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NUR3005 Chronic Illness Management In Primary Care

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NUR3005 Chronic Illness Management In Primary Care Question: Discuss about the Chronic Illness Management In Primary Care.     Answer: Introduction Osteoporosis is a disease characterized by increasing bone weakness, decreasing bone density, and elevated risk of a broken bone (Rachner, 2011). The disease is the main reason for broken bones among the seniors. Some of the common bones break include the hip, vertebrae in the spine, and bones of the forearm. The disease has no symptoms and is only discovered when bones break. It affects the density of bone leading to a porous bone which is compressible. This condition weakens the bone and results in fractures. Bone density decreases with age and is also accelerated by other factors such as lower levels of estrogen among women. It may also occur due to treatment procedures or diseases such anorexia, kidney disease, etc. Also, various medications influence the rate of bone loss and contribute to the bone weakening. Osteoporosis is a major disease among people aged 50 years and above and has raised public health concerns (Riggs, 2012). Approximately 8 million people in the US are reported to have osteoporosis (Korhonen, 2013). About 60% of people with osteoporosis in the US are aged 50 years and older. Health care costs incurred in the treatment of osteoporosis fractures amount to billions of dollars. This diseases not only increases the financial burden for families but also affects productivity. It is reported that 15% of people who experience a hip fracture are likely to die within two years (Looker, 2012). The social and financial implications of this disease adversely affect the society. Therefore, it is essential to assess how various healthcare stakeholders can tackle this condition to mitigate its risk as well as its impacts on the nation’s economy and the society. In this report, we’ll investigate osteoporosis, identify risk factors, and its impacts on people’s life. The elderly are considered as the main age group through which the disease can be assessed. The report will also look into the role of a nurse in delivering patient-oriented care that can mitigate the risk of the disease as well as improve patient outcomes. Osteoporosis Pathophysiology Poor bone mass acquisition during growth and an increase in the rate of bone loss are the main mechanisms that contribute to the development of osteoporosis. These mechanisms are influenced by environmental and genetic factors. Many postmenopausal women are at high risk of increased bone loss after reaching peak bone mass. Race also influences development of the disease as peak bone mass tends to vary among different races (Antonelli, 2014). About 50% of the bone mass gained during puberty is linked with high sex hormone levels. However, there is minimal accumulation of bone mass among young adults. Peak bone mass is realized when a person reaches 30 years of age. Genetic factors are reported to influence bone mass. Approximately 40% of the variability in bone mass is determined by genes (Emkey, 2014). Some of the genes linked to osteoporosis include collagen, transforming growth factor- β, those that regulate estrogen reception, etc. In contrast to gaining boss mass, bone loss is largely determined by environmental factors such as diet, lifestyle, medication, etc.   Risk Factors Nutritional factors Development of Osteoporosis can arise from various factors including nutrition, behavior, or medication. Key nutritional factors that play a role include calcium intake, protein intake, Vitamin D levels, among others. It is reported that low calcium intake during childhood can elevate the risk of the disease later in life. Studies show that seniors who had low calcium levels in their childhood were likely to have the disease as it was directly linked to the bone mineral mass (Garriguet, 2011). Calcium supplementation is a key treatment method that helps to reduce the rate of bone loss among elderly persons at risk of osteoporosis. Calcium intake varies depending on age. Some age groups especially the elderly and children have higher calcium intake than other age groups. The typical diet in western countries has high levels of sodium and protein which increase calcium excretion hence people in these countries require to take more calcium. Vitamin D and protein are key elements that also play a role in the body. Vitamin D plays an essential role in the bone tissue as it regulates calcium absorption. Its nutritional status affects the level of calcium absorption. Studies show that vitamin D levels decrease with age hence seniors have lower levels of Vitamin D than other age groups which significantly impact calcium absorption (Powe, 2011). Aged people have to take Vitamin D supplements to reduce the risk of osteoporosis. Protein malnutrition affects the growth of soft tissue which reduces the tissue covering the bones (Rizzoli, 2014). Protein intake largely determines the result of fractures, especially hip fracture. Behavioral Factors Various behavioral factors such as physical activity and drugs play a role in the development of the Osteoporosis. Studies show that athletes have higher bone mass than non-athletes. This is particularly noted among athletes who regularly engage in strength training. Mechanical loading during training is shown to increase bone mass (Langsetmo, 2012). On the other hand, decreasing mechanical load reduces bone mass. The relationship between bone mass density and the mechanical load is apparent at low levels of loads. Patients who are completely immobilized have high bone mass loss amounting to over 30% in 1 year. People who are physically active have high bone mass density than the average population (Khawaji, 2010). Bone metabolism occurs as a result of the interplay between hormones, nutrients and physical activity. A deficit in one of these areas can increase the risk of osteoporosis. Chronic alcohol is attributed to decreasing bone mass density in the lumbar spine and neck (Broulik, 2010). The prevalence of osteoporosis among alcoholics is reported to be over 30%. It is much higher among the elderly who regularly consume alcohol. Chronic alcohol is also associated with nutritional deficiencies which contribute to osteoporotic-related fractures (Maurel, 2010). Smoking is another risk factor for decreasing bone mass that affects bone mass development. It is associated with an increase in rate of bone loss which is pre-requisite to osteoporosis. Medications Several medications are linked with bone loss. Glucocorticoids are key medications that are attributed to an elevated rate of bone mass loss (Lekamwasam, 2012). Studies also show that bone loss is high during the first use of steroid intake. The rate of bone loss is estimated to be as high as 20% which increases the risk of fractures. Patient taking corticosteroids for more than six months have a high incidence of osteoporotic fractures. Estrogens are essential for the development of bone mass and bone maintenance in both men and women. Low levels of estrogen among women above 50 years are the main cause of postmenopausal osteoporosis (Tyagi, 2012).   Signs And Symptoms Osteoporosis becomes evidence when a fracture occurs. A majority of the fractures are painless. In some cases, patients may have fractures accompanied have episodes of acute pain after suffering a minor trauma. The pain experienced may range from sharp to dull (Nieuwenhuijse, 2012). Movement of a limb with a fracture tends to increase the pain, and in some cases, the pain is radiated to the abdomen. Muscle spasms accompany pain and are exacerbated by physical activity. Acute pain subsides after a month, but in cases where patients have multiple fractures, the pain becomes chronic. Patients with chronic pain are unable to walk or do any work at ease. Often, they stay motionless in bed with fear of exacerbating pain. Patients with a hip fracture may experience pain in the groin and medial knee. Often, the fracture decreases the hip range of motion which diminishes the walking ability of patients. The patients may also demonstrate a limited range of motion with pain and decreased weight-bearing on the fractured area. Physical examination done on patients with vertebral fractures indicate loss of lubra lordosis and exaggerated cervical lordosis. Patients that have Colles fracture may have bayonet deformity and tend to experience pain when moving their wrists (Esses, 2011). On the other hand, patients with sacral fractures experience pain when they move. People especially the elderly who have osteoporotic fractures have difficulty in performing tasks as they are limited by severe pain in the affected region.  This significantly limits them from moving and affects their productivity at work.  Person-Centered Care Person-centered care focuses on the personal needs of patients which become fundamental to the care delivery process. This implies giving preference to the patient’s needs as defined over the priorities by the healthcare staff (Ekman, 2011). This care model involves strong interest in the patient’s experience of health or illness. Nurses have to work with the person’s perspective of the situation as well as that obtained via a medical diagnosis. Various frameworks have been developed to help nurses to implement person-centered care. These frameworks share key components which define the nature of person-centered care. Typically, a patient-oriented care model involves forging relationships with patients to know them as individuals, providing meaningful care, and being responsive to the patient’s needs. Nurses have to respect the needs, values, and preferences of the patients and focus on building patient-nurse relationships which can foster trust (Morgan, 2012). Nurses have to emphasize freedom of choice to the patients and promote comfort. It is also necessary for nurses to involve patient’s family and friends in the care delivery process. This model of nursing care contrasts the traditional care model as it focuses on a patient as an individual and emphasizes on their needs. On the other hand, traditional care model acknowledges personal needs but only consider them if they align with the nursing needs. This implies that the needs of nursing care are prioritized over personal needs of the patient receiving care.    Role Of Nurse In Osteoporosis Prevention  Nurses play a key role in leading collaborative care to meet the healthcare needs of the elderly population which is at high risk of osteoporosis. Under collaborative person-centered care model, nurses have a responsibility of improving access to care, enhancing quality and safety, coordinating with healthcare professionals, and forging relationships with patients. To realize the full potential of the care model, nurses have to accept a central role in the management of patient-centered approach to care (Wolff, 2015). Specifically, nurses have to collaborate with team members and maintain a patient-centered focus on care.  They interact with patients as individuals to gain an in-depth insight into their health as well as forge trust. This is key in understanding and respecting the values and needs of a patient. Medical care delivered by nurses to prevent Osteoporosis should be aligned with the needs of the elderly patients. This involves forging a patient-nurse relationship that enhances trust and enables the nurse to know much about the patients including their medical history, health problems they may be encountering, etc. Nurses that have established a relationship with the patients can communicate effectively with them. This allows them to collect essential information about the patients which help nurses in providing care. The nurses collaborate with team members to align the patient’s needs with the medical diagnosis. For example, when nurses diagnose an older adult to be at risk of developing osteoporosis, they have to create a plan tailored to their needs. The plan may consider the diet consumed by the patient and make adjustments to the dietary routine to improve protein and calcium intake to reduce the risk of the disease.  This ensures the team delivers optimal and safe care which meets the needs of the aged patients. Effective communication is key in enhancing the coordinated care that meets the patients’ needs. Addressing the healthcare needs of the elderly at risk of osteoporosis in the most efficient manner is the key goal of inter-professional patient-centered care. Nurses play a vital role in facilitating communication between the health provider and the patients as well as supporting the patients (Bartz, 2010). In this care model, the nurse ensures families of patients are active participants in care delivery process. This enhances the efficiency of care and enhances the role of nurses in preventing osteoporosis and promoting self-care among the elderly. Nurses provide information to patients and families and answer their question on the care provided. They have to be included in discussions to make decisions about their care as well as play a role in planning how to improve their health conditions. It is the responsibility of the nurse to ensure the patients receive timely and consistent messages. Nurses have to maintain communication with the patients to monitor their health and learn more about their needs (Cloninger, 2011). Consistent communication allows nurses to identify a change in patient’s needs and respond accordingly. For example, an older adult with an osteoporotic fracture may want pain medication due to exacerbating pain. If nurses maintain contact with the patient, they can easily determine their needs and respond to improve patient outcomes. Often, the elderly have lower emergency response and their protection should be prioritized. Nurses have to focus on their safety and value their daily protection in actions such as standing up or walking down the stairs to reduce the risk of falling and occurrence of osteoporotic fractures. Nurses play a vital role in improving quality of care by gaining an insight into patients’ preferences and values through engagement (Finset, 2011). They have to assure them that their values will be respected and their needs considered in care delivery. This is vital in enhancing patient engagement and care plan decisions. Trust between the two stakeholders is dependent on mutual respect and the relationship between them. Trust between nurses and patients evolves as insight into patients’ needs and information from medical diagnosis is gained. Trust is a key element in the patient-nurse relationship that ensures the efficiency of the care delivery process.   Inter-professional care involves collaboration with various healthcare professionals. Nurses have to focus on building relationships with their team members to improve their effectiveness in delivering care tailored to the needs of the elderly population (Mezzich, 2011). Nurses have to recognize the significance of team building in improving the care process. Nurses are the key stakeholders to who guide the collaborative care model to support patient-oriented approach to care in managing osteoporosis among the aged. This is key in keeping the patients engaged and activated with the care delivered as well as help the nurses in making better care plan decisions with physicians. It also helps patients in being successful with self-management actions aimed at reducing the risk of osteoporosis.  Nurses who prescribe self-management strategies tailored to the needs of the seniors achieve better patient outcomes. Also, involving patients and their families in decision-making process improves patient satisfaction and enhance the efficiency of the care delivery process. Nurses have to engage families and patients to develop the capacity to manage pain in cases where patients have sustained fractures related to osteoporosis. This improves the effectiveness of the pain treatment method and improves quality of life. Nurses have to emphasize on the importance of pain management for healing. They also have to work with the patients and give early warnings of complications such as hip dislocation, infection, etc. Such signs should be considered as indicators of deteriorating health and should be given preference to ensure patients are diagnosed and treated accordingly. When using non-medication strategies, nurses have to consider the ones that align with the patient’s needs. Some of the non-medication strategies used to manage osteoporosis include positioning, cold packs, distraction, among others.  Pain prevention also has to be done with appropriate pain management strategies such as analgesics or cold packs. Dose and timing of the strategies have to be considered to ensure they are applied appropriately, i.e., when and how to take medication. With regards to prevention, nurses have to coordinate with the family since the patients are handled in outpatient settings. Focus should be placed on ambulation and exercises which the nurses should demonstrate to the patients to ensure they understand what they are supposed to do. The patient and family have to be involved in all phases of care to ensure the prevention strategies are successful. Families provide social support to the patient which is key in promoting healing.  It is the role of the nurse to encourage patients to perform many self-care actions. Patients have to perform as much as their pain can allow. The nurses also have to offer patients a plan that involves activities that include mild exercise. It is important for nurses attending to the aged people at risk of osteoporosis in outpatient settings to assess new pain sites and monitor patient’s pain level as well as monitor their response to the pain management strategies applied (Claesson, 2015). Nurses have to explain all treatments and procedures to patients and ensure that they understand the prescribed medications. Also, nurses have a responsibility to provide emotional support to help patients cope with pain and their health conditions. Conclusion Osteoporosis is a major disease that affects the elderly and contributes to a majority of bone fractures for people aged 50 and above. It has become a health issue that affects the society and requires concerted efforts among healthcare providers to be mitigated. Inter-professional patient-centered care is a key care model that can assist in preventing and managing osteoporosis among the elderly population. This care model involves a collaborative approach to take which incorporates a team made up of various healthcare professionals. The model focuses on the patients as an individual and prioritizes the needs and expectations of the patients. Nurses play a key role in providing patient-oriented care which is appropriate for the elderly population as it is at high risk of osteoporosis and requires attention. Nurses are the driving force behind patient-centered care hence have to be focused on forging relationships with patients to gain an insight into their health problems. It is recommendable for nurses to not only connect with the patients as caregivers but also support them emotionally. The nurses should involve patients and families in all treatment phases to ensure care given aligns with their needs and values. Also, nurses should at all times respect the values of the patients and respond to their needs accordingly.   References Antonelli, M., Einstadter, D., & Magrey, M. (2014). Screening and treatment of osteoporosis after hip fracture: comparison of sex and race. Journal of Clinical Densitometry, 17(4), 479-483. Bartz, C. C. (2010). International Council of Nurses and person-centered care. International Journal of Integrated Care, 10(5). Broulik, P. D., Vondrova, J., Ruzicka, P., Sedlacek, R., & Zima, T. (2010). The effect of chronic alcohol administration on bone mineral content and bone strength in male rats. Physiological Research, 59(4), 599. Claesson, A., Toth-Pal, E., Piispanen, P., & Salminen, H. (2015). District nurses’ perceptions of osteoporosis management: a qualitative study. Osteoporosis International, 26(7), 1911-1918. Cloninger, C. R. (2011). Person?centred integrative care. Journal of evaluation in clinical practice, 17(2), 371-372. Ekman, I., Swedberg, K., Taft, C., Lindseth, A., Norberg, A., Brink, E., … & Lidén, E. (2011). Person-centered care—Ready for prime time. European journal of cardiovascular nursing, 10(4), 248-251. Emkey, G. R., & Epstein, S. (2014). Secondary osteoporosis: pathophysiology & diagnosis. Best practice & research Clinical endocrinology & metabolism, 28(6), 911-935. Esses, S. I., McGuire, R., Jenkins, J., Finkelstein, J., Woodard, E., Watters III, W. C., … & Sluka, P. (2011). The treatment of symptomatic osteoporotic spinal compression fractures. Journal of the American Academy of Orthopaedic Surgeons, 19(3), 176-182. Finset, A. (2011). Research on person?centred clinical care. Journal of evaluation in clinical practice, 17(2), 384-386. Garriguet, D. (2011). Bone health: osteoporosis, calcium and vitamin D. Health reports, 22(3), 7. Khawaji, M., Astermark, J., Åkesson, K., & Berntorp, E. (2010). Physical activity for prevention of osteoporosis in patients with severe haemophilia on long?term prophylaxis. Haemophilia, 16(3), 495-501. Korhonen, N., Niemi, S., Parkkari, J., Sievänen, H., Palvanen, M., & Kannus, P. (2013). 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H., Erdenesanaa, D., Collerone, G., Ankers, E., … & Bhan, I. (2011). Vitamin D–binding protein modifies the vitamin D–bone mineral density relationship. Journal of Bone and Mineral Research, 26(7), 1609-1616. Rachner, T. D., Khosla, S., & Hofbauer, L. C. (2011). Osteoporosis: now and the future. The Lancet, 377(9773), 1276-1287. Riggs, B. L. (2012). Age-related osteoporosis. Nutrition and Aging, 207. Rizzoli, R., Stevenson, J. C., Bauer, J. M., van Loon, L. J., Walrand, S., Kanis, J. A., … & Reginster, J. Y. (2014). The role of dietary protein and vitamin D in maintaining musculoskeletal health in postmenopausal women: a consensus statement from the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO). Maturitas, 79(1), 122-132. Tyagi, A. M., Srivastava, K., Mansoori, M. N., Trivedi, R., Chattopadhyay, N., & Singh, D. (2012). 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