DQ: Discuss what resources are often necessary for nonacute care for cardiorespiratory issues

NRS 410 Topic 1 DQ 2

DQ: Discuss what resources are often necessary for nonacute care for cardiorespiratory issues


There are many resources a patient could need after diagnosis with cardiorespiratory issues. Depending on the disease process, whether cardiac or respiratory or both, determine what needs may arise. Some patients need to use durable medical equipment like oxygen at home or a walker to get around. Using this equipment sometimes requires rearranging the house to make it safe, like lifting rugs to reduce tripping hazards or furniture so patients can move around easily. Many modifications need to be made for an independent person now dependent on rides to appointments and help to shower. Medication resources are essential due to how expensive the medications even for those who have insurance. We must make sure patients have access to life-saving medicines and the ability to get these prescriptions, so they don’t run out (Johnson, 2018).

Cardiac rehab helps patients gain independence with activities of daily living after diagnosis with cardiac issues. They are a non-pharmological approach to help decrease mortality after myocardial infarction (MI). They help with safe exercise that can help with

DQ Discuss what resources are often necessary for nonacute care for cardiorespiratory issues
DQ Discuss what resources are often necessary for nonacute care for cardiorespiratory issues

healing and improve depression that some feel when faced with illness. They enter this usually after having an acute MI. This type of rehab improves cardiac function, ejection fraction, and resting heart rate. They can enhance the quality of life and eliminate risk factors that could contribute to rehospitalization (Kirolos et al., 2019). Pulmonary rehab is similar to cardiac rehab but specific to rehab for the lungs. It helps patients with chronic lung issues learn to exercise in a controlled environment (Johnson, 2018). These rehabs give patients tools to improve health with diet, exercise, and the ability to be independent in daily living. If used to full advantage, patients can decrease risks of further cardiopulmonary issues. Another goal of cardiac/pulmonary rehab is helping patients return to work. Some may be off work for a period of time to recover. This will mean some lose their job during this time. Factors that affect a patient’s return to work post-MI are job description, age, gender, and psychological factors like depression. Occupational rehab may be necessary to help patients return to work successfully within two years. It should start right away, along with other rehabs (Zack et al., 2022).

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Johnson, A. R. (2018). Cardiorespiratory complexities. In Grand Canyon University (Ed.), Pathophysiology clinical applications for client health (1st ed.). Retrieved from

Kirolos, I., Yakoub, D., Pendola, F., Picado, O., Kirolos, A., Levine, Y. C., Jha, S., Kabra, R., Cave, B., & Khouzam, R. N. (2019). Cardiac physiology in post-myocardial infarction patients: The effect of cardiac rehabilitation programs—a systematic review and update meta-analysis. Annals of Translational Medicine7(17), 416–416.

Zack, O., Melamed, S., Silber, H., Cinamon, T., Levy, D., & Moshe, S. (2022). The effectiveness of case-management rehabilitation intervention in facilitating return to work and maintenance of employment after myocardial infarction: Results of a randomized controlled trial. Clinical Rehabilitation, 026921552210768.

DQ: Discuss what resources are often necessary for nonacute care for cardiorespiratory issues



Older adults have multiple chronic conditions (MCCs) making it difficult to manage their healthcare needs aside from their functional deficits and social barriers adding to the complexities. An evidenced-based management approach called Transitional Care Model (TCM) have shown an improved health and economic outcomes for adults with MCCs, who experienced high rates of post-discharge complications, readmissions, or morbidity and mortality. TCM is a nurse-led intervention focusing on quality care and better patient and family/caregiver outcomes. In utilizing this model, the patient care is delivered and coordinated by a Transitional Care Nurse (TCN) usually an APRN, in collaboration with the patients, their families/caregivers, physicians, and other members of the health team. After the patient is discharged, the nurse conducts home visits and/or scheduled telephone call to the patient based on the policy to identify if there’s a change in patient’s health status and managing/preventing health problems and readmission. The nurse also works in partnership with the patient’s physician to adjust medication therapy. TCM is a multidisciplinary approach focusing on the unique needs of the patients and their families (Hirschman et al. (2015).

DQ: Discuss what resources are often necessary for nonacute care for cardiorespiratory issues

DQ: Discuss what resources are often necessary for nonacute care for cardiorespiratory issues

Better Outcomes for Older Adults (BOOST) is another intervention model (toolkit) which improves patients’ care as they transitioned from hospital to home. It has resources to help senior adults who are high risk for readmissions manage their condition by considering their individual needs, what matters to them, and the care that is aligned to their cultures and beliefs. The Care Transitions Intervention (CTI) is the third model whose goal is to improve continuity of care across care settings and providers in a patient-centered care. CTI is a low-intensity self-management program based on the input from the patients and their caregivers which provides patients with tools, support, and skills to navigate the healthcare system and manage their health conditions effectively (Earl et al., 2020).

In response to a mandate enacted by the Patient Protection and Affordable Care Act, the federal government launched the Hospital Readmissions Program in October 2012. The goal of this program was to reduce hospital readmissions by penalizing hospitals that fail to keep their Medicare readmission rates below the national average.

Although penalties are assessed using a variety of somewhat convoluted metrics, research published by the Kaiser Family Foundation shows that the program has resulted in a net decrease in readmission rates since its inception. Readmissions for cardiovascular disease have been one of the most persistent issues hospitals have encountered in attempting to achieve program compliance.


The following are some key statistics that highlight the importance of this issue in today’s medical landscape.

Congestive heart failure was named the leading cause of Medicare readmissions in a 2011 study published by the Agency for Healthcare Research and Quality (AHRQ).

The United States has the highest rate of post-myocardial infarction (heart attack) readmissions in the world according to a report published in the American Journal of Medicine. One out of every four patients diagnosed with heart failure is readmitted to the hospital within 30 days.

According to the Centers for Disease Control and Prevention, congestive heart failure is responsible for an estimated 1 million hospital admissions and readmissions each year.

While there are many factors that can contribute to this high rate of hospital readmissions for cardiovascular disease, patient-centered factors are frequently cited as a significant variable in predicting and influencing readmission rates. Numerous studies have found that low patient participation in terms of following recommended diet, exercise, and medication regimen is one of the primary causes of high readmission rates, particularly among people with chronic conditions.


When patients are discharged from the hospital, provide them with educational materials to encourage self management of their health conditions.

Provide automated follow up communications to patients via email, text, and interactive Voice Response (IVR) to remind them of upcoming appointments, checkups, and health screenings.

Send automated reminders to patients to refill their prescriptions at predetermined times in order to enhance compliance to prescribed medication regimen.





Agency for Healthcare Research and Quality, (2011). Cardiovascular Disease.


AHA Journals, (2022). Heart Disease and Stroke Statistics – 2022 Update: A Report From the American Heart Association.