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PICOT Problem Description
PICOT Question: In patients with congestive heart failure (CHF) who travel frequently (P), does education about the management of their condition (I) compared to the absence of such education (C) reduce the incidence rate of exacerbations (O) within a year of having undergone the intervention (T)?
Evidence-Based Solution
CHF is a chronic condition that frequently cannot be reversed, and treatment targets the mitigation of its symptoms frequently as a result. Gotto and Toth (2016) suggest the treatment of symptomatic heart failure through diuretics, beta-blockers, ACEI, and aldosterone antagonists. However, to spot these symptoms and prescribe the appropriate medications, medical practitioners would need to actively monitor the patient, which would not be possible if they travel. As such, treatment should focus on the prevention of exacerbations and patient education regarding medication adherence (Chang, 2017). Patients should be able to monitor their condition, manage it, and be ready to contact local healthcare services under all circumstances.
Nursing Intervention
The nurses role, in this case, will be to work with the patient to design exacerbation prevention and management plans. As Mahle and Ward (2018) note, there is a number of lifestyle modifications that can help reduce the risks associated with having CHF. The nurse will also have to draw up appropriate medication plans for the patient to follow, as the necessary medication changes based on the patients specific issues as well as possible drug interactions (Chang, 2017). Lastly, when the patient is not traveling and resides at home, the nurse should set up monitoring meetings with them to ascertain their condition and determine whether modifications are necessary.
Patient Care
Following the alleviation of any severe symptoms and the patients recovery to a degree where they are able to travel, the role of the medical facility in the patients care is effectively minimized. They should be able to assess their condition and monitor its changes over time, administer the medicine they require and use nonpharmacological interventions to manage their condition. As such, the role of the patient care facility is to teach the patient all of those competencies and instruct them in the usage of the prescribed medication. They can also support the patient via telemedicine sessions to check up on the patients condition and propose interventions.
Health Care Agency
As the patients will be traveling, no specific health care facility or agency will be solely responsible for their care. Instead, if they have any significant complications, they will have to refer to a local care provider for help, as many acute CHF exacerbations require procedures such as oxygen therapy (Aitken et al., 2019). As such, the patient will have to always be aware of the locations of local healthcare facilities as well as the methods they can use to contact providers. With that said, modern technologies such as the Internet enable advanced telemedicine approaches that can be provided by their original treatment facilities.
Nursing Practice
The problem is essential to nursing care because there are many circumstances in which the nurse will not be able to monitor the patient as much as would otherwise be advisable. As such, they should be able to teach patients who can take care of their symptoms on their own to do so with minimal reliance on outside help. The situation where the patient travels is one such circumstance in which they will not necessarily be readily available for checkups. As such, nurses should educate patients and employ modern technologies to supplement the issues created by the situation.
References
Aitken, L., Marshall, A., Chaboyer, W. (2019). Critical care nursing (4th ed.). Elsevier Health Sciences.
Chang, E. (2017). Living with chronic illness and disability: Principles for nursing practice (3rd ed.). Elsevier Health Sciences.
Gotto, A. M. Jr., & Toth, P. P. (Eds.). (2016). Comprehensive management of high risk cardiovascular patients. CRC Press.
Mahle, A. J., & Ward, A. L. (2018). Adult physical conditions: Intervention strategies for occupational therapy assistants. F.A. Davis Company.
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