Introduction
Home base care practice has achieved a great mile in helping to achieve cost-effective medical care plans for patients with chronic illnesses. Chronic COPD is a progressive affecting the airway with reduced air entry into the lungs. The commonest COPD conditions are chronic bronchitis and emphysema. Chronic COPD often does have a defined medication. However, most patients benefit from proper medical care to improve airway conditions and lung compliance (Alhammadi & Ogale, 2020). Prolonged holding of COPD patients in inpatient care programs often offers little benefit compared to practicing home-based care through follow-up by trained community-based nurses. Discharging COPD patients for remote care is a big idea in helping the patient from hospital stays and nosocomial infections, and huge hospital bills. Home-based care is thus a primary consideration in promoting good health for COPD patients over prolonged hospital-based care with minimal benefits.
Similarly, chronic wounds and femur fractures have been a major challenge in promoting faster and more efficient healing. Sacral wounds have been challenging in promoting good healing (Bowles et al., 2019). Most patients with the femur and chronic sacral wounds often have prolonged hospital stays and increased wound infection with pseudomonas bacteria. Secondly, prolonged wound healing often limits complications such as cancerous cell formation at the wound site. Patients with femur fractures and sacral wounds often improve and benefit from cost-effective care when referred to home-based care under trained community-based nurses. Providing proper care to patients with sacral wounds would help improve limb mobility and reduce wound infection compared to hospital-based care. This article will discuss the assessment need for a home-based care plan for Lee Hok Keung, a patient with exacerbating COPD and sacral wound, and the benefits of each assessment and interventional approach for each assessed approach in providing positive care support.
Healthcare Assessment and Interventional Approach
Physical health care has been regarded as the most basic assessment plan that should guide one on the care plan approach that a patient should receive. For instance, a full physical health status assessment of Mr. Lee helps determine his physical appearance (objective) and subjective health conditions. For example, Lee is discharged with known dry and fragile skin, edematous foot, purulent wound, and tenderness of the lower limb originating from the gluteal regions. The need for physical is to help ensure the patient is stable before being deferred to home-based care. (Shi, Boudouh & Grunder, 2019).
Additionally, a physical assessment conducted to establish the status of Mr. Lee’s respiratory function, including a Chest X-ray, is one of the most routine investigation procedures conducted on COPD patients (Lu et al., 2019). Mr. Lee is diagnosed with a wheezing sound on respiration. To ensure Mr. Lee is stable to survive from home-based care, he uses pharmacological remedies such as Augmentin tablet orally BD for seven days to prevent pneumonitis. He is also administered with salbutamol sulfate inhaler with a recommendation of 2puffs for two weeks to help open the airway and reduce severe risks of airway obstruction presenting with wheezing.
In most cases, the role of the psycho-social and mental condition has been neglected when providing a patient-based care approach. The patient’s mental health and psycho-social history often play a major role when providing medical care to patients (Alhammadi & Ogale, 2020). The need for psycho-social evaluation when discharging Mr. Lee for home-based care is important since it helps to evaluate Mr. Lee’s family and other social organizations before he is discharged. Living in a hostile social environment is often associated with the poor patient recovery and exacerbates the patient’s illness when released to go home for home-based care. Conversely, patients in receptive families often enjoy good medical care from their relatives through social or physical support. Before releasing Mr. Lee for home-based care, a psycho-social assessment is conducted by evaluating his relationship with his wife. Mr. Lee reported a receptive family, thus making him able for discharge for home-based care. The primary interventions for a stable social environment include counseling and explaining to the family members the illness condition of Mr. Lee.
When evaluating the patient’s stability before discharge, it is important to ensure that the patient does not abandon any previous medication. The need to ensure that all medication programs are considered is to ensure that preexisting medical conditions are managed despite current medication (Shi, Boudouh & Grunder, 2019). For example, Lee is known as a patient with Parkinson’s disease and undergoing medication. The need to ensure all Parkinson’s drugs, such as Sinemet tablet orally QID and Nocte for two weeks, are maintained is to assist Mr. Lee in gaining a stable gait. Secondly, Mr. Lee is a patient with congestive heart failure and diabetes mellitus, under good control of oral hypoglycemics such as gliclazide tablet and Metformin 500 mg daily as needed. Ensuring Mr. Lee has his antihypertensive drugs will ensure that he does not develop any heart-related complications leading to other comorbidities. The current antihypertensive drugs Mr. Lee is using include frusemide as needed daily, Amlodipine 10mg orally daily and should be continued for two weeks. Mr. Lee is also a known patient of benign prostatic hyperplasia taking Terazon HCL tablet 3mg orally daily and should continue to help reduce the advancement of prostatic hyperplasia. The need to assess Mr. Lee’s past medical condition helps ensure that he is followed up for medication for the previous medical condition so that the patient does not abandon any previous medication nor develop any health complications from preexisting illness.
For a long time, home-based care has been a major challenge in the Chinese medical care approach since most of the patients only viewed medical attention as staying in the hospital. Most patients who received home-based care approached registered poor outcomes due to several factors away from medication (Ohta et al., 2020). Assessing the home environment is a primary step to ensure the patient can benefit from remote care with zero or minimal complication. Assessing the home environment for Mr. Lee involved identifying those who would assist him in using his walking frames. Secondly, the home environment will help in evaluating how Mr. Lee will be able to receive basic needs and support. He is evaluated and fit to live with his wife, which will help him undergo his daily activities through physical support and providing essential services that he would need at home. The need to assess the home environment is to avoid releasing the student to develop more complications or prolonged recovery following poor naturing of the sac wound and femur fractures.
The medical practice aims to improve the individual nutritional status to speed recovery. Mr. Lee is a patient with various illnesses and, to the extent of poorly maintained sugar levels, he needs proper nutritional evaluation. Assessing nutritional status will help ensure the patient can receive the essential nutrients that will fully support the patient in recovering (Ohta et al., 2020). Mr. Lee’s nutritional assessment entails food characteristics and the amount of food he takes. Being a diabetic patient, Mr. Lee needs proper care to help him have low sugar and carbohydrate intake so that he does not develop increased comorbidities linked to poorly maintained glucose levels. The nutritional status assessment considered before discharging Mr. Lee included conducting random blood sugar of 16.2 mL. Good nutritional status is linked to a proper response to antidiabetic medication and an increased ability to thrive. The good nutritional assessment focuses on helping Mr. Lee feed on food that will not increase his dysphagia problems. Therefore ensuring Mr. Lee feeds on semisolid and liquid food will help him adapt to home and avoid the effect of malnutrition caused by poor feeding. Finally, increased water intake in Mr. Lee’s diet will help prevent dehydration’s side effects.
The ultimate goal of medical practice is to ensure that patients benefit from the care plan provided and that maximum recovery is achieved with minimal to zero comorbidities (Yu Lu & Qin, 2022). Poor hygienic condition has often been shown to be a major cause of poor health conditions and the advancement of ill-health conditions. Accessing hygienic conditions focuses on identifying Mr lee’s ability to bathe and dress up. Hygiene assessment is focused on the ability to carry out a self-care practice that will help him stay at home with little difficulty. Hygiene conditions will consider Mr. Lee’s ability to have proper toileting. Good hygiene helps eliminate chances of cross-contamination of dirt-associated diseases and wound infections.
The human body consists of several organ systems that ensure human health is maintained in good condition. Eliminating waste product from the body is an important part of organ system function, which help in the body’s toxic waste such as urea and ammonia. Assessing Mr. Lee’s elimination functions targets urine output monitoring and stool passage assessment (Foster, Agrawal & Davis, 2019). The goal of the elimination process is conducted by checking the chances of incontinence and constipation. The ultimate goal of ensuring the elimination process is stable and normal is to prevent the accumulation of toxic substances in the body. Improving Mr. Lee’s elimination process will involve using diapers, and laxatives drugs, increasing high fiber intake, and encouraging exercise.
Mr lee is a candidate for poor gait, and with an increased chance of developing self-support, he needs proper exercise, which will help avoid weak muscles. To ensure Mr. Lee is stable for exercise, he is administered analgesics like paracetamol, which will help relieve pain when walking and doing other exercises (Ohta et al., 2020). Secondly, providing medications to improve lung compliance help in promoting respiratory support during exercise. A good exercise regime will help improve COPD recovery, reduce blood sugar levels, help maintain cardiac functions and increase the elimination process.
Upon discharge, patients often need to have keen follow-ups to help them recover well. Follow-up activities involve enrolling the patient in regular close monitoring and ensuring the patient does not develop complications during the treatment (Foster, Agrawal & Davis, 2019). For example, Mr. Lee, a highly depleting patient, needs close follow-up to ensure he does not develop progressive COPD and poor femur fracture healing and associated sacral wound healing. Mr. Lee is thus booked for a regular clinical checkup for a chest X-ray. He is also booked for mental functions, cardiac functions, respiratory functions, blood sugar level tests, and urogenital follow-up. Close follow-up will help check medication progress and evaluate the need to terminate or proceed with medications. Follow-up activities will also help provide Mr. Lee with the education necessary for his recovery journey (Houben, 2019), for example, by educating Mr. Lee on how to maintain life and adapt to his Parkinson’s condition.
Humans exist in society and need community support and care for recovery when undergoing home-based care. Community resources considered when assessing the community’s ability to support Mr. Lee’s recovery involved assessing the social care available (Shepperd et al., 2021). Secondly, community recourse includes hygienic conditions and psychotherapeutic communications. Good community resources provide better recovery and healthcare support to speed up recovery and for better recovery.
Implementation of the Care Plan Program
The Chinese healthcare sector has greatly considered targets to improve the home-based care approach. However, full implementation of remote care has remained a daytime dream because of many limitations. Some of the limitations are intrinsic, and others extrinsic. Intrinsic factors limiting home-based care included limited healthcare resources for remote healthcare support (Foster, Agrawal & Davis, 2019). Secondly, extrinsic conditions include patients’ factors such as poor patient education and environment. The Chinese healthcare sector has adopted proper patient assessment to overcome implementation barriers to ensure stable conditions before discharge. Secondly, increased provision of patient training for high adaptability with won care, as seen in Mr. Lee’s orientation before discharge (Shi, Boudouh & Grunder, 2019). In addition, predicting the patient’s future occurrences is very important when discharging the patient for home-based care. Therefore, the plan to prevent future complications is avoided by booking clinic reviews for the patient or attaching the patient to a trained community-based nurse. Finally, the patient is made to follow and implement the care plan procedures under the close supervision of a nurse.
Evaluation of Care Plan
After providing the care plan, nurses and other medical practitioners often want to find the final report of the outcome of the initiated care plan program. Evaluation program in medical practice is based on the quality of patient outcomes and the benefits the patients have enjoyed from the care plan initiated (Iflaifel et al., 2020). Reviewing the patient recovery process is thus a key evaluation program. For instance, the case of Mr. Lee’s evaluation program would be assessed by checking respiratory improvement upon initiating the care plan program. Secondly, they are checking on the wound condition and healing process to evaluate the benefits of the care plan procedures in maintaining his wound. Finally, assessing other outcome comorbidities is considered when evaluating the benefits of the initiated care plan procedures.
Conclusion
Home-based care has shown an excellent approach to handling patients with chronic conditions. COPD and sacral would, in Mr. Lee, require home-based care to help stay away from nosocomial infection and other social stigmas of prolonged illness. Home-based care often requires proper patient evaluation before discharge to ensure the patient is stable enough to thrive alone. Home-based care is a quick, cost-effective remedy enabling patients to manage their illnesses.
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