Feb 23, 2024 NR 503 Week 6: Epidemiological Analysis: Chronic Health Problem
The widespread non-communicable respiratory illness known as chronic obstructive pulmonary disease (COPD) is treatable and preventative. COPD is the collective term for emphysema and chronic bronchitis. COPD is characterized by increasing tissue damage and persistent respiratory difficulties. The rising expense of healthcare is linked to COPD, which has been a prevalent source of morbidity and mortality in the United States. The aim of this study is to investigate COPD, covering its importance, strategies for surveillance and reporting, epidemiology, screening, and guidelines. It will also have a strategy outlining how the NP would handle the medical problem and the high readmission rates.
Background Information and Significance of the Health Issue
COPD is defined by an aberrant inflammatory response in the lungs and irreversible airflow restriction. According to Hikichi et al. (2019), long-term exposure to harmful particles and gases, especially cigarette smoke, triggers both innate and adaptive immune responses that lead to an aberrant inflammatory response in COPD. Inflammatory cells, mediators, protease and antiprotease imbalance, and oxidative stress are all elevated during the inflammatory response. The pathogenic pathways that cause hypersecretion of mucus, ciliary dysfunction, anomalies in gaseous exchange, pulmonary hypertension, and systemic consequences are the causes of the alterations associated with COPD. Mucus hypersecretion is a hallmark of chronic bronchitis, whereas tissue damage is the hallmark of emphysema.
Due to airway remodeling and the buildup of inflammatory exudates in the small airways, the small conducting airways are the main location of airflow restriction. Longer expiration and more work of breathing come from the inflammation-induced decrease of lung elastic recoil and the breakdown of alveolar support (Hikichi et al., 2019). Persistent pulmonary hypertension and right ventricular dysfunction are partly caused by pulmonary artery vasoconstriction and remodeling of the pulmonary arteries. Heart failure develops as a result, worsening the diagnosis and raising the death rate.
Clinical Presentations
Patients with chronic bronchitis have a long history of developing dyspnea, a tardy nonproductive cough, lung infections that come back frequently, and cardiorespiratory failure. According to Choi et al. (2019), the physical examination revealed the following: cyanosis, edema, coarse rhonchi and wheezing, and the utilization of accessory muscles for respiration. Emphysema patients, on the other hand, also have a long history of increasing dyspnea, a tardy onset of productive cough, and respiratory failure. On physical examination, the patients have a barrel chest and are frequently skinny. They also exhibit laborious breathing, which is defined by pursed lips breathing and the employment of accessory muscles in a hyper-resonant chest (Choi et al., 2019). Auscultation may also reveal wheezing and distant heart sounds.
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Stages
Stage 1: The majority of patients do not notice any changes in their lung function due to the minor symptoms. To widen your airways, your doctor may advise taking a bronchodilator medicine. As the primary cause of COPD, smoking will be discouraged, along with other lifestyle modifications such avoiding secondhand smoke.
Stage 2: When symptoms deteriorate to this point, most people seek medical help. You can feel short of breath when jogging or walking, and coughing and mucus production worsen. During this phase, doctors will often advise pulmonary rehabilitation so that you can learn how to control your COPD more effectively. To lessen potentially deadly flare-ups, doctors frequently administer oxygen and steroids.
Stage 3: Patients may not be able to perform basic tasks and frequently cannot leave due to their symptoms being so severe.
Stage 4: Oxygen blood levels become very low, which makes the risk of developing heart and lung failure very high. Flare-ups are often and can be fatal. Individuals may need surgical intervention such as a lung transplant or removal of large areas of damaged lungs air sacs
New Jersey Statistics
While COPD prevalence, hospitalization, death, and smoking rates are all lower in New Jersey than in other states, the state’s readmission rate is higher than normal. It is ranked 10th out of all the afflicted states nationally. According to data, the state has a 4.8% prevalence of adults with COPD who have been diagnosed, with an incidence of 366,900 compared to the 5.8 million people in the country. According to COPD (2018), the state’s COPD prevalence was greater in Blacks and Whites (4.9% and 4.6% ) respectively than in Hispanics (3.9%) and Asians (2.5%). In addition, 10608 patients in New Jersey had readmission rates, with a 25% annual 30-day readmission rate. Nonetheless, the yearly death rate is 27.7 per 100,000 people, and the annual treatment costs are close to 1.02 billion US dollars. Its influenza vaccination rate is greater than usual, but its pneumonia vaccination rate for COPD patients is lower than average.
A Table Evaluating COPD Statistics for the United States and New Jersey
New Jersey StatisticsNational StatisticsPrevalence4.8%5%Incidence366,90012.5millionReadmission25%26.5%Deaths/10000027.7%102.5%Females5.1%5.9%Males4.5%4.7%
Surveillance and Reporting
In order to track the prevalence of COPD, surveillance techniques have been introduced in New Jersey. The CDC established the National Behavioral Risk Factor Surveillance System (BRFSS), which includes the New Jersey Behavioral Risk Factor Survey (NJBRFS), to survey all of the state’s citizens (NJ gov, n.d.). To help stratify the risk of getting COPD, NJBRFS identifies important behavioral risk variables such tobacco use and exposure to lung irritants. Furthermore, the Center for Health Statistics and Informatics (CHS) of New Jersey manages the New Jersey State Health Assessment Data (NJSHAD) System, which the state created to offer on-demand access to public health datasets, statistics, and data about the state’s health status (NJ gov, n.d). Public health status indicator reports, community profiles, health issues with indicator reports, and other data and resources, including links to other data sources, partner organizations, and more details about public health data related to an illness, are all included in NJSHAD.
Analyses from epidemiology
WHAT
People over 40 years old are susceptible to COPD, a major non-communicable disease. But among Americans, it has a high prevalence of morbidity and mortality. High readmission rates for afflicted patients are frequently the result of disease aggravation. According to estimates, about 210 million
people globally suffer with COPD, and over four million of those deaths make up around 9% of all deaths (Safiri et al., 2022). According to reports, 90 percent of these fatalities happened in low- and middle income nations. Acute exacerbations of COPD, as determined by disability-adjusted life years, make the disease the sixth most common cause of poor health in the world today.
WHO
One of the main risk factors for COPD was tobacco use. Exposure to secondhand tobacco smoke at work, being older than 50, and using biomass fuels were additional risk factors. According to Safiri et al. (2022) COPD was more common in males than women, with prevalence of 35.6% in those over the age of 70. The number of nonsmoker COPD patients is rising, which can be attributed to other risk factors mentioned above. Patients with COPD exhibit poor treatment-seeking behavior, and the cost of treatment makes it difficult to continue treatment. Exacerbations of the disease have a negative impact on patients’ quality of life and accelerate the course of the illness; hospitalization costs associated with severe exacerbations can range from 7,000 to 39,200 US dollars.
WHERE
The age prevalence of COPD was greater in high-income North America, South Asia, and Australia than in Andean Latin America, high-income Asia Pacific, and eastern sub-Saharan Africa. The highest age standardized death rates from COPD were found in Oceania, South Asia, and East Asia, while the lowest death rates were found in high-income Asia Pacific, Eastern Europe, and Andean Latin America (Safiri et al., 2022). The regions with the biggest increases in COPD age prevalence were the Middle East, North Africa, and southern Latin America, while the regions with the biggest decreases were Eastern Europe, East Asia, and high-income Asia. After better patient treatment throughout the same time period, COPD death rates fell in all regions.
Furthermore, compared to urban populations, rural populations may be twice as likely to develop COPD (16%), owing to a higher percentage of people with a history of smoking and increased exposure to secondhand smoke. However, rural populations may also have less access to smoking cessation programs that could avert the disease’s onset (Ruvuna & Sood, 2020). Rural inhabitants are also more prone than urban ones to work in dusty occupations like crop farming, coal mining, and wood industries, which increases their exposure to occupational hazards. In high-income nations, tobacco use has been linked to more than 70% of COPD cases. As an illustration, household air pollution is a key risk factor for COPD, accounting for 30–40% of cases in low- and middle-income countries.
WHEN
Over time, there have been a rising number of common cases of COPD. The regions with the highest incidence were West Europe, South Asia, and East Asia (Safiri et al., 2022). Conversely, COPD has been a major cause of death, with the largest rates of death occurring in East Asia, South Asia, and Western Europe. Although the number of deaths has increased, the proportion of affected people has decreased.
WHY
Smoking tobacco exposes almost one billion people to a huge risk of developing COPD, particularly in high-income nations like the USA. Moreover, air pollution and secondhand smoke have been linked to a higher chance of COPD development, particularly in non-smokers (Ruvuna & Sood, 2020). One possible explanation for the 13% increase in COPD diagnoses is occupational exposure to respiratory irritants such paints, glues, and toxic metals. Remember that certain cases of COPD have been linked to genetic abnormalities that make people more susceptible to chronic inflammation, such as antitrypsin deficiency and Kartagener’s syndrome.
DIAGNOSTIC TEST
The primary diagnostic criteria for COPD are clinical suspicion and activity-related dyspnea, particularly in patients with a history of risk factors. Spirometry is needed to establish the diagnosis in symptomatic and at-risk people (Haynes, 2018). Spirometry can also be used to monitor illness development, check treatment response, and modify medication. Fixed is a pulmonary function test that measures the degree of airflow limitation and can determine whether an obstruction of the airway exists. According to Yawn et al. (2019), the Global Initiative for Chronic Obstructive Lung Disease (GOLD) uses the forced expiratory volume in the first second (FEV1) compared to forced vital capacity (FVC) ratio to diagnose and grade the severity of COPD. Normal FEV1/FVC is 85%, but COPD is characterized by a decreased volume in the first second of forced exhalation, which is 70%. An FEV1/FVC ratio of less than 70%, which indicates the existence of airflow limitation, is required for a post-bronchodilator response in order to validate the diagnosis. Individuals falling within GOLD group one have a FEV1/FVC ratio more than 80%, whereas those in group two have a ratio between 50% and 80% (Yawn et al., 2019). Patients in group three who have a FEV1/FVC ratio between 30 and 50% and patients in group four who have a ratio less than 30% are further categorized by GOLD.
Utilized frequently as a screening tool is the COPD Assessment in Primary Care to Identify Undiagnosed Respiratory Disease and Exacerbation Risk (CAPTURE) tool. The instrument comprises five inquiries along with a peak expiratory flow (Yawn et al., 2021). The five questions are: has the patient been exposed to any airway irritants; has his breathing changed during the season; does he have exertional dyspnea, and if so, are their age-mates also experiencing it?; and has he had pneumonia or bronchitis in the past year? For diagnosing clinically severe COPD, the test exhibited 89.7% sensitivity and 93.1% specificity with 95% confidence interval widths across a variety of sample sizes (Yawn et al., 2021). The screening test did not necessitate any additional diagnostic testing, so the cost was minimal.
PLAN
The key elements of managing COPD must be understood by an NP. According to Bollmeier and Hartmann (2020), these include appropriate pharmacotherapy, support for quitting smoking, pulmonary rehabilitation, and routine follow-up monitoring for disease progression. The NP should use the GOLDABCD tool to guide treatment based on the severity of the disease. The mainstay of pharmacotherapy is the use of bronchodilators, which are essential for the management of COPD at all severity levels. Both short- and long-acting beta-blockers and antimuscarinics are common bronchodilators. Ipratropium is a short-acting muscarinic antagonist (SAMA), while tiotropium is a long acting muscarinic antagonist (LAMA). Similarly, salbutamol is a short-acting beta-blocker, while salmeterol is a long-acting beta-blocker.
If GOLD group A patients exhibit symptoms, the NP should provide a short- or long-acting bronchodilator in addition to their prescription. For patients in group B, a LAMA or LABA is utilized as an initial treatment. Patients in GOLD group C are advised to undergo LAMA monotherapy since it enhances lung function and lowers exacerbations (Yawn et al., 2021). Finally, because of their complementary modes of action, group GOLD group D patients are advised to begin initial therapy with LAMA and LABA in order to reduce disease aggravation. The NP ought to be aware of the extra factors to be taken into account when managing specific COPD cases (Yawn et al., 2021). For instance, in COPD GOLD group D patients with a history of asthma and elevated blood eosinophil counts, the first-choice therapy regimen consists of LABA plus inhaled corticosteroid (ICS) (Yawn et al., 2021).
An acute exacerbation of COPD must be recognized by the NP nurse, who must then start therapy right once. As part of the immediate treatment, steps are taken to reverse airway blockage, guarantee sufficient oxygenation, and address the underlying cause of the aggravation. Using oxygen supplementation, bronchodilators, corticosteroids, antibiotics, and ventilator aid are all part of the therapy (Bollmeier & Hartmann, 2020). To stop further exacerbations, she can also provide pneumococcal and flu vaccinations.
As a non-pharmacological strategy to improve lung function, the NP must use pulmonary rehabilitation. According to Bollmeier and Hartmann (2020), it is crucial to teach COPD patients breathing exercises such as pursed lips breathing and strengthening their respiratory muscles in order to lower their risk of dyspnea. To stop the progression of the disease, quitting smoking is one of the additional methods. Drugs like varenicline and bupropion can be used to help with cessation. Exercise and a nutritious diet enhance life quality and avert problems.
CONCLUSION
Tobacco users are frequently affected with COPD, a chronic respiratory disease. It is one of the major causes of illness and mortality that has been found, and the number of cases may continue to climb. Remarkably, there has also been an increase in COPD in nonsmokers linked to exposure to the environment and air pollution. In order to detect and keep track of COPD cases, the state of New Jersey has been essential. To deliver proper care and enhance patient outcomes, it is imperative to get familiar with GOLD’s criteria for diagnosing and treating COPD cases.
References
Hartmann, A. P., and S. G. Bollmeier (2020). An overview on exacerbations in the treatment of chronic obstructive pulmonary disease. AJHP, the official journal of the American Society of Health-System Pharmacists, is published every four months and ranges from 259 to 268. 10.1093/ajhp/zxz306 can be found here.
Park, Y. B., Kim, Y. H., Choi, J. Y., Yoo, K. H., Park, S. J., Jung, K. S., Yoo, K. H., & Yoon, H. K. 2020). Findings from a KOCOSS Cohort of Female Patients with Chronic Obstructive Pulmonary Disease: Clinical Features. International Journal: 15, 2217–2224; Chronic Obstructive Pulmonary Disease. 10.2147/COPD.S269579 can be accessed here.
COPD, 2018. Available at:
https://www.copdfoundation.org/Portals/0/StateAssessmentCards/SAC__NJ_2018.pdf
J. M. Haynes. 2018). Basic testing and interpretation of spirometry for primary care physicians. Respiratory therapy journal published in Canada: CJRT = Revue canadienne de la thérapie respiratoire: RCTR, 54(4), 10.29390/cjrt-2018-017. 10.29390/cjrt-2018-017 is the doi.org link.
Gon, Y., Maruoka, S., Mizumura, K., and Hikichi, M. 2019). Chronic obstructive pulmonary disease (COPD) caused by cigarette smoke: pathogenesis. S2129–S2140 in Journal of Thoracic Disease, 11(Suppl 17). 10.21037/jtd.2019.10.43 can be found at this link.
NJ, [n.d.” This link: https://www.nj.gov/health/chs/njshad
Ruvuna, L., and A. Sood. 2020). The study of the chronic obstructive pulmonary disease epidemic. 41(3), 315–327; Clinics in Chest Medicine. 10.1016/j.ccm.2020.05.002 can be found here.
Mansournia, M. A., Collins, G. S., Kolahi, A. A., & Kaufman, J. S.; Ahmadian Heris, J.; Safiri, S.; Carson Chahhoud, K.; Noori, M.; Nejadghaderi, S. A.; Sullman, M. J. M. 2022). Results from the 2019 Global Burden of Disease Study on the burden of chronic obstructive pulmonary disease and the risk factors associated with it in 204 countries and territories, 1990-2019. Clinical research edition of BMJ, 378, e069679. The doi: 10.1136/bmj-2021-069679
Yawn, B. P.; Han, M.; Make, B. M.; Mannino, D.; Brown, R. W.; Meldrum, C.; Murray, S.; Spino, C.; Bronicki, J. S.; Leidy, N.; Tapp, H.; Dolor, R. J.; Joo, M.; Knox, L.; Zittleman, L.; Thomashow, B. M.; & Martinez, F. J. 2021). The protocol summary of the COPD assessment in primary care is called “CAPTURE: Validation of Undiagnosed Respiratory Disease and Exacerbation Risk in Primary Care Study.” Chronic Obstructive Pulmonary Diseases, 8(1), 60–75 (Miami, Fla.). What is the DOI for
10.15326/jcopdf.2020.0155?
Mintz, M. L., Yawn, B. P., and Doherty, D. E. 2021). GOLD in Practice: Treating and Managing Chronic Obstructive Pulmonary Disease in the Primary Care Environment. Journal of Chronic Obstructive Pulmonary Disease: International Edition, 16, 289-299. 10.2147/COPD.S222664 can be accessed here.
Assignment
Purpose
The purpose of this assignment is:
Integrate knowledge and skills learned throughout NR503 course
Direct application of course objectives utilizing epidemiological analysis of a chronic health problem, along with state and national level data.
Activity Learning Outcomes
This assignment enables the student to meet the following course outcomes:
See weekly outcomes from Weeks 1-6.
Due Date
This assignment must be submitted by Sunday, 11:59 p.m. MT at the end of Week 6.
Total Points Possible
This assignment is worth 200 points.
Preparing the Assignment
Requirements
This paper should clearly and comprehensively discuss a chronic health disease. Select a topic from the list provided by your course faculty.
The paper should be organized into the following sections:
Introduction (Identification of the problem) with a clear presentation of the problem as well as the significance and a scholarly overview of the paper’s content. No heading is used for the Introduction per APA current edition.
Background and Significance of the disease, to include: Definition, description, signs and symptoms. Incidence and prevalence of statistics by state with a comparison to national statistics pertaining to the disease. If after a search of the library and scholarly data bases, you are unable to find statistics for your home state, or other states, consider this a gap in the data and state as much in the body of the paper. For instance, you may state something like, “After an exhausting search of the scholarly data bases, this writer is unable to locate incidence and/or prevalence data for the state of…” This indicates a gap in surveillance that will be included in the “Plan” section of this paper.
Surveillance and Reporting: Current surveillance methods and mandated reporting processes as related to the chronic health condition chosen should be specific.
Epidemiological Analysis: Conduct a descriptive epidemiology analysis of the health condition. Be sure to include all of the 5 W’s: What, Who, Where, When, Why. Use details associated with all of the W’s, such as the “Who” which should include an analysis of the determinants of health. Include costs (both financial and social) associated with the disease or problem.
Screening and Guidelines: Review how the disease is diagnosed and current national standards (guidelines). Pick one screening test (review Week 2 Discussion Board) and review its sensitivity, specificity, predictive value, and cost.
Plan: Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation. Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility, are useful?) Note: Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts. All interventions should be based on evidence connected to a resource such as a scholarly piece of research.
Summary/Conclusion: Conclude in a clear manner with a brief overview of the keys points from each section of the paper utilizing integration of resources.
The paper should be formatted and organized into the following sections which focus on the chosen chronic health condition.
Adhere to all paper preparation guidelines (see below).
Preparing the Paper
Page length: 7-10 pages, excluding title page and references.
APA format current edition
Include scholarly in-text references throughout and a reference list.
Include at least one table that the student creates to present information. Please refer to the “Requirements” or rubric for further details. APA formatting required.
Length: Papers not adhering to the page length may be subject to either (but not both) of the following at the discretion of the course faculty: 1. Your paper may be returned to you for editing to meet the length guidelines, or, 2. Your faculty may deduct up to five (5) points from the final grade.
Adhere to the Chamberlain College of Nursing academic policy on integrity as it pertains to the submission of original work for assignments.
ASSIGNMENT CONTENTCategoryPoints%DescriptionIdentification of the Health Problem 157.5%Comprehensively and succinctly states the problem/concern. Clear presentation of the problem as well as the significance with a scholarly overview of the paper’s content.Background and Significance of the Health Problem3015%Background and significance is complete, presents risks, disease impact and includes a review of incidence and prevalence of the disease within the student’s state compared to national data. Evidence supports background. If the student discovers a gap in data (no state level data), this is stated within the section. A student created table is included using APA format. In the case of a gap in data the student will select two other sets of data to use in the student created table.Current Surveillance and Reporting Methods3015%Current state and national disease surveillance methods are reviewed along with currently gathered types of statistics and information on whether the disease is mandated for reporting. Supported by evidence.Descriptive Epidemiological Analysis of Health Problem3517%Comprehensive review and analysis of descriptive epidemiological points for the chronic health problem. The 5 W’;s of epidemiological analysis should be fully identified. Supported by scholarly evidence.Screening, Diagnosis, Guidelines3015%Review of current guidelines for screening and diagnosis. Screening tool statistics related to validity, predictive value, and reliability of screening tests are presented.Plan of Action3015%Integrating evidence, provide a plan of how a nurse practitioner will address this chronic health condition after graduation. Provide three specific interventions that are based on the evidence and include how you will measure outcomes (how will you know that the interventions have utility, are useful?) Note: Consider primary, secondary, and tertiary interventions as well as the integration of health policy advocacy efforts. ;All interventions should be based on evidence – connected to a resource such as a scholarly piece of research.Conclusion157.5%The conclusion thoroughly, clearly, succinctly, and logically presents major points of the paper with clear direction for action. Includes scholarly references18592%Total CONTENT Points = 185 ptsASSIGNMENT FORMATCategoryPoints%DescriptionAPA current ed.10
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