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Personal Impact

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NUR 427 Health and Chronic Disease Management

This paper will be discussing the personal impact and journey of 46-year-old Mrs. Linda being diagnosed with what is referred to as orthostatic intolerance. “Orthostasis means 'standing up'. Thus, orthostatic intolerance (OI) is defined by the inability to remain upright. It is often erroneously designated 'orthostasis'. More specifically, OI can be defined by the inability to remain upright relieved by recumbence” (Stewart, 2012). The patient spent more than 20 years with torture and life threatening symptom no doctor could identify. The patient was born in southern Minnesota. When she turn to puberty, her body change in ways she never expected. She was felling weak, fatigue, dizzy, and lightheaded. She tried to manage her symptom during adolescence with different over the counter medication. After celebrating her 18th birthday, she decide to leave Minnesota and went to Buffalo Los Angeles. As soon as she touches California a new symptom emerge. She was feeling a migraine symptom and affects her to focus. When the migraine increase she did appointment with neurologist. The doctor order CT scan to see if there is any unusual thing in her brain. The result came normal. She went to seek treatment with various doctors who were not able to explain to her the cause of her migraine. Then she left her work and return to Minnesota. This disease has had a huge impact on her everyday quality of life as well as her family and friends. It was a daily fight and struggle. After months, when her symptom improved in Minnesota, she decided to move Sunny Florida. As soon as she gets to Florida, her symptom came back. She said this time was 10 times worse than ever. Despite her pain she decided to stay and work full time. Even though, she work full time she was struggling to manage her finance because of her chronic disease. Not giving up and continue to productive about caring herself was key to survive. After a year living in Florida, she got married and start a new life. One day after a long walk her heart rate start beating fast. The patient husband insist to see a doctor and they went. After checking her blood pressure and pulse the doctor noticed there was a problem and order EKG. The patient denied to have EKG because she found out she was pregnant. For the next six month, they were waiting eagerly to see their first baby. After six month her symptom came back again. When they reach to ER, it was late, they lost their baby. She was devastated because she was taking her prenatal on time, drink plenty fluid, and eat healthy. The doctor said, the baby did not get enough oxygen and blood volume and was not enough to take care of it. It was hard to cope with the lost. After slow recovery, she got pregnant again and had a baby girl at the age of 25. After few month of having a birth, she decide to go shopping for the first time with her new born baby. It was a very warm day, she start to feel fatigue while driving. After a few minutes she blackout; she came out a moment before she crush the car. She rushed to the ER. Since her symptom was the sign of many diseases, there was nothing to find. For the next couple of days she was in and out of hospital because of syncope. When the doctor could not find anything, they offer pacemaker to manage her heart rate. Even though pacemaker could control the heart rate and helps to prevent blackout. After a pacemaker implement, she saw a big change in her life. Her episode of passing out went away. She also manage her migraine for a while by drinking plenty fluid and take frequent rest period throughout the day. After six years, the patient start to feel chest pain that goes to the left arm, neck, and face. She manage to call her husband but block out while speaking to him on the phone. After staying one day, she was discharged without any reference, diagnoses, and prescription. The family did not feel they got the right respond from the nurses. The husband said “Some of the nurses in the counter were rolling their eyes and did not really respond”. There are many diseases that can cause the same symptom. The family was very frustrated because there was no solution to go back to physicians. Her symptom went to worst. After few month, her husband encourage her to see group of specialist for the last time. They decide to travel to Nashville Tennessee to see the group of specialist. The doctor decide to do tiled table test. “The head-upright tilt-table (HUT) test is used primarily for the investigation of orthostatic symptoms.” (Lamarre-Cliché, 2001). They were monitoring her heart rate and blood pressure. When the head of the bed gradually tilled up her heart rate and blood pressure Shockley elevated. Normally the heart rate went up 10 beats to keep the blood to get to the brain. But her heart rate went up by 32 beat and the same thing with her blood pressure. Next the doctor order a catecholamine to see her neuro transmitter. Catecholamine are types of neuro transmitter release from nervous system to regulate blood pressure and heart rate. The result shows her catecholamine were extremely elevated. The doctor believes this is the cause of her problem and diagnoses her with orthostatic intolerance (OI). Orthostatic intolerance is caused by a defective autonomic nervous system. The system control involuntary body functions. Like digestion, blood flow, and body temperature. Patient with OI cannot make necessary adjustment direct to gravity once standing up. Blood form their heart and brain pulse to their extremities causing a dropping of blood pressure. Patient with OI will have headache, fatigue, weakness, syncope, and dizziness. The doctor explain OI could be the cause for them to loss her first baby. After decades of pain and confusion, she finally got satisfying answers to her questions. Since the condition has no cure, symptoms vary in different circumstances, treatment is nonspecific, and aggressive treatment can lead to marked supine hypertension, she decided to change her life style. “OI is related to deviations from optimum regulation of heart rate (HR), blood pressure (BP) and cerebral blood flow (CBF) that make remaining upright impossible. Environmental factors that promote OI (e.g., hot climate, dehydration).” (Stewart, 2012). 1- The patient decide to move to Minnesota to manage her chronic disease because the weather is suitable for her diagnose. Excessive heat can raise a person’s heart rate and can be dangerous for patient with OI. 2- The patient start organization and teach people about OI. 3- She join a support group that was held around her house.
The role of nursing is so fitting with the need for coordination and management of the care of people with chronic disease.

Reference

Extraordinary stories (May 22, 2014). “The Woman Who was Chronically Fatigue and Dizzy. [Full Documentary]”. (Video file) retrieved from https://www.youtube.com/watch?v=khM8PmMPIok

Lamarre-Cliche, M., & Cusson, J. (2001). The fainting patient: Value of the head-upright tilt-table test in adult patients with orthostatic intolerance. Canadian Medical Association. Journal, 164(3), 372-6. Retrieved from http://search.proquest.com/docview/204844196?accountid=458

Stewart, J. M. (2012). Update on the theory and management of orthostatic intolerance and related syndromes in adolescents and children. Expert Review of Cardiovascular Therapy, 10(11), 1387-99. doi: http://dx.doi.org/10.1586/erc.12.139

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