NURS FPX 4050 Preliminary Care Coordination Plan

Care coordination is an integrated interprofessional coordination process that is laid out for the patient-centred output with maximizing the role of nursing as the transformational leaders of the health care system (Steaban, 2016). The perspective of the patients is also included in the integrated health care system to optimize the benefits of the coordinated care plan (Vimalananda et al., 2018). In this paper, the care coordination plan of a specific patient with a specific health concern has been elaborately discussed by using the evidence-based approach.

The coordination is planned under the lens of the interventions of the health concern are being discussed and analyzed. According to the World Health Organization (WHO) report, 11% of the hospitalized patients face medication errors related to poor care coordination among the health care providers leading to poor medication safety, multimorbidity and cases of rehospitalization (World Health Organization, 2016). Care coordination is deemed as a safe and effective health care provision tool. This makes it a necessary implication in the services for the nurses and other professionals as well. Poor coordination of the professionals may lead to overdosing or underdosing of the medication. Sometimes in health care setups, poor monitoring is also caused by the lack of coordination of the nurses.  NURS FPX 4050 Preliminary Care Coordination Plan

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This paper highlights a major health concern and its associated evidence-based practices. The goals of the health care problem are addressed with the available community resources that can cause a measurable and realistic redemption of the health concern and provide safe and effective health care to the patient.

COPD: A Perceptive Analysis of Health Concern

COPD is abbreviated for Chronic obstructive pulmonary disorder. COPD is regarded as a major global health concern causing an alveolar degradation leading to poor exchange of gases at the alveolar-capillary bed and further poor oxygenation capacity of the blood (Rogliani and Calzetta, 2020). Currently, there are more than 328 million COPD affected patients worldwide with a risk of becoming 3^rd in high mortality rate disease (Vallabhaneni et al., 2019). COPD is associated with a high rate of rehospitalization approximately 1 in every 5 patients within 30 days. The most common causes of rehospitalization have been poor care practices (Shah et al., 2016). Most of these cases are concerned with exacerbated COPD after the initial visits. People with asthma, poor pulmonary functioning, smoking and inflammatory diseases have a high risk of developing COPD in the early or later stage (Laucho-Contreras et al., 2020). The diagnostic costs of COPD are also high for spirometer ratios and computerized scans (Johnson et al., 2021). NURS FPX 4050 Preliminary Care Coordination Plan

Associated best practice for COPD

The implementation of value-based health care in the case of COPD patients have been found significant in altering the recompilation rate in patients with COPD (Shah et al., 2016).  The patient reported surely identified the relevant information, knowledge and skill of the nurses along with the professionalism and approachability of the nurses concerned with the COPD care are the key to effective COPD care (Rose et al., 2021).

CAT assessment tools are widely used in primary care and clinical settings to assess the respiratory, cardiovascular and physical assessment of the patient. The CAT assessment was formulated by the GOLD initiative of 2011 for the diagnosis and treatment evaluation of COPD patients (Cheng et al., 2019). Early diagnosis of COPD for its symptoms can prevent the poor prognosis of COPD. The symptoms of pulmonary, respiratory and cardiovascular distress need to be examined accurately with prescription of antibiotics, pain medication and other inflammatory drugs. The spirometer ratio for FEV1/FVC is less than 0.7 (Johnson et al., 2021). The inhaler therapy for COPD is also being used frequently to address breathing difficulty. The health care providers are provided with the required knowledge of using the different types of inhalers to mitigate breathing difficulties (Carlin et al., 2016).

Evidence-based practices and their uncertainties of analysis 

The most common diagnostic technique for COPD is spirometry that evaluates pulmonary functions. The diagnosis of COPD is often confused with other respiratory distress like asthma and acute respiratory distress syndrome. The symptomatic similarity among the conditions with the continuous lung abnormalities causes a situation of misdiagnosis in some cases. There is a lack of spirometry algorithmic calculations for asthma that also leads to misdiagnosis (Heffler et al., 2018). The issues of overdiagnosis of COPD by spirometer are also common because of the wheezing sound, lung airway obstruction and respiratory distress (Sator et al., 2019). The creation of an engaging system stimulated by the patient’s perceptions and benchmarking of the feedback can enhance the behavioural, skill management and learning outcomes of the health care providers along with improvement in the patient outcomes (Bergmann et al., 2019). Sonographic evaluation of the diaphragmatic dysfunctions identifies the impairment in the movement of the lung silhouette that can be set as the standard of measuring COPD dyspnea (Scheibe et al., 2015). Multifrequency bioelectrical impedance analysis can be a useful tool for the identification of COPD, analysis of the nutritional and compositional status of COPD identifies the body composition of the patient after adjustment to weight, age and body mass index. In COPD patients the impedance ratio is low for 5250 frequency which has been attributed by the Global Initiative for Chronic Obstructive Lung Disease (GOLD) III and IV as the standardized procedures of COPD analysis (de Blasio et al., 2016).

Goals to address the COPD (realistic, measurable and attainable)

COPD diagnosis and preventing the consistent risk of readmission because of the progression of respiratory distress are the goals of addressing COPD. The increased hospitalization of COPD is because of the exacerbation of the pulmonary symptoms and another cardiovascular system. There is a need for a better early diagnosis of COPD because of the confusing asymptomatic COPD presence (Miravitlles and Ribera, 2017). The goal can be achieved by encouraging the standardization of inpatient care protocols along with the health care providers responsibility in the proper care (Patel et al., 2019).  NURS FPX 4050 Preliminary Care Coordination Plan

Community Resources for Safe and Effective Care 

The high prevalence of COPD and its risk of progression requires community-based interventions to alleviate COPD and improve quality of life. The lifestyle interventions of smoking cessation can be the best resource for reducing the symptoms of COPD. The air pollutant, tobacco of cigarettes, pollens and allergens irritate the respiratory system and trigger dyspnea (Ambrosino and Bertella, 2018). The health care providers can lead a better smoking cessation agenda.

Community providers training and information building on the discharging guidelines can be beneficial (Rinne et al., 2019). A coordinated care plan at the diagnostic evaluation of COPD can enhance the on-time addressing of COPD. Spirometry evaluation in primary care settings can be made efficient by involving professional personals in the analysis. The issues of persistent airflow can be accurately diagnosed by the pulmonologist to identify COPD at the initial stages (Soumagne et al., 2020).

Resources list with evidence to improve the community health 

The community health care providers provide the patient’s information about the use of inhalers, respiratory exercises and medication adherence. The post-discharge electronic record based navigation of the patients having chronic and severe symptoms via phone calls and follow up investigation can prevent the progression of COPD, dyspnea and increase medication adherence (Rinne et al., 2019). NURS FPX 4050 Preliminary Care Coordination Plan

Telemedicine based apps and remote monitoring of the respiratory symptoms provide on-time care. It also provides educational resources to the health practitioners in providing oxygen therapy. It also provides the patients with management tools by which they can easily track their health with the relevant information provided by the clinical trials (Nissen and Lindhardt, et al., 2017). The cessation of smoking has been found to improve breathing with fewer attacks of dyspnea. It requires electronic cigarettes, policy and regulation of smoking ban, pharmacological interventions and behavioural changes to change smoking. Enhancement of physical activity along with smoking cessation behaviour have rapid health-promoting effects on the COPD breathing rate and depth. The use of nutritional supplements and dietary optimization increases muscle mass, decreases the inflammatory effect of the toxicity of smoking (Ambrosino and Bertella, 2019).

References 

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NURS FPX 4050 Preliminary Care Coordination Plan JJ

World Health Organization. (2016). Medication errors. https://apps.who.int/iris/bitstream/handle/10665/252274/9789241511643-eng.pdf

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