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(Solved) Pulmonology Grand Rounds: Common Respiratory Problems How often have you been challenged to make a difference in improving patient outcomes for some

Differentiate between the presenting signs of symptoms of a 55-year-old suffering from acute bronchitis and a 55-year-old suffering from pneumonia. In your response, discuss the most typical community-acquired pathogens involved with each of these illnesses. Include some comments related to potential cultural influences on managing the illnesses. Provide evidence for your response as a reference.

Pulmonology Grand Rounds: Common Respiratory Problems
How often have you been challenged to make a difference in improving patient outcomes for some of the common but frequently
occurring respiratory ailments?
Asthma, pneumonia, acute bronchitis, URIs, and COPD are some of the respiratory diseases that you are likely to encounter in your
practice as advanced practice nurses (APRNs). Each of these diseases can be the cause of debilitating conditions if not managed
effectively. Enabling your patients to have a better understanding of these chronic conditions, raising their level of awareness of the
environment, and encouraging them to comply with the prescribed medications can prove to be beneficial in controlling these
diseases to a large extent. This is where the knowledge and expertise of an APRN comes in handy.
Children suffer from pneumonia, asthma, and related atopic diseases, such as rhinitis or hay fever. The middle-aged population and
elderly, on the other hand, are more prone to acute bronchitis, URIs, and COPD. Knowing this can assist you in narrowing your
likely diagnosis. Do not, however, always depend on age as a definitive decision tool as some common disorders can occur
throughout the lifespan even if it is an unusual presentation. You must always put together the complete presentation before ruling
in or out any potential diagnosis.
Advanced practice nurses should bring advanced health assessment skills to the clinical setting. Practice and apply these skills in a
systematic manner in each patient encounter by independently evaluating and caring for your patient. You must document your
findings using appropriate medical terminology. Your colleagues should be able to clearly understand what is going on with your
patient by reading your clinical notes. As you take the health history from your patients, you should begin to develop a differential
diagnosis based on these findings. The results of your physical examination and diagnostic testing will prove or disprove each of
these potential diagnoses. It is, however, advisable to have your skills validated by another professional.
For documenting your observations of the history and physical examination, either follow the conventional method of manually
writing the details or follow the current advanced practice of making electronic entries. In addition to a complete history and physical
examination report, the documentation you are required to prepare may include progress notes, procedure notes, clinic visit notes,
physician’s orders, and prescriptions. You should learn to prepare and maintain your nursing record—of the evaluation and care of
both inpatients and outpatients—in the prescribed format Pulmonology Grand Rounds: Diversity in Respiratory Care
As you treat patients who are suffering from various respiratory illnesses and diseases, remember that there are some cultural,
social, racial, and gender-specific differences that often influence diagnosis and treatment. It is important as an APRN that we
speak to our patients and gain insight into those cultural and social practices that might influence management of any potential
disorder. Consider the relationship between cultural backgrounds and morbidity or mortality rates so that you can plan your patient
education in ways that can effectively combat increased rates of the disease within multiple communities.
Lifestyle, age, culture, psychological issues, socio-economic background, diet, and certain other factors influence lifelong
respiratory health. You learned last week that patient care plans need to account for these issues in order to maximize patient
health outcomes. Your care plan for patients with respiratory disorders should address the critical psychosocial factors in addition to
the medical and nursing considerations.
Nearly all patients will have a psychological dimension to their disease state. Always examine and analyze these factors so that you
can incorporate the treatment of these issues in your plan of care. For instance, a patient with emphysema will be chronically
hypoxic and, therefore, anxious. Though medications are helpful, the patient may be experiencing severe anxiety. Helping your
patients with this psychological aspect of their disease state can lead to improved patient outcomes.
The pediatric population brings in a different aspect of care to the clinical setting. Children have their own specific responses to
treatment, which call for another set of potential differential diagnoses. You will gain much more knowledge and skill in diagnosis and management of pediatric patients in your Pediatric rotation. For now, familiarize yourself with common disorders and the
influence of age on management of disorders.
As you learned from the panel discussion last week, it is important to consider the impact of socioeconomic factors on the patient's
health. For instance, the patient's place of residence and occupation can greatly influence our diagnosis and treatment plans. The
treatment plans for an asthmatic patient living in an urban setting and an asthmatic patient residing in a rural area can be very
different because their triggers are not always the same. Similarly, access to healthcare will vary depending on each patient's
socioeconomic status. Think about whether or not your patient has the ability to get prescriptions filled routinely and the
transportation to visit their provider. How would this factor affect patient outcomes?
This is where your knowledge of evidence-based practice will help you design care plans that take into consideration patient
preferences. Pulmonology Grand Rounds: Evidence-Based Practice
You may be aware that rapid strides in the biomedical field have changed the work environment of many nurses today. There is an
increasing demand for nurses in Pulmonology specialty because of insufficient distribution of the nursing force and the ageing
workforce. What does this imply? The new brigade of advanced nurse practitioners has to acquire skills that rely less on the clinical
experience and more on examining evidence from clinical research. For example, a large number of people in the United States
suffer from asthma. The Agency for Healthcare Research and Quality (AHRQ) has analyzed the results of research trials
conducted on improving the long-term management of pediatric asthma through the use of Inhaled Corticosteroids (ICS). How can
you make use of these findings in your nursing interventions? The guest lecture you will be attending today will help you gain a
better understanding of evidence-based practice in nursing. Pulmonology Grand Rounds: Collaborative Care
You have just seen how evidence-based practice is central to improving patient outcomes. So is collaborative practice. As APRNs,
you can establish collaborative practice, wherein you share equal amount of clinical responsibility with the doctor. This confers a
great amount of freedom on the caregivers to provide quality care within the scope of their practice.
Have you ever wondered how you could use multidisciplinary collaboration to manage patient care?
Caring requires mutual understanding and consultation in order to come up with new directions and strategies that will be in the
best interests of the patient. In other words, envisioning a practice setting with the highest level of expertise calls for collaborative
Collaborative practice in respiratory disease management is essential to determine the needs of patients. This concept permits
practitioners to respect each other’s abilities and share knowledge. Consider some of the advantages.
Collaborative practice helps in: Clarifying the roles and responsibilities of various nurse practitioners, the practice environment, and the manner in which
care is provided Getting a better understanding of the areas of shared competencies, overlapping roles, and scope of practice Establishing certain ethical and legal guidelines and standards of care Enabling shared decision-making to provide safe, quality care and maximize patient health outcomes. You need to be aware of what other healthcare providers bring to the patient's plan of care. You will be required to build open
communication channels with the healthcare team and discuss your patient freely and professionally with healthcare providers in
order to assure that your patients get the best care possible. While we can spend quatity time with our patients, it is important to
remember that patients like to learn from more than one source. Including other healthcare professionals in the treatment plan
helps to improve patient outcomes. Closing Remarks
Respiratory illnesses are perhaps the most common disorders that lead to absence from school and work. Respiratory illnesses
and chronic diseases also account for the maximum number of visits to clinics. When these patients visit clinics, nurse
practitioners have to face many challenges, including: Managing patients who are dependent on various kinds of mechanical ventilation Keeping pace with the treatment practices and differences for various acute care conditions, such as COPD, asthma,
ARDS, and pneumonia Collaborating with allied medical staff in following suctioning protocols and procedures Understanding their collaborative role in the use of medical gases, medications, aerosols, lung drainage, cardiopulmonary
resuscitation, and airway management Patients will present with similar signs and symptoms, irrespective of the disorder. You must be in a position to differentiate
between these signs and symptoms and arrive at the appropriate diagnosis. You should also know when to refer your patients to
other healthcare professionals and for this, accurate interpretation of the results of treatment modalities is critical. Proper
administration of medications in collaboration with other healthcare team members will result in improved patient outcomes. In
addition, you should follow up with your patients and understand their response to treatment. Remember that a majority of patient care will be performed at the patient's home and, therefore, it is advisable to have your
patients repeat your instructions back to you and demonstrate the use of their medications in front of you. The psychosocial and
skilled support that you can provide in the specialized role of an APRN to the patient and patient's family can have important
ramifications on the patient's overall health maintenance.


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