CD can be a debilitating disease and can affect all aspects of person’s life intensely as seen in the case of SM. Using a case study of an individual with Crohn’s disease, I will address how the CD impact on patient’s social, financial, and personal life, how patient learned about her disease and educational experience while learning about her chronic disease. I want to use the initial instead of full name to protect the patient’s privacy. SM , a 40 year old teacher with two younger children from Michigan admitted to our hospital with dehydration and anemia.
She has been bloody diarrhea for six months and initial diagnosed with colitis by her primary care physician who gave her antibiotics and steroid which help her symptoms improving. Two day ago her diarrhea became very severe and reached as often as 15 to 17 times a day, accompanied by severe pain and abdominal cramping, loss of appetite, and sense of abdominal fullness. This has made it increasingly difficult for her to leave her home or go to work. “ I feel like I am a prisoner of my own bathroom . SM has become moody and depressed. She has lost 40 pounds, developed blurred vision, and is growing facial hair. Her skin started to peel and split. She is bloated and her face is swollen. Her husband has filed a divorce because she could not take care of children , family ,plus financial crisis, and she is scared because she is covered under her husband’s medical insurance. Impact of Cronh’s disease can be extensive on an individual’s social, financial, and personal as seen in MS case.
She could not work and only get 60% of her salary , plus medical expense, unable to take care her family, and her two young children so cause her husband filed divorce. Furthermore, she is isolated from her co-worker and friend since she is too weak to participate any social activity. All above caused her depression. According (Coheb. J. D, 1995) “ long term stress and repeated crisis provide fertile ground for individual maladaptive functioning as well as creating vulnerability for dysfunctional family behavior.
When psychosocial dilemmas persist over time and are left unattended, various form of dysfunction emerge” (p . 18). So psychologist was consulted for MS to help coping with her diagnosis, her debilitating symptoms ,and her husband filing for divorce. Depression can be situational and may aid in allowing MS to voice her feelings, and decrease her anxiety. The psychologist provided her more information about her disease, help her cope with her daily struggles, and gave her encouragement as another support system.
The psychologist has tried to enlighten her husband regarding MS’s disease process and her stress could worsen its symptoms. Counseling the couple could reduce marital strife and perhaps assist MS and her husband to find mutual ground and save their marriage. The doctor explained to MS in brief about her diagnosis and treatment options which include drug therapy, nutrition supplement, herbs, and surgery. The nurses according to MS and her husband literacy level and readability made the broche with pictures, DVD to educate them how to deal with the disease.
Using Bloom’s taxonomy, cognitive domain to help the patient and family to have knowledge as following: 1. What is Chron’s disease, how do the medication work, what is the main side effects, how to take the medications, what are complications so the patient and her family can participate her medical care. 2. How to maintain optimal nutrition: parental nutrition (PN) is used when symptoms of irritable bowel disease are severe. If oral foods are tolerated small, frequent, low residue feeding are given to avoid over distending the stomach and stimulating peristalsis.
It is important for the patient to restrict activity to conserve energy, reduce peristalsis and calorie requirements. 3. How to promote rest: it is important to encourage activity within the limits of the patient’s capacity. The nurse suggests bed rest for a patient who is febrile , has frequent diarrheal stools or is bleeding. 4. How to cope with the stress and anxiety: teaching the patient the art of stress relief without drugs can give the patient a sense of control over some symptoms. Such as biofeedback, routine exercise, relaxation exercises, breathing techniques, massage, etc.
According to (Mirkka et al, 2008) “ patients expect functional knowledge about self care and how it affects their health. In addition to understanding the disease and treatment, patients expect social knowledge about how to connect treatment at home. Patients expect social knowledge about how to connect treatment with work, hobbies and social life, patients also expect that their family should learn about their illness, home care, and how to participate in treatment. “ ( p. 250) After finishing the above teaching, MS and her husband accepted the facts and disease, expressed all the feeling and concerns to the nurse.
While allowing MS to explore her feeling toward he diagnosis, the nurse could encourage her to set short- term and long -term goals. How will MS cope with pain today? What methods for pain control would MS like to continue to explore in the days to come (Bloom’s Taxonomy affective domain)? Once the goals setting, MS and her husband work together to comply with treatment, follow medical advise. Financial strategies will place a huge toll on MS’s disposition. The nurse enlisting the help of social work can help her develop plans for future caring needs.
Social work can assist her to apply for other health plans that will support her alone. If she has no other support systems in place, social work can assist her with home health nursing for her recovery period and financial assistance , if she needs to be off from work for an extended time. MS’s struggles are many, but to ensure her successful recovery we must utilize all the resources of our multidisciplinary colleagues, as well as our nursing knowledge. We must take into effect what the patient’s diagnosis, prognosis, and experiences are so we can give her the best chance of survival with her illness.