Chronic Disease Management - Essay Example

Chronic illnesses and palliative care Name Course Tutor Date Introduction Chronic disease management is a form of care that involves measures taken to manage chronic diseases. Unlike the acute diseases, chronic diseases tend to be associated with a lot of complications. Because of this, a comprehensive care plan should be designed. Such care involves several measures that are channeled for each complication related to the disease in question. This care plan should ensure that both the direct impacts as well as indirect impacts are catered for. This is particularly due to the fact that chronic disease tends to result not only in the physiological effects but also to the other psychological and social effects. This paper is going to distinguish various forms of comprehensive model of disease prevention. Firstly, the paper shall explore the significance and application of primary, secondary and tertiary prevention before expounding on the measures that are applicable for a diabetic patient. Upon that, the paper would finally explore the management of diabetes from the general and individualized point of view. Each step taken, whether during the primary, secondary, tertiary, generalized or individualized care would be thoroughly explored upon which a general conclusion would be made on the best way of intervention. Primary, secondary and tertiary prevention as applied in management of diabetic diseases Basically, the management practices are broadly classified into primary prevention, secondary prevention and tertiary prevention. Primary prevention involves that kind of prevention done before the disease actually sets in. It largely involves lifestyle changes. Primary prevention is particularly important because most of the contemporary chronic diseases are caused by poor lifestyle practices. Diabetes diseases are caused by unhealthy dietary practices such as high intake of highly refined food, and excessive drinking of alcohol. With this in mind, then it is possible to design best lifestyle practices that can reduce the chances of one getting these diseases. Eating food high in fiber may aid in prevention of chronic diseases like cardiovascular diseases, diabetes and /or cancer. Primary prevention therefore is a very crucial step as far as management of chronic disease is concerned (World Health Organization, 2005). Secondary prevention on the other hand involves those practices tailored on diagnosis and treatment of diseases. These practices involve screening and treatment of identified conditions. Secondary prevention assists in ensuring that early interventions are instituted. This is important in that most of the chronic diseases tend to advance with time. Because of this advancement, some diseases might reach a stage whereby they get complicated and difficult to manage. It is easier to manage diabetes at its initial stages of development than during its advance stages (World Health Organization, 2003). However, without early screening and diagnosis, the disease might progress to other stages which would be difficult to manage. It is therefore advisable that the screening programs are in place anytime to ensure timely diagnosis of the diseases Tertiary prevention on he other hand involves the treatment of diseases especially at their advance stages. The kind of plan to be used therefore is based on various factors. Such plan do not only involves the physiological factors but also other factors that might not have direct relation with the disease. When one is first diagnosed with a chronic illness, feelings of despair and worry develops (World Health Organization, 2003). One is usually plagued, as the condition requires several changes to the lifestyle they live. These changes include diet changes, regular medication and monitoring of the body and controlling the alcoholic intake. Despite the fact that there are medical treatments to control the condition, patients suffering from chronic illnesses are affected both mentally and emotionally and is accompanied with great fears of uncertainty as to whether their condition will be permanent or will worsen day after day (Morewitz & Goldstein, 2007). Daily living with a chronic disease can be annoying, disheartening, and traumatic. It is difficult for a patient to live with chronic illness and this can be reflected by his decreasing job performance and output, mood disorders, improper social functioning and even depression. These factors therefore should be considered during the tertiary prevention. Therefore, the plan to be instituted should be tailored not only to physiological measures such as the actual treatment of disease but also to psycho-sociological measures such as easing of frustration and isolation (Gupta, 2004). Palliative care Palliative care is a kind of care that is meant to reduce suffering especially when one is succumbed to fatal diseases such as cancer, cardiovascular conditions, hepatic conditions as well as some kidney conditions. Generally, the best way of offering palliative care is by treating those condition associated with (Mitchell, 2008). The kind of palliative care given largely depends on the kind of disease. Before embarking into our main theme, management of a diabetic patient, it is important to note some of the general measures that can be taken while managing any form of chronic disease (Morewitz & Goldstein, 2007). Generally, there are some of the basic measures that should be done to a diabetic patient in need of palliative care irrespective of the kind of complication. As we have seen from the above few conditions, the nutritional status of the patient should be considered (Stein & Baum, 1995). Diabetic patient, like must observe good nutrition. This is because energy is paramount aspect as far as diabetes is concerned. The body should be strong enough for it to fight against some form of complications that might arise. Despite the fact that the goal of palliative care is not to cure the patient, adequate intake of energy would assist the body in wadding off some of the opportunistic illnesses that may worsen the state of the patient (World Health Organization, 2005). Therefore, caregiver should ensure that the patient gets good nutrition. Incase the patient is not in a position to take food in the normal way, caregiver can decide to use either the tube feeding or parenteral feeding to supply the nutrients into the system of the patient (World Health Organization, 2003). For a diabetic patient suffering from other complications such as HIV/AIDs, he or she should adjust his or her dietary practices accordingly. It is recommended that during the asymptomatic stages, the patient should increase his or her caloric intake by 10%. This increase is meant to cater for the involuntary muscle loses. During symptomatic stages, the patient is expected to further increase his or her caloric intake by 20% .this increase is also meant to replenish the energy as well as to provide some precursors meant to synthesis new tissues (Twycross, 2003). The kind of method to be adopted would be based on the tolerance of the patient. However, if the resources are available, a parenteral nutrition is appropriate for a critically ill individual. Another measure that should be taken during palliative care for a diabetic patient is the use of anesthesia. Anesthesia is a chemical meant to reduce pain or suffering. Because it is certain that the patient is generally going to die, then rather than allowing the patient to go through a lot of pain before his or her death, anesthesia can be administered, as it would block the nerves responsible for the perception of the pain (Jean & mcintyre, 2005). Administering of this form of drug is therefore very important as far as the palliative care is concerned. Additionally, psychological support is another very important component should be included in palliative care (Gupta, 2004). It should be noted that the psychological aspect of the diabetic patient is very important as far as diabetes is concerned. Research has revealed a very close relationship between the psychological state and the frequency of some minor illnesses. Men for example are likely to succumb to common cold when they are in stressful conditions. Due to this, understanding the psychological state of the patient is very important ( Chang & Johnson, 2008). The caregiver should try to find out about some of the attitudes the patient has concerning the illness. Then from this knowledge, the caregiver would have to counsel the patient accordingly in a manner that ensures that he or she would be psychologically secured (Glenda, 2010). One way of ensuring that the patient is psychologically secured is by ensuring that psychological needs such as love, inner freedom, as well as sense of belonging are provided. Therefore, those close relatives of the patients should be there to assure the patient of their love and care and even assure him or her that even if anything happens, his or her children and other belongings would be taken care of. In other words, the goal of psychological support is to reduce the tension that may accumulate if the patient was just left alone (Linda & Librach, 2007). A patient who is left alone may find himself or herself laden with many thoughts (Hahnemann, 2007). These thoughts tend to cause more pain to the patient. Hence it is one of the goal of psychological support to ensure that the patient do not have free time to get into unnecessary thoughts. Spiritual component is also one of the fundamental aspects of palliative care. It is believed that a combination of prayer, medication, nutrition, and psychological support can results in recover (Meier et al 2009). Therefore, depending on the faith of the individual, spiritual component can be integrated into the palliative care. Management of diabetes Diabetes is a disease caused by inability of the body to produce enough insulin that can regulate the blood sugar levels and or insensitivity of insulin. Because of this, there are two forms of diabetes. Diabetes type I and diabetes type II. Diabetes type I occurs at an early age. It is normally inherited. As a result, it tends to be resistant to medications. For this case, management measures normally involve lifestyle changes (Gupta, 2004). Nutritional, physical exercise and medication shall be discussed under the lifestyle measures whereas coping with frustration and isolation would fall under the psychosocial measures. Additionally, the discussion of the management measures for diabetes shall be broadly divided into generalized care plan as well as individualized care plan. (Kathryn & Claire 2008) Generalized care plan for a diabetic patient Diabetes is a condition that requires a lot of knowledge both by the caregiver as well as the patient. Therefore, before any individualized plan is made, there are some of the general issues that should be borne in mind. Firstly, it is advisable that the diabetic individual is sensitized on some of the diabetic facts such as how to monitor his or her glycemic levels and how to act when faced with a particular condition such as hypoglycemia or hyperglycemia (Hallenbeck, 2003). The patient should also be informed on the necessary lifestyle modifications like the importance of taking variety of food, and increasing physical exercise. It is also important for a diabetic patient to learn the fact that diabetes is a condition that can lead to development of other conditions such as eye diseases, kidney disease. Moreover, it is also possible for such an individual to develop permanent wounds on his or her feet (Hahnemann, 2007). Because of these, the diabetic individual should be sensitized on the need for daily self examination of the feet. In case there is any cut on the skin, then he or she should seek the medical help immediately. Moreover, the patient should be sensitized on the importance of regular dental examination and treatment. And lastly, he or she should be sensitized on the importance of regular screening of blood sugar blood levels (Hahnemann & Louis 2009). Individualized care plan Diabetes is a chronic disease whose prevalence is increasing significantly. Management of diabetes basically involves management of blood sugar. As a result most of the practices that an individual with diabetes should do involve those that directly or indirectly involve regulations of blood sugar (Hahnemann, 2007). It is clear that food is a key element responsible for rising of blood sugar. Appropriate dietary practices are therefore a basis of any diabetes management plan. But it is not just what you eat that affects your blood sugar level. How much you eat and when you eat matters, too. A diabetic patient should ensure that he or she eats food with relatively lower glycemic index. This is because the glycemic index tends to bring imbalance in the blood sugar (World Health Organization, 2003). Because of these, there are some very important concepts concerning food intake that matters a lot. Firstly, the patient should ensure that he or she eats consistently. Basically blood sugar levels of a diabetic patient tend to rise sharply an hour or two following a meal. This drastic rise is what it actually brings about imbalances in the blood sugar levels and since insulin is a hormone responsible for ensuring that the blood sugar level is regulated, it would get strained in trying to bring this unusual level to normal (Hahnemann,1999). However, because it is easy to determine the point of time when the blood sugar level is about to fall, then this can be easily counteracted by further consumption of another meal. Simply eating about the same amount of food at the same time everyday can help a diabetic patient control his or her blood sugar level (Nuovo, 2007). Secondly, the diabetic patient should generally increase the intake of carbohydrate. Of all the three macronutrients, carbohydrates have a bigger effect on the blood sugar level. Due to this, it is advisable for a diabetic patient to eat same amount of carbohydrate at each meal. This would make the blood levels stable throughout the day (Forman, 2003). Thirdly, a diabetic patient should ensure that the amount of meal he or she takes corresponds to the medication he or she is given. Conventionally, insulin is the principal medication for a diabetic patient. Normally when an intake of insulin is expected to lower the blood sugar levels, however, if the patient takes little amount of meal, then the insulin is likely to result in exceedingly low sugar levels and hence resulting in hypoglycemia (World Health Organization, 2005). On the other hand too much food may cause the blood sugar level to climb too high and hence causing hyperglycemia. Therefore, with the help of health care team, a diabetic patient should strike to balance the meal intake with the medication. Another very important measure that should be taken concerns the exercise. Physical activity is a very important area as far as diabetes management is concerned. Exercise has a direct relationship with glucose. When a diabetic patient exercises, his or her muscles would have to use sugar for energy. Due to this, exercise assist in improving the sensitivity of insulin. It also contributes to glycemic control as well as weight control (Faull& Daniels, 2005). However, the kind of exercise must be individualized. This is because there are different kinds of individuals, the way they should start exercise should be planned especially with the help of the doctor. A person who used not to exercise before should consult the doctor on how to start and proceed. However, irrespective of the individual, the kind of exercise adopted should depend on how the patient tolerates it. While exercising, the individual should be keen to monitor his or her blood sugar during and after exercise so as to determine whether he or she is responding positively. Therefore there should be good judgments during and after exercise (Nuovo, 2007). Lastly, medication is another important measure as far as management of diabetes is concerned. Insulin is one of the principal medications designed to lower the blood sugar level. However, unlike other kinds of medications, the dose and time stipulated for insulin intake should be strictly adhered to. In case the patient is taking other medication, he or she should consult the doctor because there is a high tendency of other drugs to interact negatively with insulin. This is particularly so if the kind of drugs involve are those meant for conditions such as high blood pressure (Doyle, 1984). Conclusion From the above discussion, it is clear that the management of chronic diseases entails a lot of measures and intervention. It is however clear that chronic disease like diabetes can be better managed at the primary level. This is because at this level, there are still no many complications and also the kind of intervention carried out at this stage is feasible and practical. People should therefore be sensitized on the importance of primary prevention especially on lifestyle changes and / or exercise. References Doyle, D. (1984) Palliative care: the management of far-advanced illness. Taylor & Francis. Elsevier Health Sciences. Faull, C., Yvonne, C., & Daniels, L. (2005) Handbook of palliative care. Wiley-Blackwell. Forman, W. B. (2003) Hospice and palliative care: concepts and practice: Cancer Nursing Series. Jones & Bartlett Learning. Glenda, H. D. (2010) Reversing Chronic Disease: A Journey Back to Health. Tate Publishing. Gupta, M.K. (2004). Chronic Disease. 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