Symptom Management In Clinical Practice Essays Examples
Currently, growing awareness on the occurrence of symptoms in clusters is on the rise. There is an increasing awareness of how the different clusters relate to each other in a diagnosis of a disease and how the different symptoms can be managed in order to relieve the symptoms. In my role as a Transitional Nurse Practitioner (TNP), I face different situations where patients come with different symptoms and there are cases when it becomes difficult to understand how the different symptoms relate to each other. However, recently, a woman in her 40s came to the health facility presenting with different symptoms. The woman reported to have been having persistent cough that worsened from the previous ones. The continuous worsening of her coughs as well as the fact that she had been coughing for almost a month was causing her to feel chest pain. She also presented with wheezing sounds whenever she coughed. The wheezing sounds were as a result of the obstruction of the airways that also explains the difficulty in breathing as it is difficult for the patient to breathe in an out comfortably with the obstruction of the airway.
The voice hoarseness she presented with also resulted from the infection spreading along the nerves; hence resulting in paralysis of the vocal cords. The spread of the infection across the nerves can also result in shoulder pains where the patient feels that the shoulders are heavy and pain travels towards the outer side of the arm. The other possible relation of these symptoms is dysphagia where the patient has difficulty swallowing food due to the invasion of the infection into the esophagus. Therefore, this limits the ability of the patient to feed properly. Considering that the cases of coughing are persistent and recurrent, the patient is bound to lose weight as evident in the amount of weight she claims to have lost in the last few months (Burzotta& Noble, 2011).
Headaches are also part of the cluster symptoms presented by the patient claiming that they are recurrent especially when she coughs for prolonged period. The headaches are normally throbbing and only make the patient feel worse that she did before. The headaches are as a result of neurologic symptoms of the health issue facing the patient. This can lead to blurred vision and watery eyes.
The other symptoms were unspecific in the respect that the woman was feeling fatigued, experienced common weakness and was increasingly losing her weight. All these symptoms pointed too different diagnosis including lung cancer, pneumonia and other respiratory tract diseases like bronchitis. However, the effect of these symptoms on her especially the coughing and chest pains were taking a toll on her overall health. Due to the persistent coughs, a patient will begin feeling moody and fatigued will creep in as the body tries to fight the constant respiratory infections. The other reason for the constant coughs and cold like the diagnosis of the health problem affecting the patient may further explain the causes of her fatigue and constant mood changes. Due to the constant and recurring coughs and chest pains, the patient may feel depressed over time as he or she tries to get a grip of what might really affecting him or her. This is worsened if the person does not seek medical attention or does not find someone to manage the different symptoms affecting them.
The role of a transition nurse practitioner (TNP) is to ensure the use of evidence based practices to the family members as well as the patient in regards to the improvement of health and reduction in the cases of readmission. Therefore, it is important that the management strategies applied by the nurse is applicable in reducing cases of readmission. This calls for the use of streamlined care plans that interrupt the patterns of the symptom clusters discussed above. It is evident that management of one symptom goes a long way to inhibit the prevalence of other symptoms. Therefore, this calls for different management strategies towards different symptoms using both pharmacological and non-pharmacological strategies to relieve some of the symptoms presented by the patient. TNP is more concerned with the reduction of acute hospital visits and admissions through provision of transition services that monitors the progress of patients from the time they are admitted to up to three months post admission. Therefore, the TNP in this case, focused on different management strategies for the individual patient symptom to ensure that the patient’s health improved after admission and reduce any cases of new symptoms adding to the cluster of symptoms already presented by the patient. It is evident from the fact that the patient stated that she was coughing and experiencing chest pain that led to the need to put together a management plan that would not only alleviate the chest pain and coughing, but also the other cluster of signs and symptoms associated with her illness. Therefore, an all-inclusive strategic plan that addresses each of the symptoms as well as the underlying causes was put in place through the time frame differed depending with the intervention.
The first management strategy the TNP nurse should work on is to provide a good platform for providing care to the patient. It is important that the TNP ensures that there is a good communication channel between the patient and the nurse. This is the most important aspect in providing transitioning services. The patients should be able to trust the nurse to help her as well as communicate openly about her feelings as well as her symptoms. Therefore, the first strategy to manage the cluster symptoms is create a nurse-patient bond that will see a creation of a bond that will make the relationship work for both parties. This relationship should not be with only the patient, but also close family members. This is important because the family can help update the nurse on the progress of the patient during the transitioning process. In case of a change in the progress of recovery after admission, the family and the nurse need to keep in touch until the patient is well again (Brant, Beck &Miaskowski, 2010).
Management of the persistent coughs is also a priority especially due to the presence of blood sputum in the coughs. The patient stated that this only begun recently, but considering she is a smoker, then this is an issue that need to be taken seriously and possibly points to the underlying cause of her illness. Therefore, in order to reduce the coughing, prescriptions are required to ensure that the infections causing bleeding along the respiratory tract heals. This is serious as the chest congestion coupled with the blood sputum points to something as serious as lung cancer. These calls for the immediate management of the cluster symptoms before the main diagnosis of some of the possible health problems are identified. Therefore, working with the doctors to treat the infection in order to reduce coughs and also minimize the blood sputum is a main concern. This will be effective in reducing the rate of coughing and also reduce the intensity of the blood sputum in the cough. Though the management of the cough, the patient will feel relieved; hence alleviate al most of the signs felt including the wheezing sound and chest pains. In the case of productive cough, the best management strategy will be provision of oxygen to aid in the breathlessness that arises from blocked airways. This will help with the breathing while the patient is placed on a sitting position. Considering that the patient does not have COPD, and then it is not important to manage the amount of oxygen delivered. The main idea is to ease breathing for the patient and this will help her breath easily; hence, ease some of the pain she feels during breathing. Extraction of the obstruction from the tract is also another way to manage the continuous coughing and sputum blocking the tract.
In the case of depression, nurse can do a lot to manage the symptom. It is not all about putting the patient under medication as the nurse can identify that depression is not the real symptom but Is arising due to other health problems the patient has presented (Haworth&Dluhy, 2001). Therefore, the nurse can work with the patient to understand the source f depression. In this case, the nurse will strive to understand what drives the patient to feel fatigues, unmotivated and how it has impacted on their lives. In this case, the nurse can work with the patient on how to get back to her life slowly, but surely (Zerwekh, 2006). This is tricky as the depression can progress even as the other symptoms are being managed. Therefore, if the depression has been going on for a while is severe as in it impacts so much on the daily functioning of the patient, then the nurse has to consider referring the patient to a therapist who can help the patient through different forms of therapies including behavioral therapy among others. In so doing, the nurse will help deal with both depression and mood changes while managing the other symptoms presented by the patient.
Fatigue is something that a nurse can deal with especially when the patient is undergoing medication and the other symptoms begin to fade away. It is the drive by the patient to overcome the boredom that arises with the constant coughing. Thereby, the nurse can work on scheduling different motivational activities with the patient that will help them overcome fatigue. This will also require exercising and adaption of new lifestyle in order to regain the lost weight. This will also give the patient’s immune system a boost to enable the antibodies to fight back against the constant infections. Fatigue is related with depression and weight loss resulting from lack of motivation to do anything apart from lie down and sleep. Therefore, in order to ensure it is effective, the nurses need to work on creating an environment that motivates the patient to engage in different activities. This can be done by inquiring from family members and friends some of the things the patient like and asking for their help in keeping the patient active through engaging her in different hobbies (Armstrong & Choiniere, 2013).
In the case of chest pain and the shoulder pain, medication will help relieve the pain and this being evaluated and treated (Burton, 2011). Therefore, provision of pain killers and chest decongestants will help reduce the pain and enable the patient to feel way better with the reduction of the level of pain she feels when she coughs. To achieve this, the TNP will have to work with the physician to make prescriptions of the chest and shoulder pains while aiming at treating the cause of infection resulting in all the chain of clusters apparent in the patient presentation. None other thing for the TPN handling the patient to take into consideration is the need for collective planning between the nurse and the patient. Nowadays patients are not passive in the treatment process or in the consumption of different health services. Therefore, the nurse has to ensure that the patient is well informed, has all the alternatives presented to her and the processes well explained to her. This will also need to cover the medication, therapies and other interventions that will take place. This is to prepare the patient and ensure she is aware of different health interventions and its benefits for her health.
Understanding cluster symptoms and linking them together is increasingly becoming a way of managing the health issues facing patients. This is even more so for TNPs who have to ensure that the transition between admission and recovery ensues smoothly. They should have an understanding of how different clusters link together to an underlying cause for the distress. This provides the basis for the formulation of management strategies that work best for the patient. In this case, the most common and applicable management strategy is reduction of pain through management of the different symptoms one at a time (Richards D, et. al, 2012). This is why the nurses focused on treating the different symptoms differently to facilitate the decrease of the cluster symptoms. This way the patient was in a better state to deal with the numerous cluster symptoms. The underlying cause of these symptoms can be understood through a diagnosis, but working to reduce distress and cases of recurrent readmissions is the priority for the TPNs as it not only minimizes health expenditure, but reduces the negative complaints that may arise from patients.
Armstrong, P., & Choiniere, J. (2013). Vital signs: Nursing in transition. Toronto: Garamond
Burton, R. (2011). Nursing: Transition to professional practice. Oxford: Oxford University
Brant, J. M., Beck, S., &Miaskowski, C. (2010). Building dynamic models and theories to
advance the science of symptom management research. Journal of Advanced Nursing,
Burzotta, L., & Noble, H. (2011). The dimensions of interprofessionalpractice.British Journal of
Nursing (BJN), 20(5), 310-315.
Haworth, S. K., & Dluhy, N. M. (2001). Holistic symptom management: modelling the
interaction phase. Journal of Advanced Nursing, 36(2), 302-310.
Richards D, et. al. (2012). Delivering stepped care: an analysis of implementation in routine
practice. Implementation Science, 7(1), 3.
Zerwekh, J. (2006). Nursing today: Transition and trends (5th ed.). St. Louis, Mo.: Saunders