Wednesday, February 1, 2012
Today, JoAnn Spears continues her nursing evaluation of Henry VIII.
The King’s pains.
Nursing Diagnosis: Tissue Perfusion, Ineffective, Peripheral
Nursing Diagnosis: Pain, Chronic
Nursing Diagnosis: Skin Integrity, Impaired
Henry VIII and his bandaged, suppurating, painful legs are the stuff of Tudor legend, as is “the gout”. Gout was common in Henry’s time, when diets were high in triggering, purine-rich foodstuffs such as beer, ale, and organ meats. Gout does cause excruciating pain in the lower extremities, but it tends to be episodic and associated with inflammation, rather than chronic ulceration. If Henry did have gout, it may have been the least of his problems.
Poor peripheral circulation seems a more likely explanation of Henry’s lower extremity woes. The weight and immobility that were part of his life after the age of about forty could certainly have caused or contributed to this condition. The weight gain may in turn have been either the cause or the effect of type 2 diabetes. This is the type of diabetes which is acquired later in life. To continue a sad spiral, diabetes also contributes to lower extremity problems such as easily damaged skin, neuropathic pain, and ulcers that will not heal and become chronically infected.
Nursing Diagnosis: Nutrition, Imbalanced: More than Body Requirements
Diabetes is a disorder of glucose metabolism, and type 2 diabetes is associated with excess food intake. Henry’s much vaunted gluttony and his weight in middle age—estimated by some to be as much as five hundred pounds—argue strongly in favor of this diagnosis, but not exclusively.
Hypothyroidism is also associated with weight gain and mental irritability such as Henry displayed. This condition is, though, more commonly seen in women than in men.
Tudor portraiture makes a strong argument for Cushing Syndrome as the cause of Henry’s obesity. Pituitary tumors which disrupt normal cortisol activity are a frequent cause of this disease. Portraits of Henry in later life feature the typical moon face of Cushing’s Syndrome and the characteristic distribution of excess fat deposited in the core rather than the extremities. Ironically, Cushing’s Syndrome can also cause or exacerbate mental status changes and diabetic processes, as well as erectile dysfunction
JoAnn Spears is a registered nurse with Master’s Degrees in Nursing and Public Administration. Her first novel, Six of One, JoAnn brings a nurse’s gallows sense of humor to an unlikely place: the story of the six wives of Henry VIII.
Six of One was begun in JoAnn’s native New Jersey. It was wrapped up in the Smoky Mountains of Northeast Tennessee, where she is pursuing a second career as a writer. She has, however, obtained a Tennessee nursing license because a) you never stop being a nurse and b) her son Bill says “don’t quit your day job”.