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NSG4055
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Health Science
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Feb 20, 2024
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Benefits of Individualized Care Plans
Windy L. Tanner
South University
NSG 4055 Illness and Disease Management across Lifespan CP02
Professor Kara Bral MSN, RN
April 5, 2022
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Benefits of Individualized Care Plans
Coronary artery disease (CAD) is prevalent in the southern United States. Modernized countries have seen a decrease in CAD in the last few decades. The reduction may be related to effective acute phase treatment and improvements in primary and secondary preventive measures. In the United States, variability in the incidence of CAD is observed. The most significant contributing factors to this are the Western diet and increases in sedentary lifestyle choices (Ralapanawa & Sivakanesan, 2021). Heart disease in the United States is the leading cause of death for people from various racial and ethnic groups. CAD is the most common type of heart disease, and in 2019, statistics report that 360,900 people died from CAD. The CDC reports that 18.2 million adults aged 20 and older have CAD, about 6.7%. The American Heart Association says that CAD accounts for 2 in 10 deaths in adults less than 65 (Virani et al., 2021).
CAD cost the United States about $363 billion each year from 2016 to 2017. The cost factors include health care services, medicines, and lost productivity due to death (Centers for Disease Control and Prevention, National Center for Health Statistics, 2021). Identifying people at risk for developing CAD through health screenings and social media education can help bring awareness to coronary artery disease. The early identification can start treatment early and slow the progression of the disease through behavior modifications and lifestyle changes. J. L.'s Story of being informed of a Chronic Illness
I chose a family member that has been diagnosed with Atrial Fib and cardiomegaly for about four years now. The participant "J. L." is a seventy-four-year-old female, married for over fifty-five years. J. L. has a high school diploma and no secondary education. Her family consists of her husband, three grown children, and several grandchildren living nearby. Her husband is
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three years older than her, and she rates his health as good. J. L. has been retired for fourteen years from a local store, where she stocked supplies and did the bookkeeping. Her past health history consists of three vaginal births, four miscarriages, hearing loss, and a one-pack per day smoker. She also reports recently being diagnosed with peripheral artery disease (PAD) in the last month. Four years ago, she reported having chest pressure and feeling lightheaded with a fast
heart rate. She went to the emergency room for medical care and was admitted. During the hospital stay, an electrocardiogram resulted in Atrial Fib with a heart rate of 110. An Echo was performed, revealing cardiomegaly and thrombus in the left atrium. She was started on Eliquis and Lopressor and arranged to be followed by a cardiologist as an outpatient. The medical issue was the first medical diagnosis of any concern, and it has been a life-changing event for her and her family. Analysis of Questionnaire
J. L. was happy to participate in answering a questionnaire concerning her health on March 31, 2022. She confirms that she is older than 65 years of age. J. L. does have a primary care provider (PCP) that she only visits when she is sick, she does not participate in annual wellness checks or any preventive health screenings, including labs. Her medications can be costly, and she does find herself adjusting her medications to get them to last longer due to cost factors. She lives with her husband, and they eat a minimum of two meals together daily. She follows a typical southern diet of meat (mainly fried) each dinner and a variety of fresh vegetables. J. L. does not routinely eat out or consume prepackaged meals. She lives on a farm. They grow many of the vegetables they eat. As noted in her history, she does smoke one pack per day for almost sixty years. She occasionally thinks about stopping smoking; however, it is a part of her core lifestyle, and she doesn't desire to change her habits.
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J. L. has never been overweight and doesn't weigh daily or report any weight gain. Her medical history is vague at times, with not many health visits. She only seeks medical care when extremely ill and feels she needs medical attention. The last time she had blood work collected, she was not fasting, and her cholesterol was elevated, which she thinks is due to the non-fasting state. J. L. denies hypertension, elevated glucose levels, or hypercholesteremia. J. L. is very active for her age and considers housework and yard work physical exercise. She denies any discomfort with performing activities of daily living (ADLs). She admits that she gets tired more than she used to, which contributes to age. Her sleep patterns are regular, sleeping on two pillows at night, with no cough or difficulty sleeping. Her past family history is scarce due to her growing up without knowing about her father, and her mother is deceased from cancer at age sixty-two. J. L. was able to answer almost all questions without needing any explanation. She was quick with responses and expanded on having her grown children eat with her at least once weekly. J. L.'s perception of health is that you keep pushing through, and many issues are related
to age. Patient and Family Impact of Illness
Family involvement is necessary for the management of long-term medical conditions. Disease management and interventions are evolving and directed toward patient and family-
centered care plans to improve health care quality for individuals and families (Park et al., 2018).
The collaborative healthcare team must have a shared vision when caring for the chronically ill and have considerable value-added when dealing with multiple morbidities. The focus must be on the patient rather than the disease. A patient-centered approach must value the patient and caregivers as full team members. Identifying a dedicated point spokesperson for the family is vital to bridging the gap between providers and patients (Bayliss et al., 2014). J. L. has children
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that understand Atrial Fib and PAD due to their medical background. The patient understands that Atrial Fib is when the heart does not beat regularly and expresses concern that she feels worse when her rate exceeds 85. Her daughters accompany her to medical appointments and can explain the purpose of both medications, Eliquis and Lopressor. J. L. does think it is acceptable to cut the dose of the Eliquis when she cannot afford to get her medicine filled timely. The family is very close, and the impact of financial concerns due to the patient being on a fixed income concerns her and her husband. She has Medicare advantage and part D Medicare. Due to the cost of Eliquis, she finds herself in the gap during the last quarter of the year. The emotional impact of any disease is vast due to changes in lifestyle, worry, anxiety, or depression due to the diagnosis. When asked about her health, J. L. usually laughs with most of the questionnaire and makes jokes. Also, in reviewing the questionnaire, it can be determined that J. L. doesn't fully understand the risk factors for stroke and CAD. She states she has accepted the diagnosis of Atrial Fib and PAD. She cannot explain the three signs of a stroke (facial droop, arm drift, slurred speech) (Virani et al., 2021). Her daughters can explain Atrial Fib and voices concern over their mother's smoking and not taking her Eliquis faithfully. Accepting, understanding, and being able to express risk factors for irregular heart rhythm along with the risks of taking anticoagulation medications is part of a biomedical care plan. Care teams must include the family and identify objectives and goals that the patient feels are essential and items they want to
accomplish. Evidence reveals that patient and family-centered care can be a critical approach to improving the quality of life (Park et al., 2018). Care Plan Development
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Care plans must be unique and individualized for each patient with patient-centered goals
and objectives, respecting patient values, and designing interventions and education modules in response to the patient's specific requests and individualized needs. If plans are not tailored, they may not be practical due to not capturing the patient's motivation to change behaviors and modify lifestyles (Bayliss et al., 2014). The questionnaire identified a knowledge gap in medication adherence, and a financial concern was noted to impact medication compliance. Smoking continues to be a risk factor for poor outcomes in CAD; however, if the patient does not want to align this item as a goal, it is better served as decreasing smoking or changing to lower nicotine to be successful in improving health. Education can be directed at risk factors for stroke, identifying signs and symptoms of stroke, and diet modification. Planning a session to cover heart-healthy foods would be beneficial. Including recipes incorporating current dietary customs with low salt, the low-fat alteration can be a simple change to improving heart health. An extended discussion with the patient to identify what she wants to accomplish in learning about CAD, lowering her risk factors for stroke, and preventing the progression of CAD are some needs identified. Atrial Fib is linked to Congestive Heart Failure (CHF). Preventive screenings, routine blood chemistries, and medical visits can help identify a worsening condition and start preventive medications earlier. Proper rate control, anticoagulation therapy, and modifications to health are essential to managing Atrial Fib and preventing a stroke. Specific individualized plans must direct the care provided by the healthcare team. Collaboration teams must include all healthcare team members when dealing with chronic illnesses, the patient, and the family to support patient-centered goals and objectives in the care plan. Conclusion
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CAD is a chronic illness that affects millions of Americans. The financial impact on the nation is in the billions. Considerations of goals and objectives must be patient-driven to motivate positive behavior changes. Health assessments must examine individualized needs. Healthcare teams must tailor plans that include input from the patient and family. Incorporating objectives that the patient and family want to achieve improves the quality of life for the patient and family when dealing with chronic conditions. Early identification and preventive health plans help manage the illness and improve the quality of life for individuals living with CAD.
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References
Bayliss, E. A., Balasubramianian, B. A., Gill, J. M., & Stange, K. C. (2014). Perspectives in primary care: Implementing patient-centered care coordination for individuals with multiple chronic medical conditions. The Annals of Family Medicine
, 12
(6), 500–503. https://doi.org/10.1370/afm.1725
Centers for Disease Control and Prevention, National Center for Health Statistics. (2021, February 1). About multiple cause of death, 1999 - 2019
. CDC wonder online database. Atlanta, Ga: Center for disease control and prevention; 2019. https://wonder.cdc.gov/controller/datarequest/D77
Park, M., Giap, T.-T., Lee, M., Jeong, H., Jeong, M., & Go, Y. (2018). Patient- and family-
centered care interventions for improving the quality of health care: A review of systematic reviews. International Journal of Nursing Studies
, 87
, 69–83. https://doi.org/10.1016/j.ijnurstu.2018.07.006
Ralapanawa, U., & Sivakanesan, R. (2021). Epidemiology and the magnitude of coronary artery disease and acute coronary syndrome: A narrative review. Journal of Epidemiology and Global Health
, 11
(2), 169. https://doi.org/10.2991/jegh.k.201217.001
Virani, S. S., Alonso, A., Aparicio, H. J., Benjamin, E. J., Bittencourt, M. S., Callaway, C. W., Carson, A. P., Chamberlain, A. M., Cheng, S., Delling, F. N., Elkind, M. S., Evenson, K. R., Ferguson, J. F., Gupta, D. K., Khan, S. S., Kissela, B. M., Knutson, K. L., Lee, C. D., Lewis, T. T.,...Tsao, C. W. (2021). Heart disease and stroke statistics—2021 update. Circulation
, 143
(8), 254–743. https://doi.org/10.1161/cir.0000000000000950
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Appendix
Interview with J. L.
Yes/No Questionnaire for the Assessment of CAD
This questionnaire was conducted on March 31, 2022, with participant J. L. Are you older than 65 years of age? “Yes”
Do you have a primary care provider (PCP)? “Yes”
If you have a PCP, do you schedule visits for healthcare issues when you feel sick? “No, I only go when I don’t feel well.” Do you complete routine annual wellness checks? “No, what is that?”
Do you have annual lab work completed? “No, I have blood drawn when I am sick.” Do you take any prescribed medications? “Yes”
Do you take over the counter medications? “Yes”
If you take prescribed medications, do you have difficulty affording them? “Yes”
If you take prescribed medications, do you take them as prescribed? “Yes, most of the time, when I have trouble affording them, I cut some pills in half to make them last longer.” Do you follow a healthy heart diet (low in sodium, saturated fats, and high in fiber)? “No”
Do you eat alone? “No”
Do you prepare freshly cooked meals? “Yes”
Do you consume prepackaged foods more than one day a week? “No”
Do you dine at fast-food restaurants more than once weekly? “No”
Do you eat fried foods more than once weekly? “Yes”
In the last 30 days, were you able to afford balanced healthy meals? “Yes”
Do you use tobacco products? “Yes”
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If you use tobacco products, would you like to stop? “Yes, sometimes, but not really, I enjoy it.” Have you been diagnosed with a medical condition? “Yes”
If yes to medical condition diagnosis, do you have more than one medical condition? “Yes, I have atrial Fib and Peripheral artery disease.”
Have you ever been told your blood pressure is high? “No”
Have you ever been told that your blood sugar level is elevated? “No”
Have you ever been told that your cholesterol is high? “No”
Do you know your lipid levels? “No”
Do you monitor your blood pressure? “Yes”
Are you overweight? “No”
Do you monitor your weight daily? “No”
Do you have more than 3-pound weight gain in two days? “No”
Do you exercise for 30 minutes three days a week? “No”
Do you get short of breath performing activities of daily living? “No”
Do you sleep lying flat at night? “Yes”
Do you have to sleep elevated or with more than one pillow at night? “Yes, two pillows”
Do you experience chest pain or discomfort when performing light physical activity? “No”
Do you experience chest pain or discomfort when performing moderate physical activity? “Yes, sometimes, but not always.”
Do you feel tired more than usual? “Yes, at times I do.”
Do you have a family history of heart disease? “No not really, I’m not sure my mom died of cancer at 62 and my dad left when I was young, and I do not know much about him.”