Introduction and case study

Human health is the outcome of all the surrounding factors that help in individual survival. This involves the complex interaction between biological, ecological, cultural, social and many more factors, which shape the lives of people (LeMone et al. 2015). This paper involves determining these factors for individual case study patient named Rowena. The study involves a detailed understanding of the patient’s critical health explaining her circumstances; pathogenesis of disease followed by health determinants impact her health and management strategies working to help this patient.

Rowena is an ESRD patient (End Stage Renal Disease) having a history of Type 2 diabetes mellitus. Rowena was having an undisciplined lifestyle that involved heavy smoking, alcoholism, less exercise and living alone. The initial stage of Rowena diabetes moved from bad to worst due to her lifestyle habits leading to cataract surgery and the lens implant. Rowena is also suffering from peripheral vascular disease, hydrocephalus and severe peripheral neuropathy as consequences of uncontrolled diabetes. The development of chronic kidney disease (ESRD) is also one of the major consequences Rowena is facing because of diabetes.

This critical condition of Rowena is also not managed properly due to her behavioural issues, avoidance of treatment (missing dialysis) and mismanagement by care facilities. The technique used by care facilities for vascular access (CAPD and brachiocephalic arteriovenous fistula) had a poor technique and vision leading to consequences like peritonitis, steal syndrome during her dialysis treatment but presently her treatment is stable. Further, Rowena has missed many of her dialysis treatment resulting in poor health condition. Hence, as per her medical history, the overall condition of Rowena is complicated to understand and detect the health determinants leading to this condition.

According to Zimmet et al. (2014) studies, there are different categories of nerve damages that occur due to diabetes that is termed as diabetic neuropathy. The people having uncontrolled diabetes, high blood pressure, high cholesterol, overweight etc. develop diabetic neuropathy as a consequence of their diabetes. The nerves in different body parts especially legs and feet are affected leading to pain and discomfort. In the present case, Rowena is a victim of diabetic neuropathy facing left footdrop due to peroneal nerve injury and ischemic pain in legs. Ding et al. (2015) indicated that uncontrolled diabetes leads to meningeal expansion, glomerular basement thickening and glomerular sclerosis developing a chronic renal disease. In the present case, Rowena is at the 5D stage of chronic kidney disease. Further, diabetic retinopathy is another type of diabetic neuropathy where the eye is the affected zone of nerve injuries due to diabetes (Keleher and MacDougall, 2015). The risk of diabetic retinopathy is more in DM Type -2 patient rather than DM Type-1. Rowena is also a victim of diabetic retinopathy.

Pathogenesis of disease

The individual health is always dependant on the surrounding factors that make up the determinants of health. These health determinants possess individual identity because factors affecting health depends on the physical, mental, cultural, biological and social surrounding of the particular individual, for example – family connection, community, race, childhood development, employment, housing, locality, income, law, lifestyle, health etc. (McMurray and Clendon, 2015). Therefore to study an individual health condition these health determinants play a very critical role. In the present case of Rowena, there are certain specific health determinants leading and affecting her present condition. The social factors affecting her leading are her belonging to the indigenous community, living alone, less interaction with people and her location.

According to Brown et al. (2014) studies, there is a huge gap between the health status of the indigenous and non-indigenous community of Australia. This happens due to lack of healthcare facilities, lower living standards and degraded health infrastructure to the indigenous community of Australia. Therefore, by default Rowena being an indigenous Australian becomes a victim of this health gap making her community a major health determinant affecting her present health. Further, Rowena is living in a remote location that also restricts her accessing to better healthcare facilities. Therefore, her location is another determinant affecting her health condition. Guariguata et al. (2014) indicated that indigenous Australian living in remote locations have poorer self-reported health, high risk to chronic diseases and a higher rate of hospitalisation compared to non-indigenous living in the remote location. Further, in numerous reviews study performed by Senior and Chenhall (2013), it is opined that Australians residing in the remote or very remote region have 4 times higher risk developing risky health behaviours that involve smoking, alcoholism and depression. Rowena is observed with the risky behaviour of smoking, alcoholism indicating that her physical surrounding, housing, lifestyle and her cultural background are important determinants contributing to her present health condition (Smith, 2014).

Rowena is living alone at age of 57years with such critical health situations with only occasional visits to friends and relatives. In her medical history, it is noted that behavioural issues were observed in her treatment process previously. She gets help from carer for her shopping and cleaning purposes. This indicates a risk of an unstable mental situation in her life that can increase the risky consequences of her critical health condition. As per results, her diabetes is in poorly controlled state with stage 5D chronic kidney disease. According to Webster et al. (2017) studies at 5D chronic kidney disease stage, a person needs full-time attention and cares either by family or care provider to avoid a critical situation.

Impact of health determinants

Further, the care treatment and facilities provided to Rowena have also contributed to her present critical condition. The CAPD technique used for her haemodialysis had poor vision and technique creating episodes of peritonitis. She developed steal syndrome in further vascular access processes highlighting poor techniques used for her treatment. Along with this no full-time carer is provided to Rowena by her care facility in this critical condition. Hill et al. (2016) indicated that stage 5D chronic kidney disease needs full time under observation care. Rowena is not instructed about regular walking and exercise that is a major requirement to control diabetes. Her disease condition is totally under medication control with a huge list of medicines highlighting the further risk to her critical condition (Forbes and Watt, 2015). Hence, the health care techniques and facilities provided to Rowena are improper determinants affecting her health.

Conclusion

Rowena is in the critical stage of Diabetes as well as kidney disease contributed by health determinants like her physical environment, cultural background, location, lifestyle, improper treatment and unavailability of care facilities. These health determinant are very risky once at a 5D stage of chronic kidney disease and uncontrolled diabetes mellitus type-2. Health determinants are the important part of any treatment process and any kind of loophole in health determinants can spoil the health condition. Rowena’s case is a critical one that needs a check for her health determinants for proper recovery.

References

Forbes, H. and Watt, E., 2015. Jarvis’s Physical Examination and Health Assessment. Elsevier Health Sciences: AU.

Keleher, H. and MacDougall, C., 2015. Understanding health. Oxford University Press: UK.

LeMone, P., Burke, K., Dwyer, T., Levett-Jones, T., Moxham, L. and Reid-Searl, K., 2015. Medical-surgical nursing. Pearson Higher Education: AU.

McMurray, A. and Clendon, J., 2015. Community Health and Wellness-E-book: Primary Health Care in Practice. Elsevier Health Sciences: AU.

Smith, J.D., 2014. Australia’s rural and remote health: A social justice perspective. Tertiary Press: Pearson AU.

Brown, A., Carrington, M.J., McGrady, M., Lee, G., Zeitz, C., Krum, H., Rowley, K. and Stewart, S., 2014. Cardiometabolic risk and disease in Indigenous Australians: the heart of the heart study. International journal of cardiology, 171(3), pp.377-383.

Ding, D., Chong, S., Jalaludin, B., Comino, E. and Bauman, A.E., 2015. Risk factors of incident type 2-diabetes mellitus over a 3-year follow-up: Results from a large Australian sample. Diabetes research and clinical practice, 108(2), pp.306-315.

Guariguata, L., Whiting, D.R., Hambleton, I., Beagley, J., Linnenkamp, U. and Shaw, J.E., 2014. Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes research and clinical practice, 103(2), pp.137-149.

Management strategies

Hill, N.R., Fatoba, S.T., Oke, J.L., Hirst, J.A., O’Callaghan, C.A., Lasserson, D.S. and Hobbs, F.R., 2016. Global prevalence of chronic kidney disease–a systematic review and meta-analysis. PloS one, 11(7), p.e0158765.

Senior, K. and Chenhall, R., 2013. Health beliefs and behavior: the practicalities of “looking after yourself” in an Australian aboriginal community. Medical anthropology quarterly, 27(2), pp.155-174.

Webster, A.C., Nagler, E.V., Morton, R.L. and Masson, P., 2017. Chronic kidney disease. The Lancet, 389(10075), pp.1238-1252.

Zimmet, P.Z., Magliano, D.J., Herman, W.H. and Shaw, J.E., 2014. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology, 2(1), pp.56-64.

1. The patient-centered process helps to respect individual preference, involvement, diversity and contribution to the decision making process in treatment. It is a better way to communicate and coordinate in care treatment process creating positivity in the overall treatment process (Annear et al. 2014). Definitely talking to Rowena and involving her in the decision-making process of treatment would work in a positive manner to manage her lifestyle habits like exercise, smoking, alcohol etc.

In the present scenario, the primary treatment need for Rowena is to control her diabetes by implementing healthy lifestyle habits like exercising, quitting smoking and regular alcohol consumption. According to Zimmet et al. (2014) studies physical activity helps to digest the high level of glucose present in the blood of people suffering type-2 diabetes. Exercise helps muscles to burn glucose without insulin that rapidly controls diabetes in an effective manner. Therefore, primary treatment need for Rowena is to manage her lifestyle. However, Rowena is a complicated personality living alone and reserved, therefore, it would be tough to convenience her for changing her lifelong habits but help from care experts or consultants should surely work in her case.

2. Yes, Rowena belongs to remote community living a very average and isolated life. As per observation and case data her community is negatively affecting her health. According to Mitchell (2015) studies, 67% of Australians living in remote areas face problems like limited access to healthcare (distance), developing health risk behaviours (smoking, alcohol), lack of knowledge and exposure. The environmental and geographical features of the remote region affect health. As per Zhao et al. (2014) findings, half the population in remote regions of Australia have poorer health conditions compared to the population of urban regions in Australia. Rowena is living in the remote region that becomes a basic barrier in terms of her access to healthcare.

The major barrier Rowena has faced in terms of access to adequate health care is her community and location with isolated living in the remote region. Rowena is living all by herself with no family member neither any carer to look after her health in such a critical situation. The community care facilities are also not bothered to provide any carer for the patient like Rowena. As per Ting et al. (2016) study, it is the responsibility of community healthcare to look after the basic care needs of the patient living alone in their community. But, Rowena is not provided with any such facility. She only gets help for cleaning and shopping by the carer, which is not a sufficient facility to fulfill her care requirement.

3. Yes, Rowena is from a remote location in Australia that has surely limited her access to effective healthcare. In such a critical stage of uncontrolled diabetes, she has developed chronic kidney 5D stage disease that can risk her to life-threatening hazards. Further, her past medical history indicates negligence by her healthcare providers. There was the use of poor haemodialysis technique in her case that leads to the development of critical side effects like peritonitis and steal syndrome that are very harmful to her health.

The treatment processes used to cure her present condition are not sufficient or can be considered out-dated for such a critical case of Rowena. This happened because Rowena is living in the remote region having lack of awareness about proper treatment required in her condition. Zhao et al. (2014) indicated that maximum people living in the remote region face drastic health consequences due to lack of health facility, long distance access, lacking transportation and awareness. This health determinant of remote communities badly affecting health is a major concern for regions like Australia where urbanization is still limited in some regions (Smith, 2014).

References (discussion questions)

Smith, J.D., 2014. Australia’s rural and remote health: A social justice perspective.

Tertiary Press: Pearson AU.

Annear, M., Keeling, S., Wilkinson, T.I.M., Cushman, G., Gidlow, B.O.B. and Hopkins, H., 2014. Environmental influences on healthy and active ageing: a systematic review. Ageing & Society, 34(4), pp.590-622.

Mitchell, F.M., 2015. Racial and ethnic health disparities in an era of health care reform. Health & Social Work, 40(3), pp.e66-e74.

Ting, D.S.W., Cheung, G.C.M. and Wong, T.Y., 2016. Diabetic retinopathy: global prevalence, major risk factors, screening practices and public health challenges: a review. Clinical & experimental ophthalmology, 44(4), pp.260-277.

Zhao, Y., Thomas, S.L., Guthridge, S.L. and Wakerman, J., 2014. Better health outcomes at lower costs: the benefits of primary care utilisation for chronic disease management in remote Indigenous communities in Australia’s Northern Territory. BMC health services research, 14(1), p.463.

Zimmet, P.Z., Magliano, D.J., Herman, W.H. and Shaw, J.E., 2014. Diabetes: a 21st century challenge. The lancet Diabetes & endocrinology, 2(1), pp.56-64.