NUR09400: Management of Chronic Disease: Patient Analysis

You are required to:
Part 1:

1. Identify an assessment tool relevant to you patient’s condition?
2. Discuss using relevant evidence the advantages of this tool in helping to assess the symptom?
3. Explore the evidence and discuss a limitation of this assessment tool?
4. Provide a conclusion summarising key points.

Part 2:

1. With reference to the symptom, you selected for part one of the portfolio, discuss the potential impact on the patients physical, psychological and social well-being of experiencing this symptom.
2. Support this discussion with relevant evidence (references/sources).

Part 3

1. Discuss the holistic nursing management required to enable the patient to maximise their health and well-being whilst living with their chronic condition.
2. Include the role of carers, voluntary/3rd sector, and other relevant multi- disciplinary team members.
3. Discuss how self-management can be encouraged.
4. Support this discussion with relevant evidence (references/sources).

Part 4:

1. Reflect on your learning within the module.
2. Use three bullet points to identify key aspects of your learning.
3. Clearly explain the impact these will have on your practice.

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The patient conditions selected for the purpose of analysis is 68 year old Singapore patient suffering with chronic hypertension known as Mr Lim Wei Hong, and post MI, the patient is presented with peripheral oedema suggestive of heart failure.
Relevant assessment tool: The most appropriate assessment tool for the given case scenario of Mr Lim is pitting oedema assessment scale. This scale is highly suitable as it provides grading in relation to the depth and rebound time of oedema after applying pressure to the swollen area.
Advantages: The advantage of this tool is that it is simple, quick and non-invasive and it helps in detecting severity and progression of fluid retention in heart failure situations.
Limitation: The limitation of this scale is its subjective scoring and it does not provide information on the underlying cause of fluid overload.

Impact of symptom on the wellbeing

The physical impact can be in the form of reduced mobility, shortness of breath and inability to perform daily activities, whereas the psychological impact is in the form of anxiety, loss of confidence and low mood. In terms of social impact, it leads to reduced social participation and there is high risk of social isolation because of mobility problems.
Supporting evidence: There is close association of heart failure related oedema with poor mobility, reviews quality of life and psychosocial burden.

Holistic nursing management

The nursing management is crucial in maximizing the health and wellbeing which could be achieved through daily weight monitoring, medication support, fluid and sodium restriction, skin care and encouraging physical activity. The role of carers is crucial including that of cardiologist, dietitian, physiotherapist and caregivers.
Self management is crucial and Lim needs to be taught about how to recognise early signs of fluid overload using a daily log book for blood pressure.
Reflection on learning: This module has been significant from the point of view of gaining understanding about chronic condition management and patient centred care. The key learning points are the importance of structured assessment tools, multidisciplinary teamwork and the need for patient education. Its impact on my practice will be my ability to use more reliable assessment tools during clinical evaluation.

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