Chronicity And Co Morbidity In Healthcare †MyAssignmenthelp.com

Question: Discuss about the Chronicity And Co Morbidity In Healthcare. Answer: Introduction: The health care industry has advanced considerably in the past few decades and what used to be an incurable morbidity, taking hundreds of lives; now there are different treatment options for it. However, it also needs to be considered that despite all the technological revolution in the health care industry, there still is a number of emerging public health concerns that mortality rates are increasing rapidly (Lisspers et al., 2014). One of the most common of these health priorities can be considered the chronic obstructive pulmonary disorder that targets more than 34% of the global population and this particular health disorder contributes to a large proportion of mortality to the health care sector. Chronic obstructive pulmonary disorder or COPD is a respiratory disease which can be characterized by the blocked respiratory airways, shortness of breath and excessive sputum or cough production. The patient suffering with COPD can be cared for optimally if a multidisciplinary team having different experts belonging to different care sectors; ho can address differential care needs of the patient. This assignment will attempt to evaluate all aspects associated with caring for a patient suffering with COPD taking the help of a case study. Interrelationship of complexity, chronicity and co-morbidity in healthcare COPD is the chronic illness and is associated with various comorbidities such as diabetes mellitus, cardiac disease, osteoporosis, hypertension,muscle weakness and other psychological disorders (Mellado et al., 2016). Chronicity of the illness refers to the condition that is difficult to be cured. Comorbidities are the medical condition that are associated and occur together with the main illness. These comorbidities add to the complexity of the chronic disease. COPD is the complex disease, as the patient had to cope up with various other comorbidities, which increases the length of the hospital study and exacerbation of COPD symptoms (Donner et al., 2017). Therefore, it mandates the need of more than one drug to fight the comorbidities along with COPD. Risk factors such as smoking, medication interaction, aging and lack of treatment of comorbidities add to the complexity of the comorbidities and outcomes in the patients with COPD. The complexity of the presentation of the symptoms makes it challenging for the clinicians to mage the chronic disease (De Lucas-Ramos et al., 2017). Thus, the complexity, chronicity and the comorbidity is interrelated in the health care and this concept must be clear to the health care providers to rightly handle the upcoming challenges. In the given study, Angela (COPD patient) was presented to her GP with increasing shortness of breath, increased sputum production, which has changed to dark yellow with green staining. Her condition is worsening daily. She is feeling unwell since several days. Her SaO2 is 84% on room air, temperature 38.4 C, She is significantly dyspnoeic, struggling to say more than 5 words without a breath. Her pulse is 104bpm and her BP remains elevated at 162/102mmHg. Due to inadequate intake of the medication, her symptoms have exacerbated. Consequently, she had to increase her antibiotics, nebulisers and oxygen therapy to maintain SpO2 above 92%. Due to hospitalisation, her mental well-being is affected. She is more upset due to burden of illness, inconvenience caused to her family, and at unable to care for daughters. Thus, chronic illness and associated comorbidities makes treatment more complex that ultimately affected both the physical and mental wellbeing. Pathophysiology of COPD COPD is characterised by airway inflammation, structural changes in the airway and mucociliary dysfunction. As a consequent of exposure to the inhaled irritants such as polluted air, tobacco smoke a chronic inflammation of the airway and lung tissues occurs along with the inflammation in the blood vessels (Celli, 2014). When the irritants are inhaled, it stimulates the lymphocytes, neutrophils, CD8+T-lymphocytes, and other inflammatory cells such as macrophages, and B cells. These stimulated cells are activated to trigger a cascade (Celli, 2014). Firstly, the inflammatory mediators are released such as interferongamma, tumour necrosis factor alpha, C-reactive protein, and interleukins (IL-1, IL-6, IL-8). These mediators can sustain the inflammatory process. They induce range of systemic effects and leads to tissue damage (Rodrguez-Roisin, 2014). Secondly, the chronic illness leads to various structural changes in the lugs that limit the airflow. The airway inflammation remain associated with the COPD due to airway remodelling. The narrowing of the airway is caused by the peribronchial fibrosis, over multiplication of the epithelial cells of the airways, damage of the airway and build-up of the scar tissues (Mitchell, 2015). This results in the loss of lung tissue elasticity. It is caused by the damage of the structures that support alveoli. It results in collapse of small airways on exhalation. It causes trapped air in the lungs and impedes airflow. This reduces the lung capacity (Pouwels et al., 2017). Thirdly, the mucous glands are enlarged by smoking and consequent inflammation. These glands line the lung airway and upon enlargement, it leads to goblet cell metaplasia. Ultimately, the region is filled with mucous secreting cells. COPD inflammation damages the mucociliary transport system that cleans the airway mucus. Eventually mucous is accumulated in the airways that blocks and worsen the airflow (Rogers, 2014). The pathophysiology of COPD detailed above can be related with the case study. Angela experiences dyspnoea and shortness of breath. Dyspnoea results due to airflow obstruction and exertion. The damage caused to lungs makes it hard to breath as the airflow is limited. It takes more efforts to make air travel. The breathing irritants may have damaged the tiny air sacs within the lungs. Therefore, the COPD patients develop emphysema. The shortness of breath is also related to irritants and mucous that cause swelling and inflammation. In case of Angela, shortness of breath can also be the sign of flare up or exacerbation. It may be also be caused by the infections, Flu or pneumonia (Mitchell, 2015). The elevated blood pressure in Angela can be related with the pulmonary hypertension due to arteries that transfer blood to lungs. It forces a patient to breath faster (Rodrguez-Roisin, 2014). Nursing intervention for COPD: Nursing diagnosis Care goals Interventions Rationale Expected outcome Shortness of breath or dyspnoea. The patient will retain normal breathing pattern The patient will maintain normal respirator rate. The oxygen saturation limit of the patient will increase. Placing the patient in the semi-fowlers position. Performing CPT or chest physical therapy to the patient. Increasing the fluid intake of the patient considerably. Maintaining a patent airway technique, and secrete suctioning is also performed as per the discretion of the medical practitioner. Providing respiratory support to the patient in case of aggravated dyspnoea (Punekar, Shukla Mllerova, 2014). Administering cough suppressant medicines and analgesics if the patient experiences pain and discomfort in the chest or airway. This will allow the patient to have maximum lung expansion and the breathing rate will subsequently increase. Increasing the fluid intake of the patient will liquefy the secretions as soon as possible (van der Molen Cazzola, 2012). As dyspnoea is characterized by the blocked airways due to the accumulation of sputum, the suctioning will remove the excess cough and clear the airways. In case the dyspnoea of the patient is aggravated and the patient cannot breathe on her own, respiratory support will help in stabilizing her condition. The cpugh suprresants will liquefy the accumulated cough and the mild analgesics will help the patent feel comfortable. The patient experience easier breathing exercise. The patient no longer experiences dyspnoea and the breathing rate of the patient returns to normal. Ineffective airway clearance Maintaining the airway patency of the patient with the breathing sounds getting clearer. Demonstrating breathing interventions to the patient to improve airway clearance by the means of effectively coughing and secretion removal. Auscultation of the breathing sounds of the patient checking for wheezes, crackles or rhonchi. Assessment of respiratory rate taking into accounts both the inspiratory and expiratory ratio. Assessing the presence of air hunger in the patient, characterized by restlessness, respiratory distress, and excessive usage of respiratory muscles. Providing a comfortable, safe, warm environment for the patient which is absolutely devoid of any environmental pollution (van der Molen, Miravitlles Kocks, 2013). Administration of intervention techniques like oral bronchodilators, pursed lip breathing exercises, suctioning, bronchial tapping while coughing, etc. It will indicate if the patient is expressing any indication of bronchospasm. It will assess whether the patient has tachypnea (van der Molen, Miravitlles Kocks, 2013). Presence ofb air hunger i9n the patient will indicate at the onset of severe respiratory dysfunction in the patient aggravated by any infection of allergic reaction. A warm and comfortable environment will help the patient relax, and the absence of any polluter like dust, smoke will help in minimizing the infection. These intervention techniques will help the patient breathe more effectively and facilitate better airway clearance (Glaab et al., 2012). The airway of the pati9ent will be effectively cleared. The patient will face no difficulties in maintain normal breathing pattern. Risk for infection The patient will communicate the probable risk factors or grievances. Identificatioj and administration of interventions that reduce the risk for infection. Facilitating changes in the lifestyle of the patient to promote safe and comfortable environment Monitoring the temperature of the patient Observing the nature, colour and odour of the sputum (Davis et al., 2015). Engaging the patient in effective and hygienic disposal of sputum and handwashing . Administration of oral antibiotics if presence of infection is confirmed. The fever might be indicative of the onset of infection in the patient. Presence of odor, or yellowish to greenish coloration in the sputum is indicative of pulmonary infection. Will reduce the risk of infection. Antibiotics will effectively combat the spreading infection (Lisspers et al., 2014). The patient will not acquire any infection while staying in the facility and will attain a speedy recovery. Health coaching, self-management, empowerment and advocacy: COPD is the leading cause of death in many countries and most people are not aware of the factors that exacerbate the symptoms. It is necessary for the patients to learn the COPD conditions and factors of exacerbations. Learning about the comorbidities makes the patient take better care of health. Therefore, coaching is necessary to aware patients on the indoor and outdoor air pollutants that can block the airway. It will help the patients to avoid the risk factors. Coaching the patient will help in the early detection, prevention, improved treatment and care (Baker Fatoye, 2017). In case of Angela, she must be taught about the side effects of medications (oral prednisolone, salbutamol) and signs that need immediate attention of the GP. She must be educated on the self-management skills. Self-management of COPD includes smoking cessation, self-care of exacerbations, participating in physical activities, performing breathing exercises, maintaining proper diet, adhering to the medications prescribed by the GP (). It will reduce the exacerbations as Angela is repeatedly admitted in hospital due to poor medication adherence and delayed intervention. According to Lenferink et al. (2017) comprehensive self-management is possible by coaching the patients and it has been found effective to some extent in improving the quality of life. Reducing the exacerbation will relive a Angela of anxiety and stress due to frequent hospitalisation. It will empower her to have faith in her medication. It will increase her self-efficacy and participate actively in treatment process. Collaboration by registered nurse: Registered nurses are in the key position to manage the COPD patients. The nurse must collaborate with the patients and her family members to enhance the care. The nurse must be able to initiate life style management plan for Angela. The nurse must consult with the dietician to develop appropriate diet plan for Angela. The nurse must collaborate with social worker to help Angela deal with any other psychosocial factors hampering her health such as caring for her daughters (Efraimsson et al., 2015). On addition addressing the funding issues and recognising other barriers is necessary to improve the patient wellbeing. Since COPD involves comorbidities, the registered nurse must collaborate with the pulmonologists (optimising treatment), respiratory therapists (ventilator support therapies, inhaler training), case managers (coordinate care needs after discharge) and information system specialists (for designing the medication reconciliation plan) (Flinter et al., 2017). Conclusion: On a concluding note, it can be said that chronic obstructive pulmonary disorder or COPD is a respiratory disease which can be characterized by the blocked respiratory airways, shortness of breath and excessive sputum or cough production. There can be a varied reasons contributing to the formation of this disease although the most common risk factors associated with this disease are excessive smoking, past medical history of chronic asthma, and genetic inclination towards developing this disease. 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