Getting a full and complete background of the patient before an assessment is important to know. Reviewing of systems and establishing a baseline of the systems is significant in treatment of their ailment/condition that are addressing. Observation of rate, rhythm, depth, and effort of breathing needs to be done after the heart sounds are heard. This is because with the cued breathing, the heart might increase in rate, and the nurse practitioner should assess for heart sounds at a resting rate. Evidence of respiratory distress at rest or when walking – eg, obvious breathlessness, talking in short phrases rather than full sentences, use of accessory muscles, exhalation with pursed lips (Henderson, 2015). Conpliance is the ability of the lungs to stretch. This mechanism plays the role in gas exchange in breathing. The more the lungs can stretch, the greater the potential volume of the lungs and the greater the volume of the lungs, the lower the air pressure within the lungs (Anatomy and Physiology, 2013).

During observation, if the patient has COPD, the breathing pattern might be different. Accessory muscle use signals difficulty breathing from COPD or respiratory muscle fatigue (Bickley, 2017). Other clinical observation can be that the COPD patient has delayed expiratory breaths. There might even be a possibility to see retractions with the COPD and asthma patients.

References

Anatomy and Physiology. (2013, March 06). Retrieved from https://opentextbc.ca/anatomyandphysiology/chapter/22-3-the-process-of-breathing/

Bickley, L. S. (2017). Bates’ Guide to Physical Examination and History Taking, 12th Edition. [Vitalsource]. Retrieved from https://online.vitalsource.com/#/books/9781496354709

Henderson, R. (2015, December). Respiratory System History and Examination. Information page. Retrieved from https://patient.info/doctor/respiratory-system-history-and-examination

find two new health care articles that use quantitative research.  Complete an article analysis for each using the “Article Analysis: Part 2” template.

Refer to the “Patient Preference and Satisfaction in Hospital-at-Home and Usual Hospital Care for COPD Exacerbations: Results of a Randomised Controlled Trial,” in conjunction with the “Article Analysis Example 2,” for an example of an article analysis.

“Population and Individual Health Measures and Healthcare Costs in the United States”  Please respond to the following:

• From  the  Centers of Disease Control and Prevention Website determine the most commonly used population and individual measures used in providing healthcare today. Examine the primary impact that these measures exert on the choices that consumers make in order to address their own healthcare needs. Justify your response.
• From the   World Health Organization Website , compare the magnitude of healthcare costs in the United States to that of other developed countries. Analyze at least three (3) differences that you believe exist between the decisions that U.S. consumers and the consumers in other developed countries make regarding healthcare. Provide a rationale for your response.

Comment 1

Many provisions are being done to the affordable care act most of which are trying to demonstrate reducing the cost, which is not proving to be enough. Another approach that is becoming primary is focusing on the overall quality, and coordination of the patients care. By focusing on the overall quality of care, this includes everyone who is involved in the care of the patient. Medical/Health homes are homes that provide patients with a central primary care practice or provider. The homes allow providers to focus on preventative care and chronic care management. This program will also help reduce dependence on specialist and emergency care.
The Patient Protection and Affordable Care Act authorizes who how contracts directly with the state to establish community-based interdisciplinary and interprofessional teams in supporting the patients’ primary care.
The interdisciplinary and interprofessional teams may then decided if medical specialist, nurses, pharmacists, nutritionists, dieticians, social work, behavioral health and mental health providers are necessary for care.
I believe that this can be beneficial to patients and healthcare in the fact that it reduces that amount of emergent and acute care issues. If a patient is coming into one provider for preventative care check with hope to detect symptoms early and treat with a primary doctor avoiding the need to see a specialist reducing the cost to the patient and the healthcare provider. The Patient Protection and Affordable Care Act determines who is eligible for an interdisciplinary team so not everyone will be at the mercy of the team also reducing the cost. The quality of care should remain at the same level the Medical/Health Homes just won’t be utilizing as many providers if the patient does not require them. Not to mention patient will have access to Medical/Health 24/7 interviewees reported that 24/7 access to a care provider is also an essential element of the medical home equation even if only through telephonic or electronic means, helps reduce reliance on emergency rooms and resultant preventable hospitalizations (ANA, 2010).
According to Nester (2016), succeeding in the current care environment can only be possible if inter-professional teams will come together and work as a unit. As such, the inter-disciplinary or interprofessional Practice Model as emphasized in the Institute of Medicine report can be termed as innovative.

Comment 2

One innovative health care delivery model which incorporates an interdisciplinary care delivery team is a systematic approach to the flow of care. First a patient presents with certain symptoms or complaints related to his or her health. There might be positive screenings from tests they have already received related to their symptoms. Following a diagnostic workup, a tentative diagnosis regarding their concern can be made. Following this diagnosis, it might be necessary to send the patient to a medical/surgical bed or ICU. They might require medical or surgical intensive care, or simply be sent home. Each stream follows a different set of procedures and personnel responsible for determining the correct path for each patient. This is advantageous to patient outcomes because it ensures that they receive the optimal treatment for their ailments. Standardizing the process and keeping it organizational will greatly benefit patient outcomes and ensure that there is no delay in care. “Each of these steps potentially involves a myriad of options, each of which is directed by a different specialist. This can sometimes result in care that is not clinically appropriate” (Osarogiagbon et. al, 2016, p. 984). All members of the interdisciplinary team need to communicate with one another, rather than just making care decisions based on individual assertions and collecting data together. This can cause disjunction in critical information, delay treatment, and have adverse effects in patient outcomes. 

Comment 3

As science has advanced to allow for more treatment options and cures for patients, providers have found themselves providing a more distanced type of care. With the distance of care, patient and families have been left less educated of their health status and reason for treatments leaving the patients to not feel as secure or in control of their health (Barry & Edgman-Levitan, 2012). In the Institute of Medicine report called Crossing the Quality Chasm, the IOM attempted to introduce an approach to assist in the reform of health care by explaining patient-centered care (Barry & Edgman-Levitan, 2012). The IOM described patient-centered care as care that is respectful of and responsive to individual patient preferences, needs and values (Barry & Edgman-Levitan, 2012). This care model calls clinicians to work as partners and coaches in a patient’s health care journey rather than as a dictator (Barry & Edgman-Levitan, 2012). Such a care model asks patients and their families to become allies with the health care team in designing, implementing and evaluating medical options (Barry & Edgman-Levitan, 2012). Treatment and interventions must be presented to the patient as an option as they always have a choice, especially when options are deemed to have consequences.

As clinicians relinquish their authority role of decision making and move towards a shared-decision making approach they are more equipped to view the experience through the patient’s eyes (Barry & Edgman-Levitan, 2012). This will allow providers to be more responsive to patient’s needs and treat their patients better. Also, clinicians are able to embrace the ethical principles of autonomy and beneficence with this type of model (Reuben & Tinetti, 2012). Patient centered and shared decision care benefits patients by increasing their knowledge of their disease, allow decisions to be aligned with their values, reduced internal conflict and more inclined for positive outcomes when patients are actively engaged (Barry & Edgman-Levitan, 2012). One of the largest barriers to goal-oriented and shared-decision modeled patient care is that medicine is deeply rooted in a disease-outcome–based rather than asking what patients want; the culture values managing each disease as well as possible according to guidelines (Reuben & Tinetti, 2012).