Introduction
In this scenario, health care professionals collaborate virtually to help a patient in Valley City, North Dakota. Caitlynn is a 2-year-old female hospitalized with pneumonia at the Pediatric Department of Valley City Regional Hospital (VCRH). Caitlynn had mecontal ileus at birth, and this is her second hospitalization with pneumonia in 6 months. Current symptoms are weakened breath sounds in the right base and wheezing in the upper lobes; respiration 32, shallow; temperature 101. Furthermore, the physicians suspected malabsorption due to the patient’s low weight of 20.7 pounds and decreased subcutaneous fat. Thus, Caitlynn was previously diagnosed with pneumonia and malnutrition.
After additional tests, the patient was diagnosed with Cystic Fibrosis (CF). This is a hereditary autosomal recessive disease characterized by a malfunction of the external secretion glands and respiratory organs and a decrease in the activity of intestinal and pancreatic enzymes (Sutherland et al., 2019). Caitlyn requires constant parental care and regular medical supervision. The patient is seen by pediatrician Dr. Benjamin in her hometown, and her treatment is overseen by a multidisciplinary team of specialists from VCRH. Caitlynn’s parents are separated, do not live together, and both works, consultation with social services is required to coordinate actions. One parent or both should be fully informed and trained in the care of Caitlynn and receive periodic advice from the VCRH team.
Care Plan
On admission to VCRH, a respiratory therapist administered aerosol and chest physiotherapy to Caitlynn. Dr. Copeland gave her an IV with piperacillin for cystic fibrosis before the follow-up examination. The LeCleir and Pettit study shows a high likelihood of kidney failure in pediatric patients using piperacillin-tazobactam – 55% (2017). The use of cefepime with a 13% chance of kidney failure is recommended for possible recurrence of pulmonary infection, especially in combination with vancomycin and tobramycin (LeCleir & Pettit, 2017). Aerosol therapy is one of the main treatments to promote hydration of the epithelial lining fluid (Velino et al., 2019). Moreover, aerosols are used to deliver various drugs directly to the lungs to reduce the burden on the body (Velino et al., 2019). Therefore, the patient’s parents should be trained in the use of aerosol treatment and other types of physiotherapy.
The second direction was diet therapy and malnutrition problem solving for Caitlynn. Dr. Copeland prescribed a high-calorie, high-protein, high-fat diet. A study by Sutherland et al. that such a diet protects patients from intestinal obstruction and provides them with additional energy and essential fat-soluble vitamins (2019). Particular emphasis in Caitlynn’s diet is on getting vitamins A, D, E, and K. These vitamins improve pulmonary function and positively affect the functions of the digestive organs (Sutherland et al., 2019). In addition, the patient receives pancreatic enzymes, facilitating the absorption of nutrients and reducing possible intestinal symptoms.
Evidence-Based Practice Model
Caitlyn used the evidence-based Star model or ACE to develop her care and treatment plan. This technique implies interdisciplinary collaboration, and patient-centered care, involving the patient’s family in the care process (Indra, 2018). First, the main task was to install a monitoring system for Caitlynn’s condition, given her residence in a remote city. It required a combination of the use of telemedicine with regular visits to the local pediatrician and the active involvement of nurses in parent education. Second, Caitlin’s parents needed to be provided with information and access to consultations with medical staff (Indra, 2018). Third, by working together, all participants had to introduce new treatment practices and observe how they are performed. Fourth, every new practice should be subject to rigorous analysis and risk assessment to ensure it is effective and necessary (Indra, 2018). This approach provides Caitlynn with comprehensive, evidence-based care that should improve her condition.
Interdisciplinary Collaboration Challenges
Caitlin lives in a small town 100 kilometers from VCRH and cannot be seen at the clinic all the time, given her age and condition. Being in a small town also means not having access to many quality medical resources (Gifford et al., 2021). This is why telemedicine plays such a significant role in Caitlyn’s treatment. The VCRH medical staff offered the patient’s parents various online services to educate and monitor Caitlyn’s condition. First, the doctors and nurses set up online meetings with the patient’s parents to educate them on treatment techniques, show them how to use the aerosols, and explain the diet plan. Second, VCRH staff are in touch with Caitlin’s parents and pediatrician via text messages. Third, social worker Madeline Becker helped parents find support groups for relatives of patients with Cystic Fibrosis.
Conclusion
Caitlynn’s treatment plan is evidence-based, patient-centered, and meets all the latest advances in medicine and patient care practices. The involvement of all stakeholders and various medical and social service personnel will help Caitlynn receive adequate and high-quality treatment, even in the conditions of life in a remote small town. Throughout Caitlin’s life, her parents and medical professionals will be able to help her cope with her genetic disease on her own. Proper use of telemedicine could make the patient’s life less dependent on hospital facilities in the future.
References
Gifford, A. H., Ong, T., Dowd, C., Van Citters, A. D., Scalia, P., Sabadosa, K. A., & Sawicki, G. S. (2021). Evaluating barriers to and promoters of telehealth during the COVID-19 pandemic at US cystic fibrosis programs. Journal of Cystic Fibrosis, pp. 20, 9–13.
Indra, V. (2018). A review on models of evidence-based practice. Asian Journal of Nursing Education and Research, 8(4), 549–552.
LeCleir, L. K., & Pettit, R. S. (2017). Piperacillin‐tazobactam versus cefepime incidence of acute kidney injury in combination with vancomycin and tobramycin in pediatric cystic fibrosis patients. Pediatric pulmonology, 52(8), 1000-1005.
Sutherland, R., Katz, T., Liu, V., Quintano, J., Brunner, R., Tong, C. W., Collins., E. & Ooi, C. Y. (2018). Dietary intake of energy-dense, nutrient-poor and nutrient-dense food sources in children with cystic fibrosis. Journal of Cystic Fibrosis, 17(6), 804–810.
Velino, C., Carella, F., Adamiano, A., Sanguinetti, M., Vitali, A., Catalucci, D., Bugli, F. & Iafisco, M. (2019). Nanomedicine approaches for the pulmonary treatment of cystic fibrosis. Frontiers in Bioengineering and Biotechnology, 7, 406.