Category: Nursing Essay

Scientific achievements of the 20th century provide modern medicine with evidence-based effective instruments capable of improving both the quality and the longevity of individuals life. Novel philosophies and methods of care support practically all areas of healthcare. Until present, medicine had been scholastic in its majority, namely most diagnostic and treatment approaches had been based on personal assumptions and views. With the advent of experimental medicine, randomized trials, strengthening of official institutions as well as providing educational standards, unsupported methods have become a history. Nowadays, health care delivery system monitors epidemiology of disorders in an open and trustful way, the diagnostic and treatment techniques have strong physiological basis, management approaches do not deviate from evidence-based dogmas significantly. The results of recent advances are noteworthy: many diseases can now be cured completely or at least managed at a substantially better level than 100 or even 25 years ago. Should it be cardiology, pulmonology, oncology, surgery, intensive care or pediatrics, medical teams now offer patients reliable management programs that improve health condition considerably.

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The paper approaches a concrete patient suffering from various disorders with a special accent on bronchial asthma. The paper discusses and analyzes the application of evidence-based health care promotion methods to the patient under investigation.

Case Description

Ms. Jones is a 28-year-old African American woman admitted to the emergency department for evaluation of the right foot injury. She reports to have injured her ankle two weeks ago and to have taken the prescribed painkillers (tramadol and acetaminophen) without improvement. On observation, her vital signs are within normal range, she is full contact, and the foot is swelled and infected. Allergy history includes cats (wheezing, itchy watery eyes, sneezing, and asthma exacerbation) and penicillin.

The comorbidities include asthma and diabetes. The patient suffers from asthma since early childhood. She must use albuterol when around cats. She was last hospitalized because of asthma in high school; never intubated; no tobacco usage. Her sister has asthma either. At the age of 24 she was diagnosed with diabetes type II, the woman used to take metformin but stopped recently and did not control her blood sugar. The patients BMI is 31.

Further reassessment of Ms. Jones reveals fever, blood glucose of 238, and elevated blood pressure, most probably due to persisting high pain scores (9 of 10). However, her respiration rate is within range and saturation on room air is satisfactory (98%). The case scenario does not clarify the results of her lungs auscultation, but since the signs are not alarming, one may assume Ms. Jones does not wheeze. The doctor prescribed the woman with an antibiotic (vancomycin), painkillers and NSAIDS (oxycodone & acetaminophen), standard crystalloid infusion support (100 ml / hour saline) and insulin. Albuterol puffs as required for wheezing. Her outputs are unremarkable.

The case of Ms. Jones deals with a foot trauma, surpassingly ankle dislocation that needs rest, antibiotics and pain management with subsequent optimistic prognosis. However, her comorbidities bronchial asthma and diabetes type II worsen her general health condition. As described in the Electronic Medical Record, these diagnoses do not decompensate the young females health, but the quality of her life is reduced and her health perspective may be challenged. In conclusion, Ms. Jones attended a primary care doctor a few years ago suggesting she did not participate in any health care promotion programs.

Incidence, Prevalence and Severity of Asthma

More than 23 million persons in the US suffer from asthma, and 7 million of them are children. Worldwide, over 300 million people struggle with bronchial asthma. According to the World Health Organization, 250,000 of asthma deaths are reported annually. The prevalence, morbidity and mortality from asthma is higher among the blacks as compared to the whites, indicating genetic role predisposing to this condition. However, environmental triggers play a major role in asthma development.

Asthma is a relatively common disease in developed nations. Severe asthma affects 2%-10% of all patients. Recent studies indicate an increasing prevalence of asthma among children under 6 years of age. Among children, boys suffer from the disease more often; after puberty, however, the male: female ratio approaches 1:1. Larger lung deficits from asthma occur more frequently among females.

Mortality from asthma comes from poor lung function, which is a direct result of improper treatment, especially in the young age. Asthma exacerbations contribute to restrictions of activity, thus resulting in lost work and high school. Each year almost 2 million individuals require emergent hospitalizations because of asthma with a 20.7 USD billion expenditures for health and lost productivity in 2010.

Rationale for Health Promotion

Current guidelines suggest patient education and health promotion improve the prognosis of individuals with asthma significantly. Asthma education should start as soon as high school; however, the benefits of early activities need to be proven in trials yet. Special risk factors contribute to asthma exacerbations: parental smoking, maternal smoking (in utero), family history of asthma, exposure to infections, pre-term birth, low birth weight, occupational exposure to pollutants. Preventive strategies towards these factors can be especially effective. The official recommendations state that both the patient and the caregiver must be involved in health promotion programs associated with asthma,

Health Promotion Activity

The World Health Organization defines health promotion as the process of enabling people to increase control over their health and its determinants, and thereby improve their health. Health promotion is a broad approach involving education, providing information to patients regarding the disease and encouraging them to improve their well-being. An important part of health promotion is informing patients about triggering factors and how to avoid them in order to improve condition. Health promotion involves individual activity as well as community and/or governmental activities.

Since asthma is a chronic disorder, one should adequately appreciate the fact that the patient makes an everyday to-care-or-not-to-care decision. Thus, the patient should receive knowledge and skillful support regarding self-management. Authorities suggest that for asthma evidence-based achievements to be effective in practice for concrete patients, self-management, community interventions and evidence-based principles are the three required components.

The World Health Organization proclaims May 6 the World Asthma Day in order to improve asthma awareness and care around the world. According to this initiative, the WHO launches a sequence of activities called the Global Initiative for Asthma (GINA) to involve numerous institutions, governmental authorities, communities, health care providers and diseased people. For example, the official web site gives complete and easy-to-read information on what asthma is. In addition, in each country posters, billboards, stickers, newspaper articles and radio advertisements support the campaign to reduce the number of hospitalizations; those who suffer from asthma give musical concerts; best stories of achievements realized from good asthma care receive awards; clinics provide information about asthma control. The WHO officials explain:

As the prevalence of asthma increases in many countries around the globe, we

need a practical strategy for translating scientific knowledge into improvements in

patient care. That strategy is what Global Initiative for Asthma aims to provide.

The international guidelines add that it is not enough for scholarly institutions to know how to treat asthma properly; the recent successes must be disseminated at national and local level, which is an uneasy task because of poor infrastructure, cultural factors, lack of guidelines. Thus, sound experience pays attention both to preventive strategies (especially tobacco control and smoking cessation in public places), educational techniques (checking devise techniques, discussion first aid), and follow-up (discharge plans, providing written information on asthma management, review by general practitioners).

As noted earlier, environmental triggers play a crucial role in asthma development. The United States Environmental Protection Agency proposes an action plan for home visitors, a checklist used by patients and their caregivers to assist in identification and elimination asthma triggers. The checklist consists of three parts building information, home interior and room interior (the latter subdivided by categories bedding and sleeping arrangements, flooring, window treatments, and moisture control). Ms. Jones is sensitive to allergies and I believe this checklist as a part of health promotion activity will be extremely helpful to her.

Evaluation

Asthma cannot be cured completely, but it can be effectively controlled. For the individual with this diagnosis, outcomes of adequate control mean:

No (or minimal) asthma symptoms

No waking at night due to asthma

No (or minimal) need to use reliever medication

The ability to do normal physical activity and exercise

Normal (or near-normal) lung function test results

No (or very infrequent) asthma attacks

Low risk of future asthma attacks or other negative outcomes.

In a broader, community-based recognition of asthma control, effective health promotion strategies will reduce the risk of asthma, early diagnose the disorder, asthma self-management will improve, acute exacerbations of asthma will be prevented, chronic asthma stabilized, asthma education improved.

Special Considerations (Obesity & Race)

Available literature strongly suggests overweight is associated with bronchial asthma. According to researchers, the recent epidemics of obesity in the Western world correlates with an increase of prevalence of asthma. Special scientific studies have described in detail that obesity worsens asthma severity, complicates control and lowers quality of life. Moreover, weight loss improves clinical parameters of asthma.

As for Ms. Jones, an additional control point of her health improvement lies in BMI. As noted earlier, obesity worsens asthma, thus her weight evolution will become an additional evaluation pattern.

An extended literature review by Silvers and Lang suggests that African Americans are more prone to develop and suffer from asthma because of genetics, socioeconomic status, health maintenance behaviors, air quality, and obesity. The authors claim these patients need proper knowledge to remedy these disparities. Thus, Ms. Jones may benefit from all activities and information described in the current essay.

Discussion

The aims of health promotion address a healthy society through changing lifestyles of individuals. Both individuals and organizations accept responsibility in their health condition. Worldwide and in the US, numerous governmental and nongovernmental institutions promote health care programs. For example, this assignment used materials from the World Health Organization, international executives from the Global Initiative for Asthma, Centers for Disease Control and Prevention and Australian authorities.

Modern medicine is developing at a high rate and the guidelines and recommendations are frequently refreshed and updated. However, the basic elements of asthma control usually include reducing exposure to smoke, focus on education, self-assessment, equipment and occupation. Recent advances in basic medicine, pharmacy, genetics and respiratory medicine are capable of offering effective management options to those who suffer from asthma. Health promotion activities aim at delivering these achievements to the individuals, since the substantial global burden of asthma can be dramatically reduced through efforts by individuals, their healthcare providers, healthcare organizations, and local and national governments.