Long Term Conditions

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The aim of this essay is to consider approaches to promoting the self-management of a long-term condition. The focus will be linked to module content and based on a patient that I have provided nursing care for during my clinical practice. There will be a brief introduction of the patient and the context in which I was involved in their nursing care. The pathophysiology of the chosen LTC along with the related physical, psychological and social needs of the patient will be considered. There will be a discussion of principles of self-management that will link to national LTC policies. This will also include initiatives and analysis of the evidence of the underlying principles for an approach to providing self-management support, for the chosen LTC, including benefits and challenges. To conclude I will use evidence-based recommendations of how the patient could be supported to self-manage their condition. A wide range of evidence will be used to support my discussion.

The patient chosen to explore, is one who lives with the LTC of Parkinson’s. The patient had started to experience Motor Fluctuations, also referred to as “off “ periods. Motor Fluctuations are associated with long-term use of levodopa and usually appear in people who have had Parkinson’s for some time, patients experience “end-of-dose deterioration” meaning that the dose does not last until the next dose is due (Parkinson’s.org 2008). This patient spent one week on a neurology rehabilitation unit. The context in which I worked with this patient was to assist with the teaching of an apomorphine syringe driver and to assess “on and off” periods before the use of the pump and then when the pump was in use and also to ensure that there were no side effects to its use. During this week I worked alongside a team of occupational therapists and physiotherapists, as it was essential that the patient regained confidence with daily activities, personal cares, dressing and food preparation. The aim of the teaching was to enable the patient to become independent with the apomorphine pump from being able to perform a subcutaneous injection to its removal when medication had finished. It was vital that the patient became competent and confident in the process as they had been very active throughout their life and wanted to remain so for as long as possible.

Parkinsons.org (2010) describe Parkinson’s as the disease with no obvious cause and is the most common form of Parkinsonism; the other forms of Parkinsonism are vascular, Drug-induced Parkinsonism, dementia with Lewy bodies, inherited and Juvenile. Vascular is an uncharacteristic form of Parkinsonism and usually presents with difficulties in speaking, swallowing and the ability in making facial expressions. Drug-induced Parkinsonism occurs in 7% of people and is attributed to neuroleptic medication which block dopamine these drugs normally treat schizophrenia and other psychotic conditions and once the problem has been diagnosed then the person will recover in hours, days or months after ceasing taking the medication. Dementia with Lewy bodies has no cure and symptoms include difficulties with concentration, memory, language and the ability to carry out straightforward actions. Many people suffer from hallucinations, sluggishness of movement, rigidity and tremors. Dementia with Lewy bodies is similar to Alzheimer’s. Inherited Parkinson’s is rare and there is no evidence that is can be passed on in families, however it is estimated that 5% of people with Parkinson’s may have a genetic cause. Juvenile is a term used for persons diagnosed under the age of twenty years.

As NICE clinical guidelines 35 (2006) states, Parkinson’s disease is a progressive neurodegenerative long-term condition and mainly affects those of middle to old age. Parkinson’s occurs when the cells containing dopamine die off. At present there is no consistent test that can define if a patient has Parkinson’s due to the close clinical...
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