Serious Health Issues or Complication

ASSESSMENT 3 2019 TEMPLATE
Please follow this template and use this question to conduct research.
Why is the oxygen therapy the best practice for patient with COPD
despite the disbelief that it can create serious health issues in them?
NSG2NMR (2019) Assessment 3: 2,000 individual report
Student First
Name:
Student Surname:
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Facilitator Name:
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TOTAL Word Count: 2,000 +/- 10%
Excludes: reference list, appended search history
Includes: in-text citations
DUE DATE:
Identify a clinical issue and propose a research question about this
clinical issue
(approx. word count 100)
There has always been the disbelief that oxygen therapy could have very serious
health issues or complication among the patients with COPD in the clinical
context. Often, there has been various attempts to determine the authenticity of
this belief regarding the patients’ state of health overtime as they are subjected
to the therapy. It has sometimes affected the treatment regimen of the patients
who have ever heard about this belief or the owners of the patients who have
ever had this belief especially when they try resisting from being administered to
the therapy. Despite the disbelief, the therapy has continuously gained popularity
and a broader application.
Research question: Why is oxygen therapy the best practice for patient with COPD
despite the disbelief that it can create serious health issues in them?
Conduct a literature search (using Medline AND CINAHL databases) and
identify literature relevant to the research question. APPEND THE
SEARCH HISTORY TO THE ASSIGNMENT
Write a Literature Review that describes what is already known about
your research question
(approx. word count 1,500)
According to Murphyet al. (2017), oxygen therapy that is long term is a familiar
COPD’s pharmacological treatment. Government records estimates that more
than a total Medicare population of one million get oxygen at home and that
medical costs for such exceeds a total of $2 billion annually in the US. Pandya et al.
(2019) notes that the application of oxygen in COPD condition that is stable, with
episodic hypoxemia related activity has given the required information in
explaining the significance of oxygen in the study population. The importance of
oxygen in COPD exacerbations can be therapeutic and toxic. Crucial information
particularly from the UK, have provided significant information regarding the
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concerned issue.
Long term oxygen therapy at home setting has showed improvement survival in
patients with severe resting hypoxemia and COPD. They further state that the
support for LTOT is based on two landmark trials that were published close to
forty years ago. They state that the results from the reimbursement and
prescription basis of LTOT to this very day. The work that has been done recently
demonstrates that there is no beneficial outcome of LTOT on patients with stable
COPD having moderate destruction during the activity or even at rest. Corrado,
Renda and Bertini (2016) further note that during activity and exercises, oxygen
therapy has been shown to eliminate the symptoms and maintain arterial
saturation of oxygen, but not improve outcomes that are long term. There are
usually many functional, physiological and biological impacts that are associated
with oxygen therapy in COPD. Fraser et al. (2016) also notes that oxygen therapy in
COPD exacerbations could be helpful at the same time harmful. This is the reason
why new guidance on application of oxygen therapy in the prehospital care was
published in the UK. The researchers also show that technological changes in the
Long-term oxygen therapy poses a challenge for prescriptions to physiology,
medical equipment suppliers that are durable, caregivers and patients. Even
though the new technology in LTOT seemed to be promising, it has hampered
various regulatory processes and pressures. Lately, changes in the
reimbursement in the for Long term oxygen therapy also poses difficulties that
sometimes are hard to manoeuvre through. Pisani et al. (2017) claims that
technology at the same time prove important but because of reimbursements and
cost constraints innovation has been limited.
Holm et al. (2017) observes that when taken together, the two different trials
among the patients show that the oxygen dose is essential. The treatment groups
from NOTT nocturnal oxygen and MRC showed a smaller duration in comparison
to the group that was receiving continued oxygen from NOTT. It is only the
patients that were receiving continuous oxygen therapy that showed a decrease
in pulmonary and haematocrit vascular resistance. Comparing the groups in their
study between the subjects that were receiving oxygen demonstrated increase in
median survival by 2-fold.
According to Ergan and Nava (2017), they assessed the effect of continued oxygen
therapy on pulmonary hemodynamic among the subjects of COPD and having
resting hypoxemia. They showed that from the starting point to the point of LTOT
initiation, there was an evident worsening of oxygenation and a continuous
pressure increase of the pulmonary artery. Following LTOT, the pressures in the
pulmonary artery fall because of the decrease in the resistance of vascular
pulmonary. It is in this study that the data obtained forms the foundation for the
use of ambulatory oxygen at home signifying hypoxemia reversal with improved
chances of survival, a salutary impact on the pulmonary vascular resistance and
supplemental oxygen. These findings are likely applicable to patients with COPD
and resting hypoxemia that is dated unfortunately. The effect of variations in the
caring of those with COPD suggest that LTOT should be visited. At the present
however, there is a clear evidence of the application of continuous oxygen
therapy over therapy of nocturnal oxygen to attain the required results.
Holm et al. (2017) observes that long term oxygen therapy is beneficial to the
survival in patients with chronic obstructive disease of pulmonary and severe
hypoxemia to rest. According to the landmark trials that were performed by the
study, these benefits depends on the exposure time to oxygen. They also note
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that following the introduction of oxygen concentrator, various studies have been
focusing on patient’s compliance to home oxygen therapy. In such a context,
compliance refers to the level at which the behaviours of the patients coincide
with the prescription from the clinic, it has been observed that compliance and
adherence are similar and they could be used interchangeably. The study’s
evaluation on compliance of the patients on home oxygen mostly relied on
reports from patients based on the questionnaires and interviews. They further
note that given the costs incurred and the assumed relationship between the
exposure time to oxygen and its importance on a person’s survival, compliance
then becomes an issue of interest. Similarly, understanding better of the home
oxygen therapy and it determinants may aid physicians and allied professionals of
health in improving patients’ care and cost effectiveness.
According to Ergan and Nava (2017), many patients having severe COPD have a
tendency of developing hypoxemia at rest when awake as there is progression in
their disease state. In some instances, this may or might be accompanied by
hypercapnia, however it remains to be a poor prognostic feature and independent
of the forced volume of expiration. For several years according to Ekström et al.
(2016), the scientific study of COPD has been largely driven by the need to gain an
understanding and comprehension of the processes which contributed to the
disorders of gas exchange. As a result, it led to the introduction of effective
treatment aimed at increasing the arterial oxygen tension a level beyond 8.0 kpa
for 15 hours every day. The randomised control trials are the building blocks of
evidence based oxygen prescribing. Since the publication of these studies, the
oxygen therapy cost has progressively been increasing in different parts of the
world as it is embraced. Many patients with advanced COPD according to Murphyet
al. (2017), rarely do they use oxygen during exercising. Much more, they utilize
oxygen to rapidly relieve their breathlessness and this has broadly explained why
there are large number of oxygen cylinders in people’s homes. Nevertheless,
many patients only choose their oxygen after breathlessness has been induced
using physical exercises.
Pisani et al. (2017) claims that in a study of individuals with COPD, when the
treatment with oxygen was compared with treatment by receiving air, those
patients that were treated with oxygen felt less breathless. Despite the
experience, when the patients were asked to report what they preferred at their
individual level, they could not differentiate between the air and the oxygen. In
other words, it is difficult to explain whether the patients manifest the kind of the
trade-off between exercise performance and dyspnoea.
Murphyet al. (2017) observes that long term oxygen therapy does not contribute to
the risk for hospitalization or increase expectancy of life for significant number of
patients with mild or moderate COPD, however, it may lower the patient’s quality
of life. For several decades, the physicians have repeatedly prescribed long term
oxygen therapy to patients having COPD based a research showing that the
therapy could extend their lives. However, these studies were carried out in the
1980s which were significantly flawed. Researchers have realized that the more
recent studies do not replicate the old results. Throughout the field of medicine
there are usually practices and treatments that continue because they have
always been employed and done to bring the desired change or outcome
according to Ekström et al. (2016). But it is important that physicians consider new
evidence and adjust accordingly. While there is little evidence of long term
oxygen therapy, it is accompanied with lots of challenges including the fact that it
is expensive; patients are forced to pay out of their pockets to sustain the
Medicare. The most recent research by Pisani et al. (2017) shows that patients with
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