NURBN 3033 Assessment Task 2 Analyse and Develop a Self-Management Plan

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 1. Introduction and SMART Goals
Client Jamie is a female patient of 14 years who has been diagnosed with cystic fibrosis (CF). CF is a progressive, life-threatening genetic
disorder that mostly affects the lungs and digestive tract. Respiratory infections, pancreatic insufficiency, and vitamin inadequacy are the key
chronic health conditions that need to be addressed in a self-management strategy. Chronic, progressive, and currently fatal, cystic fibrosis
damages the lungs and gastrointestinal tract. Recurrent pneumonia, pancreatic insufficiency, and vitamin deficiencies are the key chronic health
concerns that need to be addressed in a self-management plan for a patient with cystic fibrosis. Cystic fibrosis is an autosomal recessive disease,
meaning that it may afflict anybody. It is the cyclic adenosine monophosphate (cAMP)-regulated chloride channel, or CFTR, that regulates the
transport of chloride, sodium, and bicarbonate across epithelial membranes. Heterozygotes may have subtle abnormalities in epithelial
electrolyte transport, although they usually have no outward signs. Only those who are homozygous for the condition will show signs of it. Six
classes of CFTR variations have been established according to the ways in which they affect the protein's processing or function. It is generally
agreed that individuals with 1 or 2 class IV, V, or VI variations have a milder genotype, resulting in residual CFTR function, whereas those with
1 or 3 class I, II, or III changes have a more severe genotype, resulting in very little or no CFTR function. However, in other cases, clinical
testing findings (i.e., organ function) will give more accurate information than genotyping for predicting outcomes. Mutations in CFTR may
cause the gene to cease functioning altogether (known as nonsense-mediated silencing) or cause the gene to be read in a different order (known
as frameshift) due to a deletion or insertion in the DNA. The age of the patient affects the manifestation of the disease in the clinic. About two-
thirds of individuals with CF are identified by their first birthday. The age of onset, the severity of symptoms, the rate of organ decline, and other
factors may vary widely. Newborns often have meconium ileus, although anasarca and other disorders are rarer. Wheezing, coughing, recurrent
respiratory infections, and pneumonia are typical concerns from parents of infants and toddlers.
Jamie has been hospitalized numerous times owing to problems that need her to take various medicines around the clock. These include
malnutrition from pancreatic dysfunction, vitamin deficiencies, and serious chest infections. Jamie has to wear a gadget that vibrates within his
chest wall every morning and night in order to break up the heavy mucus in his lungs and make breathing easier. Jamie already takes a huge
number of medications to prevent this from happening, but this is new. A typical session with a therapist may last up to an hour. Chronic health
problems in a patient with cystic fibrosis include recurrent pneumonia, pancreatic insufficiency, and vitamin deficiencies. The three SMART
goals are:
1. The patient will need many medications around the clock to treat the many complications of her pancreatic dysfunction, including
malnutrition, vitamin deficiency, and severe chest infections.
2. To facilitate mucus dislodging and easier evacuation, the patient will employ an electronic-driven, high-frequency percussion device for one
hour in the morning and again in the evening.

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 3. Increase vitamin stores by taking a multivitamin every day.
2. Discuss and Critically Analyse Consumer Directed Care/Self-Management
Patients and caregivers are given more latitude and control over their treatment under care management and planning systems known as
"consumer-directed care" (CDC) or "Self-Management." Jamie and other clients like her have an urgent need for consumer-directed care and
self-management planning in order to continue living independently in the community. Careful planning of the client's care may help them stay
healthy and capable of doing everyday duties on their own for longer. Self-management education therapies for cystic fibrosis have been
developed, but their effectiveness has not been systematically evaluated.
CDC is founded on a number of guiding concepts, including the following:
 A higher degree of adaptability and selection
 An increase in people's ability to get the information they need to make well-informed choices about their health, such as which services
to seek out, which providers to collaborate with, and how those services will be provided.
 Individuals' health and patients' capacity to make choices about their treatment may benefit from more transparency and collaboration
between healthcare professionals and patients. The CDC's mission is to help individuals live more independently so they may achieve
their own goals. The ultimate goals of this empowerment are to increase resident autonomy and quality of life by reversing the
conventional order of decision-making and offering residents more influence in day-to-day problems.

Self-management
An important aspect of the CDC is developing a plan for self-management. It's a strategy for dealing with long-term health problems that stresses
the importance of the individual's own free choice and accountability. Self-care encompasses the many measures one takes to alleviate the
symptoms of a long-term health problem. The plan stresses the importance of individuals taking charge of their own health. A lifetime strategy
for health and self-care is adopted, including evaluation, collaborative care, client empowerment, increased capacity, referrals to community
resources, and an emphasis on embracing personal responsibility for one's health. Community-based continuance of daily activities (CDC) and
self-management planning are crucial to clients like Jamie's ability to remain in their own homes in the community. Careful planning of the
client's care may help them stay healthy and capable of doing everyday duties on their own for longer. Recently, Jamie was discharged from the
RCH's respiratory ward after being treated there for an acute respiratory illness. Two or three hours each day, a nurse from a hospital-in-the-

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 home (HITH) service will visit Jamie's home once he is released to provide an IV antibiotic infusion using a continuous ambulatory delivery
device (CADD) pump.
Jamie's chronic illness has forced her to learn how to take care of herself from an early age, and she has done so in order to preserve her
independence and quality of life. Jamie needs consumer-directed care and self-management planning in order to live on his own in the
community. Careful preparation will help Jamie keep her health and her ability to do her daily tasks independently. Maintaining maximum health
while self-managing a chronic condition like Cystic Fibrosis calls for a thorough attention to detail on a daily basis to minimise problems that
might need hospitalisation. Jamie has been aware of the need of taking her medications on time, doing her chest physical therapy, and
monitoring her body weight and respiration since she was a young child. Moreover, she is sensible enough to recognise the symptoms of distress
and know when to seek professional help. Jamie, as an adult, will have to take on the emotional and social burdens of caring for herself for the
duration of her chronic illness. She has to be backed up by her loved ones and the people in her professional life. And she needs a plan
explaining her self-management process and what to do in the case of an aggravation. High-frequency percussion is one of several medications
and therapies used to treat and prevent the malnutrition, vitamin deficiency, and potentially deadly chest infections that may develop from the
chronic condition cystic fibrosis. Patients will also be evaluated by a respiratory physiotherapist and a clinical nurse specialist. Certain persons
with cystic fibrosis have early onset of symptoms like coughing and shortness of breath, however these symptoms are not caused by the disease
itself but rather by external circumstances.
Patients with chronic illnesses, such as cystic fibrosis, must engage in consumer-guided care/self-management planning if they are to retain their
independence in daily life. An effective care plan can assist the individual in maintaining health and independence by providing information
about the individual's chronic illness, teaching the individual how to take their medications and perform activities like chest physiotherapy, and
helping the individual recognise early warning signs of deterioration. Consumer-directed care or chronic disease self-management planning
(CDT/SMP) refers to patient-centered treatment in which the patient has an active role in decision-making. The individual's medicines, dose
instructions, and a discussion of any potential adverse effects should all be included in the training.

3. Design a Self-Management Care Plan

Student to fill out Goals and SMART GOAL 1: SMART GOAL 2: SMART GOAL 3:
corresponding intervention
under each goal The patient will need many To facilitate mucus dislodging and Increase vitamin reserves and
medications around the clock to easier evacuation, the patient will availability in the body by taking

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 treat the many complications of
her pancreatic dysfunction,
including malnutrition, vitamin
deficiency, and severe chest
infections. Also, use a nebulizer to
clear air pathways.
employ an electronic-driven, a multivitamin every day and
high-frequency percussion device seeing a physiotherapist.
for one hour in the morning and
again in the evening.

Self-Management Verify that the patient is of an Jamie should take a multivitamin

Intervention 1 and Rationales
In order to limit the frequency of appropriate age for use of the every day to boost her vitamin
respiratory infections, the first line electronic, high-frequency levels, as prescribed by her Cystic
of defense is for Jamie to strictly percussion device and is capable Fibrosis Clinical Nurse
adhere to her antibiotic dosing and of reading, understanding, and Consultant. This is an essential
nebulizer usage schedules. You complying with the instructions. part of treating her Cystic Fibrosis
may use antibiotics for both and will improve her overall
curing existing conditions and health. Low nutrition absorption
avoiding future infections. The in the digestive tract is a common
nebulizer will help reduce airway cause of vitamin deficiency in
irritation and mucus production, people with cystic fibrosis.
facilitating better breathing. Supplementing with a
multivitamin may help remedy
these nutritional gaps and boost
health in general.

Self-Management
Intervention 2 and Rationales In order to provide the framework
for effective regimens and
adherence, it is critical for nurses
to establish open channels of
contact with their patients.
Moreover, it will help nurses
Talk to Jamie about the positive
effects of Postural Drainage. For
postural drainage to work, the
patient must be positioned such
that any secretions may drain out
of the body and down the legs.
The second tactic is regular chest
physiotherapy sessions to enhance
respiratory health. This will help
loosen mucus and minimise the
effort required to cough.
Physiotherapy for the chest is an

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 recognise warning signs that a
patient may have problems
complying and have fruitful
dialogues with such patients about
avoiding the hazards.
Self-Management
Intervention 3 and Rationales Jamie plans to keep track of her
progress by documenting the
drugs and therapies she uses on a
regular basis. Jamie, who suffers
from Cystic Fibrosis, plans to
keep track of her condition by
documenting the drugs and
therapies she undergoes on a
regular basis. By keeping track of
her symptoms and responses to
therapies, she can make sure she's
getting the best possible care.
Self-Management
Intervention 4 and Rationales A more efficient, team-based
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High- Frequency Assisted Airway
Clearance devices are only
effective for as long as their users
take care of them, therefore it's
important to teach patients how to
keep theirs in good working order.
important part of treating cystic
fibrosis. It facilitates mucus
clearance and coughing. This may
help keep lung infections at bay
and boost lung health in general.
Make use of a percussive
instrument or technique.
Percussive treatment is a manual
technique often used by
respiratory physiotherapists to
promote secretion mobilisation in
one or more lung segments toward
the central airways. Percussion
over the affected area transmits a
wave of energy to the lungs and
airways.
Jamie will schedule frequent
 nursing process might be
beneficial for both nurses and
their patients. Every member of
the care team, from the front desk
to the pharmacy, may do their bit
to encourage more participation
from patients. A patient's
apparently innocuous statement,
"I'm so sick of taking that
medicine," may really be a red
flag to the care team. After talking
to your pharmacist, you may be
able to take precautions against
them.
Self-Management
Intervention 5 and Rationales Help people tailor the help they
get to their own needs. The degree
to which a patient uses the
available adherence tools and the
degree to which those tools are
personalised to their preferences
are both related to the patient's
level of adherence.
Self-Management
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Medical treatment of cold and
cough symptoms is known as
expectorant therapy. Airway
stenosis may be treated with this
method, as can the reinfection and
worsening of the condition, and
the decline in lung function can be
delayed.
An electronic, high-frequency
percussion device will be worn by
the patient for an hour each
morning and night in order to
facilitate vibrations inside the
chest wall, so stimulating
dislodging of the mucus and
making it simpler to evacuate.
appointments with her respiratory
physiotherapist to make sure she
is getting the care she needs.
Jamie has committed to working
closely with her respiratory
physiotherapist to ensure that she
gets the highest standard of care
for her CF. They will examine her
health situation and come up with
a plan to alleviate her symptoms
and enhance her standard of
living.
Don't waste the patient's
appointment time by having him
sit quietly. Help keep the patient
engaged in and focused on the
healing process.
 Intervention 6 and Rationales Using technologies to evaluate A medicine called an expectorant Meet regularly and without fail.
patient adherence, promote might be given to increase mucus The patient will be more likely to
proactive communication, and activity, change mucus viscosity, keep their psychiatric appointment
maintain a record of interactions, and/or hasten mucus clearance. with this reminder.
pharmacists may not only
improve patient outcomes but also
save considerable time and
resources.

4. Reference List

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