An Interprofessional Case Study - World Ready

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AsthmaAn interprofessional case studyTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Asthma - an interprofessional case studyAt the end of this presentation students will be able to: Give a definition of asthma Discuss what could cause asthma Identify four triggers of asthma Describe symptoms of an asthma flare-up Explain three asthma treatment strategies Develop an interprofessional plan of care foran asthma suffererTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

What is asthma?THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

What is asthma?‘Asthma is a chronic inflammatory disorder of the airwaysthat is characterised by recurrent episodes of wheezing,breathlessness, chest tightness, and coughing’.Lemone and Burke 2000THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

What causes asthma?Cause not reallyknown, thoughclear links toboth genetics(family history)andenvironment.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

What are some of the factors contributingto the development of asthma?THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Factors contributing to development ofasthma Genetic factors Obesity Smoking mothers Air pollution Modern diets Exposure to allergens Exposure to tobaccosmoke Children: more common among boys Adults: more common amongwomen Smoking during pregnancy howeverbreast-feeding reduces risk Respiratory infections as an infant Occupational asthma - exposure tocertain substances in the workplacewww.asthmafoundation.org.auTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

What are the triggers foran asthma flare up?www.drugster.infoTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

What happens during an asthma flare affects.htmlTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

The Peak Flow Meter Measures how fast patient breathesout PEF: peak expiratory flow. Used to help diagnose asthma,check response to treatment, orrecognise when asthma is gettingworse PEF needs to be measured regularlyto be useful. Use same device (or‘meter’) for consistencyTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Treatment - medicationDivided primarily into ‘relievers’,‘preventers’ and ‘symptomcontrollers’.Most asthma medicines aredelivered by an inhaler device,although some are available intablet or liquid form.In hospitals, medication may begiven by intravenous infusion.www.asthmafoundation.org.auTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Treatment - medicationRelievers Fast acting Bronchodilators e.g. Salbutamol, VentolinTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Treatment - medicationPreventers Make airway less sensitive Reduce redness and swelling,dry up mucus Take time to take full effect Most commonly inhaledcorticosteroids e.g. Seretideor SymbicortTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Treatment - medicationSymptom controllers Long-acting relievers which relax airway muscles Prescribed if patient already taking preventers and stillhave symptoms Can make symptoms worse if taken on their own! Serevent is a symptom controllerTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Simple changes to eliminate the symptoms Re-consider pets in the home Replace carpets with hardfloors Anti-allergenic bedding Regular vacuuming/steamcleaning of mattresses andhousehold furniture Consider diet changes Review medication regularlyTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Complementary therapies - any benefits?Herbal remedies, such asginkgo biloba, have beenidentified as potential agentsfor further research as asthmatreatments.Breathing techniques, such asthe Buteyko technique — somestudies have shown asubjective improvement ofsymptoms and reduction in useof reliever medication.Relaxation techniques, such asyoga — the evidence for abenefit in asthma isinconclusive.Acupuncture and Hypnosis —current evidence doesn'tsupport it as treatment forasthma.Homeopathy, which can involvepreparing a medicine thatincludes a tiny amount of theelement that triggers an allergicreaction, such as house dustmites and then diluting it untilno trace of the element remains– research is inconclusive.Dietary modification — peoplewith diagnosed food allergiesshould avoid certain foods,however, routine dietaryrestrictions in people withasthma have not been shown tobe beneficial. Some foodsupplements, such as fish oilsmay offer benefit in asthma.www.asthmafoundation.org.auTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Activity – case studyIn groups, examine the following case study and prepareanswers for the following questions:1. What health concerns can you identify with Mrs Joy?2. What would a health professional consider whendeveloping a care plan for this individual?3. Consider how each discipline within theinterprofessional health care team can help theindividual to achieve their goals.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Case StudyMrs Joy – 55 years of ageEmployment : Full time office administrationW: 83kgsH: 174cmBMI : ?BP: 132/93RHR : 83 bpmFasting Glucose : 5.3 mmol/L Total Cholesterol : 2.3mmol/LExercise : Tries to go to the gym 3 x a week but find she gets veryshort of breath. She believes this is due to her low level of fitnessand excess weight. She tries to work in her garden regularly , butfinds she also gets very out of breath, even with minimal exercise.She also becomes quite congested and sometimes feels a bit faint.Smoker: NoDrinking habit: A glass of red wine every nightMusculoskeletal : Mrs Joy often gets headaches and lower backpain, particularly after long working days.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Case StudyDiet :Breakfast : Full cream Greek Yoghurt with honey and mixed seeds.Morning tea: 2 Anzac biscuits and packaged soupLunch : Subway - usually seafood or meatball sub on wheat breadAfternoon tea: Mixed nuts and dried fruit and a cup of milk withNesquikDinner: Seafood (shrimps or prawns) or chicken with frozen vegDesert: Packaged mousse or custard with choc covered macadamianutsOther : Mrs Joy says she is always tired and lacking energy, evenafter an early night. She attributes this to stress in particularsome strain in her relationship/marriage. Her husbandcomplains of her heavy snoring.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Case StudyMrs Joy does not take any medications except her Ventolin inhalerwhen she absolutely needs it.On further discussion, you find out she does have a history ofasthma, which was particularly bad when she was a child, but shereports improvements in this condition since adolescence.She only uses her Ventolin inhaler when she feels extremely out ofbreath (usually with exercise) and very rarely uses her preventor,only when she had an attack last year. She says this is because shesaw an article on Wikipedia about the dangers of regular Ventolinuse.She doesn't otherwise believe her asthma is a problem, althoughadmits she has never really known much about it.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

1. What health concerns can you identify? Asthma - Potential allergies or intolerances including possiblyfoodOverweightHigh blood pressurePossible sleep apnoeaHeadaches and lower back pain – Musculoskeletal issuesConsider tight neck and shoulder muscles; bad posture;inappropriate office chair; muscle imbalances; poorgardening posture; inadequate overall body strength.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

2. What would a health professionalconsider when developing a care plan forthis individual? Weight management- Exercise program- Dietary assessmentAsthma management- Medication- Allergies: diet & environmentPain managementTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

3. Consider how each discipline within theinterprofessional health care team canhelp the individual to achieve their goalsWho can help? Doctor/NurseExercise Physiologist/PhysiotherapistDietitianClinical PsychologistTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

How do we help?Doctor/NurseThe doctor or nurse will complete a medical historyand physical assessment of the client and reviewmedications.A doctor, nurse or pharmacist can provide informationabout the medication taken and how this should betaken.Health assessments will include pain score and painmanagement of the lower back and headaches, aswell as looking into other health concerns.Provide education about inhaler techniques.Provide education about the specific monitoring ofasthma and exploration of triggers.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

How do we help?Exercise Physiologist/PhysiotherapistThe aim is to increase fitness and overall strengthand treat musculoskeletal tightness and backdiscomfort. Improving core strength may help.The Physiotherapist can specifically assess postureand work position.Compliance with an individual exercise plan willbuild confidence, strengthen muscles and help tokeep the individual fit and active, enhancing qualityof life.Resulting weight loss may aid in reducing symptoms.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

How do we help?DietitianThe Dietitian will assess the client’s diet and makerecommendations for weight loss and healthy eating.He or she will also be able to consider possible food allergies orintolerances related to asthma.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

How do we help?Clinical PsychologistHelps the client to address any barriers or motivationalissues surrounding weight loss and exercise. They may alsobe able to explore any marital problems or other stresses.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Key IPL Discussion Points1. How can we ensure that the care is client centred? Actively encourage client involvement in clinical decisionmaking Respond to the changes in the client’s needs Discuss with the client what care options are available Encourage self management, health promotion anddisease preventionTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Key IPL Discussion Points2. How can we demonstrate effective communication withother members of the interprofessional team? Show respect and interest when listening to other teammembers’ ideas and viewpoints; do not dominatediscussions and activities Come to an agreed care plan Use terminology that is understood by members of theinterprofessional care team and provide clarificationwhen required.THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Key IPL Discussion Points3. How does an interprofessional team differ from amultidisciplinary team? Identify where each health disciplines fits within thisinterprofessional team, acknowledging skills and knowledge ofteam members Consider where disciplines overlap so that duplication isavoided and where disciplines enhance others in the provisionof health care Identify misconceptions relating to own and health professionslisted in this case study Holisticclient centred care: clientis partof theI decisionmakingTAGCHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THEUSTRALIANTRAINING CAPACITY (ICTC) PROGRAMOVERNMENT UNDER THE NCREASED LINICAL

Questions?THIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

ReferencesLeMone P and Burke K (2000). Medical – Surgical Nursing. Critical Thinking in Client Care. 2nd edition.Prentice Hall Health, USAWhy asthma makes it hard to breath (2011). Retrieved from: www.achooallergy.comAsthma Foundation (2011). Retrieved from: www.asthmafoundation.org.auKidsHealth (2011) What happens during an asthma flare Up? Retrieved sthma triggers.htmlWhat are the asthma triggers (2011). Retrieved from: www.drugster.infoMyDr (2009) Asthma treatments. Retrieved from: www.mydr.com.au/asthma/asthma- treatmentsImages retrieved omwww.news.softpedia.comwww.dustmitesbites.comTHIS CLINICAL TRAINING INITIATIVE IS SUPPORTED BY FUNDING FROM THE AUSTRALIAN GOVERNMENT UNDER THE INCREASED CLINICALTRAINING CAPACITY (ICTC) PROGRAM

Asthma - an interprofessional case study At the end of this presentation students will be able to: Give a definition of asthma Discuss what could cause asthma Identify four triggers of asthma Describe symptoms of an asthma flare-up Explain three asthma treatment strategies Develop an interprofessional plan of care for

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