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

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1. Introduction and SMART Goals

Simon, a 65-year-old man, was diagnosed with Crohn's disease when he was a teenager. When the lining of the digestive system
becomes inflamed, as in Crohn's disease, it causes several unpleasant symptoms. Simon describes many symptoms, including chronic diarrhoea,
rectal bleeding, an urgent need to pass stools, abdominal cramping, the discomfort of incomplete evacuation, and constipation (Lu et al.,2019).
Although Crohn's can afflict anyone of any age, ethnicity, or gender, it is most common in young adults. What triggers this illness is still a
mystery to scientists. While Crohn's disease often manifests at the proximal end of the small intestine and the proximal end of the colon, it can
affect any portion of the gastrointestinal tract, from the mouth to the anus. Possible side effects of this condition include lack of appetite,
weakness, and lethargy (Schreiber et al.,2021). Since Crohn's is a long-term condition, people can go through periods of symptomatic flare-ups
and symptom-free remission.
Simon was just taken to the hospital with worsening symptoms, including severe stomach discomfort, bloating, and diarrhoea with
melena. The upcoming hospital discharge of Simon necessitates a self-care management plan for him to follow once he returns home. In
addition, Simon's catheterisation necessitates nearly autonomous care, as the device might function as a route for the spread of infection if
sterility is not maintained. Along with medical treatment (such as antibiotics or surgery), self-care is crucial in managing Crohn's disease (Van et
al.,2021). Self-management of inflammatory bowel disease, including medication adherence, is linked to better health and results for individuals.
Although patient self-management is multifaceted, it can be broken down into three distinct sub-concepts: patient-centred, provider-centred, and
socially inclusive. Self-management activities, especially treatment adherence, can be improved at the individual level by fostering problem-
solving abilities and self-efficacy (Lichtenstein et al.,2018). While there is currently no treatment for Crohn's disease, it may be controlled with
antibiotics like Flagyl or corticosteroid, as well as dietary and lifestyle modifications, including increasing fibre intake (Chateau et al.,2020).
Crohn's disease has no known cure; however, it may be managed, and its symptoms mitigated with the proper medication. Generally, medication
is used to manage; however, surgical intervention may be necessary in some cases. In extreme instances, colon resections remove a portion of
the affected bowel. It is discouraging to deal with Crohn's disease day-to-day, but science is progressing, and treatment options are expanding.
The three SMART goals are:
1. Because of his various medical issues, including a bowel blockage, anal fissures., ulcers, fistulas, malnutrition, and more, Simon will need to
take many medications around the clock.
2. Simon should take a multivitamin daily and see a physiotherapist once weekly for three months to replenish his depleted vitamin levels.
3. To reduce the severity of his Crohn's disease, Simon should follow the treatment plan, which includes a healthy diet, regular exercise, social
support, and medication.
2. Discuss and Critically Analyse Consumer Directed Care/Self-Management
The term "consumer-directed care" (CDC) or "Self-Management" refers to a set of practices in nursing informatics and planning that
provide patients and their caretakers greater involvement in how they are cared for (Wildman et al., 2021). According to Wildman et al. (2021),
Consumer-directed care and self-management planning are crucial if Simon and other patients like him are to maintain their independence in the
community. If care for the client is well-organised, they may be able to maintain their health and independence for a more extended period
(Logan et al.,2020). Although self-management education interventions for Crohn's disease have been created, their efficacy has not been
extensively examined.
The Centres for Disease Control and Prevention (CDC) are based on many key ideas;
1. Enhanced capacity for adaptation and natural selection.
2. An increase in people's capacity to receive the necessary data to make well-informed health-related decisions, such as treatments to seek out,
which providers to work with, and how these therapies will be offered.
3. More open communication and teamwork between healthcare providers and patients may improve patient health and patients' ability to make
treatment decisions. The CDC's primary objective is to promote self-sufficiency among its constituents. By reversing the traditional decision-
making sequence and providing residents with more involvement in day-to-day challenges, this empowerment aims to promote individual
autonomy and quality of life.
 Creating a strategy for self-management is an integral part of the CDC. It is a method for handling chronic health issues prioritising
individuality and self-responsibility. The word "self-care" refers to the wide variety of actions one does for oneself in order to deal with the
discomfort associated with a chronic illness. An individual's responsibility for their health is emphasised throughout the strategy (Al-Yateem et
al., 2016). Incorporating assessment, collaborative care, client empowerment, expanded capacity, referrals to community resources, and a focus
on taking personal responsibility for one's health, this approach aims to improve health outcomes throughout a person's lifetime (Attauabi et
al.,2021). Clients like Simon can rely on CDC planning and self-management planning to help them stay in their homes and communities.
Clients may enjoy more prolonged periods of good health and independence if their treatment is planned precisely (Eberl et al., 2019). Simon,
whose Crohn's disease symptoms have been controlled, has been discharged from the hospital and will soon return home.
Due to his chronic disease, Simon has to learn to take care of himself in old age. Now that he is divorced and lives alone, he must
continue to do so in order to protect his autonomy and quality of life. So that he can function independently in the community, Simon requires
consumer-directed care and self-management planning (Gomollón et al.,2017). Simon can maintain his health and independence by being well-
prepared for each day. In order to avoid unnecessary hospitalisations while maintaining optimal health when self-managing a chronic condition
like Crohn's disease, careful attention to detail is required daily. Simon has to be reminded to take his medicine as prescribed, participate in his
physical therapy, and keep track of his diet and nutrition because of his GIT condition (Kennedy et al.,2019).
Furthermore, he must be sensitised to the point where he can notice the signs of discomfort and understands when to seek expert treatment.
Simon, now an adult, must shoulder the psychological and interpersonal demands of self-care for the lifetime of his chronic condition (Al-
Yateem et al., 2016). His loved ones and the individuals under his care must support him. Furthermore, he needs a strategy outlining his self-
management technique and what to do in the event of aggravation. To combat chronic malnutrition, vitamin deficiencies, and possibly fatal GIT
and urinary tract infections resulting from Crohn's disease, high-frequency percussion is used with other drugs and treatments (Attauabi et
al.,2021). There is a need for a GIT physiotherapist and a clinical nurse expert to assess his health. Some people with Crohn's disease experience
early-onset symptoms, such as constipation (which can develop into bowel blockage), chronic diarrhoea, and stomach cramps and discomfort;
nevertheless, these signs are not caused by the illness but rather by external factors.
Consumer-guided care/self-management planning is essential for patients with chronic diseases like Crohn's disease who wish to
maintain their functional autonomy. An excellent care plan can help the individual stay healthy and independent by informing them about their
chronic condition, instructing them in the proper use of drugs and other treatments (such as physical therapy), and alerting them to the earliest
indications of decline (Kammermeier et al.,2016). Healthcare planning in which the patient is involved plays an instrumental part in making
decisions, also known as consumer-directed care or chronic disease self-management planning (CDT/SMP), which is increasingly becoming the
norm in the medical community (Vernia et al.,2020). The training should cover the individual's medications, dosage instructions, and a
discussion of any possible side effects.
3. Design a Self-Management Care Plan
SMART GOAL 1:
Nutritional adherence Constipation, malnutrition, and
vitamin inadequacy are a few
Crohn's disease complications that
necessitate constant nutritional
observance for Simon (Ding et al.,
(2016).
Abdominal pain management
by using analgesics Panadol
PRN for 14 days Within hours of an exacerbation,
the pain level should decrease by
a scale of 2-3 when it arises at
home using the Panadol PRN.
Simon's two-hour education Simon should participate in a self-
sessions aim to increase his management education
understanding of Crohn's program that teaches him to how
SMART GOAL 2:
Simon should ensure that every
food he eats contains fibre daily.
Foods rich in soluble fibre can
help him slow his digestion and
ease diarrhoea.
Simon shows enhanced mobility
in a week. Enhanced movement
lessen the likelihood of additional
pain abnormalities when at home.
Education in the use of balance
exercises, regular intervals of rest,
and pharmacological therapies to
SMART GOAL 3:
Simon should take a multivitamin
daily to boost his body's vitamin
stores and availability (Ding et al.,
(2016).
Simons' vital signs, such as heart
rate, blood pressure, respiratory
rate, and muscle tone or posture,
return to normal within a week.
Effective nutrition management
and fewer carbohydrates are both
possible for Simon's education on
disease.
Enhancing Patient Compliance
with Medication through
teaching their importance to
Simon for 30 minutes.
to control their own Crohns
disease. Benefits to his health and
infection management will be
realised as he will get more
insight into pharmacological and
non-pharmacological therapies for
Crohn's disease (Dolinger et
al.,2020).
Simon has been given
prednisolone to increase his
immune system and bring down
the inflammation in his colon.
Disease development can be
halted by patient adherence to
medication (Bullock et al., 2018).
Simon must follow the prescribed
course of treatment. It is necessary
to develop the ability to keep
medication on one's habits
regarding medication non-
adherence and replace those
unhealthy ones with ones that
promote more confidence in one's
abilities (Adamina et al.,2020).
boost joint activity, facilitate nutritional management (Chateau
mobility, and decrease & Peyrin-Biroulet, 2020).
inflammation
Simon needs to take his Simon is to receive a monthly
medication each day without fail 0.9%;1000 millilitres of normal
timely. saline to maintain the hydration
The symptoms will worsen if the level in the body and prevent
medication is not taken as constipation.
prescribed. Simon has to learn to
self-manage the medicine he takes
to lower his risk of developing
poor QoL and mental health
issues due to his limited mobility
and poor self-care (Adamina et
al.,2020).
Educating Simon on dressing
for peripherally inserted central
catheter for 15 minutes.
Self-management of Crohn's
disease via a multidisciplinary
team (MDT) or other health
specialists.
Providing psychological
support for one month.
During dressing the peripherally
inserted central catheter, the
insertion site should be checked
for signs of infection every two
days for redness or swelling.
Simon needs to be exercising by
using the physiotherapist after
every two days. Studies show that
exercise effectively alleviates
Crohn's symptoms by lowering
stress (Lu et al., 2019).
Simon requires a counselling
session regarding his stress for
two weeks visit to a counsellor.
His risk of mental stress and
anxiety will decrease by two
weeks of counselling, and he will
be more motivated to live a
Simon requires instruction on
maintaining the PICC line,
including the possibility that he
will need to flush it once a day
while it is not in use.
These exercises, performed under
a physiotherapist's guidance, aid
in restoring normal bowel and
muscular function and reducing
inflammatory processes in a
month.
Through a visit to counselling
services for two weeks, Simon's
 social interaction will help him
move about more efficiently and
reduce the likelihood of future
deformities. Reduced body image
and self-esteem are avoided when
Simon must examine the dressing
to guarantee it is clean and in
good shape. The dressing may
need to be changed if it shows
signs of wear and tear, such as
peeling edges, dirt, or blood.
Simon needs to see a nutritionist
every month so that he may make
dietary changes to help him
manage the risks associated with
his Crohn's disease.
There is a need for the counsellor
to engage the relatives, such as his
sons, so show him support
throughout his disease process for
an hour of counselling. His
insecurities may cause him to
healthy lifestyle by sticking to a
nutritious diet, avoiding flare-ups,
and prioritising his health care if
he receives psychological
assistance (Logan et al.,2020).
people have access to
psychosocial help (Logan et
al.,2020).
withdraw from friends and family.
These issues stem from stress,
despair, and anxiety. Better
Crohn's disease management can
be achieved by increased social
engagement, which he should be
encouraged to pursue (Van
Rheenen et al.,2021)
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