
opined that this is an irregular and rapid heart rate when the chambers of the heart may have
chaotic electrical signals; as a result, the ranges of heart rate from 100 to 175 beats per
minute. This would affect Jason and his family economically as it requires a regular and
continuous treatment procedure.
Jason was 115 kgs and his height was 5 feet and 4 inches that indicates his Body Mass
Index is 43.5. Therefore, it can be concluded that he was obese. He has a smoking habit of
two packets per day, drinks alcohol on a regular basis and does not take his medication for
hypertension in an ethical manner. This affects the lifestyle habit of Jason and his family in a
mental aspect.
The condition that may be responsible for the production of thick phlegm from
repeated inflammation of his airways is Bronchiectasis. As per the opinion of King (2016), it
is a lung issue that involves persistent coughing and production of phlegm or sputum. This is
a chronic illness that worsens over time, and the bronchi dilate in an irreversible manner
because of phlegm build-up. The condition leads to recurrent lung infection resulting in
complete damage to the lung. Jason has an issue of ongoing right knee pain because of which
he self-medicates with Ibuprofen after coming back from work. This might have a profound
impact on his ability to working and conducting Activities of Daily Lives (ADLs) (Basavaraj,
et al., 2019).

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As per the opinion of the local doctor, there is wear and tear of the knee due to his
weight and playing of football vigorous during his childhood. This indicates that he was
suffering from Knee Osteo-Arthritis, which is a degenerative condition there gradual wear
and tear of the cartilage and bone in the surface of knee joint occur, subsequently leading to
inflammation (Wallace et al., 2017). This would limit his working hours; thus; have an
impact economically on the family.
Another significant symptom of personality disorder can be seen in Jason as he
blames for his condition. Even though the situation is not severe in nature; however, he stated
that TIA occurred while arguing with his partner and in hospital; he had initially refused to
cooperate with the staffs. During his hospitalisation, partial blocking of one of the arteries in
the brain due to a blood clot was observed that indicated that he had ischemic stroke
incidence. According to Kernan et al. (2016), ischemic stroke occurs due to a blockage in the
artery from a thrombus or clogged blood vessel due to the hardening of the arteries, a
condition known as atherosclerosis. This involves the narrowing of the artery and less and
improper flow of blood in the body (Sommer, 2017). This requires an investment of time for
treatment; however, Jason cannot afford it since his partner does not work.
Part 2
After the diagnosis of ischemic stroke, Jason had referred to the treatment team, and he
stated that he understands the benefits of the rehabilitation program; however, he declares
that he will not be able to comply with the referrals. This is because he had to work for his
family as he does not hope that his partner, Jane would find another job and it would be
unfair to pressurise his son, George, a 25 years-old man. Therefore, the interdisciplinary team
decided to use self-management framework, which would be the most appropriate model in
his care process. According to Leventhal, Phillips and Burns (2016), a self-management

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framework is a comprehensive approach that helps in managing chronic illness. It can be seen
that the prevalent chronic condition such as cardiac disorder, diabetes, and arthritis have
various unique demands and characteristics and thus, pose a challenge in the management
process. These include disability, monitoring of the physical aspects, and the complex regime
of medications, maintaining a proper diet, exercise, and adjustment of the psychological and
social needs (Mills et al., 2017). The identification and management of the patient-centric
strategies in order to manage the challenges are stated to be the main focus of self-
management. Irrespective of chronic illness, a generic strategy or set of skill need to be
developed based on the condition that will allow the person to effectively handle the illnesses
as well as improve the health outcome. The steps that can be adopted in the case of Jason
with respect to self-management are:
 To provide knowledge and educate him about the condition: As per the opinion of
Orellano et al. (2017), evidence-based practice is one of the most effective strategies
in educating and providing awareness to people about the chronic disease. The
information that needs to be given is related to the causes, sign and symptoms; it
impacts daily living and ways of managing complications.
 Strategies to maintain a healthy lifestyle: Jason Chen must be aware of the impact
of smoking, drinking and not having his medication on time. This will help him in
realising the issues that he was creating for himself that affected his body even more.
Thus, referrals need to be advised that will help him in cessation programs
(Measureevaluation.org, 2020).
 The use of reminder calls can be set for remembering to have medicines on time:
This is a strategy that can be adopted by Jason in order to have his medicines on time.
Since he has multiple chronic illnesses and needs to have a number of medicines at

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different times and different dosages, it is important that he set a reminder for each of
them.
 Nursing intervention for exercise and diet: Metsios and Kitas (2019) opined that
diet and exercise are important aspects for arthritis and cardiac disorder; thus, a diet
and exercise plan needs to be given to Jason by the nursing professional involved in
the interdisciplinary team, and regular follow-up through telephone needs to be done.
Moreover, a relationship of trust needs to be built with the team in order to discuss all
the aspects of the treatment of chronic illnesses.
Part 3
As a nurse, I am responsible for facilitating the discharge of Jason from the hospital
after suffering from TIA. Jason had decided upon performing the steps stated in the self-
management process for his chronic illnesses in a religious manner. Therefore, it is important
to communicate the plans to the appropriate public health facilities, which will be responsible
for doing the follow-up. There are many health services available in Singapore. The chosen
service is the smoking cessation program; I Quit group counselling that is under the Health
Promotion Board of Singapore (Hpb.gov.sg, 2020).
Name of the Authority
Position
3 Second Hospital Ave
Singapore 168937
23 March 2018
Subject: To conduct a follow-up session with Mr. Jason Chen regarding his smoking
cessation program

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Respected Sir/Ma’am
My name is Marie, a registered nurse of Mount Elizabeth Hospital, who was responsible for
the patient named Jason, 42 years old, admitted as he was suffering from Transient Ischaemic
Attack. As per his diagnosis and review of his case, it was found that he might be suffering
from a number of chronic illnesses, such as atrial fibrillation, obesity, Bronchiectasis, Knee
Osteo-Arthritis, mental disorder and risk of ischemic stroke. The patient had clearly stated
that he has certain financial issues because of which his partner, Jane, does not have any job.
He is a chain smoker where he consumes two packs of cigarettes a day, drinks alcohol and
does not have his hypertension medication timely. He is a GRAB car driver from Bukit
Timah and lives in his private apartment with his partner and son, George. His education
level is low as he left schooling at the age of fifteen. His father died in a cardiac arrest; thus,
genetic factor plays a major role in his case.
The chronic illnesses that Jason was suffering from indicated that he requires a thorough
assessment and treatment process that involves the investment of time. However, due to his
personal binding, he clearly stated that he would not be able to devote time to the
management of his conditions. Therefore, the interdisciplinary team had decided upon the use
of self-management framework, which would work best for him. A step-wise plan has been
developed as per his condition, and while discharging from hospital, he had agreed that he
would follow them. A copy of the plan will be attached to the letter.
I request you to enroll Jason in the I Quit Group Counselling, which is a six-week program
that involves quitting smoking with 28 days using SMS coaching involvement. I request you
to prepare a personalised quit strategy for him, as most of the chronic illness is associated
with respiratory tract and heart that is profoundly affected due to smoking. Your program will
allow him to choose strategies as per his choice and need and can participate through an open

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platform where other participants can also support each other. Since this is one of the
practical and short-term programs, thus, I had recommended it to Jason to enrol. Kindly see
to it that he rigorously follows the program, therefore, maximise the outcome of his health
condition and improving the quality of his life. The follow-up session needs to be done after
the program and kindly send a report of the patient, which can be used for reviewing the self-
management plan and modifying it if necessary.
Thanking You
Yours faithfully
(Signature)
Name of the Registered Nurse
Mount Elizabeth Hospital

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References
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