NRS 410 Topic 1 DQ 1
DQ Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion
Asthma is defined as a chronic inflammatory illness of the airways that affects people of all ages. According to McCracken et al. (2017) chronic inflammation is linked to airway hyper responsiveness; an exaggerated airway-narrowing response to particular triggers such as allergens, viruses, and exercise. This disease process results in recurrent episodes of wheezing, breathlessness, chest tightness, and/or coughing that vary in frequency and intensity over time. Symptom bouts are frequently accompanied by variable airflow blockages in the lungs, which is usually reversible either naturally or with proper asthma medication, such as a fast-acting bronchodilator (McCracken et al., 2017).
Heart failure (HF) is a condition in which the cardiac and respiratory systems are interrelated. With HF, the heart fails to adequately distribute blood throughout the pulmonary system and systemic vasculature (Cross et al., 2020). HF is a chronic, progressive condition, and the heart cannot pump blood efficiently to help meet the body’s needs. As the heart tries to keep up with demands, it becomes enlarged and pumps faster. As the heart weakens, the blood tends to back up in the body, and fluid passes into the tissues, which leads to swelling (Gilbert, 2018). It can affect the blood pressure in the lungs, also leading to the build-up of fluid in the air sacs causing shortness of breath and fatigue. To explain, a nurse would educate the patient and family on how the heart and lungs interact—using easy-to-understand terms to explain how the heart pumping action delivers oxygen and nutrient-rich blood throughout the body. The nurse can use a model or handouts illustrating the blood flow between the heart and lungs. They can also use videos or website sources to demonstrate how a weakened heart can cause respiratory symptoms. Assessing patients for their preferred learning styles is necessary to ensure they can learn and understand the information provided.
There is evidence that asthma development may be linked to a genetic predisposition. Several chromosomal areas connected to the generation of IgE antibodies, expression of airway hyper responsiveness, and the creation of inflammatory mediators has been linked to asthma susceptibility (Davis & Smallwood, 2020). However, further research is needed to identify particular genes involved in asthma, as well as gene-environment interactions that could lead to disease manifestation.
In regards to management of this illness, allergen-specific immunotherapy has the potential to change the course of disease, but it should only be prescribed by allergy specialists according to (Davis & Smallwood, 2020). All asthma patients should have regular follow-up visits during which their asthma control, adherence to therapy, and inhaler technique are evaluated.
DQ Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion
Limiting the amount of time spent outside during peak pollen seasons, as well as avoiding exposure to tobacco smoke and other relevant allergens/irritants, is an important part of asthma management. I chose this respiratory issues because I have been dealing with asthma most of life and I am seemingly developing more triggers as I age. I think it is important for a person dealing with this disease to learn their personal triggers if possible to help with management and prevent predictable occurrences. Currently in Central Florida we are having a streak of rainy days, accompanied by the wonderful pollen and fluctuating temperatures, I woke up wheezing with chest pressure and audible wheezing. I can often tell when the weather will change all because of my breathing. Thus far, my asthma has not inhibited how I live my day to day life and prayerfully it never will.
Patient compliance is usually suboptimal because these avoidance strategies can be difficult. According to Trevor &Chipps (2018) only 22% of asthma patients were treated by a specialist on a regular basis in a 2012 survey, and 48% of patients had never seen a specialist. Adherence to these strategies often requires frequent reassessments, encouragement, and empowerment. Patients should also be encouraged to use a combination of avoidance measures for best results, as single-strategy interventions have shown no measurable benefits in asthma control (Davis & Smallwood, 2020).
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Response
Thank you for sharing. Your post is detailed and impeccable. Asthma is among the top chronic conditions and a major cause of deaths
globally. Despite the superior quality of existing medications and treatment procedures, asthma is still inefficiently controlled globally. Majority of asthma patients reports symptoms on a daily basis and virtually all patients report restraints to daily activities (Qazi et al., 2021). There are various health promotion interventions for asthma. One of the interventions that health care organizations can adopt is Chronic Care Model (CCM) to manage asthma. According to Zheng et al., (2019), CCM connote a multi-faceted care model supported by clinical information system, decision support, delivery-system design, and self-management support. The objective of the CCM is to leverage on the above mentioned tenets to create and enhance the interactions between well-versed, activated patients and the proactive and prepared teams of health care providers. The CCM has proven effective in reducing health care costs and reduction in the use of health care services in managing chronic conditions such as asthma (Zheng et al., 2019).
DQ Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion
References
Qazi, A., Armour, C., & Saini, B. (2021). Perspectives of general practitioners about a collaborative asthma care model in primary care. Journal of Asthma, 58(12), 1648-1660. https://doi.org/10.1080/02770903.2020.1823408
Zheng, L. F., Koh, Y. L. E., Sankari, U., & Tan, N. C. (2019). Asthma care based on chronic care model in an aging Asian community. NPJ Primary Care Respiratory Medicine, 29(1), 1-5. https://doi.org/10.1038/s41533-019-0130-1
Asthma is a chronic condition that affects the airways, it is reversible and it causes inflammation and bronchospasms. Approximately 25 million people suffer from asthma in the United States, with 20 million of those people suffering are above the age of 18 years old (Centers for Disease Control and Prevention, 2020). The triggers are allergens, viral infections and exercise, and the classic symptom of an attack is wheezing (Johnson, 2018). Medications such as antihistamines and anti-inflammatory drugs can help combat the allergen triggers of asthma (Johnson, 2018).
Severe asthma is defined as a condition that affects patients 6 years and older requiring medium or high doses of corticosteroids in combination with longer acting meds. Identification of these patients depends upon the treatment that the patient is receiving and how well that they are responding to the treatment plan (Trevor &Chipps, 2018). This chronic condition requires long-term care and people who suffer from this condition have a greater risk of developing COPD.
Doctors can use incentive spirometry which looks at how well the lungs are functioning, and blood tests such as serum immunoglobulin E (IgE), to help diagnose asthma (Trevor &Chipps, 2018). They will also conduct a complete history and physical, and possible chest or sinus x-rays (Asthma and Allergy Foundation of America, 2021).
DQ Identify a cardiac or respiratory issue and outline the key steps necessary to include for prevention and health promotion
Tools such as the Asthma Yardstick and Asthma Action Plans are used by care providers and patients in managing asthma. The Asthma Yardstick, used by care providers is a way to increase or step-up therapy measures for individuals with poorly controlled asthma (Trevor & Chips, 2018). Asthma action plans direct patients, or provide instructions on what to do if their asthma symptoms flare up, tracks medications, and what to do to remain feeling well (Wagner &Steefel, 2017).
Corticosteriods, inhalers, and biologic agents such as Fasenra are some of the medications used to treat asthma. There are many tips on how to manage or keep asthma under control, such as taking your asthma medication as prescribed, using inhalers properly, quit smoking and avoid second hand smoke, keep fit by exercising as tolerated and instructed by primary care provider, stay current on preventive shots such as the flu and pneumonia vaccines, use proper hand hygiene and frequent hand washing during flu season and follow your asthma action control plan (Canadian Lung Association, 2015).S
Chronic obstructive pulmonary disease (COPD) is a group of chronic pulmonary diseases that cause blocked airflow and make breathing impaired. The most two most common pulmonary diseases that are part of the group are emphysema and chronic bronchitis. These two illnesses are diagnosed together. There symptoms are wheezing, lack of energy, unintended weight loss, swelling in lower extremities, chest tightness, shortness of breath, and or a chronic cough. COPD can be treated but not cured. COPD is caused by long term exposure to irritants such as chemicals, gases, particle matter, and tabaco smoking (Bozkurt & Bozkurt, 2022). Individuals diagnosed with COPD are more susceptible to acquiring heart disease, lung cancer, and other long term medical diagnosis.
Even though, COPD does not have a cure and gets worse over time there are various treatments to help control COPD systems and exacerbations. The correct medical management such as medications, stopping irritants, healthy lifestyle and regular medical appointments (Ambrosino & Bertella, 2018).
Ambrosino, N., & Bertella, E. (2018). Lifestyle interventions in prevention and comprehensive management of COPD. Breathe, 14(3), 186–194. https://doi-org.lopes.idm.oclc.org/10.1183/20734735.018618
Nurgul Bozkurt, & Ali İhsan Bozkurt. (2022). Effects of active/passive smoking exposure in patients with COPD. Ankara Medical Journal, 22(1), 93–103. https://doi-org.lopes.idm.oclc.org/10.5505/amj.2022.79026
Amongst cardiac issues, I see in the hospital, one of the most prevalent is atrial fibrillation. Atrial fibrillation has many etiology sources. According to Zeid Nesheiwat who works for the University of Toledo, usual sources of atrial fibrillation include “advanced age, congenital heart disease, underlying heart disease, increased alcohol consumption, hypertension, endocrine disorders, genetic factors, neurologic disorders, hemodynamic stress, obstructive sleep apnea, and inflammation of the myocardium or pericardium” (Nesheiwat et al., 2023). Usually when the body is in an inflammatory state, under stress, or the cardiac muscle is getting inadequate oxygen; the heart is more prone to develop atrial fibrillation. There are different classifications of atrial fibrillation, and they have different treatment procedures. Paroxysmal atrial fibrillation is when the disorder reverts to a normal rhythm on its own within seven days (Nesheiwat et al., 2023). Even though the paroxysmal type reverts to a normal rhythm, the heart remains with ectopic foci that need to be eradicated to prevent a recurrent episode; therefore, cardiac ablation is the best treatment for paroxysmal atrial fibrillation (Neshiewat et al., 2023). Treatment for persistent atrial fibrillation is a bit different when resolving the issue. Persistent atrial fibrillation is when the heart stays in a fibrillating type rhythm for more than seven days and rapid ventricular rate may be present, which can structurally change the cardiac muscle cells leading to dilated cardiomyopathy (Neshiewat et al., 2023). Intervention when treating persistent atrial fibrillation is either with the use of pharmacological means or cardioverting the heart to shock it back into a normal rhythm. Then there is permanent atrial fibrillation, which lacks a response to all types of treatment attempted to fix the rhythm and becomes a lifelong disorder managed with medication (Neshiewat et al., 2023). The main type of pharmacological methods used for atrial fibrillation includes rhythm control medications, rate control drugs, and stroke prevention pharmaceuticals (Li et al., 2020). Rhythm control drugs include some medications names such as flecainide, propafenone, soltal, amiodarone, ibutilide, and dronedarone, they are prescribed based on the classification of a-fib the patient is suffering. Rate control medications are some of the familiar beta-blockers, calcium channel blockers, and cardiac glycosides. Then stroke prevention is implemented by means of anticoagulation drugs (Li et al., 2020). Steps instructed to patients at risk to minimize their chance of a-fib encompass managing hypertension, treating hyperthyroidism, proper management of diabetes, reducing overall BMI, smoking cessation, and decreasing alcohol consumption (Li et al., 2020). Incorporation of these modifiable health risks can help reduce the risk of developing atrial fibrillation.