Medicare and chronic COPD patients
Medicare and chronic COPD patients
In the provision of care, providers are usually driven by the urge to ensure that the health of patients is safeguarded, and a positive eventuality is guaranteed. As a result, care providers use every available way to ensure that patients are provided with high-quality care. It is unfortunate that, in some instances, it may be hard to achieve good health for patients suffering from certain conditions. For instance, chronic obstructive pulmonary disease (COPD) is one of the diseases that subject patients to great suffering. Besides making it hard for patients to breathe, this disease may take a long time to heal (Whitney, et al., 2010). Health care policies have been developed to ensure that maximum attention is given to patients presenting with this group of disorders. Some of these policies have resulted in a change in Medicare rules. In 2014, Medicare payment rules made it clear that health care facilities would start being penalized if patients returned within thirty days of treatment presenting with the same problem. One of the health conditions targeted by this payment rule was COPD. This has necessitated the implementation of an interdisciplinary team to ensure a safe transition between the acute care setting and home for the patient with COPD. Through critical analysis of published works, peer-reviewed articles, and other legitimate sources, the paper is going to address the disease management needs of adult patients suffering from COPD for a safe transition between the acute care setting and home. The role of the interdisciplinary team in that transition will also be looked at. The paper will also look at the importance of medication adherence, dietary modification and physical activity in the management of COPD.
COPD Management Needs
One of the most important steps in the management of COPD is an accurate diagnosis. This helps in determining the most appropriate treatment strategy to take right from the beginning before the condition progresses to extreme stages. Persistent cough, production of sputum and shortness of breath are all signs that physicians may rely on for diagnosis of COPD. Spirometry is also conducted to confirm the presence of COPD. Treatment of COPD is a continuous process that starts immediately after diagnosis. One of the advices given to patients to facilitate the recovery process is to stop smoking. Some medications may be prescribed to widen the airways, reduce cases of inflammation, and treat infections. The three broad categories of medications used for these purposes are bronchodilators, antibiotics and anti-inflammatory drugs (Chung & Barnes, 2009). Patients are advised to adhere strictly to medications for recovery to be successful.
It can be noted that there is no single remedy that can be used in the treatment of COPD. It is essential to ensure that patients stick to the prescribed medications, which play different roles in the management of this disease. Medications given in inhalers are used in the management of stable COPD (Chung & Barnes, 2009). These medications are usually in powder form and are inhaled directly into the airways. An inhaler containing medications that have bronchodilator properties may be prescribed to relax the bronchus muscles and open the airways for efficient breathing. Salbutamol and antimuscarinic inhalers are some of the commonly prescribed inhalers. The effects of these drugs last for up to six hours (Barnes, et al. 2009). Under severe conditions, patients may need to use inhalers regularly. However, there are some negative effects associated with bronchodilators. These include palpitations, headaches, nervous tension and muscle cramps. These drugs may also lead to nausea and vomiting, diarrheas and insomnia. Bronchodilators have been shown to alter the nutritional needs of a person. Some bronchodilators increase the loss of potassium from the body. This can be counteracted by the intake of potassium-rich diet. Meals with high-fat content increase theophylline levels in the body (Barnes, et al. 2009). It is advisable to keep fat content in meals low to maintain drug concentration in the body within the desired levels. Caffeine increases the side effects of bronchodilators, such as insomnia, and thus patients should not consume caffeinated products
Steroid inhalers are also administered to prevent flare-ups. These inhalers have negative effects ranging from dry mouth, hoarse voice and sore throats. To minimize these side effects, the patient should rinse the mouth with water and spit after every inhalation with the drugs (Chung & Barnes, 2009). COPD patients, who experience frequent flare-ups, should be advised on how to develop a self-management plan. This is a plan of action that patients should take as guide by the physician whenever flare-ups start to develop. Patients may be advised on how to increase the dosage of inhalers when appropriate. These patients may also be given some antibiotics and steroid tablets and advised when to use them. It is necessary to advise patients on when it is crucial to seek special medical attention. When the condition of the patient improves quickly, the patient should be told to decrease the dose or stop taking certain medications altogether. In this case, continuous use of certain drugs, especially steroid tablets, can have severe consequences for the patients. Some of the side effects associated with steroid include decreased bone density, gastrointestinal bleeding, suppression of the immune system, and excessive weight gain (Chung & Barnes, 2009). The body’s capacity to make certain hormones are also decreased significantly (Barnes, et al. 2009). Patients, who are placed on long-term steroid medication, should be provided with medications to protect them from osteoporosis. Patients, whose conditions do not improve after administration with these drugs, should be admitted to a medical facility for closer monitoring (Chung & Barnes, 2009).
Mucolytic drugs may also be administered to reduce the thickness and stickiness of the phlegm. Mucus and infectious substances can be coughed up easily thereby decreasing the likelihood of chest infections. Combination therapy is the most effective method of managing COPD. It is important to ensure that prescriptions are strictly followed to minimize chances of resistance of infectious substances (Barnes, et al., 2009).
Licensed Practical Nurses are the best-suited group of medical professionals to ensure adherence with medications. These professionals are involved in the direct patient care and thus have a better chance to understand the needs of the patients. LPNs also give injections whenever necessary. They assist in monitoring the patients and reporting all forms of negative reactions. LPNs can help in forming a close link between registered nurses, family members and the patient. They can provide family members with the necessary medical information related to COPD to promote medication adherence and a safe transition to home.
There are many factors believed to increase the likelihood of developing COPD. Some of these factors include smoking, consumption of substances that increase mucus secretion, as well as substances that lead to thickening of the muscles of the airways. Inhalation of pollutants for a long time also can increase the risk of COPD. Dietary modification may be considered as a practical COPD management strategy. A healthy diet for a COPD patient should contain substances that assist in maintaining a healthy weight, provides the necessary amount of energy for breathing purposes, gives enough calories for muscle building, and helps in strengthening the immune system (Whitney, et al., 2010).
It is important to understand the culture of COPD patients since some cultures do not allow consumption of certain types of food especially meat, which is a very rich source of proteins. Alternative measures should be taken to ensure patients from these cultures are provided with proteins. Some people also consume high quantities of coffee and caffeinated products, which are disastrous for COPD patients. Cultural beliefs may create challenges in trying to advise patients to abandon behaviors derived from their communities. Members of certain communities are known to consume a large amount of food substances such as turnips, cauliflower, broccoli, cucumbers, and raw cabbage, which increase gas production in the stomach (Whitney, et al., 2010). Gas makes COPD patients uncomfortable. These patients should be advised to stay away from such food products.
LPN may play a critical in facilitating dietary modification among COPD patients. Besides helping keep patients comfortable, LPNs are involved in maintaining the hygiene of patients as well as in feeding whenever necessary. LPNs ensure that feeding recommendations are followed strictly to minimize cases of food-drugs interaction. These professionals should collaborate with the lead registered nurses and family members to ensure the feeding recommendations are observed even after the patient has been discharged from the hospital. LPNs should enlighten family members on the importance observing the established feeding guidelines (Whitney, et al., 2010). Maintaining a healthy diet is essential for all people, but family members of patients with COPD should be made aware of the role played by diet in the health of these people. LPNs should make it clear to patients and family members that underfed COPD patients are highly likely to get an infection, have trouble in breathing, and have weak breathing muscles (Whitney, et al., 2010). The nutritionist may also be included in this team for purposes of providing guidance on the best types of food for these patients.
Due to the devastating nature of COPD, it is essential for patients to learn how to make use of their lungpower more effectively. Patients should be provided with all information that can facilitate management of this condition. Enrolling in a Pulmonary Rehabilitation Program is one of the helpful steps that patients can take once they have been discharged from the hospital. In rehabilitation, patients are taken through different physical activities that hold the promise of increasing the rate of recovery. Patients undergo training on how to control their breathing, rather than allowing the breathing to control them (Thorpe, Kumar, & Johnston, 2014). Exercise is a major challenge for many patients due to their COPD status. It is important to note that physical activities that can strengthen the breathing muscles are highly beneficial. These exercises improve general circulation; facilitate efficient use of oxygen and decreases the devastating symptoms associated with this disease. It has been revealed that physical activity can protect people at risk from development, progression and slow decline of lung function associated with COPD (Madell, 2012). Cardiovascular exercises help strengthen the muscles of the lungs and the heart thereby improving the patient’s ability to use oxygen efficiently. Resistance exercises strengthen the muscles of the upper body as well as the respiratory muscles. On the other hand, flexibility helps in coordination and breathing (Thorpe, Kumar, & Johnston, 2014).
Registered Nurses can promote adherence to daily activity routine among patients by creating an exercise program for this population. These professionals should be directly involved in supervising the involvement of patients in exercise programs. For continuity of exercise, RNs should collaborate with family members and notify them of the importance of physical activities. In a manner similar to the other cases, LPNs are best suited to ensure that the patients observe an effective exercise routine. This group of professionals plays a crucial role in ensuring that the frequency of exercise if maintained at appropriate levels. In this case, overdoing of the exercises may be harmful to the delicate respiratory muscles of the patients.
LPNs and RNs should work in collaboration with each other as well as with family members and the patient to ensure that a healthy exercise routine is maintained at all times. Nurses are aware of the conditions under which exercise among COPD patients can be effective. Patients and family members should be notified of the environmental conditions that may result in detrimental effects on patients if they engage in physical activities. This collaboration should ensure that maximum benefits are obtained from the exercises. All exercises that can lead to over-exertion should be avoided (Troosters, et al., 2013).
Chronic obstructive pulmonary disease (COPD) is one of the diseases that subject patients to great suffering. Besides making it hard for patients to breathe, this disease may take a long time to heal. A strong interdisciplinary team comprising of physicians, registered nurses, licensed practice nurses and nutritionists should be formed to facilitate the recovery process of COPD patients. Medication adherence, dietary modification, and physical activity are among the main activities that this team should focus on if COPD patients are to be helped. Patients and family members should be made aware of the fact that sedentary and underfed COPD patients are highly likely to get an infection, have trouble in breathing, and have weak breathing muscles.
Barnes, P., et al, (2009). Asthma and COPD: Basic Mechanisms and Clinical Management.
Mahwah, NJ: Elsevier.
Chung, K., & Barnes, P. (2009). Pharmacology and Therapeutics of Airway Disease, San
Francisco, CA: CRC Press.
Madell, R., (2012). COPD and Exercise: Tips for Breathing Better. Retrieved on May 26, 2015
Thorpe, O., Kumar, S., & Johnston, K. (2014). Barriers to and enablers of physical activity in
Patients with COPD following a hospital admission: a qualitative study, International Journal of Chronic Obstructive Pulmonary Disease, 9(1):
Troosters, T., et al (2013). Improving physical activity in COPD: towards a new paradigm.
Respiratory Research, 14:115
Whitney, E. et al (2010). Nutrition for Health and Health Care. New York, NY: Cengage