The Role Of Community Nurses In Delivering Optimal Quality Care To Patients Suffering From Cardiac Health Issues

Patient Profile

Discuss about the Community and Chronic Care Model Teams.

The role of community nurses in delivering optimal quality care to patients suffering from cardiac health issues is noteworthy. According to Towfighi et al., (2017) nurses working in this sector are supposed to be leading the rehabilitation process for patients in order to combat the chances of recurrence of stroke and related complications. The common symptoms that follow diagnosis and medication management of the patients are to be accurately assessed by the nurse and suitable interventions are to be given accordingly. As opined by Takahashi et al., (2017) patients are to be supported optimally for self care and strategies for managing side effects of the medications are to be educated. In the present case, the patient Tim is to be supported by the community nurse to manage medication related side effects and demonstrate self-care strategies for rehabilitation after ischemic stroke.

Myself- Hello I am the community nurse who would be attending to Tim Hewson.

Patient- My name is Tim Hewson and I live at 2 Mawson St, Stafford Heights. My age is 61 years and I am a widow and have no children. I live alone in apartment block. I had recently suffered

• The patient suffered ischemic stroke 6 months ago.
• At present the patient is being treated for increasing symptoms and side effects of medications that have been prescribed to him.

“Mr. Tim Hewson lives alone in his apartment block since he is a widow with no children. On reaching out to the patient he has found to be showing signs of loneliness and isolation, accompanied by signs of ill health. The main health concern of the patient is ischemic stroke that he had suffered 6 months ago. The patient had been prescribed medications owing to his multifactoral conditions. Tim has been exhibiting signs of suffering side effects of the medications prescribed. This highlights poor skills of self-management and ineffective rehabilitation process.

The patient has a past history of hypertension and ischemic heart disease. In addition, the patient had been suffering from Gastro oesophageal reflux. Hypertension has been denoted to be the most significant modifiable risk factor for ischemic stroke. In this regard it is to be mentioned that antihypertensive treatment is pivotal for the reduction is incidence of stroke morbidity ad mortality (Koton et al., 2017).

The pathophysiology by which high blood pressure causes ischemic stroke is well studied. High blood pressure is responsible for damaging the arteries of the body, leading to conditions in which clogs are formed easily. Under circumstances when the weakened arteries in the brain are clogged to a considerable extent, the patient suffers stroke. The section of the brain does not receive adequate oxygen and thus starts to lose its functionality (He et al., 2014). Ischemic heart disease is when artherosclosis has an impact on the coronary arteries of the heart. When the flow of oxygen-rich blood to the heart muscle is reduced, the patient suffers from chest pain, or angina, or heart attack (Kyu et al., 2016). One of the most prominent factors for ischemic heart disease is high blood pressure.

Health Concerns and History

Gastro-oesophageal reflux disease (GORD) is a long term condition where stomach contents come back up into the esophagus leading to symptoms or complication. The common symptoms are chest pain, heart burn, and breathing problems among others (Roman et al., 2016).

The following medications have been prescribed to the patient in light of the health conditions he has been suffering from-

• Lisinopril: 20mg mane
• Frusemide: 40mg daily
• Aspirin: 150mg daily
• Coloxyl and Senna: 2 tablets mane
• Nexium: 40mg mane
• Cymbalta 60 mg Nocte
• Panadol 1gm PRN
• Ibuprofen 400mg TDS- frequently taking prior to bed

Lisinopril is a commonly used drug for treating high blood pressure. Lowering the high blood pressure leads to prevention of heart attacks, stroke, and kidney problems. It is used for treatment of heart failure and improving survival after a heart attack (Karch & Karch, 2016). Frusemide is administered for reducing extra fluid in the body which is edema due to conditions such as heart failure. Aspirin is a nonsteroidal anti-inflammatory drug (NSAID) for reducing pain (Culman et al., 2017). Coloxyl with senna is a dual action laxative, providing fast relief from constipation within 12 hours. Nexium is used for treating stomach and esophagus problems. While cymbalta is used for treating anxiety and depression, Panadol is a drug for relief of aches such as stomach ache (Adam & Urban, 2015). Ibuprofen is administered for relieving pain from conditions such as headache and fever.

The goal of the physical examination of the patient was to assess the vital signs of the patient and understand the functionality of the major organs of the patient such as airway, breathing and circulation (ABC). Identification of signs and symptoms of stroke was the main aspect of patient assessment (Black, 2016). The patient complained of suffering bouts of chest pain in the past one week. The patient also complained of shortness of breath at certain instances. Verification of the last known well time was done. The blood pressure was recorded at 140/100 bpm. The patient also complained of frequent nausea, vomiting and dizziness. Irregular sleep pattern was also a concern for the patient. The patient showed signs of depression and anxiety.

A rapid assessment of degree of disability was considered for the patient. This included vision, speech and spatial perception, coordination and walking and hemiparesis (Moorhead et al., 2014). The patient was found to be having difficulties while climbing stairs and also felt general weakness most of the time. The issue in mobility was due to CNS impairment. The National Institutes of Health Stroke Scale (NIHSS) was used for guiding the assessment of disability (Blais, 2015). The score of 4 indicated transient risks of ischemic attack due to increasing symptoms.

• Recommendation to the GP to review the present condition of the patient in relation to side effects of the medication and high blood pressure is urgent (Rao et al., 2017).
• Referral to the occupational therapists for support in mobility is needed.
• The patient is to be provided with social support so that he can combat loneliness and isolation.
• A holistic patient-centered care approach is needed for reducing risks of ischemic stroke and increasing quality of life of patients (Morton et al., 2017).
• Educate the patient on self-management strategies for reducing side effects of medications

Medications Prescribed

Planner

Time	Patient 2
0700	Start work and collect patient notes and all equipment needed
0730	Assess patient notes and self-study
0800	Consult with nurse leader regarding patient care strategies
0830	Travel
0900	-Do-
0930	Communicate with patient and establish strong therapeutic relationship
1000	Study patient information and analysis background information
1030	Carry out patient assessment
1100	Provide patient education on the background information of the presenting condition
1130	Provide details of recommendations
1200	Prepare patient education notes to be provided to the patient
1230	Communicate with patient to educate self-management strategies
1300	Break
1330	-Do-
1400	Assess the effectiveness of patient education and understand the further concerns of the patient
1430	-Do-
1500	Report back to office complete all documentation
1530	Finish work

References

Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson Education.

Black, B. (2016). Professional Nursing-E-Book: Concepts & Challenges. Elsevier Health Sciences.

Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson.

Culman, J., Jacob, T., Schuster, S. O., Brolund-Spaether, K., Brolund, L., Cascorbi, I., … & Gohlke, P. (2017). Neuroprotective effects of AT1 receptor antagonists after experimental ischemic stroke: what is important?. Naunyn-Schmiedeberg’s archives of pharmacology, 390(9), 949-959.

He, J., Zhang, Y., Xu, T., Zhao, Q., Wang, D., Chen, C. S., … & Peng, Y. (2014). Effects of immediate blood pressure reduction on death and major disability in patients with acute ischemic stroke: the CATIS randomized clinical trial. Jama, 311(5), 479-489.

Karch, A. M., & Karch. (2016). Focus on nursing pharmacology. Lippincott Williams & Wilkins.

Koton, S., Tanne, D., & Grossman, E. (2017). Prestroke treatment with beta-blockers for hypertension is not associated with severity and poor outcome in patients with ischemic stroke: data from a national stroke registry. Journal of hypertension, 35(4), 870-876.

Kyu, H. H., Bachman, V. F., Alexander, L. T., Mumford, J. E., Afshin, A., Estep, K., … & Cercy, K. (2016). Physical activity and risk of breast cancer, colon cancer, diabetes, ischemic heart disease, and ischemic stroke events: systematic review and dose-response meta-analysis for the Global Burden of Disease Study 2013. bmj, 354, i3857.

Moorhead, S., Johnson, M., Maas, M. L., & Swanson, E. (2014). Nursing Outcomes Classification (NOC)-E-Book: Measurement of Health Outcomes. Elsevier Health Sciences.

Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a holistic approach (p. 1056). Lippincott Williams & Wilkins.

Rao, G., Lopez-Jimenez, F., Boyd, J., D’Amico, F., Durant, N. H., Hlatky, M. A., … & Solomonides, A. E. (2017). American Heart Association Council on Lifestyle and Cardiometabolic Health; Council on Cardiovascular and Stroke Nursing; Council on Cardiovascular Surgery and Anesthesia; Council on Clinical Cardiology; Council on Functional Genomics and Translational Biology; and Stroke Council. Methodological standards for meta-analyses and qualitative systematic reviews of cardiac prevention and treatment studies: a scientific statement from the American Heart Association. Circulation, 136, e172-e194.

Roman, S., Pandolfino, J. E., & Kahrilas, P. J. (2016). Gastroesophageal reflux disease. Yamada’s Textbook of Gastroenterology, 906-928.

Takahashi, J., Omoto, S., Kawakami, E., Sakai, K., Komatsu, T., Sakuta, K., … & Murayama, Y. (2017). Acute stroke support nurse practitioners improve the timeliness of thrombolytic therapy for in-hospital acute ischemic stroke. Journal of the Neurological Sciences, 381, 525-526.

Towfighi, A., Cheng, E. M., Ayala-Rivera, M., McCreath, H., Sanossian, N., Dutta, T., … & Razmara, A. (2017). Randomized controlled trial of a coordinated care intervention to improve risk factor control after stroke or transient ischemic attack in the safety net: Secondary stroke prevention by Uniting Community and Chronic care model teams Early to End Disparities (SUCCEED). BMC neurology, 17(1), 24.