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Nursing Assignment: Discussion on National Strategic Framework for Chronic Condition

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Case Study: Mrs Anya Strico

Mrs Anya Strico is a retired 75-year-old widower who is originally from Croatia. She has an eight (8)-year history of Chronic Obstructive Pulmonary Disease (COPD). Her past medical history includes increasing breathlessness, frequent respiratory infections, chest tightness, a chronic productive cough, persistent wheezing, pitting oedema in the lower extremities, exercise intolerance, fatigue, and a lack of energy. At the time of diagnosis, she was advised to lose weight (at least 5kg) as her BMI was 30 and to attend Pulmonary Rehabilitation, but no further action was taken. Mrs Strico lives in a rural and remote area that is 150 kms from the nearest tertiary hospital, medical centre, and Pulmonary Rehabilitation Clinic. English is her second language.

Mrs Strico presented to her nearest General Practitioner (GP) with another “chest infection”. Mrs Strico presents with a productive cough with green sputum, breathlessness, fatigue, pitting oedema in the lower extremities, confusion, chest tightness and wheezing. She has visited her GP three or four times a year with similar symptoms for the past three years. Her last COPD plan was reviewed was nine months ago, where she was advised to cease smoking, given a prescription for Varenicline tartrate but relapsed after a week, and did not return for a follow-up appointment. Mrs Strico has wanted to lose weight and increase her exercise tolerance over the past 12 months, but states that she lacks motivation.

Mrs Strico is prescribed an a short acting Beta2-agonist (reliever) inhaler and a long acting Beta2-agonist inhaler (maintenance). She tolerates these medications but admits that she regularly forgets to take these medications and can never remember which medication to take during a COPD flare-up. She routinely runs out of these medications as the nearest pharmacy is 150kms away.

Mrs Stricos husband died 8 years ago, and she has been receiving an aged care pension since that time. Mrs Strico manages at home by herself, she refuses social help and is adamant that she does not want to leave the home that she has lived in for 30 years. She reluctantly relies on her nearest neighbour to travel with, as it is 150 kms to the closest metropolitan centre for food, health care services and other essentials. Mrs Strico used to be very active as a volunteer in the small community she resides in however, she now finds that she is too exhausted to keep this up. Mrs Strico states that she now has “nothing to do” and feels “isolated and lonely”. She has no children or living relatives in Australia. Although she is aware that her father had COPD, Mrs Strico has limited knowledge regarding the management of this condition and states that she thought little could be done to slow the progression COPD.

During the last year Mrs Strico has gained 6kg and has become less physically active. She has never seen a dietician and her diet consists mostly of snacks and packaged meals that are high in salt and saturated fat. Since her husband’s death, Mrs Strico has been consuming more alcohol (approximately 14 standard drinks per week).

As Mrs Strico is unable to regularly travel the distance to her closest medical centre or tertiary hospital, she only has occasional medical check-ups and her medical records indicate that that her exacerbations of COPD have increased over the last three years.

Step 1: Read the case study of Mrs Anya Strico as provided on page six of this task sheet.

Step 2: Read the National Strategic Framework for Chronic Conditions via the link provided in the Resources available to complete the task section below.

Step 3: Using the information provided in the case study and supported by the best available evidence, apply the National Strategic Framework for Chronic Conditions Strategic Priority Areas (1.1, 2.1 and Objective 3 – Target priority populations) in essay format responding to the following criteria:

Nursing Assignment criteria
Criteria One. Identify the risk factors for Mrs Anya Strico and clearly explain why these are risk factors for her. The discussion must be linked to the National Strategic Framework for Chronic Conditions Strategic Priority Area 1.1 (Promote health and reduce risk).

Criteria Two. Using the best available evidence identify the nursing assessments that are required to be conducted for Mrs Anya Strico and the rationale for each of these.

Criteria Three. Using the best available evidence and demonstrating links to the National Strategic Framework for Chronic Conditions Objective 3 - Target priority populations, discuss why Mrs Anya Strico may be identified as being a priority population and the impact this may have on her chronic condition self-management.

Criteria Four. Using the best available evidence, discuss the self-management priorities that would be developed in collaboration with Mrs Anya Strico. These should consider health promotion and reducing the risk of complications (Strategic Priority Area 1.1) and demonstrate links to the risk factors identified in Criteria One.

Criteria Five. With support from the best available evidence, explain how goal setting may impact on Mrs Anya Strico actively engaging in her care (Strategic Priority Area 2.1)

Answer

Introduction
The case study examined in the present context of nursing assignment focuses on a retired 75 years old widow whose origin is Croatia. Mrs. Anya is facing chronic obstructive pulmonary disease from 8 years since her husband died. Her past medical history reflects a list of diseases that includes breathlessness, chest tightness, coughing, persistent wheezing, edema, fatigue, exercise intolerance, and lack of energy. In order to get a diagnosis with pulmonary rehabilitation, she is asked to lose 5kg weight approximately. She has no children as well as no relatives who can motivate her for losing weight. She takes the help of her neighbor to approach city from her home. She has never consulted any dietitian for her diet, which is now increasing complication of chronic obstructive pulmonary disease. She is not conscious about the negligence of skipping of medication or not following of proper diet. Hence, the aim of the essay is to discuss the National strategic framework for a chronic condition in respect to Mrs. Anya Strico's case study.

The risk faced by Mrs. Anya Strico
Mr. Anya is facing chronic obstructive pulmonary disease for the past 8 years. There is an increase in the severity of chronic obstructive pulmonary disease and this is making her face more complications. There are several risk factors as per the National Strategic Framework for Chronic Conditions that contribute to increasing the level of severity in her chronic condition. It includes behavior risk factors, biomedical risk, and non-modifiable risk determinants that contribute to increase in the level of risk of chronic obstructive pulmonary disease. Behavior risk includes poor diet, as she is more regular to the snacks and packages meal which consist of a high amount of saturated fats, and snacks. These unhealthy things are making her gain more weight. Even, she has increased her alcohol consumption which is approximately 14 drinks per week (Stellefson, Paige, Barry, Wang & Apperson, 2019). Such high level of drink contributes to the increase in the level of fat in her, leading to cause more complications. Biomedical risk factors include factors like the weight that is contributing to the chronic disease. Mrs. Anya has increased 6 kg within a year, which is making her less active physically. Non-modifiable factors such as her age, as she is a 75 years old individual also lead to increase complications. Her age is a factor that offers to reduce the level of metabolism within the body and making it difficult for her to cope up with the progressing complication due to COPD (Patel, Ram, Patel & Kumar, 2019). Hence, these are risk factors or determinants that are becoming risk factors for Mrs. Anya.

Nursing assessment for Mrs. Anya Strico
There are several nursing assessments that are required to be conducted while dealing with the COPD patient such as assessing patient exposure to risk factors, assessing the patient’s past and present medical history, assess the sign and symptoms of COPD and their severity. Assessing patient exposure to the risk factors is necessary to understand the causes that are leading to the progression of COPD is very important (Øfsti, Devik, Enmarker & Olsen, 2020). Assessing the patient's past and present medical history is also an important part of the nursing assessment, as Mrs. Anya Strico is having a list of complications mainly related to the lungs. Hence, also contribute to the progression of COPD in Mrs. Anya Strico. Therefore, this assessment also becomes important for Mrs. Anya Strico. Another nursing assessment that is important is the sign and symptoms of COPD. Assessing the sign and symptoms will help to understand the level of severity Mrs. Anya is facing. Mrs. Anya is facing a number of complications like chest tightness, cough, fatigue, and lack of energy; all indicate that she might be in some critical condition. Hence, for collecting this type of information about the condition of Mrs. Anya, it becomes necessary to condition assess the sign and symptoms of her. There is a primary nursing assessment that is compulsory to be conducted in order to assess the present condition of Mrs. Anya. And finally, another assessment that is required to be conducted is to assess breathe sound and pattern (Cox, Macleod, Sim, Jones & Trueman, 2017). As she is facing COPD, the airways are highly affected, hence marking the breathing sound and pattern help to understand whether Mrs. Anya is facing any complication in the breathing process or not.

Mrs. Anya Strico part of the priority population
The chronic disease impacts Australia, but there is some cause that leads to disproportionally impact the population that is due to the interaction between the social, cultural, physical environment, biomedical, behavior and many such factors (Kitamura et al., 2020). These factors make the population more prone to chronic disease hence they are known as the target priority population. As per the National strategic framework for chronic conditions, it includes a number of populations within their range. Hence, a number factor has worked together to ensure that Mrs. Anya Strico is a part of the priority population (Australian Health Ministers' Advisory Council, 2017). As the framework considers older Australians to be part of the priority population, and Mrs. Anya is 75 years old female living in Australia. Secondly, the framework includes those who live in a remote or rural area and Mrs. Anya need to drive for 150kms to approach the hospitals, to buy necessary things, and every sort of work. And thirdly is facing chronic obstructive pulmonary disease for the last 8 years and as per the National strategic framework for chronic conditions, those who are facing chronic disease will compulsorily be part of the framework. All these factors let Mrs. Anya lead to impact on the chronic condition self-management as her age does not permit her to remember her medication and other necessary steps to manage her (Baird, Lovell, Johnson, Shiell & Ibrahim, 2017). Living in a rural area and old age, even lead her to face a shortage of medication, as regular driving to the city is quite difficult for her. Hence again this hinders the self-management process of Mrs. Anya.

Self-management priorities
Self-management is very important in order to manage chronic disease especially. Chronic obstructive pulmonary diseases are chronic diseases and have a number of risk factors associated with the environment, behavior, and many such things (Vogelmeier et al., 2020). Hence, bringing change required considering the priorities of the self-management and ensures the range of positive health. (Hillebregt et al., 2017) Hence as per National strategic Framework for Chronic Conditions evaluated the fact that prevention of the chronic condition not only relies on the activity undertaken by the health sector but also on the action of the individual (Australian Health Ministers' Advisory Council., 2017). The collaborative approaches for Mrs. Anya focus to provide non-pharmacological steps such as breathing exercises, nutritional programs, light exercise, and stress management. This collaborative approach will help to build on a systematic and clear healthy environment for Mrs. Anya. It will help her to provide clear guidance to deal with the present complication of her (Ogunbayo et al., 2017). Apart from that, it will work to reduce the impact of the risk factors such as behavior, and physical environment determinants. And will provide better self-management capability to deal with COPD.

Impact of Goal setting on Mrs. Anya
The goal setting on Mrs. Anya will let her engage actively in her person-centered treatment. It is very important to set goals and actively participate to ensure a positive outcome. As per the National Strategic Framework for Chronic Conditions, active engagement in the set goals help to improve the knowledge of Mrs. Anya about her COPD, appropriately set goals work to provide the health and social needs to her, it will allow her to have the right care of planning, and finally will provide a quality life (Australian Health Ministers' Advisory Council. 2017). Hence, the goal that will be set for Mrs. Anya Strico includes proper management of enhancing the COPD with the help of the self-management, a regular light physical activity that will work to lower the weight she has gained, it will also consider providing quality of lung function, preventing the reoccurrence of the exacerbation and improving all the symptom that is adding up to the outcome (Kosteli et al., 2017).

Conclusion
It can be stated from the above discussion, that chronic obstructive pulmonary disease is a chronic disease, and self-management is an important part of managing the situation. Mrs. Anya's increasing complication required her engagement in managing herself along with the guidance of the health care. The risk factors are contributed to increasing the level of chronic obstructive pulmonary disease in her and making her face several complications. There is a need to strictly continue the medicine as well as to focus on the other self-management elements such as physical activity, and proper diet control. This will help her to improve the symptom and ensure a quality of life as per her age.

Reference
Australian Health Ministers' Advisory Council. (2017). National strategic framework for chronic conditions. Retrieve through: https://www.health.gov.au/sites/default/files/documents/2019/09/national-strategic-framework-for-chronic-conditions.pdf

Baird, C., Lovell, J., Johnson, M., Shiell, K., & Ibrahim, J. E. (2017). The impact of cognitive impairment on self-management in chronic obstructive pulmonary disease: a systematic review. Respiratory medicine, 129, 130-139. Retrieve through: https://www.sciencedirect.com/science/article/pii/S0954611117301725

Cox, K., Macleod, S. C., Sim, C. J., Jones, A. W., & Trueman, J. (2017). Avoiding hospital admission in COPD: impact of a specialist nursing team. British Journal of Nursing, 26(3), 152-158. Retrieve through: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2017.26.3.152

Hillebregt, C. F., Vlonk, A. J., Bruijnzeels, M. A., van Schayck, O. C., & Chavannes, N. H. (2017). Barriers and facilitators influencing self-management among COPD patients: a mixed methods exploration in primary and affiliated specialist care. International journal of chronic obstructive pulmonary disease, 12, 123. Retrieve through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5214516/

Kitamura, S., Igarashi, A., Yamauchi, Y., Senjyu, H., Horie, T., & Yamamoto?Mitani, N. (2020). Self?management activities of older people with chronic obstructive pulmonary disease by types of healthcare services utilised: A cross?sectional questionnaire study. International journal of older people nursing, 15(3), e12316. Retrieve through: https://onlinelibrary.wiley.com/doi/abs/10.1111/opn.12316

Kosteli, M. C., Heneghan, N. R., Roskell, C., Williams, S. E., Adab, P., Dickens, A. P., ... & Cumming, J. (2017). Barriers and enablers of physical activity engagement for patients with COPD in primary care. International journal of chronic obstructive pulmonary disease, 12, 1019. Retrieve through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5378459/

Øfsti, R., Devik, S. A., Enmarker, I., & Olsen, R. M. (2020). "Looking for Deviations": Nurses' Observations of Older Patients With COPD in Home Nursing Care. Global qualitative nursing research, 7, 2333393620946331. https://journals.sagepub.com/doi/full/10.1177/2333393620946331

Ogunbayo, O. J., Russell, S., Newham, J. J., Heslop-Marshall, K., Netts, P., Hanratty, B., & Kaner, E. (2017). Understanding the factors affecting self-management of COPD from the perspectives of healthcare practitioners: a qualitative study. NPJ primary care respiratory medicine, 27(1), 1-9. Retrieve through: https://www.nature.com/articles/s41533-017-0054-6.pdf

Patel, S., Ram, F., Patel, S. K., & Kumar, K. (2019). Association of behavioral risk factors with self-reported and symptom or measured chronic diseases among adult population (18–69 years) in India: evidence from SAGE study. BMC public health, 19(1), 1-17. Retrieve through: https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-6953-4

Stellefson, M., Paige, S. R., Barry, A. E., Wang, M. Q., & Apperson, A. (2019). Risk factors associated with physical and mental distress in people who report a COPD diagnosis: latent class analysis of 2016 behavioral risk factor surveillance system data. International journal of chronic obstructive pulmonary disease, 14, 809. Retrieve through: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6462160/

Vogelmeier, C. F., Román-Rodríguez, M., Singh, D., Han, M. K., Rodríguez-Roisin, R., & Ferguson, G. T. (2020). Goals of COPD treatment: focus on symptoms and exacerbations. Respiratory medicine, 166, 105938. Retrieve through: https://www.sciencedirect.com/science/article/abs/pii/S0954611120300780

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