Creating a Plan of Care

Creating a Plan of Care

South University

NSG4055 Illness & Disease Management across Life Span

Professor

Creating a Plan of Care

The chronic disease selected for the plan of care is cardiovascular disease. This disease continues to pose major challenges not only for patients and their family members but also to the nation’s health care system. The rationale for choosing cardiovascular disease is because of the high rates of mortality and the effects of the co-morbidities associated with the chronic illness. According to Santulli (2013), cardiovascular disease is the single leading cause of fatalities in the United States, accounting for approximately 600,000 deaths annually. In 2011, approximately 26.6 million Americans were living with the chronic disease. The health care costs associated with the disease account for more than $500 billion annually. There are also many disparities in prevalence of risk factors, mortality, access to treatment and treatment outcomes based on race/ethnicity, socioeconomic status, gender, age and geographic area. Hence, tackling the disease should be a major priority for the US government. The main objective of the Healthy People 2020 initiative for cardiovascular disease is “improving cardiovascular health through early detection, prevention and treatment of the risk factors for stroke and heart attack”. This report outlines a comprehensive plan of care that can help in addressing and mitigating cardiovascular disease.

Holistic Plan of Care

Creating a holistic plan of care will indeed be essential for ensuring that people with chronic conditions such as cardiovascular disease lead a healthy life. Cardiovascular disease has a significant impact on the patient and the health care system. Apart from the emotional distress, patients with this condition also face some financial burdens, social burdens and increased levels of discrimination (Earnshaw & Quinn, 2012). In the course of completing the project, I administered a questionnaire to a coworker by the initials C.K. during week 2 to find out how she deals with the condition.

The questionnaire looked into various aspects such as family history, related medical conditions, the risk factors of cardiovascular disease, lifestyle choices and the coping strategies or support received by the patient. Understanding all these aspects can help in developing a well-managed care plan (Larsen & Lubkin, 2013). The results of the questionnaire revealed that C.K. observes healthy lifestyle, has the right levels of support and adheres to the medication regimen. All these factors helped her to cope effectively with the condition. However, even though she attested to leading a healthy lifestyle, C.K. also revealed that her family faced some level of emotional distress and financial burdens due to her condition.

The subsequent discussion in week 3 tackled the issue of catering for the support needs of patients afflicted with cardiovascular disease. As it became apparent, the support needs can aid the patients to cope effectively with their conditions. In terms of priority, the most essential support needs for these patients are emotional support, informational support, self-management support needs, financial support and spiritual support. Apart from providing the support needs for patients, professional nurses can also play a proactive role towards the acceptance of treatment and diagnosis by patients with chronic conditions. To this end, they must be on the frontline in sensitizing patients about the importance of taking regular screening tests as well as teaching them about available therapies and self-management techniques (Wagner, Austin, & Davis, 2001).

Noteworthy, environmental factors such as exposure to contaminants and various chemicals can increase the susceptibility of people to cardiovascular disease. Furthermore, social determinants such as socioeconomic status, availability of support networks and social norms prevalent in the society can also aggravate the chronic conditions faced by patients. The week 4 discussion revealed that people with cardiovascular disease could gain tremendously from community resources available in the localities. For example, in my region of Miami, some of the vibrant community resources that provide support to patients include the Baptist Health South Florida, the Heart Smart Initiative and the Patti and Allan Herbert Wellness Center. All these centers offer free screening services and sensitize patients with chronic illnesses on the best ways that can enable them to cope effectively with their conditions. Incorporating these centers can help in the development of a well-managed care plan.

Nursing Diagnoses

A nursing diagnosis is essential for identifying the problems that might arise from cardiovascular disease. For the patients with impaired cardiovascular function, one applicable nursing diagnosis is decreased cardiac output. According to Larsen & Lubkin (2013), the symptoms to look for in this diagnosis include abnormal heart rhythm, rapid breathing, restlessness, fatigue, edema, restlessness, dizziness and chest pain. The other applicable nursing diagnosis for cardiovascular disease is activity intolerance. The signs and symptoms to check for activity intolerance include statements of fatigue, exertional dyspnea, dizziness or chest pain, a significant change in blood pressure with activity (15-20 mm Hg) and abnormal heart rate response to an activity, for example an increase in rate of 20 beats per minute above resting rate (Dzau & Antman, 2006). The other applicable nursing diagnosis for cardiovascular disease is ineffective tissue perfusion (cardiopulmonary). Some of the defining characteristics of this diagnosis include altered respiratory rate, chest retraction, abnormal arterial blood gases, chest pain, nasal flaring, dyspnea and sense of “impending doom”.

Assessment Data (Subjective and Objective)

The subjective assessment data includes information about the present symptoms and signs, the onset of the symptoms, frequency of the illness and exposure to allergens. Apart from the symptoms aforementioned in the nursing diagnosis section, the subjective data will also include family history, past medical history and risk factors. The subjective data will also seek to inquire about any family history of coronary artery disease, hypertension, diabetes or obesity. For the risk factors of cardiovascular disease, important data will include cholesterol level, activity level, cigarette smoking and blood sugar levels (Dzau & Antman, 2006). The objective data will come from various measurement instruments including electrocardiograms, x-rays, stress tests, radiological images and echocardiograms. These instruments will be able to reveal valuable data about the blood sugar levels, blood pressure and level of cholesterol, all of which are critical indicators of the presence of cardiovascular disease.

Subjective date: C.K is visiting the health center for a follow-up. C.K is now asymptomatic. Patient would like to discuss about high blood pressure, hypercholesterolemia, and family history. Patient’s mother died of heart disease. C.K reported having one sister with high blood pressure and one brother with type 2 diabetes. C.K’s level of education is high school. She works now as a secretary with a salary of $30,000.00 yearly. Patient engages in regular physical exercises, refrains from smoking and observes a healthy diet.

Objective Data: Patient's temperature is 97.9 degrees Fahrenheit. Normal values: 97.8 - 99.1 degrees Fahrenheit (MedlinePlus, 2013). Patient's pulse is 68 beats per minute. Normal ranges: 60 - 100 beats per minute, (MedlinePlus, 2013). Respiration rate is 17 breaths per minute. Normal ranges 12 - 18 breaths per minute, (Medline Plus, 2013). Blood pressure level is 150/88, Normal ranges from 90/60 mm/Hg to 120/80 mm/Hg, (Medline Plus, 2013). No pain this follow-up visit. Patient's height is 61 inches. Currently weight is 144 pounds. No findings at the physical assessment follow up. Lab Tests and Results: Total cholesterol 198. Considered Normal. Normal values 150-199 (Merck Manuals, 2015). Low-density lipoprotein (LDL). 132. Considered a little high. Normal values of 130 and below (Merck Manuals, 2015). High-density lipoprotein (HDL). 38. Considered low. Normal values above 40 (Merck Manuals, 2015). Triglycerides. 249. Considered Normal. Normal value below 250 (Merck Manuals, 2015). Fasting blood sugar (FBS). 110. Normal values between 70-105 (Merck Manuals, 2015).Hemoglobin A1c 5.5. Normal level is below 5.7 percent. Chest x-ray is normal. Electrocardiogram shows a normal sinus rhythm.

Interview Results

The interview results indicate that the patients with the chronic illnesses have taken some realistic measures to increase their coping strategies with the condition. For instance, C.K. confided that she frequently goes for routine medical check-ups including blood pressure check-ups and tests to determine her cholesterol levels. Although initially her blood cholesterol and blood pressure levels were high, she has managed to normalize them because of adhering to the prescribed medications. Furthermore, the results from the interview indicated that the patient engages in regular physical exercises, refrains from smoking and observes a healthy diet, all of which can go a long way in enabling her to cope with her condition more effectively.

Desired Outcomes

One of the desired outcomes is that the patients maintain adequate cardiac output as evidenced by systolic BP within 20 mm Hg of baseline, strong peripheral pulses and heart rate of 60 to 100 beats per minute with regular rhythm. Another desired outcome is for the patients to report decreased episodes of angina and dyspnea (Santulli, 2013). After the interventions, patients will also be able to check the blood sugar levels and cholesterol levels and ascertain whether they are normal or high. Another desired outcome is for the patients to verbalize understanding of the condition, treatment and diagnosis of cardiovascular disease. People afflicted with the chronic condition will also be able to initiate measures such as healthy dieting and refraining from self-destructive behaviors that increase their susceptibility to the disease such as smoking.

Evaluation Criteria

The evaluation will strive to ascertain whether the plan of care meets the outcome criteria. As Larsen & Lubkin (2013) clearly point out, an important instrument for evaluating whether the plan meets the desired outcomes will be by using a checklist. The checklist will outline all the desired outcomes including adequate cardiac output, patients’ ability to monitor their blood pressure and the ability of patients to make informed lifestyle choices, after which I will assign a relevant score indicating the extent to which patients have satisfied the requirements of the desired outcomes.

Actions and Interventions

One of the nursing interventions for the patients with cardiovascular disease will be providing assistance with the self-care activities that patients require for functioning optimally. The other important action and intervention will be sensitizing patients on various coping strategies for cardiovascular disease. To this end, it will be paramount to inform them the importance of adhering to medication regimen, the importance of weight control and blood pressure control as well as the importance of diet, physical exercise and smoking cessation (Wagner et al., 2001). The education will help to support individual efforts of controlling or preventing the risk factors associated with cardiovascular disease. Another intervention will be liaising with faith and community based organizations that can help in various domains such as screening patients with cardiovascular disease. Furthermore, it will be critical to provide behavioral counseling in order to empower the chronically ill patients to deal with various issues such as stress and discrimination from members of the community.

Evaluation of Patient Outcomes

Evaluating patient outcomes will be essential for guaranteeing that the plan of care realizes its intended goals. One way of evaluating the patient outcomes will be comparing the progress that patients make against national benchmarks such as the objectives listed under Healthy People 2020 initiative. This will help to ascertain whether the patients are taking the necessary measures to alleviate the risk factors associated with the chronic illness. It will also be critical to use patient registries in order to evaluate the outcomes. According to Dzau & Antman (2006), a patient registry is a powerful tool for observing the course of the disease, understanding variations in outcomes and treatment, describing care patterns, measuring quality of care as well as examining factors that influence quality of life and disease prognosis.

Strategies for the Family or Caregiver

Family members and the caregiver will play an instrumental role in guaranteeing the success of the care plan. They will need to provide the right level of support to the patients in order to enable them cope effectively with their chronic conditions. The main forms of support that the family and caregiver will provide include emotional support, social support, informational support and financial support (Earnshaw & Quinn, 2012). Furthermore, family members and the caregivers will have to ensure that patients adhere to the prescribed medications and go for regular check-ups as advised by the health care practitioner. In addition, family members will provide relevant information about the patient’s progress in order to ensure that nurses offer safe, appropriate, quality, patient-centered and culturally congruent care.

Conclusion

Cardiovascular disease continues to be a major public health concern in the nation. This disease is the major leading cause of fatalities in the US. In addition, it causes tremendous suffering to patients and places a huge burden on the health care system. Hence, coming up with a realistic plan of care will help patients afflicted with the disease to find effective coping mechanisms. The assignments covered from week 1 to week 4 have been valuable in creating a well-managed plan of care. For instance, they have identified the impact of cardiovascular disease, the importance of meeting the patient’s support needs and the community resources that can help patients with the chronic disease. The holistic plan of care will be effective since it has identified the nursing diagnoses for cardiovascular disease, the assessment data, interview results, desired outcomes, evaluation criteria, actions and interventions as well as evaluation of patient outcomes. In order to enhance the success of the plan, it will be vital to incorporate family members and caregivers in it, mainly because of the support that they can provide to the patients.

References

Dzau, V. J., & Antman, E. M. (2006). The Cardiovascular Disease Continuum Validated: Clinical Evidence of Improved Patient Outcomes. Circulation , 114, 2850-2870. Retrieved October 1, 2015, from http://circ.ahajournals.org/content/114/25/2850.full

Earnshaw, V., & Quinn, D. (2012). The impact of stigma in healthcare on people living with chronic illnesses. Journal of Health Psychology , 17 (2), 157 –168. Retrieved October 1, 2015, from http://www.researchgate.net/publication/51530503_The_impact_of_stigma_in_healthcare_on_people_living_with_chronic_illnesses

Larsen, P. D., & Lubkin, I. M. (2013). Chronic illness : impact and interventions (8 ed.). Burlington, Mass.: Jones & Bartlett Learning.

MedlinePlus. (2013). Vital signs. Retrieved from

http://www.nlm.nih.gov/medlineplus/ency/article/002341.htm

Merck Manuals (2015). Blood test: normal values. Retrieved form http://www.merckmanuals.com/professional/appendixes/normal_laboratory_values/blood_tests_normal_values.html

Santulli, G. (2013). Epidemiology of Cardiovascular Disease in the 21st Century: Updated Numbers and Updated Facts. Journal of Cardiovascular Disease , 1 (1), Online. Retrieved October 1, 2015, from http://researchpub.org/journal/jcvd/number/vol1-no1/vol1-no1-1.pdf

Wagner, E. H., Austin, B. T., & Davis, C. (2001). Improving Chronic Illness Care: Translating Evidence Into Action. Health Affairs , 20 (6), 64-78. Retrieved October 1, 2015, from http://content.healthaffairs.org/content/20/6/64.long