Chronic Care Across the Lifespan - Part A

Asthma is one of the negative respiratory episodes that directly increase breathing complication for the patient and lead to poor health status. Some of the factors that trigger the asthma prevalence include smoking, genetic factor, unhealthy working space, unhealthy food, stress and alcohol use (Oland et al., 2017). These risk factors are evident in the case study that directly reflects the triggering factor that has increased risk for Noel to encounter asthma. The study presented by Gans et al. (2019) discussed that if tobacco is the triggering factors it leads to the Th17 cells activation lead to the release of the IL-17 and IL-22 that activate the neutrophils. The allergens from the pollution and the systemic inflammation lead to the activation of the Th2 cells that lead to the IgE production leading to bronchoconstriction causing the respiratory complication. The prognosis of asthma in the case study can be due to the smoking habit of Noel as he smokes 30 cigarettes a day that leads to the triggering of asthma and another reason that can initiate the prognosis is the allergens from the mining.

One of the abnormal data that is related to the case study is that Noel has habit of smoking 30 cigarettes per day. One of the studies presented by Belvisi et al. (2018) discussed on average more than 10-15 cigarettes per day lead to the increased risk for the asthmatic condition. The body mass index of the patient reveals that he is in in the initial phase of the obesity due to the BMI is 30.7 kg/m2 which also increase the complication for the patient. According to Vennu et al. (2019) obesity increases risk health-related complication for the patient like a cardiovascular issue or diabetic condition which deteriorates patient condition. The patient blood pressure that is 155/95 mmHg reveals the hypertension state which increases health-related complication like cardiovascular disorder risk. Singh et al. (2017) state that hypertension that is blood pressure above 140/90 mmHg is the health issue that leads to the poor health status of the patient by increasing susceptibility for different disorder. Some other data that is deviated include increased heart rate with respiratory rate, audible wheeze, decreased air entry and decrease SpO2. The overall health interpretation reveals that Noel is facing issue while respiration due to asthma that has also increased the complication for increasing heart rate leading to hypertension state.

Chronic Care Across the Lifespan - Part B

The patient has faced both acute and chronic state that has directly decreased the health wellbeing of the patient. One of the acute issues related to Noel is the asthma attack he encountered that lead to the admission to the emergency department with the complaint of dyspnoea and wheezing. One of the studies presented by Quirt et al. (2015) discussed that asthma attack is the state that occurs in the patient having past medical history of asthma that initiated due to the exposure to the triggering factor. The exposure from the triggering factor leads to the reoccurrence of the symptoms that increase patient complication. Another acute issue that can be identified from the case study is the hay fever of the patient leading to increase seasonal complication. According to Geddes (2015), discussed that hay fever is the reaction that occurs due to the allergens which trigger the negative episode in the patient.

There is a different chronic issue that leads to the increasing patient complication includes hypercholesterolemia, hypertension and obesity. The study presented by Ibrahim et al. (2020) discussed that when bad cholesterol increase in the body leading to a negative effect over the body know as hypercholesterolemia state. Another study presented by Jiang et al. (2016) hypertension and obesity is considered to be a health disorder that increases cardiovascular or metabolism issue for the patient and leading to hypertensive state that is life-threatening. The current patient information reveals that the patient has increased BMI, increased blood pressure, cholesterol level that negatively impacted the patient health status leading to increase complication like negative cardiovascular events. Smoking is another chronic issue that leads to the increased complication for Novel leading to the asthmatic condition and attack in the patient. Wang et al. (2019) added that tobacco consumption is considered to be the chronic issue in the patient as increase the complication for the patient leading to the deteriorated health condition like respiratory disorders, cancer. 

Specific: I will try to decrease the smoking on daily bases from 30 cigarettes to the 10 cigarettes in the one month to improve the health status and decrease negative episode prevalence and it will be measure by using Fagerström Test

Measurable: 1 week: 25 cigarettes

2 week: 20 cigarettes

3 week: 15 cigarettes

4 week: 10 cigarettes

Achievable: The goal can be attained by slowing decreasing the dependency over the cigarettes which help in the cessation process.

Realistic: The goal is realistic as smoking cessation is an attainable goal and different therapies session can is used to improve the commitments to reduce the number of cigarettes successively.

Timely:  The four-week time span is right to reduce the smoking rate in the individual and evaluation will be done to understand the progress of the smoking cessation.

One of the nursing interventions that can help Noel is the educational intervention which will help them to improve their understanding concerning the negative aspect of the smoking. One of the studies presented by Sherman & Smith (2019) discussed that nurses are the major player in the patient care and they are expected to provide the right assistance to the patient by adopting educational intervention. The educational intervention will help the nurse to explain the patients about the negative effect of smoking over the body and strategies that help to decrease the dependency over the cigarettes. The nurse can also help them to understand the different pharmacological and non-pharmacological option that can be adopted to improve the cessation process.

Another intervention where nurses can help Noel is cognitive behavioural therapy which will also help him to decrease the dependency over the cigarettes which lead to a reduction in the consumption rate of the patient. The article presented by Martínez-Vispo et al. (2019) discussed that thought process play an important role in quitting something and smoking is one of the difficult habits that can be quitted without external help. Cognitive behavioural therapy is considered to be the preferred option to improve the thought process of the individual that is necessary to decrease the dependency over smoking. The therapy helps the individual to improve the skills and self-efficacy to slowly reduce the rate of smoking by improving the self-determination. Cognitive behavioural therapy leads to the behavioural activation that is important to support the quitting process and improve the health wellbeing (Martínez-Vispo et al., 2019).

The last intervention that can be adopted to improve the smoking cessation goal of Noel is the 5 A’s model on smoking-cessation interventions that help the patient to get the support of nurses in the process. The study presented by Mak et al. (2018) discussed that 5 A’s model on smoking-cessation interventions is the preferred option to initiate the quitting process. The framework includes Ask, Advise, Assess, Assist and Arrange from the nurse’s end to support the patient and improve the behavioural change in the patient leading to the smoking cessation.

Two methods will be used for the evaluation purpose of the smoking cessation rate in the Noel and these methods include Smoke Check meter and oral questionnaires. The study presented by Aggarwal et al. (2014) discussed that smoking cessation is a gradual process thus continuous evaluation is important to understand the progress of the process. The Smoke Check meter is the device that can help to detect the intensity of the smoking pattern of the individual by detecting the gases in the exhalation process. The detection of smoking intensity of the individuals will be displayed concerning the different colour that helps to detect the intensity of the smoking. Another option that can be adopted in the evaluation process is the oral questionnaire that will understand the patient perceptive by using the open-ended question concerning the smoking pattern of the individual. The questionnaires will also help the patient in the reality check concerning the commitment to the goal and it will help them to improve the practice which ultimately leads to the smoking cessation. Both of the methods can be utilized to evaluate Noel current dependency and smoking pattern to identify the success of the intervention in the setting.

Chronic Care Across the Lifespan - Part C

The chronic health condition of Noel needs the support of the health care professional to improve the self-efficacy and self-management ability to deal with the odds situation related to health status. Nurses are considered to be a major workforce in the health care setting that directly increased their responsibility to help the patient in the care by using the holistic approach (Farley, 2019). Chronic health condition of the patient requires the better ability of the individual to deal with the odds so that further complication cannot occur. Nurses are expected to improve the self-efficacy of the patient by providing the supporting environment and accessibility to the patient toward the right care resources. The nurses are expected to support the patient in the care process that leads to the better commitment of the patient toward the care which leads to the better health status of the patient. The nurses are expected to understand and support the patient health literacy so that patient can effectively participate in the care process which is important to improve the self-efficacy of the patient (Farley, 2019). The nurse can help Noel by improving the understanding regarding the right approach toward the strategies that can help to improve the self-efficacy of the patient leading to better health status.

Self-management is important skills of the patient that help them to hold the power to stabilize their health status by utilizing their skills. Patient with a chronic health condition is expected to have better self-management ability to deal with the fluctuated health status that is important to maintain the wellbeing (Grady & Gough, 2014). Nurses are expected to support the patient in improving their self-management ability by improving the individual skills to regulate the different activates that positively support health. The nurse should collaborate with the patient to improve their understanding concerning the entire negative event that occurs due to the chronic health condition and improve their understanding of reading different strategies to deal with them. The better rapport of the nurses and patient in the care directly improve the individual self-management skills which are important to support the health status and self-manage the deteriorated health to decrease the risk of any major complication. The self-management skills improve the individual ability to take account of their health and work in a constructive way (Grady & Gough, 2014). The nurses can help Noel to improve his self-management skills to deal with the asthmatic condition which will directly improve the wellbeing by reducing the chances of asthmatic attack. 

References for Chronic Care Across the Lifespan

Aggarwal, P., Varshney, S., Kandpal, S. D. & Gupta, D. (2014). Tobacco smoking status as assessed by oral questionnaire results 30% under-reporting by adult males in rural India: A confirmatory comparison by exhaled breath carbon monoxide analysis. Journal of Family Medicine and Primary Care3(3), 199–203. https://doi.org/10.4103/2249-4863.141606

Belvisi, M. G., Baker, K., Malloy, N., Raemdonck, K., Dekkak, B., Pieper, M. & Birrell, M. A. (2018). Modelling the asthma phenotype: Impact of cigarette smoke exposure. Respiratory Research, 19(1). https://doi.org/10.1186/s12931-018-0799-7 

Farley H. (2019). Promoting self-efficacy in patients with chronic disease beyond traditional education: A literature review. Nursing Open7(1), 30–41. https://doi.org/10.1002/nop2.382

Gans, M. D. & Gavrilova, T. (2019). Understanding the immunology of asthma: pathophysiology, biomarkers, and treatments for asthma endotypes. Paediatric Respiratory Reviews. https://doi.org/10.1016/j.prrv.2019.08.002 

Geddes, L. (2015). Hay fever: Not to be sneezed at. New Scientist, 226(3016), 29–30. https://doi.org/10.1016/s0262-4079(15)30120-2 

Grady, P. A. & Gough, L. L. (2014). Self-management: A comprehensive approach to management of chronic conditions. American Journal of Public Health104(8), e25–e31. https://doi.org/10.2105/AJPH.2014.302041

Ibrahim, M. A, Asuka, E. & Jialal, I. (2020). Hypercholesterolemia. Treasure Island, United Kingdom: StatPearls Publishing.

Jiang, S. Z., Lu, W., Zong, X. F., Ruan, H. Y. & Liu, Y. (2016). Obesity and hypertension. Experimental and Therapeutic Medicine12(4), 2395–2399. https://doi.org/10.3892/etm.2016.3667

Mak, Y. W., Loke, A. Y. & Wong, F. (2018). Nursing intervention practices for smoking cessation: A large survey in Hong Kong. International Journal of Environmental Research and Public Health15(5), 1046. https://doi.org/10.3390/ijerph15051046

Martínez-Vispo, C., Rodríguez-Cano, R., López-Durán, A., Senra, C., Fernández Del Río, E. & Becoña, E. (2019). Cognitive-behavioral treatment with behavioral activation for smoking cessation: Randomized controlled trial. PloS One14(4). https://doi.org/10.1371/journal.pone.0214252

Oland, A. A., Booster, G. D. & Bender, B. G. (2017). Psychological and lifestyle risk factors for asthma exacerbations and morbidity in children. The World Allergy Organization Journal10(1), 30-35. https://doi.org/10.1186/s40413-017-0169-9

Quirt, J., Hildebrand, K. J., Mazza, J., Noya, F. & Kim, H. (2018). Asthma. Allergy, Asthma, and Clinical Immunology: Official Journal of the Canadian Society of Allergy and Clinical Immunology14(Suppl 2), 46-50. https://doi.org/10.1186/s13223-018-0279-0

Sherman, J. J. & Smith, B. L. (2019). Effect of a smoking cessation educational intervention on knowledge and confidence of pharmacy students versus community leaders. Pharmacy Practice17(1). https://doi.org/10.18549/PharmPract.2019.1.1302

Singh, S., Shankar, R. & Singh, G. P. (2017). Prevalence and associated risk factors of hypertension: A cross-sectional study in urban Varanasi. International Journal of Hypertension, 5491838. https://doi.org/10.1155/2017/5491838

Vennu, V., Abdulrahman, T. A. & Bindawas, S. M. (2019). The prevalence of overweight, obesity, hypertension, and diabetes in India: Analysis of the 2015-2016 national family health survey. International Journal of Environmental Research and Public Health16(20), 3980-3987. https://doi.org/10.3390/ijerph16203987

Wang, R., Jiang, Y., Yao, C., Zhu, M., Zhao, Q., Huang, L. & Zhao, G. (2019). Prevalence of tobacco related chronic diseases and its role in smoking cessation among smokers in a rural area of Shanghai, China: A cross sectional study. BMC Public Health, 19(753), 1-10. https://doi.org/10.1186/s12889-019-7110-9

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