«Adults with Complex Health Care Needs» - Great Essay Sample

«Adults with Complex Health Care Needs»

Without any doubt, in the 21st century the society has faced a big problem commonly known as heart disease. It is generally true that this issue has thrown doubts on the existence of the future generation, since everyday it causes the deaths of many people. According to the statistics, heart disease is the biggest killer of American society. SCAI (2005) indicates that the patients, who experienced heart disease in a given year, will die from it. Unluckily, this disorder has affected the Ball family, since their mother Jackie Ball has found out that she is suffering from coronary artery disease (CAD). Jackie Ball is 66 years old woman, who is currently discharged. She has two children, who live in another state with their families. Jackie is living alone, since her husband died in 2000. Her family history is complicated, since her father died from alcohol addiction in 1971 and her mother died from heart attack in 1978. Looking at this family history, it is clear that Jackie inherited susceptibility to heart illnesses and addictions. Consequently, it is obvious that her health problems did not suddenly occur, while she was suffering from diabetes, high blood pressure, stress and obesity during long time. Moreover, Jackie Ball has been smoking for 25 years; this bad habit has considerably impaired her health. She became more irritated, mentally exhausted and depressed.  Furthermore, she used to eat unhealthy high-calorie food; this irrational nutrition had a big impact on the course of CAD. Finally, after the death of her husband in 2000, her health condition became worse, because she has been constantly worrying about the future of her children in case if she dies. Jackie’s negative thinking influenced the relationship between her and her children, and she became an isolated person, who reflects only about the death and worthlessness of the human life. The following genogram will better explain the genealogy in the Ball family. With its help, one can get to know how genes can influence the health condition in the future generations.

Genogram of the Ball family

In the framework of identifying the current health problems of Mrs. Jackie Ball, it is necessary to examine her past medical history, where there are certain physical diseases that have considerably impaired her health condition. Currently, Mrs. Jackie Ball is facing a big health problem, commonly known as a coronary artery disease. Amenably to the definition, the coronary artery disease (CAD) is caused by the gradual increase of plaque on the internal membranes of the coronary arteries (Munther, 2008). In the medical literature this disease can be called a coronary atherosclerotic heart disease. The Coronary atherosclerotic heart disease is extended irregularly in different blood vessels. This insidious disease highly influences the reduction of systole expansion and the blood flow. Consequently, this obstruction of blood propagation can affect the areas of myocardium and lead to myocardial ischemia (National Heart Lung and Blood Institute, 2012). In this particular case, concerning the medical history of Mrs. Jackie Ball, this disease has relentlessly influenced her life. One of the main causes of her disease is diabetes, from which she has been suffering during the past twelve years. It is highly recommended to define the medical condition of diabetes in order to understand the main dysfunctions of the organism caused by this disease. According to the definition, diabetes is a serious illness that leads to the misbalanced distribution of sugar into blood instead of penetration into the body’s cells. Jackie found out that she was suffering from diabetes when she was 54 by taking the HbA1c test (the hemoglobin assay) that helped her to indicate her great increase of the glucose level. At that time, she noticed the irregular changes in her body, such as weight loss, excessive thirst, nausea, annoyance, blurry vision, fatigue, skin wounds, and yeast infections. Moreover, she was suffering from high blood pressure that has considerably influenced the beginning of coronary artery disease. In the age of 58, she observed the worsening of her health condition that was followed by the symptoms of CAD, such as:

  • Angina or chest pain;
  • Anxiety;
  • Dizziness;
  • Irregular heartbeats;
  • Nausea;
  • Shortness of breath;
  • Weakness.

Indisputably, in the 21st century the scientists have developed various advanced approaches in the field of investigation of the pathophysiology of the coronary artery disease (CAD). According to the definition, coronary atherosclerotic heart disease is a progressive disease that does not develop spontaneously. The pathophysiology of CAD is divided into the three stages, such as fatty streak, fibrous plaque and complicated lesion. During the first stage, the muscle cells will be lipid-filled. Moreover, a yellow tinge can be arisen. Consequently, the level of fatty streaks can be significantly increased in the coronary arteries. The development of these changes can be observed by the age of 15. In the second stage, the level of the endothelium of the arterial wall can be increased. This can be amplified by the fact that the surplus of the endothelium cannot be immediately replaced in a person, who is suffering from CAD. The deterioration of the health will be followed by a reduction of the blood flow to the distal tissues and the vessel lumen. Finally, the final stage of the pathophysiology of CAD, commonly known as a complicated lesion, is characterized by the growth of the fibrous plaque and the formation of the thrombus. Furthermore, the scientists have distinguished the modifiable factors (alcohol consumption, lack of exercise, hypertension, diabetes, and stress), and non-modifiable factors (age, gender, and genetics) of the pathophysiology of CAD (Libby & Theroux, 2012).

In the framework of identifying the causes and risk factors of coronary artery disease, it is advisable to investigate the modern high-qualified treatment tools in order to provide the effective and quick recovery to the patient. One of the advanced methods of treatment is Hybrid coronary revascularization. This procedure was firstly developed at the Emory Heart & Vascular Center by a cardiothoracic surgeon Dr. Halkos. Hybrid revascularization is the most advanced therapy with the minimal invasive approach. According to the definition, this surgical operation is performed on a person, who is suffering from a plaque in the artery located in the front of the heart. Furthermore, a combination of the coronary artery bypass surgery (CABG) is applied in the process of Hybrid coronary revascularization. The advantages of CABS can be explained by the application of the robotic-assisted techniques that help to perform a surgery by using minimal incisions between the ribs (Stamou & Corso, 2001). The second and the most advanced new treatment is the utilization of the Diamondback 360° Coronary System. This system helps to remove plaque and to restore the blood flow to the heart chambers (DMS Cardio Vascular Institute, 2011). Indisputably, the scientific books provide different possibilities of adopting the treatment methods, such as balloon angioplasty, laser ablation, local radiation therapy and intracoronary stenting. On the contrary, patients can prefer Western medical therapies in the process of CAD treatment. For instance, they can ask for the prescription of drugs, rather than for the surgical interference. Moreover, Western medical method provides an effective CAD treatment, such a dietary modification and smoking cessation. To counterbalance the scientific approaches of treatment of the coronary artery disease, the patients, who are suffering from this disease can resort to application of alternative medicine, such as folic acids, garlic, hawthorn, resveratrol, omega-3 fatty acids, vitamins B3, B6, B12 and D (Gaziano, Ridker, & Libby, 2011).

Undeniably, modern scientific approaches and technological development have a great influence on the nursing career, as a fundamental basis of ensuring the professional medical care. In 1960s Imogene M. King propounded a new theory of the nurse’s role, commonly known as a theory of Goal Attainment. According to this theory, nursing practices should include the three dynamic interacting systems, such as personal, interpersonal, and social ones.  Personal system consists of several ideas, such as development (satisfaction about recovery concerning CAD), perception (patient’s understanding of anxiety, emotional exhaustion and chest pain), space (assessment about the patient’s feelings in all directions), time (a continuous flow of changes that includes experience from the remote past and future), and body image that helps a nurse to understand patient’s inner world. Interpersonal system includes communication (sharing the information from patient and his/her family to doctor), interaction (a process of expressing personal feelings due to inquiry about CAD between a nurse, a patient, and patient’s family), personal role, transaction, depression and stress. Social system consists of authority, decision making, organization, power, leadership position and social status. Furthermore, the theory of Goal Attainment includes the two following concepts: metaparadigm and philosophical concepts. First of all, metaparadigm concept consists of four dominating constituents, such as a person (who always collaborates with environment and society), health (an implication of adjustments to the internal and external stressors, well coordinated behavior, and dynamic achievement of energy for daily living), environment (a wall between the internal and external human life), and nursing (a successful cooperation, where a nurse and a patient interact in order to maintain health). Secondly, philosophical concept focuses on nursing, as a core work of providing care to humans. Without any doubt, King’s theory of Goal Attainment is a very important one, since it provides the vital information in the nursing process, such as assessment, formation of nursing diagnosis, decision making plan, implementation of goals, and evaluation for patients, who are suffering from CAD. First of all, assessment of the theory of Goal Attainment is characterized as a parallel interaction amidst the nurse and patient. In this case, assessment is basic knowledge of providing an effective communication in order to get the accurate data of the patient’s mental and psychical state. Secondly, according to the King’s theory of Goal Attainment, formation of nursing diagnosis is identified as an obtainment of the vital information about the patient’s health, his/her evolution of the course of CAD, and genetic history during making an assessment. Thirdly, King determined decision making plan as a mutual exchange between the nurse and the patient, in which the patient can easily express personal point of view about his/her future treatment. Furthermore, King described implementation as the most important step in the nursing career, since during this process a nurse has a profound opportunity to exercise his/her knowledge in order to provide the professional recovery for the patient. Finally, King identified evaluation as a final step of providing health care, in which a nurse should sum up the consequences of goal attainment, its effectiveness or failure (Hampton, 1994).  

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Undoubtedly, physiological, psychological, and psychosocial issues influence the course of the coronary artery disease to a great extent. In this case, it is highly recommended to address these problems in order to manage the care of the patient effectively. For instance, in the medical history of Jackie Ball one can find these physiological, psychological, and psychosocial issues that have caused the impairment of her health. Physiological causes of CAD include the following risk factors:

  • High blood pressure has a big impact on the walls of the left ventricle and heart’s pumping ability. Therefore, congestive heart failure can occur and heart pump cannot provide enough blood for the organism;
  • High blood cholesterol rate is the problem with lipoproteins that can cause an incorporation of cholesterol into the inferior parts of arteries;
  • Obesity is determined as a medical condition that can lead to serious diseases, such as diabetes and hypertension. Inappropriate nutrition is one of the strongest causes of obesity and diabetes. Consumption of big amounts of high-calorie food and drinks causes adults to be overweight;
  • Age is a risk factor for coronary artery disease for women over 55 years old. In the particular case with Jackie she was 57 when she found out that she was suffering from CAD;
  • Family history. According to Jackie’s genogram, her mother died from heart attack at the age of 58. It is clearly seen that genetics can be a decisive factor in the course of heart disease.

Moreover, one can identify psychological factors that had an impact on the determination of Jackie’s health. First of all, it is stress that was caused by a physical change (diabetes), environmental change (such as discharge from office and financial concerns), and emotional change (inferiority complex and daily hassles). Secondly, it is depression that belongs to a risk factor that has led to Jackie’s coronary artery disease. Unfortunately, according to various researches of Frasure-Smith and her colleagues, depression is determined as an important factor of mortality in patients, who have the diagnosis of CAD. Thirdly, living alone is also one of the main psychological factors associated with the coronary artery disease. According to Jackie’s Ball medical history, she has been living alone for thirteen years, since her husband died and her children are living with their families in another state. In this case, family support is undoubtedly important, since a person, who is suffering from CAD, needs care and attention. Finally, psychological denial is well-recognized as a key factor of this disease. For instance, at the age of 54, Jackie Ball found out that she had diabetes by taking the HbA1c test. Furthermore, she saw numerous inexplicable changes in her body that has led to the development of the coronary artery disease. However, she denied that she had this disease by ignoring its evident features. This condition can be amplified by the psychological trauma of a patient, who is afraid of having serious heart illness. In this case, a patient can show constant worry, inability to concentrate, compulsive eating, sadness, difficulty sleeping, tiredness and general aches. Finally, psychosocial issues of CAD can be associated with bossiness, critical attitude to others, impulsive behavior and withdrawal from society (Langosch, 1988). For instance, Jackie’s diet change and stopping smoking have highly influenced her psychosocial behavior and relationships with her family. She became a socially-isolated person and concentrated on imprudent lifestyle that contributed to the development of the coronary artery disease. This psychological condition can be explained by the fact that considerable changes can cause detestation of oneself.

Nursing care plan

Name of the patient: Jackie Ball Gender F Age 66 Code Status Full Admission Date  18-01-03

Presenting signs/symptoms:

  • Chest pain;
  • Anxiety;
  • Dizziness;
  • Irregular heartbeats;
  • Nausea;
  • Shortness of breath;
  • Weakness.
Primary diagnosis: chronic CHF

Surgeries related to this admission:


Secondary diagnosis: coronary atherosclerotic heart disease (CAD)

History of present disease:

Client felt loss of energy, tiredness and anxiety two weeks ago. Lasix was grown to 41 mgs qd on 3/ 01/13

Health history:

diabetes with acute exacerbation x 12 years;

her mother died from heart attack at 66;

CAD x 11 years;

CHF x4 years.

Substance use of tobacco x 25 years. Quit 1989.

Diet change x 2 years ago


Allergies/Reactions: NKA
Religious Preference: Baptist Ethnicity: Native American Marital Status: W Occupation: Discharged

Indisputably, any type of heart disease is not merely an individual problem; this issue can relentlessly influence an entire family. It is clearly seen, when one member of the family is suffering from a serious disease, others should make adjustments and be prepared to behave in a different way by learning a new family role, not just for the sick person, but also for their own sake. The Ball family has faced this problem, when they discerned that Jackie had coronary heart disease. First of all, the health worsening of this patient can be caused by the cultural influence. Ethnically Jackie belongs to the Native American ethnical group. It is evident that American society is suffering from heart diseases caused by obesity and irrational daily consumption of fast and convenience food. For instance, the Centers for Disease Control and Prevention indicate that 600000 Americans die of heart disorder, this rate is equal to 1 in every 4 deaths (Willett, Stampfer & Manson, 1993). In Jackie’s family dieting in the fast food restaurants was an ordinary event. In this case, it is clearly seen that her ignorant behavior has not only appallingly influenced her health, but also cast doubt on her children’s health. Secondly, Jackie’s coronary disease has tremendously affected the values of her family members, since they changed their views at life. On the one hand, on the emotional level all members of the family were suffering from stress and mental exhaustion, since they did not know how to take care of the sick person. Moreover, Jackie’s children felt the pressure from their mother, since she always talked about the death, miserable human life, and the impasse.  

This psychological condition has led to the emotional disturbances and fears amidst the family members. On the other hand, they utterly changed their attitude to Jackie; they were more condolent, attentive and tolerant. Moreover, they called her on the daily basis and on weekends they visited her. It is obvious that their values have considerably changed; they have understood the role of mother, her persistent work, kindness and love towards her children. Furthermore, on the communication level Jackie felt support and care from her children due to their desire to help her in any difficult situation. Finally, the dynamics of the Ball family resembles the reverse triangle. This figure better explains the decay and the increase of the dynamics in their relationships and attitude to each other. The decay of dynamics can be explained by the anxiety and low self-esteem of Jackie, since she was in a big depression after she learned about her sickness. Moreover, the decay was significantly increased due to mental exhaustion of her children, while they do not know what measures to take in order to help their mother. Fortunately, the Ball family decided to visit a psychologist, who considerably improved the level of communication in this family and helped to avoid feeling of fear. Consequently, the increase in dynamics in this family is undoubtedly apprehended, while Jackie and her children have completely understood the vitality of respect, ability to listen and ultimate love.

All in all, one apprehends the coronary artery disease as a serious issue caused by the unconscious behavior of a person, smoking and alcohol addiction, stress, depression, obesity, diet changes and genetic history. In this case, it is highly recommended to get the appropriate treatment of the patient’s mental condition, to perform lifestyle modification, such as diet therapy, smoking cessation, physical exercises and  receiving healthy nutrition. Moreover, when a person has found out that he/she is suffering from CAD, it is advisable to get the professional advice in a prompt and accurate manner. Furthermore, families play a crucial role in helping owns to combat with the coronary artery disease, while the effect of CAD to some extent depends on children’s and families’ acknowledgement and realization of self-care and support.



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