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linked item M6A3: Making a Safe Transition Paper
In December 2014, changes were made in Medicare payment rules. Hospitals are now penalized when a patient returns within 30 days for treatment of the same problem. One of the targeted medical diagnoses for this payment change is chronic obstructive pulmonary disease (COPD). Therefore, it is essential that the interdisciplinary team be utilized to ensure a safe transition between the acute care setting and home for the patient with COPD.
Using APA format, write a six (6) to ten (10) page paper (excludes cover and reference page) that addresses the disease management needs of adult patients with COPD for a safe transition between the acute care setting and home and the role of the interdisciplinary team in that transition.
A minimum of three (3) current professional references must be provided. Current references include professional publications or valid and current websites dated within five (5) years. Additionally, a textbook that is no more than one (1) edition old may be used.
The paper will consist of four (4) parts and must be submitted by the close of week 6.
Parts 1, 2, and 3 will focus on a disease management issue for the patient with COPD and the role of the interdisciplinary team in this issue.
Part 4 is the conclusion and needs to evaluate the effectiveness of the interdisciplinary team in making this a safe transition for the patient with COPD.
Part 1: Medication Adherence
Medication Adherence and Disease Management Essay Paper Guidelines
Part 1 must include the following:
Two common classes of medications used to manage COPD are bronchodilators and corticosteroids. Why are these medications used to manage COPD?
What are some common side effects of these classes of medications? Which of these side effects would be reported and why? Which side effects would not be reported and why?
Describe any special instructions that would be included with each class of these medications. For example, food-drug interactions and medications that should be avoided.
Which health care discipline, in addition to the RN, is best suited to help with medication adherence? How will this team member collaborate with the RN, the patient and the family to help promote medication adherence and a safe transition to home?
Part 2: Dietary Modifications
Part 2 must include the following:
What is the role of diet in managing COPD? What changes need to be made to the present diet? What role does culture play with diet?
What obstacles might be encountered when informing the patient about the changes in diet?
Which health care discipline, in addition to the RN, is best suited to help with dietary modifications? How will this team member collaborate with the RN, the patient and the family to help promote healthy eating and a safe transition to home?
Part 3: Physical Activity
Part 3 must include the following:
What is the role of physical activity in managing COPD?
How would the RN promote adherence to a daily activity routine?
Which health care discipline , in addition to the RN, are best suited to help with physical activity? How will this (these) team member collaborate with the RN, the family and the patient to help promote physical activity and a safe transition home?
Part 4: Conclusion
Part 4 must include the following:
A detailed conclusion that includes an evaluation of the effectiveness of the interdisciplinary team in making a safe transition for the patient with COPD.
Compose your work using a word processor (or other software as appropriate) and save it frequently to your computer. Use a 12 font size, double space your work and use APA format for citations, references, and overall format.
Medication Adherence and Disease Management Sample Answers
Introduction
Changes have been done in the public medical cover including Medicare and Medicaid rules. This includes the penalizing of hospitals whenever a patient is readmitted within one month of treatment of the health complication. One of the health care medications impacted by this change is Chronic Obstructive Pulmonary Disease (COPD). This calls for utilization interdisciplinary strategies to ensure that COPD patients have a safe transition from acute care settings to home (Bryant t al., 2013). This paper addresses these strategic interdisciplinary interventions that focus on the disease management including medication adherence, dietary modifications, and physical activity. The paper concludes by evaluating the effectiveness of the interdisciplinary team in ensuring safe transition.
Medication adherence
According to statistics from the World Health Organization (WHO), 210 people are diagnosed with COPD. Research estimates that COPD prevalence rates are 9-10%, which is expected to increase by three folds by 2030. This is attributable to the increase in the aging population and tobacco use. Evidence based research indicates that interdisciplinary management of COPD improves patients quality of life, and reduces the progression of the disease considerably. The main challenge in the management of COPD is medication adherence, which often gets suboptimal (Troosters Et al., 2013).
The common medication used to manage COPD includes bronchodilator drugs. This class of medication aids by making it easier to breath. The medication action involves the widening of the lungs and relaxation of the bronchi. The main goal of this treatment is to relief disease symptoms by treating flare-ups. The short acting bronchodilators include pirbuterol, albuterol and ipratropium. The drug offers quick relief of breath shortness. The Long acting bronchodilators include tiotropium and formoterol (Bryant t al., 2013). Beta 2 agonists and anti-cholinergic are the most common types of bronchodilators and the anti-cholinergic. The Beta 2 agonist mechanism of action is through the stimulation of the beta 2 receptor cells in the airways muscles, making them to relax and dilate. Anti-cholinergic blocks the cholinergic nerves responsible for secretion of bio-molecules, which causes the bronchi muscles tighten. Examples include glycopyrronium. The side effects of the bronchodilators vary according to each medication, but the general side effects are dryness in the mouth, diarrhea, palpitations, headaches and muscle cramps (Balsamo, Lanata & Egan, 2010).
Corticosteroids are also effective in the management of COPD. This is medication is particularly important in the management of the inflamed airways and increased mucus production. Examples of corticosteroids include prednisione, prednisolone and methylprednisolone. The medication mechanism of action is through anti-inflammatory action, particularly by redistributing granulocytes. Additionally, the drug regulates protein synthesis responsible for metabolic functions that often lead to inflammation. This causes reversal of mucosal edema, reducing the secretion of secretagogue, which in turn reduces the vascular permeability by inhibiting LTC4 and LTD4. This causes reliefs the disease symptoms. The general side effects include weigh gain, mood swings, acne, high blood pressure, and osteoporosis (Adams, 2010).
These medications effectively work if coupled with other disease management strategies such as dietary modifications. The patient is expected to take balanced diets. The patient diet should consume low fats but with high protein content. The COPD patient is encouraged to take whole grain meals such as oats, bran and brown rice, because they have high mineral content. The patient should also take many fruits including tomatoes, asparagus, and bananas. The diets restricted in both medications are use of salt, and reduction of taking caffeinated drinks, tobacco use, and alcohol. Despite the advantages of milk, in COPD patients increases mucus production. Therefore, dairy products should be minimized in COPD patients. Crucifeoru vegetables, especially from the cabbage families should be avoided as they cause bloating, which causes it difficult to breath. Fried foods should also be limited to minimize the bloating incidents. This is similar with carbonated beverages, which can reduce gas. This is because the interaction of the medication with these restricted substances at molecular level causes toxic reaction (Bryant t al., 2013).
Other than dietary, medication adherence is key factor in ensuring management of COPD. Non-adherence is the leading cause for readmission among the COPD patient. Most of the non-adherence is unintentional and intentional because of patient knowledge deficit. Therefore, the registered nurses have a huge role to play in ensuring that patients are empowered. This involves patient and caregiver education on the objectives of treatments and disease impact on medication non-adherence. Other than registered nurses, patient caregivers and relatives have important role in ensuring that medication is administered and adhered to, as required. These people should be integrated when planning for COPD disease and the implementation of the care plan. This will ensure that patient adheres to medication even at their home place, thus promoting a safe transition from acute setting to home (Adams, 2010).
Dietary modifications and Medication Adherence and Disease Management
Dietary is one of the main aspects of health care management strategies. Proper medication is important because it reduces the levels of carbon dioxide levels, thus aids in easy breathing. COPD patients should be advised to focus on the ratio of fat, protein and carbohydrate contents in their diets. This is because these medications influence the respiratory quotient i.e. the ratio of oxygen and carbon dioxide. This is because these fats undergo aerobic respiration, where they are converted to energy, carbon dioxide, and water. The RQ for carbohydrates, fats, and proteins is 1, 0.7, and 0.8 respectively. The highest carbon dioxide yield is associated with high intakes of carbohydrates, thus COPD patient diets should have low amounts of carbohydrates. Some medications such as prednisone have impacts on COPD patient appetite. Therefore, patients should seek advice from their physicians if feeding change is observed (Yamalz et al., 2015).
Patients are also encouraged to take high intakes of fluids, about 6 to 8 ounces of water every day. These fluids should not be carbonated or caffeinated. This is to reduce stomach upset and mucus concentration respectively, making it easy for the patients to cough up and to breathe with ease. Additionally, these fluids interfere with the medication molecular level. Patients should take high vegetable, whole grain and legumes as described previously. This is to minimize heartburns, bloating and shortness of breath. COPD patients should avoid intake of salts as it alters the homeostatic condition, causing high retention of fluid in the lungs, which causes difficulty in breathing. The patients should also avoid taking food that causes allergic reaction as they could lead to bloating making it difficult to inhale. The patient should also be given potassium, calcium and Magnesium (Bryant et al., 2013).
These dietary guidelines face various challenges including economic constraints. The best dietary diets recommended for COPD patient are organic foods. These feeds are costly and may not be affordable and easily accessible. The cultural barriers and knowledge deficit are other challenges faced by COPD patient. This is because the patient lacks information of cheap organic alternatives. In some cultures, some food products such as dairy products are used in all dishes. The most recommended cultural food is the Mediterranean diets (Adams, 2010).
The RN should work in partnership with the patient’s caregiver, relatives and healthcare nutritionist can improve COPD patients in identifying the right dietary that is individualized. This way, the patient gets empowered and even as he or she is undergoing transition for acute settings to home is safe and effective (Kuzma et al., 2008).
Medication Adherence and Disease Management and Physical activity
Physical activeness is important in the management of COPD. This is because physical activeness is associated with the rehabilitation of the pulmonary. Pulmonary rehabilitation describes the process where patients are shown activities that make it easier to breathe. This process involves counseling as well as training on the techniques that aid in breathing technique. This includes activities such as Aerobic exercises, which facilitates blood circulation, ensuring that all vital organs have ample supply of oxygen. Physical activeness also reduces cholesterol levels, hypertension and enhances the flexibility of joints. Physical activeness is associated with improved self-image and self esteem (Gimeno-Santos et al., 2014).
The most common physical activities include stretching four limbs. This improves activity, and reduces muscles injuries and muscles strains. Cardiovascular training strengthens the heart activity and the lungs activity. This improves the rates oxygen utilization reducing breath shortness (Kuzma et al., 2008).
The registered nurses should work in partnership with the physiotherapy to understand the patient’s physiological function, which can be used when designing individualized care plan. This helps in identifying the activity that the COPD patient can manage with ease, and address barriers to physical activeness. The Physical activity therapist is able to identify the subjective and objective measures that can used on patients, and to ensure that they comply with the care plan. The caregivers and relatives can also help the COPD patients take short walks around the neighborhood, swimming, and jogging. This ensures that physical activeness is maintained even at home, thus facilitating safe transition process (Adams, 2010).
Medication Adherence and Disease Management Conclusion
COPD disease is life threatening, but it can be managed and prevented. The underlying concept of COPD exacerbation is due to unhealthy lifestyles including poor dietary, smoking, and physical inactivity. From systematic analysis of management of COPD diseases, the most intervention recommended includes behavioral modifications including healthy diets, increase in physical activity and reduction of tobacco use and alcohol. Thus, it can be concluded that COPD exacerbation is attributable to habitual factors, and thus to effectively manage safe acute settings and home transition of COPD patients, multi-factorial approach is effective strategic. This is because COPD is incurable, chronic, and most importantly, it affects the vital organs of the body (Troosters Et al., 2013).
This also calls for working in partnership among various healthcare stakeholders including pharmacists, patients, RN, occupation therapists, respiratory physicians, and nutritionists. They should work towards achievement of one goal, which is improving patient quality of life. This minimizes medication errors and reinforces on individualized patient’s care plan. Therefore, the aforementioned multidisciplinary effectiveness should be evaluated at every treatment, and based on the findings; the interventions can be modified to meet the patient demands (Kuzma et al., 2008).
Medication Adherence and Disease Management References
Adams, S. (2010). Integrated management strategies for chronic obstructive pulmonary disease. Journal of Multidisciplinary Healthcare, p.181.
Balsamo, R., Lanata, L. and Egan, C. (2010). Mucoactive drugs. European Respiratory Review, 19(116), pp.127-133.
Bryant, J., McDonald, V., Boyes, A., Sanson-Fisher, R., Paul, C. and Melville, J. (2013). Improving medication adherence in chronic obstructive pulmonary disease: a systematic review. Respiratory Research, 14(1), p.109.
Gimeno-Santos, E., Frei, A., Steurer-Stey, C., de Batlle, J., Rabinovich, R., Raste, Y., Hopkinson, N., Polkey, M., van Remoortel, H., Troosters, T., Kulich, K., Karlsson, N., Puhan, M. and Garcia-Aymerich, J. (2014). Determinants and outcomes of physical activity in patients with COPD: a systematic review. Thorax, 69(8), pp.731-739.
Kuzma, A., Meli, Y., Meldrum, C., Jellen, P., Butler-Lebair, M., Koczen-Doyle, D., Rising, P., Stavrolakes, K. and Brogan, F. (2008). Multidisciplinary Care of the Patient with Chronic Obstructive Pulmonary Disease. Proceedings of the American Thoracic Society, 5(4), pp.567-571.
Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R., Vogiatzis, I., Weisman, I. and Kulich, K. (2013). Improving physical activity in COPD: towards a new paradigm. Respiratory Research, 14(1), p.115.
Yalmaz, D., Ãapan, N., Canbakan, S. and Besler, H. (2015). Dietary intake of patients with moderate to severe COPD in relation to fat-free mass index: a cross-sectional study. Nutr J, 14(1).
