Nurs-fpx 4030 assessment 4 – Remote Collaboration and Evidence-Based Care

Nurs-fpx 4030 assessment 4 – Remote Collaboration and Evidence-Based Care

Caitlynn is a two-year-old child who was recently admitted to Valley City Regional Hospital with pneumonia and malabsorption syndrome. Dr. Copeland diagnosed Caitlynn with cystic fibrosis after carefully examining her symptoms and testing results. Because of her new diagnosis, Caitlynn’s family will face many challenges, and important family dynamics must be considered when planning her treatment. The family lives nearly an hour away from Valley City Regional Hospital in a town of less than 100 people. As a result, resources for cystic fibrosis education and treatment are scarce. Caitlyn’s parents are also married but separated. They both work very long hours. Caitlynn’s father has insurance through his new job that will cover her newly diagnosed condition. But, money is tight for this family as he has only recently returned to work after a long absence. I will be assisting the interdisciplinary team in developing an effective Evidence-based care plan to improve Caitlynn’s safety and overall patient outcome. I will address all of the parents’ concerns using evidence-based practices, focusing on how effective interventions can benefit Caitlynn and her parents.

Care Plan

Dr. Copeland, Caitlynn’s pediatrician, recommended a wide range of treatments that her parents should incorporate into her daily care routine to promote optimal health. These new treatments include dietary supplements, a high-protein diet, and home monitoring for bowel obstruction and respiratory distress. In 2017, Naehrig et al. published evidence-based treatment recommendations that align with Dr. Copeland’s. The article stated that cystic fibrosis is caused by a gene mutation that causes CFTR protein dysfunction. It affects the lungs, pancreas, upper airways, liver, intestine, and reproductive organs. Obstruction, inflammation, infection (in the lungs and upper airways), tissue reorganization, and loss of function are the outcomes. The severity of the disease depends on other disease-modifying genes, as well as the patient’s socioeconomic status. Early diagnosis and treatment improve the quality of life of people with cystic fibrosis.

Prevention of organ complications is the main goal of treatment. A high-calorie, high-fat diet with 110–220 percent of the daily caloric intake recommended for healthy people and supplementation of fat-soluble vitamins and trace elements are required for 87 percent of patients with cystic fibrosis. Caitlynn’s parents should consult a dietician to develop a realistic meal plan. In order to optimize vitamin supplementation, Caitylnn’s well-child checkups will include labs to be checked at least once per year for serum levels of fat-soluble vitamins A, D, and E, as well as the INR for vitamin K function. Age-appropriate dietary counseling and education of caregivers (e.g., kindergarten teachers) are as important as regular clinical measurements (at least every three months).

Lung disease is the leading cause of death worldwide (in 77 percent of patients). Chronic endobronchial bacterial infection, infectious exacerbations, and structural changes in the lungs. According to an article published by Lechtzin et al. (2017), the main goals of treatment are to improve mucociliary clearance, which is impaired by the disease’s underlying defect, and to prevent and suppress chronic bacterial infection with antibiotics. Caitlynn’s parents can help her perform inhalation therapies, effective coughing techniques, mobilization of secretions, and use of the chest muscles until she is old enough to perform them independently. Respiratory therapy is aided by sports therapy. Keeping Caitlynn active is important. Consistent clinical examinations, pulmonary function testing (3-month body plethysmography), and imaging studies (plain X-rays and CT or MRI of the chest) are recommended to monitor chronic lung disease and optimize treatment. Caitlynn’s parents should keep a symptom diary as well to aid in monitoring for acute exacerbations.

Other organ involvement complicates cystic fibrosis. Secondary biliary hepatic cirrhosis, steatosis, and fibrosis affect 32% of patients (10 percent ). Annual transaminase and ultrasonographic screening can detect liver involvement in children and adolescents. Conversely, type 3 diabetes, arthropathy, osteoporosis, and comorbid mental illnesses like anxiety and depression increase with age. Distal intestinal obstruction syndrome (6%) occurs when viscous intestinal secretions cause sub ileus. The emotional strain on Caitlynn (adolescent or adult) and her parents can lead to anxiety and depression (prevalence 21% and 10%), reducing treatment compliance and efficacy. These issues should be addressed in a yearly psychological screening.

Nurs-fpx 4030 assessment 4 – Remote Collaboration and Evidence-Based Care

Challenges of Interdisciplinary Collaboration

Caitlynn and her parents live in a rural town with limited healthcare resources. Telemedicine will allow them to connect with experts like dieticians, respiratory therapists, pediatric pulmonologists, and others who can help Caitlynn manage her newly diagnosed chronic disease. Interdisciplinary teamwork is required to provide educational and clinical resources to patients and families. Managing Caitlynn’s symptoms, treatment compliance, and coping mechanisms is critical as the family learns to navigate this disease process.

Cystic fibrosis patients are often seen in specialized clinics. Regular follow-up visits by multidisciplinary teams have improved care and patient outcomes, but patients must travel longer distances, causing missed school and work. Video-conferencing appears to be a promising option for delivering health care between routine visits while reducing travel time and costs for Caitlynn’s parents. Treatment non-adherence is the leading cause of treatment failure in cystic fibrosis patients. Thee et al. stated in 2021 that the role of digital technologies in supporting CF patients in managing their complex therapies is becoming more recognized. These applications allow patients to inhale all standard medications while accurately monitoring inhalation therapies. Early detection of pulmonary exacerbations has also been achieved using spirometry and smartphone telehealth apps. These services could help Caitylynn’s parents learn more about how to best care for their daughter’s condition.

The above digital technologies, combined with individualized phone coaching by psychologists, would be very helpful for her parents’ anxiety and depression during this transition. In addition to feeling supported, the family needs to learn effective coping mechanisms as they learn to manage their child’s chronic medical condition. Introducing Caitlynn and her parents to a telehealth support group helps them feel less alone in their disease journey. It allows them to connect with other parents and learn from others on the same path.

These telemedicine interventions have been shown to improve treatment adherence, reduce pulmonary exacerbations, improve lung function, and improve quality of life compared to standard care.

Nurs-fpx 4030 assessment 4 – Remote Collaboration and Evidence-Based Care

Evidence-Based Model

Caitylynn’s care plan was created using the Knowledge-to-Action (KTA) model. This model allowed the interdisciplinary healthcare team to assemble resources and providers via telemedicine who developed an individualized plan of care, set goals for Caitlynn and her parents, measured the success of these interventions, and adjusted the care plan accordingly at set review periods (the University of Illinois at Chicago [UIC], 2021). The multidisciplinary team consisting of physicians, physiotherapists, dieticians, psychologists, social workers, and nurses worked together to create this plan of care. Using this model, the healthcare team recognized that telemedicine knowledge management would improve the quality of safe, effective, person-centered care.

Conclusion

Cystic fibrosis is a difficult and complex disease to manage. Symptoms and their severity can vary greatly between individuals. Many factors influence a person’s health and disease progression. Following a positive screening test, the patient should be evaluated by a multidisciplinary team consisting of physicians, physiotherapists, dieticians, psychologists, social workers, and nurses. Caitlynn’s parents will be able to access real-time urgent care consultations and learn about treatment options in minutes. It can help them cope with their depression, anxiety, and stress and keep Caitlynn out of the hospital. Due to their remote location and lack of access to specialists, Caitlynn’s parents will benefit greatly from telemedicine. This will reduce their travel costs and improve Caitlynn’s overall patient outcomes.

References

Lechtzin, N., Mayer-Hamblett, N., West, N. E., Allgood, S., Wilhelm, E., Khan, U., Aitken, M. L., Ramsey, B. W., Boyle, M. P., Mogayzel, P. J., Jr, Gibson, R. L., Orenstein, D., Milla, C., Clancy, J. P., Antony, V., Goss, C. H., & eICE Study Team (2017). Home Monitoring of Patients with Cystic Fibrosis to Identify and Treat Acute Pulmonary Exacerbations. ALICE Study Results. American Journal of Respiratory and Critical Care Medicine, 196(9), 1144–1151. Retrieved February 27, 2022, from https://doi.org/10.1164/rccm.201610-2172OC

Naehrig, S., Chao, C. M., & Naehrlich, L. (2017). Cystic Fibrosis. Deutsches Arzteblatt International, 114(33-34), 564–574. Retrieved February 27, 2022, from https://doi.org/10.3238/arztebl.2017.0564

Thee, S., Stahl, M., Fischer, R., Sutharsan, S., Ballmann, M., Müller, A., Lorenz, D., Urbanski-Rini, D., Püschner, F., Amelung, V. E., Fuchs, C., & Mall, M. A. (2021). A multicenter, randomized, controlled trial on coaching and telemonitoring in patients with cystic fibrosis: conneCT CF. BMC Pulmonary Medicine, 21, 1-11. Retrieved February 27, 2022, from http://dx.doi.org.library.capella.edu/10.1186/s12890-021-01500-y

University of Illinois at Chicago. (2021, August 23). Nursing experts: translating the evidence-public health. Retrieved February 27, 2022, from https://researchguides.uic.edu/c.php?g=252564%26p=3977492

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