NP HEALTH PROBLEM
Common Health Problem in Primary Care Nurse Practitioner Practice and Recommendations for Its Medical Management

Nurses are the initial point of contact for the patients in many medical settings, and the nurse practitioners (NP) are the primary source for providing basic medical care such as physical examinations, diagnostic tests, providing counseling, and writing prescriptions. A large growth is being witnessed in nurse practitioners around the world due to the arising pandemics; however, they have been of great help in usual health cases since they function in institutes like clinics, hospitals, schools, and workplaces. As they are the first initial source of medical care for the patients, they are the first-hand problem solvers since they have to guide them according to their medical requirements. This paper analyzes a common health problem faced by NPs and would recommend medical management for it. In further sections, the problem would be deeply analyzed for evaluation and providing suggestions.

Healthcare Problem Identified

Asthma inhalers are a source of relief for asthma patients since they are breathed directly into the lungs for the prevention of symptoms of this disease. The correct usage of inhalers is crucial for controlling the disease, and various studies have shown that patients were unable to use the asthma device incorrectly, causing uncontrolled asthma. Repeated education is needed; this should include physical demonstrations of the inhalers, checking if the patient's technique is workable, correcting the technique, and rechecking for its effectivity. It was also observed that trained staff id required for better instructing of the patients, and for this purpose, nurse practitioners play an important part. Additionally, the choice of the inhaler should depend on the cost-effectiveness, whether the patient can afford it or not so that he should be able to use it correctly and enhance its compliance.

A study indicated that metered-dose inhaler (MDI) had the most frequent number of errors; in terms of coordination, 45 percent, speed, and depth of inspiration 44 percent, no breath-hold after inhalation 46 percent (Sanchis, Gich & Pedersen, 2016). Even dry powder inhalers (DPI) were checked for errors too, which revealed that incorrect preparations accounted for 29 percent error, no full expiration before inhalation was 46 percent, and no holding of breath after inhalation was 37 percent. The general prevalence of the correct technique was 31 percent.

These problems occurred soon after metered-dose inhalers were launched. However, efforts were made to educate the patients about their usage. Nonetheless, there were still some patients who could not understand the particular method. The instruction methods included regular training programs, printed materials, videos, and software. Nurse practitioners also helped in the first-hand instructions to make it easier for them, including both children and adults.

Chronic obstructive pulmonary disease (COPD) together with asthma are the two of the highly ranked diseases in the world that are leading causes of deaths of around 339 million people globally (Bhushan et al., 2018). It accounts for up to 1000 people dying each day, including both children and adults. COPD is the fourth leading cause of death and can go up in the rank in third place by the year 2020. Various studies have indicated that improper use of inhalers has led to an increase in asthma and COPD. Therefore hospital visits have surged as well. As it was noted that poor inhalation technique was the main reason for increased clinical visits, this was also because patients missed at least one serious step of the technique and had low literacy levels.

The poor technique has been linked to factors like age, sex, educational levels, and emotive problems (Milanese et al., 2019). Younger asthmatic patients have reported more mishandling of the device, which resulted in poor disease control. In older patients, COPD is more common but requires prescribed medication, including inhalers. High rates of poor device handling were also reported among these patients, inducing severe exacerbations.

In epidemiological terms, children have been more prone to this disease as compared to adults. Still, it would be difficult to reside upon these results since there have been different definitions of age for asthma status around the world (Dharmage, Perret & Custovic, 2019). For older people, the co-morbidity rates are hard to define since asthma symptoms could be related to breathlessness or COPD, inciting to heart failure. Environmental exposure at an early age, such as those among children, is the primary cause of early asthma. In utero parental smoking can provoke asthma in young children; studies have revealed that female smokers are more likely to have asthma as compared to non-smokers, but this data might not apply to men. Outdoor air pollutants are globally manipulating the quality of air inhaled by children and adults; thus, impacting heavily on asthmatic patients. Indoor allergens also should not be ignored since they have intense effects on asthmatic subjects. Occupational exposures are greatly affecting asthma patients since there are now two categories: work aggravated asthma (WEA) and occupational asthma (OA). Lifestyle factors, such as westernization and eating habits, have a command over asthma severity as well.

In pathophysiological terms, the rise in asthmatic cases is due to extra clean air conditions, especially in western culture, since it would expose them less to the environment and increase the infections. When they interact with the outdoor air, the chances of getting air pollutants into the lungs and upsetting the immune systems rise. Bronchiolar inflammation is bound to happen to produce less resistance against asthma. The inflammation hurts trachea and bronchi, accelerating an increase in mucus production and a decrease in mucus clearance.

Practice Guideline

The clinical practice guideline addresses the identified health problem, which is poor inhaler education among asthma patients. The guidelines focus on the pivotal diagnosis stage and the asthma management for devising bronchodilator therapies and keeping track of periodic measurements of lung functioning before and after the therapy (Amerigroup Real Solutions, 2016). This practice guideline is based on current evidence that is available within the last five years. It was published in the year 2016 in line with US data. The strength of this evidence is the detailed information provided about the aesthetic patients and precautions for them. Also, there are follow up plans once the asthma action design has been put to effect.

The practice guideline adequately directs the health care provider in the management of asthmatic interventions. There is a thorough description of the contributing factors for this disease, what triggers the patients and what methods should be used to avoid them, assessment and monitoring techniques are guided, pharmacotherapy is mentioned for better identification of individual's needs, and patient education plan, which is the basis of the problem identified in this paper.

The clinical guidelines clearly state management procedures for the health care provider that includes reducing impairment and maintain normal lung function. This is guided by...…are adopted include, to begin with, hiring of culturally competent nurse practitioners. They would hold empathetic discussions with the patients. They would take asthmatic patients into confidence so that they share their backgrounds and the history of their ailment. Practitioners should also discuss with them how culture strikes the use of medications and, in such cases, what medications would be best suited for them. With the help of demos and constant coaching, use of inhalers would be implanted in the minds of patients even if they are reluctant. Secondly, emphasizing the use of technology for reminding about the medications and self-monitoring is of vital significance. In today's world, even the simple tasks are now simplified with the use of technology, and smart apps would be of great benefit in tracking asthmatic patients' timely intake of inhalers and medications. The patients would not only be connected with their doctor but also with the pharmacies so that in-time deliveries of their supplies are possible. Education about the use of those apps would also be included in these strategies.

Evaluation

An evaluation for determining the effectiveness of revised clinical guidelines is important since it would identify how helpful the newly implemented guidelines are in inhaler education and asthma control.

i. Firstly, shared decision making is quite helpful since with the help of nurse practitioners; the patients can discuss their health issues along with asthma, and their trigger points.

ii. The practitioners will get to know what cultural and language barriers can the patient face and try to resolve them with shared decision making. The practitioners should also speak slowly and in the teach-break method to let the patient understand the instructions in simpler language. This would be greatly helpful for culturally diverse patients.

iii. Individualized self-management plans should be generated with the mutual consent of the patients, and the inhalers should be selected based on affordability and adherence. Adherence is only possible if patients know all the necessary steps in their usage, and that is only workable through proper education given by practitioners.

iv. It should be made mandatory for the patients to install smart apps on their phones, which would remind them of their medication times and would be worthwhile in contacting practitioners or contact the pharmacies for a refill of their finished medical supplies.

v. Sharing data between different departments of the healthcare is important so that if an asthma patient does not buy medications or inhalers for a particular month, the hospital pharmacy should notify the appointed doctor for that patient, and the doctor would then reach him for discussing reasons for non-adherence to the medical plan.

vi. Moreover, this data interoperability would be necessary for measuring achieved outcomes through quantifying of readmission rates for asthma patients.

Learning Points

Few learning points from this case are mentioned as follows:

· Inhaler education is imperative for lessening asthma in both young and old patients. For this purpose, nurse practitioners play a major role since they are the first contact points for the patients to seek advice.

· Cultural diversity, urbanization, and changing health care policies should be kept in mind for devising clinical guidelines, and how the patient should be treated or prescribed inhaler types based on their cultural and religious beliefs should be of utmost importance.

· One cannot emphasize enough on the inclusivity of technology for monitoring and following up on the patients for asthma control.

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