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Table of Contents
The purpose of this study is to critically assess and analyze a psychological, biological, and sociological point of view, holistic care requirements and its impact on the well-being and health of the patient from placement. The patient was hospitalized with Crohn's disease. Jasmine Singh is a 24-year-old patient who suffered from Crohn's disease. Her father had a history of hypertension and arthritis. Her mother had no history of past treatment. As a clinical course at the hospital, two days ago she was referred to the emergency department in a condition experienced by Jasmine for three days with severe lower right quadrant abdominal pain. It is associated with diarrhea that lasts for several weeks and rectal bleeding begins at the beginning of the week. Jasmine is feeling tired, sick and her colleague in the office feel she has lost weight (Kemp et al. 2018). Further evaluation of her GIT system revealed that she has had period of anorexia in the previous, mainly when her bowel motion become too frequent.
It is clear that Jasmine is suffering from anorexia again. A fecal occult blood test confirms blood in her stool and her blood results show low hemoglobin and low blood cells as indicators of anemia and high C-reactive protein. Jasmine was diagnosed with the acute exacerbation of her Crohn’s disease and was admitted to the University Hospital. She was admitted in the ward for nutritional support to maintain or monitor fluid as well as nutritional support, electrolyte balance, and stool/bowel management and evaluation (e.g. volume, color, frequency, and stool continuity). Jasmine also admits that she suffers from severe stress at work and her normal coping mechanisms have not been supporting (Lichtenstein et al. 2018).
Her abdominal pain is 6-10. Jasmine tells me that it is awful before she had the bowels motion, put double pressure; there is some relief when she passes stool, but after eating it increased again. The pain started 3 days ago and it is normal but the intensity varies. It is moved from the feeling of obstruction when it is in the worst position, sharp and perforated, bad on the right. Sometimes a hot water bottle provides some relief.
Several examinations are used to diagnose and evaluate the severity of long-term IBD, such as endoscopic, biochemical, histological, and radiological. Additionally, diagnosis of Crohn’s disease (CD) depends on barium and endoscopic studies to detect the stage of the disease as well as the occurrence of granulomatous inflammation in the biopsy. In this context, certain diseases of the CD are diagnosed due to indeterminate results related to sigmoidoscopy and colonoscopy, as well as failure to detect granuloma on the histology. In this case, a diagnosis of indeterminate colitis is completed (Wilburn et al. 2017).
This is more likely to occur before the age of 30. Several studies indicate that 1 in 5 people with Crohn's disease had a family member with same condition. It means that family history increases the chances of contracting the disease.
There are a number of factors that can contribute to Jasmine's stress and these can also contribute to the progression and severity of the condition. Stress has harmful effects that can increase the chances of people making a CD.
Maintain good and trustworthy relationships with other healthcare providers to get better results from your patient care plan.
S - As future nurses we need to maintain good working relationships with other healthcare teams. When the clinical practice begins, I will increase my confidence with all the team members I work with, such as recreational and health practitioners, dietitians and director of healthcare to personalized nursing care plan of my future patient in the healthcare (Siegel, 2018).
M - Before starting the shift, I will take the confirmation from the nurse on duty and read the report from the earlier shift so that I can find out what has happened in the last 16 hours.
A - I will give at least 30 minutes for patients to attend care conferences and staff meetings to find out if there are any updates to patient care plans and if I have any notions that I can propose and I can share. In case, there are some explanations that I should understand I can ask my coworker.
R - I work as a care assistant and I work with all the nurses and other care teams to design the best care for patients. As an ambitious nurse I have to work with the whole target care team because we have shared the goal and to improve the patient (Stewart, 2017).
T - After clinical practice, I will use the collaborative experience with all healthcare providers and ensure that we maintain the same attitude to patient well-being.
To better known Jasmine’s grief, denial of the condition, and bereavement of relationship is the “Elizabeth Kubler-Ross's” research on a five-stage of grief. It is owing to the grief means emotional reaction to other loss of the social status of individual, the loss of health because of illness as grief is recognized to be individualized. Moreover, this theory describes that Jasmine can overcome the grief and stages that include anger, denial, bargaining, acceptance, and depression. Additionally, this theory is very effective in recognizing the levels of crisis at individual levels, but it also gives the long term that people can have this problem. It is important for the nurse to understand the grief process, because without the understanding and support of the nurse and the multidisciplinary team (MDT) during the grief process, the patient may feel more restless, angry and isolated. Research also shows that when separated, people may experience feelings of anxiety and sadness that are stronger than expressing their emotions, these emotions are usually hidden. This study was applied to Jasmine because not mentioning her feelings can be frustrating and possibly worse (Farraye et al. 2017).
It is understandable that Jasmine did not want to be categorized as an ill role and said that she did not want to lose her independence as she did not get family support because of her mother and father living abroad. So, in that situation nurses should educate Jasmine about her mentality and assure her that she would not be lost her independence or accept feeling of weakness, but by taking an ill role, she is better able to deal with her condition by working with healthcare experts to communicate with Jasmine effectively in the non-judgmental way and make her feel comfortable. In addition, taking on unhealthy roles can lead to further health promotions such as helping Jasmine participating in healthy eating and exercise programs that nurses can provide. However, as a result of this intervention, Jasmine had to work with MDT to provide more information on how healthy eating habits and unhealthy lifestyle choices affect her condition (Farraye et al. 2017).
In order to provide adequate nursing care to Jasmine, the Neuman’s system model is thought to be related to psychological problems related to her condition. This model addresses stress issues and their relationships with caring patients. Also, the model emphasized that most human components in patients are surrounded by various dense processes, including different lines of resistance, common lines of defense, and flexible lines of defense. This model can be applied by nurses to teach Jasmine the importance of taking antidepressants medication and other medicines to prevent CD remission. Further, the nurse should educate her about the impact of depression and stress while preparing for her surgery. A study by Farraye et al. (2017) explains that depression and stress during surgery can affect quality of life of patient as a result of poor patient outcomes. This study is certainly relevant to Jasmine because she believes that an unhealthy lifestyle has nothing to do with the predictions of her condition, but it is an appropriate way to deal with the stress related to CD as those who do not live a healthy life generally believe that it decreases the stress levels. As a result, it is important for nurses to recognize Jasmine as individual and to analyze the health behaviors and the health beliefs associated with her.
The physical management of Inflammatory bowel disease remains a significant factor of caring for IBD patients. However, the psychological and social challenges of managing IBD need to be addressed in order to achieve holistic treatment. Nurses working with IBD patients should have a clear idea of the problems, physical symptoms, and psychological and social effects that the patient is experiencing. Awareness of basic nursing concepts is important for understanding patients ’experiences and providing support such as acceptance, empathy and trust. Continuing to study is also important. The goal of education is to allow the patient to manage daily symptoms of her condition, to improve self-control and integration with medication, enable self-management, as well as reduce inpatient stay and hospital visit. In general, the goal is to accomplish a more proactive way to managing long-term conditions (Day et al. 2020).
In the healthcare, specialist nurse provide assistance to IBD patients. The nurse works as a part of the multidisciplinary team to enhance the management of patient with Crohn’s disease, provide nurse-led surgeries, open access telephone services, and immunoprecipitation monitoring.
In other words, nutrition is a foremost reflection in the management of IBD patient. A complete nutritional assessment should be documented regarding body mass index, dietary intake, current weight and weight loss. In addition, weight loss shows the severity of disease activity. Also, nutrition is provided as a therapy in CD management. The initial diet covers pre-digested nutrients fascinated in the first meter of the small intestine. This diet is supposed to reestablish nutritional status and allow the bowel to rest, both of which are measured to be the best condition for intestinal treatment. It is used less than the polymeric diets that has a standard nutritional balance. It has been proven that nutritional therapy, including adequate emotional and physical support can accomplish the remission rate of around 70%. The success of nutrition therapy for Jasmine relies upon the actual support of a multi-disciplinary team. The team will include nursing and medical staff, psychologists, and specialist dietitians. They will make sure that patient is able to handle therapy both physically and emotionally (Day et al. 2020).
Nursing care plan
Nursing care management of Jasmine with inflammatory bowel disease contains promoting optimal bowel function and nutrition, control of diarrhea, prevent or minimize complication, and provide information on disease processes and treatment requirements. Acute abdominal muscular pain is associated with double degree pain scores of Crohn’s diseases, verbalization of abdominal pain and cramping, as well as protecting sign on abdomen. The patient will show a relief of pain as demonstrated by the pain score of 0 out of 10, stable vital signs, and no instability (Péntek et al. 2017).
Administer prescribed medicines that lessen the symptoms of stomach pain.
Anti-inflammatory drugs, such as oral 5-aminosalicylates and corticosteroids – primarily used to minimize the inflammation.
Biologic and Immunosuppressant drugs – reduce inflammation by pointing the immune system.
Antibiotic – used to drive away harmful bacteria found in the bowel and to reduce fluid formation as well as drainage from abscess and fistula.
Vitamins and supplements
Evaluate the patient’s actual sign and nature of pain as a minimum 30 minutes after the administration of drug.
To review the efficiency of medical treatment for the relief of stomach pain and heartburn.
The time of examining of vital sign may rely upon the topmost time of the medication administered.
Educate the patient on how to make non-pharmacological pain relief techniques, for example massage, deep breathing, acupressure, distraction, biofeedback, guided imagery, and music therapy.
To minimize the levels of stress, thus relieving the symptom of Crohn’s disease, mainly stomach pain.
Assist the patient to choose suitable dietary selections to minimize the intake of caffeinated drinks, milk products, and high fat foods.
To relieve abdominal pain and cramping, lessen diarrhoea, and healthy food behaviours
The key to successful management of IBD patients is psychological support. Give patients the ability to make choices, educate themselves about the disease and its impacts on their lives, so that they can be responsible for their condition. This should be supported by building effective relationships. The role of the nurse cannot be underestimated by satisfying all these elements. In conclusion, the terms health and wellness are defined as lack of disease, physical illness, and mental distress. The concept of health and well-being differ between different stages of human life, different cultures and changes over time. In addition, the biopsychosocial model of well-being and health were used to understand Jasmine’s insight of her psychological, physical, and social well-being. Besides, Crohn’s disease affects parts of the gastrointestinal tract from the mouth to the anus with symptom from weight loss, abdominal pain, and diarrhea. Moreover, the biopsychosocial model of well-being and health has confirmed to be effective in recognizing Jasmine’s complete treatment requirement as well as giving person-centered and individualized care to the patient.
Day, A., Wood, J., Melton, S., & Bryant, R. V. (2020). Exclusive enteral nutrition: An optimal care pathway for use in adult patients with active Crohn's disease. JGH Open, 4(2), 260-266.
Farraye, F. A., Melmed, G. Y., Lichtenstein, G. R., & Kane, S. V. (2017). ACG clinical guideline: preventive care in inflammatory bowel disease. American Journal of Gastroenterology, 112(2), 241-258.
Kemp, K., Dibley, L., Chauhan, U., Greveson, K., Jäghult, S., Ashton, K., ... & Moortgat, L. (2018). Second N-ECCO consensus statements on the European nursing roles in caring for patients with Crohn’s disease or ulcerative colitis. Journal of Crohn's and Colitis, 12(7), 760-776.
Lichtenstein, G. R., Loftus, E. V., Isaacs, K. L., Regueiro, M. D., Gerson, L. B., & Sands, B. E. (2018). ACG Clinical Guideline: Management of Crohn's disease in adults. American Journal of Gastroenterology, 113(4), 481-517.
Péntek, M., Lakatos, P. L., Oorsprong, T., Gulácsi, L., Pavlova, M., Groot, W., ... & Group, C. S. D. R. (2017). Access to biologicals in Crohn’s disease in ten European countries. World Journal of Gastroenterology, 23(34), 6294.
Rao, B. B., Click, B. H., Koutroubakis, I. E., Ramos Rivers, C., Regueiro, M., Swoger, J., ... & Binion, D. G. (2017). The cost of Crohn's disease: varied health care expenditure patterns across distinct disease trajectories. Inflammatory bowel diseases, 23(1), 107-115.
Siegel, C. A. (2018). Refocusing IBD patient management: personalized, proactive, and patient-centered care. American Journal of Gastroenterology, 113(10), 1440-1443.
Stewart, D. (2017, December). Surgical care of the pediatric Crohn’s disease patient. In Seminars in Pediatric Surgery (Vol. 26, No. 6, pp. 373-378). WB Saunders.
Venkata, K. V., Arora, S. S., Xie, F. L., & Malik, T. A. (2017). Impact of vitamin D on the hospitalization rate of Crohn's disease patients seen at a tertiary care center. World journal of gastroenterology, 23(14), 2539.
Wilburn, J., Twiss, J., Kemp, K., & McKenna, S. P. (2017). A qualitative study of the impact of Crohn's disease from a patient's perspective. Frontline Gastroenterology, 8(1), 68-73.
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