NURS-FPX4050 Assessment 1 Preliminary Care Coordination Plan

Preliminary Care Coordination Plan

Lifestyle factors are important in disease etiology. Changes in lifestyle behaviors have recently been blamed for an increase in cardiovascular disease cases. Unhealthy eating habits, cigarette smoking, alcohol consumption, and physical inactivity are all examples of risk factors for cardiovascular disease. Roth et al. (2020) believe that combining lifestyle changes with pharmacological therapies for various diseases yields the best results. Stroke is an example of a cardiovascular-related event characterized by a high-risk lifestyle. Here below, find a discussion about the health concern of stroke, best practices for health improvement, management and prevention goals, and community resources for a safe and effective continuum of care.

NURS-FPX4050 Assessment 1 Preliminary Care Coordination Plan

Analysis of Stroke, Best Practices for Improvement

Over the years, the definition of a stroke has evolved. Many scholars now define it as a rapidly developing episode of focal or, at times, global loss of cerebral function that lasts more than 24 hours (Roth et al., 2020). According to the World Health Organization, the global burden of stroke is estimated to be 15 million cases per year, with an estimated 5.8 million deaths per year (Tarvonen-Schröder et al., 2019). The majority of cases, roughly two-thirds, occur in developing countries, with a decreasing incidence reported in developed countries. The literature has extensively discussed two types of stroke: ischemic, which is the most common, and hemorrhagic.

The pathophysiologic processes are based on a clot that causes Vaso occlusion in ischemic stroke and, hemorrhage into the cerebral tissue in hemorrhagic stroke (Tarvonen-Schröder et al., 2019). There are numerous risk factors for stroke, which can be classified as non-modifiable (such as advanced age, Black race, male sex, and previous history of stroke) or modifiable (such as hypertension, Diabetes Mellitus, cardiac diseases, tobacco use, alcohol use, HIV, and oral contraceptives (Tarvonen-Schröder et al., 2019). Among the factors listed, hypertension and diabetes are the most common modifiable risk factors, affecting 80% and 34% of stroke patients, respectively.

Physical, psychosocial, and cultural strategies can be used to improve health and prevent the occurrence, treatment, or recurrence of stroke. Physical primary prevention strategies include screening for and treating risk conditions such as hypertension, diabetes, hyperlipidemia, and obesity, as well as reducing behavioral risk factors such as quitting smoking and limiting or stopping alcohol consumption (Tarvonen-Schröder et al., 2019). Secondary strategies aim to reduce the risk of disability by preventing recurrent strokes, preventing brain tissue damage, and reducing disability risk. One of the strategies is to use an antiaggregant such as aspirin.

Blood pressure control, behavioral risk reduction (smoking cessation and alcohol consumption limitation), a healthy diet, and physical activity are all recommended (Tarvonen-Schröder et al., 2019). Stroke may have neuropsychiatric consequences because of (1) direct damage to cerebral tissues and (2) the stigma and debilitation that accompany stroke (Nemani & Gurin, 2021). As a result, psychological support, such as providing information to patients and caregivers, assessing dependency and providing assistance in daily activities, being present and communicating with them, and reminding patients to take their medications, is provided (Nemani & Gurin, 2021).

In terms of cultural influence on stroke, some communities still believe in spiritual explanations for the condition; however, this belief is fading as a result of the increased awareness created by social media (Sanuade, 2018). As a result, many communities now believe that early detection and treatment of diseases is the way to go. Furthermore, because stroke is perceived as more disabling than other conditions, communities move quickly to help stroke patients access the nearest available health center.

Goals Established to address Stroke

Specific objectives guide stroke management and prevention. The first goal in dealing with stroke is to prevent its occurrence. This goal is attained through a variety of strategies, some of which have already been discussed. A patient with high stroke risk factors, such as a hypertensive individual, will benefit greatly from taking antihypertensive medications, lowering the risk of stroke occurrence. Patients who have no obvious risk factors but, say, a positive family history of cardiovascular disease, should be screened for the risk diseases, begin early treatment, avoid risk behaviors such as alcohol consumption, and be physically active as much as possible (Pandian et al., 2018).

The second goal is to prevent stroke recurrence and disability associated with stroke. This is accomplished through the use of antiaggregants (Aspirin), antihypertensives, the cessation of risk behaviors, healthy eating, and physical activity (Pandian et al., 2018). Furthermore, physiotherapy is an important intervention in stroke management to prevent disability; speech therapy is also important to prevent speech difficulties. Moreover, frequent turning in bed, the use of supportive items such as pillows and foam pads, and keeping the skin dry and clean aid in the prevention of decubitus ulcer. Finally, the other goal of management is to address stroke comorbidities. Patients are given thromboprophylaxis to prevent deep venous thrombosis, as well as antibiotic prophylaxis to prevent pneumonia and urinary tract infections, both of which are common in stroke patients.

Community Resources

There are several community resources available to help with stroke prevention. Warmline, for example, connects stroke survivors and their families with a person, usually a health professional, who can offer support or a listening ear. If there is a problem with medications, a recurrence problem, or any other psychosocial sequelae, the patient or family members can reach out using the contact information provided (Erlebach et al., 2021). Aside from that, community physiotherapy halls are available to assist stroke patients in their recovery and to reduce the incidences of stroke-related disabilities (Erlebach et al., 2021). The physiotherapy sessions are conducted by qualified physiotherapists, for example, twice a week or as needed based on the patients’ condition. Furthermore, community nursing homes for the elderly are plentiful, and they help elderly patients recover well while also living a safe and secure life.

Conclusion

To summarize, stroke is a cardiovascular disease with significant morbidity and mortality. There are numerous risk factors for stroke, both non-modifiable and modifiable, the two most important of which are hypertension and diabetes. Stroke incidences will be significantly reduced if risk diseases are identified and treated early. Lifestyle changes, which have recently been prominent in the etiology and risk for various cardiovascular conditions, add to the risk. As a result of this discovery, interventions that target lifestyle changes have been shown to be beneficial in stroke management. Even as pharmacology plays an important role in stroke treatment, community resources such as physiotherapy joints, elderly homes, and Stroke organizations help to speed up the recovery process.

NURS-FPX4050 Assessment 1 Preliminary Care Coordination Plan References

  • Erlebach, R., Bächli, E., Gerrits, E., & Hess, M. (2021). Stroke management in a Swiss community hospital – in close collaboration with a stroke centre. Swiss Medical Weekly, 151, w20490. https://doi.org/10.4414/smw.2021.20490
  • Nemani, K., & Gurin, L. (2021). Neuropsychiatric complications after stroke. Seminars in Neurology, 41(1), 85–100. https://doi.org/10.1055/s-0040-1722723
  • Pandian, J. D., Gall, S. L., Kate, M. P., Silva, G. S., Akinyemi, R. O., Ovbiagele, B. I., Lavados, P. M., Gandhi, D. B. C., & Thrift, A. G. (2018). Prevention of stroke: a global perspective. Lancet, 392(10154), 1269–1278. https://doi.org/10.1016/s0140-6736(18)31269-8
  • Roth, G. A., Mensah, G. A., Johnson, C. O., Addolorato, G., Ammirati, E., Baddour, L. M., Barengo, N. C., Beaton, A. Z., Benjamin, E. J., Benziger, C. P., Bonny, A., Brauer, M., Brodmann, M., Cahill, T. J., Carapetis, J., Catapano, A. L., Chugh, S. S., Cooper, L. T., Coresh, J., … GBD-NHLBI-JACC Global Burden of Cardiovascular Diseases Writing Group. (2020). Global Burden of cardiovascular diseases and risk factors, 1990-2019: Update from the GBD 2019 Study. Journal of the American College of Cardiology, 76(25), 2982–3021. https://doi.org/10.1016/j.jacc.2020.11.010
  • Sanuade, O. (2018). Understanding the cultural meanings of stroke in the Ghanaian setting: A qualitative study exploring the perspectives of local community residents. Welcome Open Research, 3, 87. https://doi.org/10.12688/wellcomeopenres.14674.2
  • Tarvonen-Schröder, S., Hurme, S., & Laimi, K. (2019). The World Health Organization Disability Assessment Schedule (WHODAS 2.0) and the WHO Minimal Generic Set of domains of functioning and health versus conventional instruments in subacute stroke. Journal of Rehabilitation Medicine: Official Journal of the UEMS European Board of Physical and Rehabilitation Medicine, 51(9), 675–682. https://doi.org/10.2340/16501977-2583

NURS-FPX4050 Assessment 1 Preliminary Care Coordination Plan – Health Problem and Best Practices for Improvement Example 2

In-patient management and care in rehabilitation facilities have for long been significantly affected by the incidence of pressure ulcers. The National Pressure Advisory Panel (NPUAP) indicates that the distribution of pressure ulcers is as follows; hospitals (38%), nursing homes (24%), and 24% in home care agencies (Boyko, Longaker & Yang, 2018 Preliminary Care Coordination Paper). Pressure ulcers occur in long-term bedridden patients and have been shown to worsen their outcome in terms of morbidity and mortality (Zaidi & Sharma, 2020). First, the condition causes pain and discomfort to the patients hence reducing their quality of life. It is also disproportionately burdensome for the elderly patients who tend to have comorbidities hence further complicating the course of their treatment and outcomes (Boyko et al., 2018). Pressure ulcers especially in grades 2 and above are open wounds that generally predispose those patients to hospital-acquired infections (HAIs), which are difficult to treat and also complicate recovery.

Financial and psychological effects also arise from pressure ulcers. The condition prolongs hospital stay either directly or indirectly when HAIs develop. Zaidi & Sharma (2020 Preliminary Care Coordination Paper) intimate that the cost of treating decubitus ulcer patients averages 2.5times more than treating patients without them. It is these spiraling healthcare costs, extended hospital stay, and the general physical discomfort that occasion the development of psychological distress in the patients (Schiffman, 2017). Collectively, the complications deprive the patient’s quality of life and also impact their family and support systems. Interventions for the health issue thus span preventive practices, early recognition, and prompt care.

Decubitus ulcer risk factors and causation include prolonged immobilization, advanced age, diabetes mellitus, peripheral vascular disease (PVD), nutritional deficits, and nursing factors. Post-surgical patients, patients with fractures, ICU patients, or those with severe motor deficits are of the highest risk (Kopuz & Karaca, 2017 Preliminary Care Coordination Paper). However, in the spectrum of care, the risk can be reduced by instituting specific nursing interventions. These include 2-hourly turning or use of pressure pads and ripple mattresses to reduce effective pressure at the bony prominences as well as bladder and bowel care to minimize skin moisture which increases incidences of ulcers (Boyko et al., 2018). Patient education on the same is important to enhance understanding and adherence.

In those who develop the condition, regular wound cleaning and dressing, analgesia, antibiotic cover, and appropriate nutritional supplementation are key (Schiffman, 2017). In the latter, a diet rich in vitamin C, and iron aid in wound healing. Further, for the specific predisposing comorbidities, controlling the underlying conditions is vital; diabetes and PVD have to be managed through sugar control and appropriate lifestyle modifications, and neurologic patients may also benefit from physiotherapy (Zaidi & Sharma, 2020). Control of, and management of pressure ulcers is thus a multidisciplinary endeavor, bringing aboard the nurses, nutritionists, physicians, physiotherapists, and psychologists.

Established Goals to Address the Pressure Ulcers Problem

Use Guides to Prevent Pressure Ulcers

Prevention of pressure ulcers from happening is the best bet against managing the nagging healthcare issue. It is thus paramount that all hospitals and nursing facilities be furnished with prevention guides that provide the general outlook of averting the problem. Specific facilities can then modify the guide to suit their patient population. The Braden Scale is effective in risk stratifying patients for pressure ulcers (Shiffman, 2017). It employs an assessment of the individual risk of patients developing pressure ulcers using six parameters checked within 6 hours of admission. The parameters include sensory perception, moisture, activity, mobility, nutrition as well as friction and shear, each graded in 0-4, with total scores of more than 16 indicating greater risk (Shiffman, 2017). Therefore, the scale is easy to implement, reproducible, and evidence-based hence can be adopted by such facilities to assess the development of pressure ulcers.

Simplified Pressure-Ulcer Management Algorithms

Management needs simplification in the event prevention fails and bedsores develop. Evidence-based measures can be simplified into an algorithm that aids in the management of the condition. Shiffman (2017), while citing Padula et al. notes that a process flow chart used to demonstrate the steps in pressure ulcer care is then availed to nurses in the facilities and nursing homes. Uniformity of care and results is aided by the institution of specific inputs, outputs, implementation procedures, and monitoring parameters. Inputs then include prevention procedures such as nutritional optimization, ambulation, skincare, and regular turning or wound care, antibiotics, and analgesics in established ulcers. Implementation mechanisms involve demonstrations of application as well as relevant consultations (Shiffman, 2017 Preliminary Care Coordination Paper). Expected outcomes are then outlined as ulcer-free patients.

Active Ulcer Monitoring Mechanisms

Aside from managing the condition, active monitoring is essential in ensuring recovery is attained and that recurrences are avoided. The Pressure Ulcer Scale for Healing (PUSH) can be employed to assess information on wound exudate, size, and tissue type, to show whether the ulcer is healing (Zeigler et al., 2016 Preliminary Care Coordination Paper). Also, to effect patient-centered management, patient-specific risk factors can be analyzed using a Pareto chart to enhance the efficacy of interventions instituted. Accordingly, the caregivers have to be trained on the use of and reading the charts and guides to promote a reduction in the burden of bedsores and enhance recovery.

Community Resources for Effective Care Continuum

Varied community resources exist for the advancement of knowledge regarding the prevention and managing of pressure ulcers. The ‘Advancing Excellence in America’s Nursing Homes Campaign’ refers to a campaign towards the improvement of life and care quality in nursing homes to reduce pressure ulcers (Nazarko, 2018 Preliminary Care Coordination Paper). The ‘California Quality Improvement Organization’ also works with nursing homes to help in reducing pressure ulcers. Finally, ‘Hartford Institute for Geriatric Nursing’ also provides vast information relating to pressure ulcers hence is important in educating both the public and the caregivers.

NURS-FPX4050 Assessment 1 Preliminary Care Coordination Plan References

Also Read: NURS-FPX4040 Evidence-Based Proposal and Annotated Bibliography Paper