NR 603 Week 4 Reflection, Assignments of Nursing

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Reflection on Diagnostic Testing and Patient Education for COPD Management Chamberlain University NR603: Advanced Clinical Diagnosis and Practice Across the Lifespan Practicum July 28, 2024

Reflection on Diagnostic Testing and Patient Education for COPD Management In managing a patient with Chronic Obstructive Pulmonary Disease (COPD), careful selection of diagnostic tests is crucial to ensure accurate diagnosis and effective treatment while considering cost implications. For this patient, the diagnostic tests selected include Chest X-Ray (PA and Lateral), CBC, Pulmonary Function Tests (PFTs), 12-Lead ECG, Arterial Blood Gas (ABG) analysis, Brain Natriuretic Peptide (BNP) test, D-dimer, CT Chest, and Echocardiogram (Transthoracic). These tests are essential for evaluating the extent of lung damage, cardiac function, and overall respiratory status (Sagana et al., 2022). Based on estimated national average costs, the total expense for these diagnostic tests is approximately $2,368 if the patient were uninsured. The breakdown is as follows: Chest X-Ray ($127), CBC ($20), PFTs ($450), 12-Lead ECG ($153), ABG ($213), BNP ($81), D-dimer ($24), CT Chest ($400), and Echocardiogram ($1,850) (MDsave, n.d.). Such a substantial cost impacts decision-making, especially for uninsured patients. In practice, it may be necessary to prioritize tests that are most critical for diagnosing acute exacerbations of COPD, such as the CT Chest and PFTs, while considering more cost-effective alternatives for other tests (Parekh et al., 2020). To support these patients effectively, primary providers should ask pertinent questions to ensure they have the resources needed for ongoing care. Key questions include: "Do you have access to health insurance or financial assistance programs to help cover medication and follow- up care costs?" to explore financial resources (Miravitlles et al., 2022). "Do you have the necessary home equipment, such as a nebulizer or oxygen therapy, and do you understand how to use them properly?" to explore home support (Bagge et al., 2021). "Do you have a support system or caregiver who can assist with managing your condition and attending follow-up

appointments?" to explore the patient’s support system. To explore medication adherence, the practitioner should ask, "Are you able to afford and consistently take your prescribed medications? Do you need assistance accessing or understanding them?" Addressing these questions helps ensure patients can manage their condition effectively, reducing the likelihood of costly hospital readmissions and improving their overall health outcomes. By carefully considering both the financial and practical aspects of diagnostic testing and patient support, providers can deliver comprehensive care that is both effective and considerate of patients' financial constraints.

References Bagge, K., Sivapalan, P., Eklöf, J., Hertz, F., Andersen, C., Hansen, E., Jarløv, J., & Jensen, J.-U. (2021). Antibiotic treatment in acute exacerbation of copd: Patient outcomes with amoxicillin vs. amoxicillin/clavulanic acid—data from 43,636 outpatients. Respiratory Research , 22 (1). https://doi.org/10.1186/s12931-020-01606- Global Initiative for Obstructive Lung Disease. (2023, February 17). Pocket guide gold 2023 ver 1.2 [PDF]. https://goldcopd.org/wp-content/uploads/2023/03/POCKET-GUIDE-GOLD- 2023-ver-1.2-17Feb2023_WMV.pdf Miravitlles, M., Auladell-Rispau, A., Monteagudo, M., Vázquez-Niebla, J., Mohammed, J., Nuñez, A., & Urrútia, G. (2021). Systematic review on long-term adverse effects of inhaled corticosteroids in the treatment of copd. European Respiratory Review , 30 (160),

210075. https://doi.org/10.1183/16000617.0075- Miravitlles, M., Kawayama, T., & Dreher, M. (2022). LABA/LAMA as first-line therapy for COPD: A summary of the evidence and guideline recommendations. Journal of Clinical Medicine , 11 (22), 6623. https://doi.org/10.3390/jcm Parekh, T. M., Cherrington, A. L., Bhatia, S., Turan, B., Patel, S. B., Kim, Y., Turan, J. M., & Dransfield, M. T. (2020). The association of low income and high stress with acute care use in copd patients. Chronic Obstructive Pulmonary Diseases: Journal of the COPD Foundation , 7 (2), 107–117. https://doi.org/10.15326/jcopdf.7.2.2019. Sagana, R. L., Wesorick, D. H., Byrne, B. T., Fitzgerald, L. J., & Georgia, T. E. (2022). Care of the hospitalized patient with acute exacerbation of copd. http://europepmc.org/books/NBK