Making a Safe Transition

In December 2014, changes were made in Medicare payment rules. Hospitals are now
penalized when a patient returns within 30 days for treatment of the same problem. One of
the targeted medical diagnoses for this payment change is chronic obstructive pulmonary
disease (COPD). Therefore, it is essential that the interdisciplinary team be utilized to
ensure a safe transition between the acute care setting and home for the patient with
Using APA format, write a six (6) to ten (10) page paper (excludes cover and reference
page) that addresses the disease management needs of adult patients with COPD for a safe
transition between the acute care setting and home and the role of the interdisciplinary
team in that transition

Making a Safe Transition Paper

Changes have been done in the public medical cover including Medicare and Medicaid rules.
This includes the penalizing of hospitals whenever a patient is readmitted within one month of
treatment of the health complication. One of the health care medications impacted by this change
is Chronic Obstructive Pulmonary Disease (COPD). This calls for utilization interdisciplinary
strategies to ensure that COPD patients have a safe transition from acute care settings to home
(Bryant t al., 2013). This paper addresses these strategic interdisciplinary interventions that focus
on the disease management including medication adherence, dietary modifications, and physical
activity. The paper concludes by evaluating the effectiveness of the interdisciplinary team in
ensuring safe transition.
Medication adherence
According to statistics from the World Health Organization (WHO), 210 people are diagnosed
with COPD. Research estimates that COPD prevalence rates are 9-10%, which is expected to
increase by three folds by 2030. This is attributable to the increase in the aging population and
tobacco use. Evidence based research indicates that interdisciplinary management of COPD
improves patients quality of life, and reduces the progression of the disease considerably. The

Making a Safe Transition Paper
main challenge in the management of COPD is medication adherence, which often gets
suboptimal (Troosters Et al., 2013).
The common medication used to manage COPD includes bronchodilator drugs. This class of
medication aids by making it easier to breath. The medication action involves the widening of
the lungs and relaxation of the bronchi. The main goal of this treatment is to relief disease
symptoms by treating flare-ups. The short acting bronchodilators include pirbuterol, albuterol
and ipratropium. The drug offers quick relief of breath shortness. The Long acting
bronchodilators include tiotropium and formoterol (Bryant t al., 2013). Beta 2 agonists and anti-
cholinergic are the most common types of bronchodilators and the anti-cholinergic. The Beta 2
agonist mechanism of action is through the stimulation of the beta 2 receptor cells in the airways
muscles, making them to relax and dilate. Anti-cholinergic blocks the cholinergic nerves
responsible for secretion of bio-molecules, which causes the bronchi muscles tighten. Examples
include glycopyrronium. The side effects of the bronchodilators vary according to each
medication, but the general side effects are dryness in the mouth, diarrhea, palpitations,
headaches and muscle cramps (Balsamo, Lanata & Egan, 2010).
Corticosteroids are also effective in the management of COPD. This is medication is particularly
important in the management of the inflamed airways and increased mucus production.
Examples of corticosteroids include prednisione, prednisolone and methylprednisolone. The
medication mechanism of action is through anti-inflammatory action, particularly by
redistributing granulocytes. Additionally, the drug regulates protein synthesis responsible for
metabolic functions that often lead to inflammation. This causes reversal of mucosal edema,
reducing the secretion of secretagogue, which in turn reduces the vascular permeability by

Making a Safe Transition Paper
inhibiting LTC4 and LTD4. This causes reliefs the disease symptoms. The general side effects
include weigh gain, mood swings, acne, high blood pressure, and osteoporosis (Adams, 2010).
These medications effectively work if coupled with other disease management strategies such as
dietary modifications. The patient is expected to take balanced diets. The patient diet should
consume low fats but with high protein content. The COPD patient is encouraged to take whole
grain meals such as oats, bran and brown rice, because they have high mineral content. The
patient should also take many fruits including tomatoes, asparagus, and bananas. The diets
restricted in both medications are use of salt, and reduction of taking caffeinated drinks, tobacco
use, and alcohol. Despite the advantages of milk, in COPD patients increases mucus
production. Therefore, dairy products should be minimized in COPD patients. Crucifeoru
vegetables, especially from the cabbage families should be avoided as they cause bloating,
which causes it difficult to breath. Fried foods should also be limited to minimize the bloating
incidents. This is similar with carbonated beverages, which can reduce gas. This is because the
interaction of the medication with these restricted substances at molecular level causes toxic
reaction (Bryant t al., 2013).
Other than dietary, medication adherence is key factor in ensuring management of COPD. Non-
adherence is the leading cause for readmission among the COPD patient. Most of the non-
adherence is unintentional and intentional because of patient knowledge deficit. Therefore, the
registered nurses have a huge role to play in ensuring that patients are empowered. This involves
patient and caregiver education on the objectives of treatments and disease impact on medication
non-adherence. Other than registered nurses, patient caregivers and relatives have important role
in ensuring that medication is administered and adhered to, as required. These people should be
integrated when planning for COPD disease and the implementation of the care plan. This will

Making a Safe Transition Paper
ensure that patient adheres to medication even at their home place, thus promoting a safe
transition from acute setting to home (Adams, 2010).
Dietary modifications
Dietary is one of the main aspects of health care management strategies. Proper medication is
important because it reduces the levels of carbon dioxide levels, thus aids in easy breathing.
COPD patients should be advised to focus on the ratio of fat, protein and carbohydrate contents
in their diets. This is because these medications influence the respiratory quotient i.e. the ratio of
oxygen and carbon dioxide. This is because these fats undergo aerobic respiration, where they
are converted to energy, carbon dioxide, and water. The RQ for carbohydrates, fats, and proteins
is 1, 0.7, and 0.8 respectively. The highest carbon dioxide yield is associated with high intakes of
carbohydrates, thus COPD patient diets should have low amounts of carbohydrates. Some
medications such as prednisone have impacts on COPD patient appetite. Therefore, patients
should seek advice from their physicians if feeding change is observed (Yamalz et al., 2015).
Patients are also encouraged to take high intakes of fluids, about 6 to 8 ounces of water every
day. These fluids should not be carbonated or caffeinated. This is to reduce stomach upset and
mucus concentration respectively, making it easy for the patients to cough up and to breathe with
ease. Additionally, these fluids interfere with the medication molecular level. Patients should
take high vegetable, whole grain and legumes as described previously. This is to minimize
heartburns, bloating and shortness of breath. COPD patients should avoid intake of salts as it
alters the homeostatic condition, causing high retention of fluid in the lungs, which causes
difficulty in breathing. The patients should also avoid taking food that causes allergic reaction
as they could lead to bloating making it difficult to inhale. The patient should also be given
potassium, calcium and Magnesium (Bryant et al., 2013).

Making a Safe Transition Paper
These dietary guidelines face various challenges including economic constraints. The best
dietary diets recommended for COPD patient are organic foods. These feeds are costly and may
not be affordable and easily accessible. The cultural barriers and knowledge deficit are other
challenges faced by COPD patient. This is because the patient lacks information of cheap
organic alternatives. In some cultures, some food products such as dairy products are used in all
dishes. The most recommended cultural food is the Mediterranean diets (Adams, 2010).
The RN should work in partnership with the patient’s caregiver, relatives and healthcare
nutritionist can improve COPD patients in identifying the right dietary that is individualized.
This way, the patient gets empowered and even as he or she is undergoing transition for acute
settings to home is safe and effective (Kuzma et al., 2008).
Physical activity
Physical activeness is important in the management of COPD. This is because physical
activeness is associated with the rehabilitation of the pulmonary. Pulmonary rehabilitation
describes the process where patients are shown activities that make it easier to breathe. This
process involves counseling as well as training on the techniques that aid in breathing technique.
This includes activities such as Aerobic exercises, which facilitates blood circulation, ensuring
that all vital organs have ample supply of oxygen. Physical activeness also reduces cholesterol
levels, hypertension and enhances the flexibility of joints. Physical activeness is associated with
improved self-image and self esteem (Gimeno-Santos et al., 2014).
The most common physical activities include stretching four limbs. This improves activity, and
reduces muscles injuries and muscles strains. Cardiovascular training strengthens the heart
activity and the lungs activity. This improves the rates oxygen utilization reducing breath
shortness (Kuzma et al., 2008).

Making a Safe Transition Paper
The registered nurses should work in partnership with the physiotherapy to understand the
patient’s physiological function, which can be used when designing individualized care plan.
This helps in identifying the activity that the COPD patient can manage with ease, and address
barriers to physical activeness. The Physical activity therapist is able to identify the subjective
and objective measures that can used on patients, and to ensure that they comply with the care
plan. The caregivers and relatives can also help the COPD patients take short walks around the
neighborhood, swimming, and jogging. This ensures that physical activeness is maintained even
at home, thus facilitating safe transition process (Adams, 2010).
COPD disease is life threatening, but it can be managed and prevented. The underlying concept
of COPD exacerbation is due to unhealthy lifestyles including poor dietary, smoking, and
physical inactivity. From systematic analysis of management of COPD diseases, the most
intervention recommended includes behavioral modifications including healthy diets, increase in
physical activity and reduction of tobacco use and alcohol. Thus, it can be concluded that COPD
exacerbation is attributable to habitual factors, and thus to effectively manage safe acute settings
and home transition of COPD patients, multi-factorial approach is effective strategic. This is
because COPD is incurable, chronic, and most importantly, it affects the vital organs of the body
(Troosters Et al., 2013).
This also calls for working in partnership among various healthcare stakeholders including
pharmacists, patients, RN, occupation therapists, respiratory physicians, and nutritionists. They
should work towards achievement of one goal, which is improving patient quality of life. This
minimizes medication errors and reinforces on individualized patient’s care plan. Therefore, the
aforementioned multidisciplinary effectiveness should be evaluated at every treatment, and based

Making a Safe Transition Paper
on the findings; the interventions can be modified to meet the patient demands (Kuzma et al.,

Making a Safe Transition Paper
Adams, S. (2010). Integrated management strategies for chronic obstructive pulmonary disease.
Journal of Multidisciplinary Healthcare, p.181.
Balsamo, R., Lanata, L. and Egan, C. (2010). Mucoactive drugs. European Respiratory Review,
19(116), pp.127-133.
Bryant, J., McDonald, V., Boyes, A., Sanson-Fisher, R., Paul, C. and Melville, J. (2013).
Improving medication adherence in chronic obstructive pulmonary disease: a systematic
review. Respiratory Research, 14(1), p.109.
Gimeno-Santos, E., Frei, A., Steurer-Stey, C., de Batlle, J., Rabinovich, R., Raste, Y.,
Hopkinson, N., Polkey, M., van Remoortel, H., Troosters, T., Kulich, K., Karlsson, N.,
Puhan, M. and Garcia-Aymerich, J. (2014). Determinants and outcomes of physical activity
in patients with COPD: a systematic review. Thorax, 69(8), pp.731-739.
Kuzma, A., Meli, Y., Meldrum, C., Jellen, P., Butler-Lebair, M., Koczen-Doyle, D., Rising, P.,
Stavrolakes, K. and Brogan, F. (2008). Multidisciplinary Care of the Patient with Chronic
Obstructive Pulmonary Disease. Proceedings of the American Thoracic Society, 5(4),
Troosters, T., van der Molen, T., Polkey, M., Rabinovich, R., Vogiatzis, I., Weisman, I. and
Kulich, K. (2013). Improving physical activity in COPD: towards a new paradigm.
Respiratory Research, 14(1), p.115.
Yalmaz, D., Ãapan, N., Canbakan, S. and Besler, H. (2015). Dietary intake of patients with
moderate to severe COPD in relation to fat-free mass index: a cross-sectional study. Nutr J,

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