What is rheumatoid arthritis nursing essay

Rheumatoid arthritis (RA) is an inflammation and pain in the hands within the knuckles and second joints. There also can be pain in the wrists, knees, ankles, elbows, shoulders and feet. This usually begins between the age of 30 and 50. Women are affected three times more than men. It may occur in children mainly girls from 205 years of age. When children get this it is called Juvenile rheumatoid arthritis. RA can affect any joints in the body. This chronic disease may not go away completely and this is a systemic disease which basically means that it can affect other organs in the body like the skins, blood vessels, lungs and the heart. RA affects 0. 8% of the UK adult population.

Causes of Rheumatoid Arthritis

Rheumatoid arthritis cause is yet not fully understood however research shows that it is an autoimmune disorder which basically mean that the body immune system is attacking the body’s tissues. This then leads to inflation in the joints which causes pain, stiffness and swelling and can lead to joint deformity. RA can be genetic or inherited. Infectious agents such as virus, bacteria and fungi are thought to be the cause how this is not proved. Environmental factors can affect the risk of causing these disorders. Smoking has been reported that this increases the risk of RA. Inflammation is a normal body defense mechanism which is there to help fight of viruses and bacteria which causes illness. Whilst antibodies try to die down the illnesses to destroy it in RA it becomes a long term chronic process. Yet it is not known why this happens. You can get RA due to infections, viruses, and injury.

Changes to the body system

The process of inflammation and destruction are known by the terms pathogenesis. A joint has several parts which are the bone, cartilage which covers the bones ends, the joint space which is filled with fluid and the joint lining which produces the joint fluid. Finally the last part is the joint capsule which is a tough coat which keeps everything together. Joints require little energy and is paint however joints has to be lubricated so it is able to move and if formed with two bones that move together for example in the knee bones cover with cartilage which is smooth so that both can glide together. The bones end which is the joint capsule is a tough coating keeping everything together and the lining of the capsule called synovium produces fluid which is a effective lubricant than= t helps them move together. This how the joints should be however when you have RA the joint lining that has few blood vessels and no white blood cells however when having RA the joint lining is very thick and is crowded with white blood cells which have been entered through new blood vessels. White blood cells produce large number of chemical substances which causes the pain, joint swelling and joint damage. These chemical are released in to the blood stream which can cause fatigue and feeling unwell. A normal joint and how it should beThis is when RA happens. http://en. wikipedia. org/wiki/Rheumatoid_arthritis#JointsDue to the entry of the white blood cells into the joint lining which because inflammation then the joint is swollen, hot, tender to touch, painful and the functions are poor and over time can be deformed. The joints are mainly affected however other body parts can include such as: Eyes – dryness, inflammationLungs – fluid, fibrosis, nodules (rare)Skin – nodules, ulcersHeart – fluid, nodules, ischaemic heart diseaseBlood – anaemia, low countsRheumatoid arthritis is a risk factor for heart attacks and strokes therefore General practitioner should reduce this risk by controlling risk factors such as diabetes, high blood pressure, and high cholesterol. If you are a smoker then you would need to stop!

Diagnosis of Rheumatoid Arthritis

Having a blood test help diagnose RA however if you have joint inflammation then you would need to see a rheumatologist. There are different types of blood tests that are taken which are: Erythrocyte sedimentation rate (ESR) – this is a sample of your red blood cells which is place in to a test tube of liquid. Once it is placed in the tube it is timed to see how fast the cells have fallen to the bottom of the tube. If they are sinking faster than usual you may have RA. This sample is measured in millimetres per hour. ]C-reactive protein (CRP) – this test helps indicate if there in any inflammation anywhere in the body by checking how much CRP is present in the blood. CRP is produced in the liver and if there is more CRP than usual there is inflammation in your body. Full blood count- This counts the blood in your red cells to check if anaemia is present. Anaemia is a condition where the blood is unable to carry enough oxygen therefore has a lack of blood cells. People with RA can have anaemia and the chances are 8 out of 10. This helps to identify whether there is a chance of having RA but does not prove you positively do have it. Rheumatoid factor – this is a blood test to check if there are any specific antibodies present in your blood. Negative point is that this cannot be detected at a early stage to confirm you have RA , if this is negative then antibody test (for anti CCP) can be done which is more accurate to check if you have the disease. Joint imaging is also done such as x rays. X rays of your joints help differentiate between types of arthritis and regularly getting x rays of your joints helps to show the condition is progressing. Musculoskeletal ultrasound can be used in the clinic to see the presence of the disease as it would show how severe the condition is and show in inflammation of the joint damage. Magnetic resonance imaging (MRI) scans help to shop what damage has been done to the joint.

Treatment for Rheumatoid Arthritis

To help treat yourself from stopping the condition getting worse then you would need to find a balance between exercise and rest. The reason why it is important to exercise is because it stops your joints from becoming weak and stiff. Too much is not good. Swimming would be a great idea because it helps to strengthen you muscles and joints without putting any strain on them. Going to physiotherapist can help to. If you are obese or weight quite a lot then it would be a good idea to lose excess weight as this will reduce the pressure on your joints. If you’re finding it hard moving around then an occupational therapist can help suggest ways of making everyday tasks much easier by being able to provide you with specialist equipment. Eating healthy and having a balanced diet helps cut down on saturated fats. Having omega 3 fatty acids with is found in oily fish such as salmon, plants and nuts are great food supplements. However they have limited evidence to show it helps. Medicines cannot cure RA but they can help the symptoms. Medicines such as : Painkillers like paracetamoll can help to relieve pain and stiffnessNon-steroidal anti-inflammotory drugs help reduce symptoms of inflammation relieving the pain. A disease-modifying anti-rheumatic drug slows down the progression of RA and ease it symptoms which can take up to several months to work so continuing taking them would be important. Biological medicines made from animal or human proteins blocks the progress of RA in the immune system therefore trying these can help to cure the symptoms. NSAIDs are available as creams or gel that rub on to painful areas which can help stop the pain hurting more however this doesn’t treat or help the inflamed joints. Having really bad pains then you can be offered a corticosteroid injection to a specific joint to reduce inflammation.

Lifestyle

You would need to have more rest than you would having before having this condition as this will reduce the inflammationAlso you would need to exercise daily which will relieve the stiffness of the joint.

Diet

Going on a vegetarian diet will help symptoms to get better therefore cutting down specific food as they could make symptoms worst. Having omega 3 fatty acids which contain fish oil help pain relief therefore taking this regular can help the pain.

Employment

Having this can affect your career as you may not be capable to do things such as moving your joints as much which can happen in your fingers legs etc this can stop you from typing also having to move around means you having to cut down moving around and if this is necessary then you wouldn’t be capable to work. Fewer hours as well as you would need to have less for pain relief.

Treatment

Surgery can be done but is less likely done as medical treatments helps Ra however if you have severely damaged joints and the medication has help then the Doctor can recommend one of the following operation to help reduce the pain and discomfort. A hip or knee replacement. Synovectomy to remove the lining of an inflamed joint. Removal or repair of severely inflamed tendons. Surgery to fuse a joint to make it more stable. Therapy such as acupuncture and aromatherapy can help relieve pain and main you feel relaxed but this doesn’t have an affect on the disease.

Physiological changes due to treatments for disorder

This disease can affect people as they may go into depression. Individuals that go through this will be concerned or themselves as well as there family as well as there independency. They would need to be helped more by there family and be less independent as they would need help moving around and keeping eye on just in case. Also pain threshold they would go through due to inflammation on the joints however this can be helped as mentioned above but this also links into why they have depression. They cannot take the pain may be unbearable therefore they would need professional help. However stress is a helpful way of dealing with the condition as the pain is just normal in there daily lives which helps. RA can be an inherited trait as this is carried in there gene by there parents therefore this could be the reason of why it has occurred. However they are advertised to lead a healthy lifestyle which includes no smoking and having a moderate intake of alcohol. Should have a calcium rich diet and do the right amount of exercise.

Signs and symptoms

Symptoms include: Muscle painFatigueStiffnessWeaknessFlu-like feelingsRheumatoid lumps of tissues under the skinsLoss of appetiteDepressionEye soreness and tirednessIf any of these symptoms occur then you should go see your local GP to get checked up as they can diagnose you with the disease. They would also need a 2nd opinion from another health care professional for referralA young woman was diagnoses with RA but before her new she had this disease she had symptoms of this disease. She had a loss of appetite and always feeling tired, she even felt so weak she was in bed and couldn’t go to work however she didn’t decide to do anything about she thought it was just a fever that would go away. She even started to get muscle pain after a while and decided she couldn’t take the pain and wanted to be back on her feet again so she went to the hospital because that night she was in a lot of pain. She then went to a GP who did a x ray test as she was having pain in her joints. GP then got second opinion from another health professional before she was diagnosed with RA. There was inflammation in her joint and the doctor gave her advice on what she should do. She took ibroprofen to help reduce the pain in her joints and recommended she exercise a little bit and not staying in bed all day. Going to the physiotherapist was recommended. At her stage it prevented her joints from completed eroding. She needed a health balanced diet by having health food such as fruit and vegetables and food that was good for you. She didn’t need to cut down in her weight because she was skinny and with the loss of appetite she loosed more therefore it was important for her to have a balanced diet. Regular check at the hospital she had to go as she would do scans to see progress of her joints however the advice GP gave was part of her new lifestyle and had to maintained otherwise she would have got worst. She had to quit her job as she was fit and able to do the job she even went through depression because her lifestyle changed and she couldn’t bare the idea of that happening however this helped her face her condition and pain she was going through. Special equipment was given to her to help her get up and down the staircase by a chair lift that was fitted on her stair case. Her life had changed completely. Yet still not known why she has this disease.

What is acute myeloid leukaemia (AML) and changes to the body system?

AML is a rare cancer and around 2, 000 adults are diagnosed with AML each year in the UK. This can affect anyone at any age however it is mostly common in elderly people over the age of 65. This is a disease of the bone marrow due to abnormal cells. Normally white blood cells help fight infections and diseases whilst red blood cells give oxygen around the body however these white cells become abnormal due to leukaemia cells growing and stopping the red and white blood cells to do its job. Blood cells are made in the bone marrow which is the soft inner part of your bones. White blood cells are found in the lymph nodes and the spleen. Myeloid cells are affected in AML and monocytes or granulocytes are made in the bone marrow and are not able to work. AML is a fast growing cancer. Bone marrow produces stem cells (immature cells) that develop into mature blood cells. There are 3 types of mature blood cells: Red blood cells that carry oxygen and other materials to all tissues of the body. White blood cells that fight infection and disease. Platelets that help prevent bleeding by causing blood clots to form. In AML, the stem cells usually develop into a type of immature white blood cell called myeloblasts (or myeloid blasts). The myeloblasts in AML are abnormal and do not mature into healthy white blood cells. Sometimes in AML, too many stem cells develop into abnormal red blood cells or platelets. These abnormal white blood cells, red blood cells, or platelets are also called leukaemia cells or blasts. Leukaemia cells are unable to do their usual work and can build up in the bone marrow and blood so there is less room for healthy white blood cells, red blood cells, and platelets. When this happens, infection, anaemia, or easy bleeding may occur. The leukaemia cells can spread outside the blood to other parts of the body, including the central nervous system (brain and spinal cord), skin, and gums.

Causes of acute myeloid leukaemia

Causes of AML include people being exposed to high levels of radiation so if working in a nuclear industry or industry accident then they are at higher risks of developing this. Smoking also increases the risks due to the concentrated levels of benzene. 17% of cases are due to people smoking however if deciding to stop smoking this can reduce the levels of getting this cancer. People with blood disorders such as myelodsplasia can cause AML and genetic disorders such as Down syndrome have higher risks of developing it. Childhood people with previous cancers have 10 more of chance of catching AML than other people. There is not great information of the reason why leukimia is mainly caused. Being overweight can increase the risk of developing leukaemia. AML is more common in men then it is in women.

Diagnosis of acute myeloid leukaemia

Leukaemia can be found during a normal blood test procedure and if you feel you have the symptoms of AML then physical examination is done which the GP is checking for swollen lymph nodes, spleen or liver. When blood tests are done the lab does a blood count to check the number of white blood cells, red blood cells and platelets. And leukimia causes a very high level of white blood cells. It can also cause low levels of platelets and haemoglobin which is found inside red blood cells. A biopsy can be done were your Doctore removes tissues to look for cancer cells. This biopsy is the only way to know whether leukimia cells are found in the bone marrow. Before this biopsy is taken an anesthesisia is used to numb the area as this helps to reduce the pain. The Doctor then removes some bone marrow from your hipbone one another large bone and then a pathologist uses a microscope to check the tissues if it has leukimia cells. A thick needle is used to take samples from the bone marrow or small pieces of bone marrow can be removing to be tested. Questions are asked about your health such as questions about any previous illnesses to get a better understanding. And also help find out the reason why they may have this cancer.

Signs and symptoms

Bleeding from the noseBleeding gumsBruisingBone pain or tendernessFatigueFeverHeavy menstrual periodsPallorShortness of breath (gets worse with exercise)Skin rash or lesionBruised easilySwollen gums (rare)Weight lossBlood in your urine stoolsThese all mainly caused by abnormal white blood cells. If any of these symptoms occur then you should go see your local GP to get checked up as they can diagnose you with the disease. They would also need a 2nd opinion from another health care professional for referral

Treatment for Acute myeloid leukaemia

The goal of treatment is to destroy signs of leukaemia in the body and make symptoms go away. This is called a remission. After people go into remission, more therapy may be given to prevent a relapse. This type of therapy is called consolidation therapy or maintenance therapy. Many people with acute leukaemia can be cured. Chemotherapy treatments reduce the production of blood cells by the bone marrow|. The rest periods between courses of chemotherapy allow your bone marrow to recover. However, there is a limit to how much chemotherapy you can have without it causing permanent damage to your bone marrow. Chemotherapy, with or without radiotherapy|, is given, which destroys all the cells in your bone marrow. Soon afterwards, stem cells (the immature blood cells which develop into red cells, white cells and platelets) are given back into your blood through your central or PICC line|. These cells make their way into the bone marrow and start to make healthy blood cells. However they are side affects which arelowered resistance to infectionanaemiaincreased risk of bruising and bleedingtiredness (fatigue)a sore mouthfeeling sickHair loss. The above side effects are short-term. Some side effects can cause longer-term problems, including: changes to the way that your heart worksInfertility. You can have a transplant using your own stem cells (autologous transplant) or with stem cells donated by someone else (allogeneic transplant). Allogeneic transplants are more common than autologous transplants in AML. The donor can be a relative, usually a brother or sister whose bone marrow is a close match to your own. It’s also possible to use an unrelated donor if tests have shown they are a good match with you. This type of transplant is called a VUD (Volunteer Unrelated Donor) transplant. The donor stem cells will also contain healthy immune cells, which attack any leukimia cells that are left. After a transplant the new stem cells take a few weeks to settle in your bone marrow and produce the blood cells that you need. During this recovery time you would need to stay in hospital for the time being. If you need a bone marrow or stem cell transplant you may have a type of radiotherapy called total body irradiation, or TBI. Here, radiotherapy is given to the whole body to destroy the bone marrow cells. This is described in our section on stem cell and bone marrow transplants|

Physiological changes due to treatments for disorder

Your body will be going through a change therefore you would need as much rest as you can get also you would also need to plan with doctor or regular check up and test to see improvement of this cancer. Also if recovering form AML then it is required a good healthy lifestyle such as a healthy weight and diet, being more active having more energy level etc. however before being more active and getting out more full recovery is required as leukimia can lead to other health problems. Supportive care is given to prevent infections and helping to control pain of other symptoms. Also support is given to help you cope going through cancer. Help is given because people can feel depressed and in a state therefore someone being there and being supportive giver you courage and help not to go though that stage. Drugs and antibiotics can be given because people with leukimia can catch infections very easily and these also receive vaccines again the flu. Being more hygienic is more of an issue for people that have been diagnosed with leukimia. Your lifestyle and diet wouldn’t get affected as this won’t affect you having leukemia once better you would be able to do thinks you could do before however eating health food can help you fight bacteria’s and viruses better. For environmental make sure you kept away from bacteria and viruses which can be travelling can be restricted as you must keep away from flu etc. if you doing physical activities a lot then you would need to cut down because during course of leukemia blood clotting can happen and this can be the risk of heavy bleeding and injury.

Environment

Keep personal hygiene is essential also keeping the house very hygienic is important and getting rid of bacteria’s and viruses are important so you won’t get affected by them.

P3

There are different types of referral whether it is professional or unprofessional. There a three types of referral which is self referral, professional referral r third party referralSelf referral is when refers themselves to a health professional. They usually tend to refer themselves to there GP. Being self referral can be due to obvious symptoms that they may want to check out to be on the safe side or maybe referring them selves back to GP after a previous consultation if told to return. They may not only refer themselves to health professionals such as GPs they may also refer themselves to private health professionals such as remedial physiotherapist. Professional referral usually happened when a doctor examines the patient and decides that they need to be referred to certain specialist. They refer them to other specialist by letter or even a phone call. Sometimes other health professionals may be busy to be referred to as soon as possible therefore people that are well of can be seen within a day or 2 through private health hospitals. Doctors may not refer them as soon as possible they may decide to examine them more by seeing if medication prescribe help the patients and decide after whether they should be referred on not. When being referred it can take up to several weeks before being seeing after being referred depending on how serious diagnosis may be. Third party referral can happen when a relative or even a friends feels that a certain individual should be seen by a health professional such as a GP because that certain person is unable to do this for themselves. This can also happen when professional notices something that needs to be further investigated such as finding out that they may have diabetes. Investigation is based on sighs and symptoms for example if a patients if complaining about a burning sensation when urinating the GP would tell them to have a urine test so that it can be investigated. They wouldn’t have a blood test because the symptoms so obvious were it is coming from therefore urine test best way to examine and be more accurate about the problem. Blood test can be used if someone may have sign of symptoms such as feeling tired all the time. Therefore blood test would be suitable to check blood cells etc. can be the case of being anaemic. Not all investigation is laboratory tested as they are very simple to do. Another easy way of signs and symptoms that need to be investigated are investigation that can be done by yourself or done by the GP to look out for swelling or lumps for men they are advised or examine there testis and for women are for breasts. Also if going to a local chemist or GP blood pressure and blood glucose can be checked up as equipment are easily available. Any investigation that does be carried out will be very specific to each disorders but medical history should always be included as well as standard blood tests. When investigation are carried out the doctor listens to the patients about what they have to say and to ask about patients previous symptoms and disorders that may affect the development of a current symptom that they are having now. This helps the doctor to have clues to the nature of the illness. The doctor can elicit information that will point two or more conditions and they will try to find out the best diagnosis. Doctors usually ask for family history and disorders than can affect them. It is important to find out what the illness maybe and if the patients are in pain or distress ten a form of treatment is necessary to help this symptom get better. Once medical history is recorded then the doctor will carry out a physical examination and this may be a short or long examination. If the patients have not been seen in a long time then doctor may do regular checks such as listening to patient’s heart and lungs and measure blood pressure. As I mentioned earlier if someone has problem with urine then it is obvious the doctor isn’t going to examine any other part of the body. Here are the examinations that can be taken; Palpation – this is a technique of feeling organ shapes and sizes by touching the surface with hands. It is particularly useful on the abdomen because doctors are taught to examine for larger organs than normal such as livers and bladder. Areas that seem unusual that can be tenderness are noted. Blood tests – samples of blood test can be obtained by inserting needle into the vein which is called venepuncture. It can also been done by a finger prick which is usually a small, sterile lancet. Venepunctur is used when a lot of amount of blood is required for analysis. An examination of blood provided a good indication of the health and wellbeing of patients. When doing blood test can heck the level of haemoglobin, levels of salt to fin diabetes or even bone disorders, hormones which helps to find out whether you are pregnant or not and much more. Blood cell count is a special which reveals whether the different blood cells are present in normal quantities and appearance. Finger test prick uses small quantity of blood which is measure such as finding whether you’re diabetic by placing that little sample in a special device to be monitored. Urine tests – this is the physical characteristics such as colour smell and clarity of PH concentration. As well as chemical composition of urine such as urea which is a nitrogenous substance resulting from the lives breaking down amino acids from the digestion of protein. Like blood test it can reveal the protein, hormones and blood to find out diseases such as kidney disease and pregnancy. Urine test is more of a specific test and another way of finding out disease and infection. This mainly helps to detect microbial infections to. Radiological investigations – investigation such as x rays which are ideal for viewing skeleton in a non invasive way even the contains radiation which is harmful however if using it not as much then it is fine. These types of investigation are viewed in a more detailed and certain angle to help detect situations. radio-opaque materials can be used to fill hollow organs , such as the alimentary canal filling defects (black areas not filled by radio-opaque material) caused by tumours and polyps or bumps caused by ulcer erosions will be displayed. Most common radio- opaque a material is barium compound and patient will drink this so upper or lower part of the alimentary canal can be examined. Scans – they are different types of scans and the most common scan is a ultrasound scan and it is very advanced which can be used for different things. Most people use this with pregnancy monitoring but can also be used to see the liver and bladder etc. ultrasound works by high frequency sound waves of internal organ but can be difficult where this is a lot of gas such as in the adult’s brains. Ultrasound is very safe to use and no radiation is emitted. Another type pf scan is CAT scan which uses x rays passed at different angles through the body and transformed using a computer to produce sliced images. This is useful way to find issues with the brain and other organs. Function test – these are test that are specially designed to determine the degree if a function of particular parts of the body, to assist with diagnosis and assess the value of treatment. For example glucose tolerance tests for diabetes and liver function tests. Function test for an organ can include imaging techniques as well. Reproductive and endocrine function test can measure hormone levels in blood. Measurements are undertaken routinely such as pulse rate, breathing rate, blood pressure, body temperature and body weight and height. To check body weight and height BMI (body mass index) is calculated by dividing a person’s weight in kilograms by their height in metres squares. Normal BMI considered is between 18. 5 and 24. 9 and less that the average is underweight, between 25 and 29. 9 is over weight and above that is obesity. Systolic blood pressure corresponds to the pressure of the blood when the ventricles are contracting and the diastolic blood pressure responds when the ventricles are relaxed. Blood pressure is written as systolic/diastolic and the units are in mmhg. 120/80 mmhg is a standard healthy adults blood pressure. Can be measured using a sphygmomanometer. To check breathing rate peak flow measurement can be taken and people with asthma can monitor there own disorder. This is important in a lung function testing as it is easy to do and it measures the maximum speed of expiration related to the main airways. Special sizes can be used for adults and children. Electronic peak flow meters are available yet expensive. Checking pulse rate doesn’t require equipment and can be done using fingers on the pulse and counting beats per min. this tells you how healthy your heart is etc.

M1

Rheumatoid arthritis signs and symptoms may not be too serious at the beginning such as loss of appetite. Person may feel that it is nothing to worry about however as time goes by they may also be getting muscle pain which she can cope with which would mean a self referral to the GP. The GP would do a medical history check and may not seem to find what the problem is therefore may just prescribe prescription for the symptoms however as time goes by person may feel that it is nothing and feel like they do not need to go back to the GP. Family may decide that she needs to go to the GP which is a third party referral and the reason for this referral may be due to depression. GP would look more in to her symptoms therefore due to stiffness and muscle pain the GP decided to book them an appointment in hospital for an x ray appointment. This process can take up to a week therefore to reduce the pain the GP would give them a prescription to help them cope ibroprofen may be given to reduce the pain. After x ray they would need a second opinion so they are able to refer them to another profession. If finally said that they have this disease then going to the physiotherapist which can be recommended to help however this might no be the because as they may not have transport to be able to go to the physiotherapist or no baby sitter to look after there children . if attending to the physiotherapist they would check her BMI and it may be very low due to her not having a health balanced diet they would need to change they diet and have healthy food such as fruit and vegetables which would be good for them however loss of appetite would mean not being able to eat it all or even money problems in there life can affect them therefore this would be a very difficult situation. Regular check at the hospital they have to go toThey would do scans to see progress of the joints however the advice the GP gave was part of there new lifestyle and had to maintained otherwise she would have got worst. If not maintained then they wouldn’t be capable to look after there children by them self or even be independent as they used to be. Instead they would need a carer which can be helped by the NHS. Due to this disease this can affect the person’s job which would mean no income coming in the house therefore would have to live on benefits. They may also feel even more depressed due to not being able to do the things they use to do. GPS diagnosing Rheumatoid arthritis can be very hard is it may not be that actual disease and may be something else and by looking at X rays even though it may be one of the diseases symptoms it can be something else therefore more tests has to be done to make it more reliable that is actually rheumatoid arthritis. This can take a lot of time by trying to diagnose the patient however as time goes by the patient can disease can go worst therefore to prevent it for getting worst they need to find out what it is and treat it before it does get worst. The symptoms of leukaemia you wouldn’t actually think that it is serious therefore you wouldn’t go to the Gps. Once symptoms start to add up such as tiredness shortness of breath and irregular bleeding then you would self refer your self to the GPs after quite some time? The GP would do medical history as well as a blood test to check the blood cells. The results would come back after some time therefore you would have to wait which can make you feel very nervous. The GP would call you back to talk about the results as checking blood cells can show whether you have leukaemia or not due to lack of cells. The GP would get a second opinion and then professionally refer you to the hospital. Being referred into hospital can make life difficult for the person as not having an out door social life as well as not going to work. Having to stay in hospital for quite some time can make you feel depressed as life isn’t very interesting as all you have to do is rest and get help from nurses. Also losing hair from remission can lack the person self esteem especially if you are a woman. If person a woman then infertility can affect them therefore not being able to have kids can affect there relationship with there partner. Person would need to make time for regular check up a test to see the progression as well as making time for therapy to make sure this disease leukaemia doesn’t occur again. GPS diagnosing someone with leukaemia is very straightforward as blood test done is very clear as they aren’t another possibility of it being something else. When doing a blood test they do a blood count to check the number of white blood cells, red blood cells and platelets and leukemia causes a very high level of white blood cells.

P4

A care pathway is a description of the way services are brought together to meet an individual’s needs. The purpose of a care pathway is to benefit the individual for example they ensure that they are receiving a good quality of care. It also ensures that everyone involved knows what care they will be receiving. Another benefit of a care pathway is that it eliminates pointless or repetitive documentation. For a care pathway a care plan is done to specify what it going to be done and when it is going to be done. Primary care is a type of care that happens in the community other than hospitals. This usually involves General practitioners and other staff connected to the practice. Opticians, pharmacists and dentists also carry out primary care in the community despite the fact that they are not attached to a health practice. The services provided in the community are primary care services. Secondary care is carried out in hospitals usually once after someone has been referred by the GP which is a primary care, hospitals provide emergency services and medical and surgical services also beds as well as scans etc. with hospital equipment out-patient and in-patients care is provided. Tertiary care is a specialist care establishments such as cancer management, neurosurgery, cardiac surgery, plastic surgery, treatment for severe burns ect. For both rheumatoid arthritis and leukemia you would go through all these stages for care as primary care you would go to see a GP to help diagnose the problem and then get referred to a hospital where specialist help can be provided. For leukemia patient hospitals beds may be required as care needs to be given as they are felling very tired. With rheumatoid arthritis secondary care would be used to help identify issues by doing x ray, scans etc. Tertiary care would also be used for example leukemia is a cancer therefore going to cancer care will provide extra useful information. Formal and informal carer’s are involved in the delivery of care pathways. Formal carers such as GPs that are qualified and trained must follow specialized codes of conduct. Informal carers such as family carers or caregivers support people meeting their individual needs physically and emotionally. For an example someone with rheumatoid arthritis may find it hard walking up the stairs therefore the family may care for them helping them physically to go up the stairs as well as emotionally talking to them and making them feel better about themselves. Other agencies are involved to help individual’s needs for example transport such as cars are provided to take children to school or hospital appointments. Drivers that take them usually have their own car and are paid by the mileage they do or buses are used to help them take children. They belong to a nonprofit organization this is the same for meals for individuals who cannot manage their own daily living activities such as cooking and buying groceries. If you have leukemia or rheumatoid arthritis then you wouldn’t be capable on your own to go shopping and make your own food therefore this service is very useful as it provides hot cooked food for them. Monitoring review of care is important so that professionals, friends and family involved in the care pathway know what needs they need to meet however if it was to change then the people in the involved in pathway will know that they need to changed to meet there needs such as physically needing more assistance than before and they may become more emotional as their condition gets worse. Being reviewed helps keep up to date the needs of a patient. A care pathway shows how to meet someone’s needs for example Linda Jenson suffering from rheumatoid arthritis she would find it hard to move therefore she would require someone to help clean her house. Due to her condition checkups are required regularly therefore nurses would check up on her to check on how her condition is progressing which requires transportation to get her there. She would also need warm meals to get her through the day Tesco online shopping would help her to get snacks and other items delivered to her home during the day. All this would meet her needs and below is his care pathway plan. A middle aged man named Derrick Johnson suffering from leukemia and is bed bound in hospital therefore he is looked after by them all day however at times he does not like hospital food and wants something different therefore his family provide him with food that he desires also nurses keep an eye on him at all times and give him regular checkups which helps to create his pathway. Nurses provide medication and tend to him however doctors assess him and assist his improvement to meet his needs as the disorder improved he was able to go out for certain time to socialize with friends as long as he is being looked after and is brought back on time. The reason why doctors have to check up on him is because if he just decides to go out when she isn’t recovering then he can catch diseases and bacteria’s as his immune system is weak.

M2

The agencies and practitioners involved in the care pathway work together to provide care needed to provide the care for the two disorders which I have chosen which are Myeloid Leukemia and Rheumatoid Arthritis. Care pathways help the people involved about what is going on and if any problems occur then they can find out the reason and who is responsible and contact them straight away to resolve the issue as soon as possible. This information helps as it’s continuously being updated as they are looking how the condition is progressing also they are keeping up to date in the new medicine that is being prescribed and how it relieves them. This can easily be checked by using computers to look at the individual’s records which can be accessed by practitioners that need this information. For an example having medicine for leukemia will be prescribed and patients are not going to be that concerned about what they are taking and when they started taking it therefore keeping a record of this can help practitioners to figure out how it’s affecting them. The case is the same for rheumatoid arthritis as updates will be kept on what medication they have taken and what operations they may have undertaken . These records help practitioners to help meet the needs of an individual. Care pathways are essential for practitioners because if a patient has a deficiency in something then they can check whether they are receiving help for it or if they are not they can organize for them to get it. It may be an informal carer helping them however this needs to be known because practitioners wouldn’t know that they are receiving help. When practitioners know they are receiving help they know that they are helping to meet the needs of a person. For an example Linda Jenson with Rheumatoid arthritis has help by having a cleaner cleaning her house therefore practitioners knowing this then they know they are receiving help and living a healthy lifestyle. If he didn’t have a cleaner than his lifestyle wouldn’t be very hygienic and he would also struggle doing it himself and cause him a lot of pain therefore practitioners wouldn’t want them being in pain. Having leukemia can affect someone lifestyle therefore Derrick Johnson would receive help to meet his needs. Practitioners need to be aware of how his lifestyle is and how they are meeting it for example he wouldn’t be able to have the energy to cook his own food so it is important practitioners know that he is receiving help from his wife because if he wasn’t receiving it from an informal carer (wife) then they would try to make sure he would be receiving this help. Nurses who examine him every week may prescribe him medication therefore they would need to keep a record of who has prescribed it and when it was prescribed so this information can be passed on to other practitioners so they are aware of the medication she is receiving. Also the pharmacist would need to know this so they know that this prescription he needs is recent and needs to be given. Pharmacists would also need to update when this medication was given so other practitioners such as GPs would know that it was received so there no conflicting issues.

D1

I think that having a care pathway is important as it lets practitioners meet the need of the person more effectively. Not having a care pathway plan would mean not helping the patients properly and identifying issues. I think that practitioners knowing what medication they are taking help them to understand the side effects they would have if an issue has occurred and also would tell you who has prescribed and the reason why it has prescribed. Having rheumatoid arthritis can cause a lot of pain and discomfort and you also may not know you have this order however health professional you would go to see is a GP there role is to find out the reason why she is having these issues and may prescribe them medication to help solve the symptoms such as pain by giving a cream to them to help ease the pain however this would involve the pharmacist as they would give this prescription to them and if they wasn’t a care pathway then pharmacists wouldn’t know when it was prescribed and when it should be given to them. Without care pathways then it wouldn’t be a great service. GP may think they have rheumatoid arthritis and to make sure of this they would make them have gone see a radiologist that will give them an X ray scan. This shows that other care are involved which is need them to help find out the problem. Without care pathway I think that that service wouldn’t be very reliable and organised because person would turn up to hospital to get a Scan and then radiologist wouldn’t know what they are going to X ray and why they are going to do it also they wouldn’t know who wants this scan. Also this would frustrate the patient due to a slow service and them not helping to meet the needs properly as this would mean it would take time to help them. If I could improve the care pathway plan then I would make sure that old records are kept as well as new ones up to date as well making sure those patients are being helped soon as possible. Also I would make sure that patients who are not able to get lifts to the hospital are helped and that they know they can get help for this. Patients not knowing they do not have this help then this would mean them giving up and not receiving help. Leukaemia symptoms can mean affecting your whole lifestyle therefore patients would expect to solve this issue straight away as they would want to get better and get back to there lifestyle also Joanne Hogan who I did care pathway for has Kids and she would want to be sure she has the ability to bring up her kids and be able to do it therefore a care pathway plan will help her organise her to get better by meeting her needs quickly and positively for an example going to Nurses they would do regular check up to assess her on how she is improving and also may give medication to help her with issues that may be bugging her however this information needs to be passed on to her GP as he would need to know what is being prescribed to her as well as condition she has had which is leukaemia. Knowing background information helps GPs and other professionals to work out issues. If they did not have this information it would mean having to try and find out why she is having issues which may be reason because of her disorder which a GP wouldn’t know if it wasn’t recorded. Care pathway make sure that information is recorded which means a better service provided to her to help her get better quickly rather than her getting worst. Improving care pathways for someone with leukaemia I would make sure that they have agencies helping her at an early stage to make her life better at ease rather than stressful as this can lead to becoming depressed and making problems worst. I would also make sure a GP or a Nurse sits down with her talking about how her lifestyle now and how they can make it better for them. They may have they own suggestions and opinions which the service should take in to account as it would be helping her meet her needs.

P5

They are different care strategies that can be used to support individuals with there disorders. Below are the types of strategies that can be used. Statutory: this is required by the law and is governed by legislation. Type of statutory services are primary care trusts and hospitals are the part of the laws that arte required to have to deliver service to people to help meet there needs. William Smith who had rheumatoid arthritis uses this service as they used self referral to GP for help as they didn’t know what was wrong with them. The law was that they had the right to a service to provide care. Also they were referred for X-trays in the hospital to help them get better by finding out the reason. Also Joanne Hogan used this service as they were referred to the GP to help find out what was wrong with them and they were then referred by the GP to the Hospital for test to check there blood test as GP felt that they may be something wrong. Non- statutory: this service is private or voluntary. Giving care can be provided by business that takes care of care sector. The aim of the non statutory is for business to make profit and voluntary is there for people who really need the help from them. Services such as domiciliary care is when people would prefer to be care for at home in there privacy and would rather pay for the services then having to live away also private residential care home so they can receive best service from the business. Also catering can be private therefore doesn’t need to be provided from the NHS and patient needs to pay for this service as NHS do not offer this as it is private. Having Rheumatoid arthritis then you would be able to be able to provide food for yourself therefore in my care pathway plan William smith has decided to have catering service private to receive delicious food of their own choice. Care setting change over time when as disorder become diagnosed and treated as well as care managed. William Smith who suffers from Rheumatoid arthritis would use a GP service first as he was not diagnose with that condition as he only just got worried about the symptoms he was getting such as pain in muscles etc. With the GP knowledge he was able to provide care and help to William Smith. This was William Smith primary setting because this was the first he went to. The GP will do a medical checkup and questions that will help them to find the causes of William smith Symptoms. GP decided he needed to do x ray check up to check the bones therefore had to arrange appointment with hospital so they could do this checkup. Also blood test was needed to check the blood. After the results the GP would then decide whether they need help from the hospital after the x ray and blood test. Joanne Hogan also went to the GP first after getting symptoms she was experiencing. This was her primary care and GP did a routine checkup checking her weight and height as well as taking blood samples to check in her blood to find out reason experiencing symptoms such as feeling tired. Once this was done she would then need to ring GP surgery for the results and asked to make another appointment as it was a serious case and GP had to talk about arrangements and what she needs to do as being diagnosed with leukemia she needed extra care and help in the hospital. Both William and Joanne who have rights to access to hospital care is serious and Joanne being admitted with leukemia needs a care plan which I have done to help her with the condition as well as regular checkups after treatment to make sure she is doing fine. However she had to be admitted in hospital as soon as possible to cure leukemia therefore she had to stay in hospital for a while and be treated. She prefers to stay at home in her own space therefore to do this she needed care as her symptoms means she couldn’t look after herself. Mrs D Hogan who is her mother stays with her at home therefore she has care at home so she can be fed and house can be looked after which meant the Hospitals do not need to arrange for a formal carer to do this. Also William Smith suffering from Rheumatoid arthritis used the hospital for x rays to check the bone to see images if they were anything they could see wrong with it a find the reason of the cause and how to treat it. Also surgery could be done in the hospital to make joints more stable which meant he needed regular checkups to hospital at least twice a month to check the improvements of having arthritis. He had to live at home as he needed to get back to daily routine however needed rest for a while after being diagnosed and treated and he wasn’t able to cope making his own meals and doing physical movements which meant meals were provided as he couldn’t prepare himself. GPs are primary care therefore first both William and Joanne went to be diagnosed with a conditions they have. This meant regular medical checkups and questions to help find out what could be the reason and how tests should be carried out. For Rheumatoid arthritis GP decided best way to do this is being transferred to a specialist to do and X ray as well as an phlebotomist to take blood test and people that take these are skilled people who are able to take samples from the vein and absorb the blood with a syringe. Someone in the GP surgery could do this if they are qualified also a nurse in the GP would do this as they are capable of doing so. This is then sent off to laboratory workers to analyze the results. Joanne smith having leukemia would also go to the GP and do the same medical checkup and routine to help the GP find out what could be done and what test should be taken. Decided on the conditions and symptoms phlebotomist is needed so a blood sample could be taken from the blood to analyses the white and red blood cells. The GP could do this if he has the time or this could be arranged by someone qualified to do this such as the Nurse. This is then analyzed in laboratory workers who would do a blood count and realize that the cause is leukemia. This is then reported back to the GP so the GP could then explain and help the person to get better. Pharmacist provide prescription to both of my clients and William smith prescriptions would be to reduce the pain in the joint he has which would be on a repeat prescription as he needs it and for Joanne Smith tablets would be taken to get more energy and feel better to get back to normal life she lives. Professionals allied to medicine would be used for arthritis as physiotherapist is needed to help joints become better and moved about without being damaged again and with professional help this can help the client feel better and get better. Radiographers are used to take x rays therefore having arthritis x rays needed to be taken to check the bone. Therefore this setting is needed to check and be sure William smith has Rheumatoid arthritis.

M3

Different care strategies have advantages and disadvantages depending on the physiological disorder they have. Non statutory service has its advantages such as if William Smith who has Rheumatoid Arthritis then he can decide to use non statutory service which means receiving better care in its privacy. He would be either paying money to the business so he can receive better care than non statutory service. The advantage is that he would have better care as the service will give great and more can to him as he has paid them to do so. Also the business strategies would be different to the non statutory service as he would have more of a choice of what he eats and the lifestyle he will be living in this care home. His room would be better than a non statutory service as businesses decide on the quality of it. The disadvantage of non statutory service is that it could be too expensive and my client i have chosen may not be able to afford therefore what choice would he have if he wanted to use this service. Instead he would have to use the statutory service which means he isn’t going to be happy with it which can affect his lifestyle and can affect him emotionally as he feels trapped and doesn’t feel happy staying there. Also if he decided to stay at his own home that he can decide whether he wants prepared meals from a private business or from the NHS. Having no money as he does not work then this could mean William not enjoying the NHS meal. Joanne Hogan who suffered from leukaemia may feel isolated like she the only one that had this conditions however if a non statutory service which provides a day care were people suffered or have suffered can talk over there gets Joanne to let out her feelings and does not have to pay for this and feel that she isn’t lonely and make her feel good about herself. The disadvantage of this service means that if the charity cannot afford to keep this day care going then people who use the service are going to feel like no one is really bothered about them and have a knock on their self esteem or they could break down emotionally. Using a statutory service has its advantages such as Joanne Hogan who has Leukaemia could have bed rest in hospital and receive care whilst she is really poorly without any costs attached. This is primary care that is needed to help her get better however the disadvantage is that she may feel that she wants her own privacy in her own room which may not happen as governments cannot afford this and give care that is reasonable and affordable. William Smith suffering from rheumatoid arthritis is able to get examined to get diagnosed with what he has this can be having X rays he does not need to pay to help him find out what’s wrong with him however the disadvantage is that he may feel that he needs to get his x rays done soon as possible and that using the statutory service in can take a few days or even weeks. GPs that are primary care help and try to diagnose issues for William Smith and Joanne Hogan to be able to have courage to go to the doctor they must have bond between each other so that they have trust in each other and feel comfortable talking about the issues. The advantage of having a GP is that when going to your local surgery you can decide which doctor you want to see. The disadvantage is that if surgery keeps changing GPs then clients may feel that they don’t know much about them and won’t understand them which can mean clients not attending.

D2

Evaluating the care strategies that can be used to support an individual I think that when needed a blood sample that Joanne Smith needed to get her diagnosed with leukaemia should be done straight away on the same day. I think because making her re arrange a new appointment for a blood test can be a hassle for her to arrive to her surgery or make her more anxious which means her not coming. Also when the blood tests results has come in i think that they should not take longer than a day to get the results as this can take a lot time to help her get better quickly as the condition she may have can get worst. Within a day the receptionist or GP i think must not tell results through phone as this may not be the person. Another reason is that normally if the result isn’t bad then they tell the results through the phone and if it’s bad then they tell patients to come into the surgery with someone so I think its best not to give away ideas and always recommend they come into the surgery for their results. I also feel that patients who do not know much about their conditions and do not know where they can go and meet people in day care who they can talk to. Leaflets should be given out to them once diagnosed by the GP so they can decide to go talk to someone privately or a charity to get involved on not feel like they are on their own. Also leaflets of places to go to help them to be more confident and be more prepared to help themselves get better. Also leaflets can help them to try out places that help them get physically and emotionally better.