Crystal Dunlevy
EdD, RRT, RCP
Crystal Dunlevy, EdD, RRT, RCP, is a clinical associate professor at The Ohio State University in Columbus, Ohio.
Courses Authored
Dyspnea is a distressing symptom that has been described since ancient times, but only recently has it been comprehensively assessed and managed across disease states. The sensation of dyspnea results from interactions among multiple physiological, psychological, social and environmental factors. As with pain, adequate assessment of dyspnea depends on self-report by the person reporting breathing discomfort. Potential causes, underlying mechanisms and management options are addressed.
Despite progress in managing acute care disease, acute respiratory distress syndrome (ARDS) continues to pose challenges for critical care clinicians. Respiratory failure that characterizes ARDS is a common cause of morbidity and mortality, with mortality rates of 40% to 50%. ARDS is associated with injury to the alveolar-capillary membrane of the lungs, which alters oxygenation status and results in a reduced concentration of oxygen in the blood. A variety of conditions that predispose the lungs to injury can cause ARDS, and both direct and indirect injuries can lead to it. Prompt recognition of the distinct signs and symptoms of acute lung injury, often a harbinger of ARDS, can set a targeted treatment plan in motion. Likewise, early recognition of the progressively worsening respiratory function seen in ARDS can alert the team that the patient will need special types of mechanical ventilation to preserve and improve oxygenation.
Nearly 26 million Americans have been diagnosed with asthma, a disease marked by variable and recurring symptoms, airflow obstruction, bronchial hyper-responsiveness, and underlying inflammation. Inflammation of the airways and airway hyper-responsiveness are the hallmark pathophysiological features of asthma, resulting in the typical symptoms: coughing, wheezing, chest tightness, and breathlessness. The goal of asthma pharmacotherapy is to relieve or minimize symptoms by targeting the underlying pathophysiological processes. Because of the high prevalence of asthma, all clinicians must be up to date on the current guidelines for the diagnosis and treatment of this chronic illness. This course will summarize the key guideline changes, with a focus on adults.
The Joint Commission standards are no longer in effect and the topic of pneumonia is being rewritten and should be available in 2019. The Joint Commission and the Centers for Medicare & Medicaid Services partnered in 2004 to create core measures for disease management for community-acquired pneumonia. The measures create consistent evidence-based practice in institutions caring for CAP patients. The Centers for Medicare & Medicaid Services measures hospitals' adherence to the core measures and publishes the results for key stakeholders, such as patients and insurers, to compare. The CAP core measures provide a common set of measures for hospitals to use. The intent was to construct a system that would be easier and less costly for hospitals to follow. Core measures are integral to improving the care of inpatients and focus on the results of that care. The CAP treatment guidelines were developed with the support of the American Thoracic Society, the Infectious Disease Society of America, and the Centers for Disease Control and Prevention.
Obesity and undernutrition have a paradoxical relationship, yet both fall under the category of malnutrition. According to the UDSA and the WHO, consumer choices about food spending and diet are likely to be influenced by the accessibility and affordability of food.There are valuable links between food deserts, rural and urban areas, healthy living habits, malnutrition, and the impact this has on the US economy.
The Centers for Disease Control and Prevention (CDC) estimates that nearly 34 million adults in the U.S. smoke, and 16 million have a serious illness attributable to their smoking habit. With nearly half a million U.S. deaths attributed to smoking or exposure to secondhand smoke annually, the CDC identifies smoking as the number one cause of preventable disease, disability, and death. This course provides an overview of the need for smoking cessation and components of a successful program. Working as an interprofessional team, helping patients navigate the behavioral stages of smoking cessation, and smoking cessation aids are also discussed.