IDEAL Discharge Planning Strategy - Essay Example

6 YEAR OLD WITH ASTHMA 6 YEAR OLD WITH ASTHMA Background After patients have spent their time at the hospital and havestarted showing signs of recovery, it is important that they will be discharged home. The discharging process is however not to be an end to a means but a means to an end. This means that discharging the patient must not be seen as the end of the role of the nurse or health professional (Windom, Burgess, Crane et al., 2011). Discharging must only be seen as a transition in the health care process from the hospital as the centre of care to the home (Pearson, Ryland & Harrison, 2010). But in order to achieve this, it is important that the discharge process will be well planned and guided in its delivery. It is for this reason that this discharge plan is being prepared for the 6 year old boy who is being made ready for discharge from the hospital. The boy had been at the hospital for 4 days with asthma. As part of the discharge, the patient will be using a nebulizer and metered dose inhaler at home. The essence of this discharge plan is to ensure that the patient is given much education on the use of the metered dose inhaler and the nebulizer. It is hoped that the plan will help in reducing and eventually stopping the pathological process that have resulted from the asthma. Objectives The objectives of this discharge plan are to: 1. See the patient transit from hospital to the home 2. Education the patient on the use of metered dose inhaler and nebulizer 3. Put in place interventions to stop pathological process that result from asthma Analysis To achieve the objectives, the nurse will use what has been known as the IDEAL discharge planning strategy. The name of this discharge planning strategy is taken from acronyms built for IDEAL. The meaning of IDEAL as given by the Agency for Healthcare Research and Quality (AHRQ) (2010) has been spelt below. Include the patient and family in the discharge planning process as stakeholders Discuss with patient key areas to prevent problems at home Education patient and family about the current condition of the patient and the next steps to take Assess how well the discharge process has been from the point of all service providers involved Listen to and honor patient and family goals and concerns about the patient and his condition Planning Patient and family will be engaged in 30 minutes of health teaching that borders on the current state of the patient. Specifically, it will be explained to patient and family that the condition of asthma has not been totally healed but has been brought under control, which when all intervention processes are followed can make the patient even better. After this, the activities expected to be involved in the intervention will be spelt out to the patient. These activities have been given a vivid explanation below. Patient and family will then be asked to enumerate the activities that were given out to them. Very specifically, the patient and family will be made to role play the use of nebulizer. The rationale for doing this is to ensure that the patient and caregivers at home (parents) will have a hands-on approach to responding to the interventions that will be put in place. Interventions The following interventions are provided to be followed as the patient goes home. The section has been tabulated to clearly outline intervention, rationale for selecting it, and comments on how the intervention stops the pathological process resulting from the asthma. Intervention Rationale for Intervention Response to Pathological Process Allowing for much mucus plug expulsion as possible This intervention will ensure that there is sustenance of respiratory function, which will subsequently relieve patient of bronchoconstriction (Hart and Davidson, 2009). The pathological process resulting from the asthma leads to presence of tenacious plugs of exudates and mucus occluding the airway (Christopher, Wood, Eckert et al., 2003). this intervention will thus clear plugs and thus free the airway for proper functioning. Use metered dose inhaler periodically to inject specific amount of medication to treat onset of symptoms of asthma. Since there is narrowing of the breathing airways, patient finds difficulty in air movement activity of the lung (Windom, Burgess, Crane et al., 2011). The metered dose inhaler is thus needed to support transfer of medication into the lung. One of the pathological processes is that the airway surface epithelium becomes frail (Pearson, Ryland & Harrison, 2010). This intervention will therefore stop further frailty by rather putting the metered dose inhaler to work Patient must be placed in semi-fowler position for most of the time. This semi-fowler position will encourage diaphragmatic breathing to take place. This intervention will stop the pathological process associated with the base of epithelial reticular membrane becomes thickened because there will be better function of the lung. Reinforce the use of nebulizer to suppress chemical mediators and nerves found in the bronchial tubes. The activity of chemical mediators and nerves located in the bronchial tubes are responsible for the muscles becoming constricted and leading to Bronchospasm (Hart and Davidson, 2009). This intervention will therefore prevent this from happening. As a result of the asthma, the mass of bronchial smooth muscle becomes enlarged leading to bronchospasm. Using the nebulizer to suppress chemical mediators and nerves from constricting the muscles in the bronchial tubes will therefore bring an end to this pathological process Avoid any contacts with allergen and other irritants as much as possible This intervention is necessary because inflammation will naturally occur as a response to allergen and irritants (Rebuck and Read, 2003). As part of the pathological process, there is bronchial vessel dilation resulting from inflammation (Christopher, Wood, Eckert et al., 2003). This intervention will therefore stop inflammation and thus prevent this pathological process. Recommendations and Specifications for using the metered dose inhaler Once the patient has been discharged and using the metered dose inhaler as one of the interventions, it is important for the following to be ensured. 1. The inhaler is to be shook for 5 seconds with or without the spacer before it is used 2. Use of index finger in releasing medication from canister is preferred 3. Inhaler should be held away from the face so that the medication does not get to the eye 4. The injection is to be done three times 5. Priming of the inhalation is necessary only after it has been unused for 2 weeks or more 6. If possible, should be used under the supervision of a caregiver 7. The inhaler must be with the patient at all times. References Agency for Healthcare Research and Quality (AHRQ) (2010). Care Transitions from Hospital to Home: IDEAL Discharge Planning. Implementation Handbook. Retrieved June 11, 2014 from http://www.ahrq.gov/professionals/systems/hospital/engagingfamilies/strategy4/Strat4_Implement_Hndbook_508_v2.pdf Christopher K L, Wood R P, Eckert R C. et al. (2003). Vocal cord dysfunction presenting as asthma. N Engl J Med 19(4), 342-274. Hart S. R. and Davidson A. C. (2009). Acute adult asthma: assessment of severity and management and comparison with British Thoracic Society Guidelines. Respir Med 10(10), 938-1102 Pearson M. G., Ryland I. & Harrison B D W. (2010). Comparison of the process of care of acute severe asthma in adults admitted to hospital before and 1 yr after the publication of national guidelines. Respir Med 12(5), 545-565 Rebuck A S. and Read J. (2003). Assessment and management of severe asthma. Am J Med 8(2), 517-569 Windom H. H, Burgess C. D, Crane J. et al. (2011). The self‐administration of inhaled beta agonist drugs during severe asthma. NZ Med J 34(4), 197.207 Read More