4.2.5: FRAME 5- Take Action
- Page ID
- 90018
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The role of the home health nurse is to advocate for a safe environment that facilitates self-management and risk reduction. The nurse discusses self-management education programs and how they assist individuals with ongoing, chronic health conditions and how to live life fully. The nurse explains that CDC self-management education programs are clinically proven to reduce symptoms and improve quality of life. The nurse continues to discuss specific interventions with Stanley.
QUESTION: Matrix Multiple Choice
Scoring Rule: 0/1
After reviewing the client’s chart, what interventions would the nurse recommend to Stanley for the self-management of his COPD? Each row should include a single choice.
| Intervention | Recommend | Not Recommend |
|---|---|---|
| Administering a dose of amitriptyline for anxiety | ||
| Encouraging eating small, frequent meals | ||
| Educate on how to take medications correctly | ||
| Instruct how to use oxygen appropriately | ||
| Taking sleeping medications for rest and sleep | ||
| Sleeping in recliner chair to aid with restful nights | ||
| Obtain weekly weight and assess trends | ||
| Reduce exposure to pollens | ||
| Continue efforts for smoking cessation |
Putting It All Together
DEBRIEF
The nurse recognized that it is difficult for Stanley to eat and that he does not feel hungry. Eating small frequent meals may be more tolerable for Stanley. Nutritional supplements may also help with caloric intake. Monitoring Stanley’s weight and observing trends will allow for earlier intervention of cachexia. Reviewing the client’s medications/treatments and assessing proper use and compliance is important. Having the client demonstrate how he prepares and administers his nebulizer and inhalers and determines how much oxygen is in the oxygen tank is an effective way to assess his knowledge and compliance.
Sleeping in a recliner optimizes client positioning to avoid pressure exerted by gravity when lying flat in a bed. An upright position helps to elevate the torso, expand the rib cage, and control coughing.
It is important for the nurse to assess triggers for COPD exacerbations. Common triggers include common allergens and pollens. Allergens and pollen can irritate the lungs and create more breathing problems. The nurse should also encourage smoking cessation support and referral.
RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)
A fourth SDOH domain addressed in this case study is Economic Stability. This domain aims to help people earn steady incomes that allow them to meet their health needs. Economic Stability is a concern for individuals with a disability who are unable to work. The Social Security Administration (SSA) considers COPD a disability if the client is unable to work. The SSA defines a disability as the inability to engage in substantial gainful activity. Substantial gainful activity is work that involves significant and productive duties and pays more than the current monthly income limits set by the SSA by reason of any physical or mental impairment(s) which has lasted or can be expected to last for a continuing period of 12 months or more or result in death (SSA, n.d.; Disability Benefits Help, 2023).
Chronic disease affects health and quality of life. It also is a significant driver of healthcare costs and has a related impact on business, such as absenteeism and presenteeism. Nearly 60% of adult Americans have at least one chronic disease. More than two-thirds of all deaths are caused by one or more of five chronic diseases: heart disease, cancer, stroke, chronic obstructive pulmonary disease, and diabetes (Hoffman, 2022). Further, approximately 40% of American adults have multiple chronic conditions, and evidence is growing that one chronic illness has a negative impact on the risk of developing others, particularly as people age. The nation’s aging population, coupled with existing risk factors (e.g., tobacco use, poor nutrition, and lack of physical activity), suggests that these problems will continue to grow if they are not effectively addressed (Hoffman, 2022).
What Do You Think About?
- What other risk reduction interventions could the nurse suggest?
- What SDOH could increase Stanley’s risk for exacerbations?
- Describe how chronic disease affects quality of life.