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Matrix

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Words 1722
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Personal Impact Paper

Anissa Spada Rn

May 3, 2012

NUR427

Laurie Baumgartner RN, MSN, CNS, NP, CCRN

Introduction

This paper will examine the chronic disease of lupus. A big portion of information in the

paper comes from a patient Anna. The areas of her life that are affected by the

disease , and the motivators for lifestyle change are discussed. The education of Anna

regarding the disease and learning model theory will be examined.

What is Lupus?

Lupus is a chronic autoimmune disease. The immune system fights off invaders in the body. The body develops antibodies to protect from invaders. The immune system affected by lupus cannot tell the difference between good and bad tissue. This process causes the immune system to attack itself. There are many different types of lupus. The type Anna has is cutaneous and systemic. Cutaneous affects the skin. Systemic lupus in her case affects the joints. Cutaneous lupus causes skin rashes/lesions. The most familiar rash is the butterfly rash. The rash occurs on the bridge of the nose and across upper cheeks. Systemic lupus cause the joints become painful and inflamed.
Anna
The interview with Anna was held over a couple of days. Anna was diagnosed a year and a half ago with lupus. Anna believes that she has had the disease for longer than a year and a half. The rashes that she experienced had been occurring since she was 19. Anna is now 41 years old. Anna is married and has two children. She practices as a nurse in orange county, CA. Her children are two boys five and 10. Anna resides with her family in Long Beach, Ca. Her husband travels quite a bit with his work. This can be very hard for Anna when flare ups occur. The signs and symptoms of the disease are different for each person. The signs Anna experienced that raised her attention. Extreme fatigue that lasted for over 3 weeks. Anna went in for a yearly physical and had blood drawn. The internists ran lupus levels, and ANA levels (anti-nuclear antibody). Abnormal results do not definitively give a diagnosis of lupus. The diagnosis is a combination of abnormal ANA and chronic symptoms of joint swelling, chronic rash, and extreme fatigue. The signs and symptoms did not appear all together at the same time. Lupus is a disease of flares. This means the symptoms come and go. The extreme fatigue would subside. The next flare up would be rash on the chest. The rash would last for a couple of weeks. The joint swelling and pain are the most painful and disrupts functioning of everyday life.
The effects of the disease
Social: Anna described the affects lupus on her social life. Anna has always been very physically fit. When the joint swelling/pain occur it limits physical activity. Anna has always been a runner. Long distance running has always been a refuge. The long distance running is hard while in a flare up. Long distance running was a hobby she shared with several friends. The running would be a weekly occurrence. Lupus has taken that part of life away. The running has turned into walking her dogs and riding her bike with her husband. Anna feels isolated from her friends with whom she would run. There is no longer the commonality of running with her friends. Applied nursing research Journal suggests that lupus affects all areas of quality of life. Sleep, rest, home management and social activities.

Financial affects have been moderate. Anna has insurance through her employer. The deductible for each individual is nine hundred dollars. The beginning of the year is always somewhat costly. Anna considers herself very lucky to have good insurance. There are many americans without health insurance with lupus. The disadvantaged with chronic illness have a great impact on our emergency departments. The journal of Nurses Scholarship performed a study in Wichita, KS. The study concluded. Uninsured patients with chronic illness was 65%. The 65% of the uninsured were continually in the emergency room. The estimated cost for community hospital was $14 million. The area the disease has impacted is the ability to perform at work. Anna is a RN. This can be very physically challenging. The director encouraged Anna to file for an intermittent leave of absence. This would allow for Anna to call into work and not be penalized as an actual absence. This leave falls under Family Medical Leave Act. When flare ups occur the absence from work can be financially straining. Personal Impact
The personal impact of lupus is one of great proportion. There is not a lot of sound knowledge of Lupus. The cause is not definitive. There are so many different types of lupus. The type of lupus Anna has can be have painful and cause extreme fatigue. Anna has been in a conversation with medical professionals. The conversation fell along the path of the unknown with lupus. The disease is vague and gray. Some of the professionals doubt the diagnosis when given to a patient. This is very hurtful to Anna. She knows the pain is very real. The pain and fatigue cause great disruption in her life. The term Chronic Fatigue always reminded Anna of a lazy person. Upon the diagnosis she was stunned and disappointed in herself. Anna was now on the other side of the fence. She came to understand the frustration, and lack of support lupus patients experienced. Anna has always been hesitant to express to others she has lupus. Anna feels people will label her as one of the “chronic pain” people. Anna experiences these types of patients in her work. Anna would always jump on the band wagon with everybody and label the patient as a “chronic pain” patient. When she started having swollen joints and pain. The shoe was on the other foot. Anna’s attitude towards the chronic pain patient has changed. Everybody experiences pain differently. This needs to be respected in nursing. The personal impact for Anna has a positive impact on her nursing practice. However, the perception of other people is still worrisome for Anna.
Education
The education process is ongoing. The diagnosis of lupus came as a shock. The internist referred Anna to a rheumatologist for further treatment. The rheumatologist basically explained the course of treatment is to treat the symptoms and flare ups. The treatment for the pain and swelling is steroids. This was a very big disappointment to Anna. She knew this was the first line of defense. Anna thought maybe she could manage the pain with over the counter pain relief. The first flare up she experienced was severe. The time lost from work and family and friends indicated she needs to start therapy. The side effects of steroids on Anna are moodiness, easy bruising, increased appetite. The pain and loss of time greatly outweigh the side effects. The education process with the internist included; exercise as tolerated, clean diet, 8-10 hours of sleep a night. The weight can go up and down. The use of steroids can make managing weight difficult. The clean diet can insure proper intake to increase health and maintain weight. Exercise is a very key point to successful management of lupus. Moderate exercise can improve joint health and ease joint flare up. Extreme fatigue can be very disruptive. Proper rest is an excellent tool to counteract this symptom. Anna tries to maintain these three key factors in her life. The management of the key elements can help with overall health mental and physical. Anna understands the importance of education with chronic illness. According to Minority Nurse.com. Nurses are the first line of education for lupus patients.
Motivators
The motivators for change in Anna’s life were her family. She has three very important people that need her to be healthy and strong. The change to exercising moderately and eating better were easy changes to make. Anna learned the day to day care of yourself directly affects the flare ups. Anna’s two children are very active boys. This was even a bigger motivator. The joint pain and fatigue can interfere with play time. The better she can manage the flare up or help to prevent severity. The more time she has to spend with the children. Anna has also been a motivator to herself. Anna decided to not disappear and stop living. Anna is living with lupus. Anna is very active at work involved in many ongoing projects and is also in school. The goal of being a nurse practitioner is on the horizon. Anna decided to keep going and not stop because she was diagnosed with lupus.
Trans-theoretical Model
The learning theory that would best fit the situation is transtheoretical model. This model envelops the idea of change over stages of time. There are five stages. Pre-contemplation: which is a stage of considering change. Contemplation: change is a high consideration. Patient may stay in this stage for an extended period of time. Preparation: the patient is taking some steps toward change. Action: the patient making overt changes to modify health behavior. Maintenance: six months of continuous change. The patient has potential to relapse to one of the earlier stages. ebook. Anna was in the maintenance stage. Anna is constantly trying to keep her lifestyle healthy and productive.
Conclusion
The disease of lupus has affected every area of Anna’s life. Fortunately Anna has skills of effective coping. She handles the flare ups well and follows a healthy lifestyle. Through the course of the interview she would always repeat that it is very difficult to always accept that she has a chronic condition. She has a support system and is very fortunate to have a good career. Anna is not the worst case scenario. But, even when you are fortunate to have health insurance and a good support system. Chronic disease is very difficult to manage and accept.

References
Lupus Foundation of America. www.lupus.com retrieved on April 30, 2012.
Lash AA (1998). Applied Nursing Research Journal vol 11(3) 130-7 Retrieved from www.pubmed.gov on April 30, 2012.
Smith-Campbell, B (2005). Journal of Nurse Scholarship vol 37(1) 80-6 Retrieved from www.pubmed.gov on April 30, 2012.
Minority Nurse (2011). Retrieved from www.minoritynurse.com on April 30, 2012.…...

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