PROMPTS Discussions


Please respond to the discussion prompt. 1 and2 Week 4  chapters 5, 7, 8, and 9.

Prompt 1 mosses

Type 1 diabetes is a chronic condition that accounts for about 10% of all diabetes and in which the pancreas usually does not produce insulin (Mayo Clinic, 2021). In 2018, there were a total of 1.6 million Americans with type 1 diabetes, which included around 187,000 children and adolescents (American Diabetes Association, 2018). This chronic condition involves all age groups. Unfortunately, there is no cure for type 1 diabetes, so there are many different costs for those with type 1 diabetes and their caregivers. The total annual cost of diagnosed diabetes in America in 2018 was $327 billion (American Diabetes Association, 2018). According to the American Diabetes Association, there are 2.3 times greater health care costs for those with diabetes (American Diabetes Association, 2018). Also, those with diabetes incur around $16,750 per year on diabetes-related expenses, and expenses for diabetes increased by 26% from 2012 to 2017 (American Diabetes Association, 2018). One of the most expensive costs is hospitalization due to type 1 diabetes, which accounted for around $26,000 per year for those with this condition (Sussman & et al., 2020).

It seems to be that the costs and expenses to manage type 1 diabetes increase every year, which negatively affects families. These expenses do not only affect those with type 1 diabetes, but also those who are a part of the patient’s family. It is especially difficult when children and adolescents in the family setting suffer from type 1 diabetes. According to the literature, the out-of-pocket cost for children with type 1 diabetes is about $2,500, and insulin only accounts for 18% of the out-of-pocket costs (Mostafavi, 2020). More specifically, children who suffer from type 1 diabetes had out-of-pocket costs around $823 compared to costs for adults which averaged $445 (Mostafavi, 2020). It is obvious there are increased costs for pediatric patients compared to adult patients. And according to another study, the annual cost of type 1 diabetes care increased from $11,178 to $17,060 within a matter of four years, with insulin costs rising from $3285 to $6255 (Crossen & et al., 2020). These numbers are staggering, and the annual costs of diabetes continue to increase over time. Because the financial strain on families can be significant as time progresses, families need help in caring for those with type 1 diabetes. What is the role of the advanced practice nurse in this situation? The advanced practice nurse’s role is to advocate for families who are struggling to find alternatives of care for patients, to coordinate care for these families to manage care properly, and to educate families on type 1 diabetes. Some educational points include learning how to count carbohydrates, learning what the different types of insulins there are, understanding how to check the child’s blood sugar, understanding what the specific blood sugar levels mean, and learning how to administer insulin shots or how to use an insulin pump (Juvenile Diabetes Research Foundation, 2021). It is important to understand that type 1 diabetes affects both the patients and their families financially because of the increasing annual costs. It is important to support them, to listen to them, and to guide them through this condition as an advanced practice nurse.


Chronic illness of one family member affects and impacts the function and stability of the family as they cope with caring for their loved one. Family members will be involved in their care, influence decision making, engage in family planning, and play roles that positively and negatively influence disease management (Kaaniken et al., 2015). Life and routines are disrupted when facing long-term or chronic illnesses that affect physical abilities, appearance, and independence. For chronic illnesses that require extensive services such as specialty providers, regular treatments or testing, multiple drug regimens, or intense therapies can place families under financial strain. For this week’s post, I wanted to focus on an inherited genetic condition that affects children with chronic illness. Certain illnesses require constant out-of-pocket health care (such as autism, cystic fibrosis, or mental health needs) that can range from $2,669 to $69,906 per year, compared to $676 to $3,181 for families with children without chronic illnesses (Kaaniken et al., 2015).

Cystic fibrosis (CF) is a life-shortening genetic disease that currently has no cure, diagnosed in infancy. The current lifespan for CF patients in the United States is roughly 40 years with advancements in medicine (Van Gool et al., 2013). Cystic fibrosis (CF) is a complex disease characterized by a progressive decline in pulmonary function that results in impaired airway clearance, obstruction, and inflammation of the airways (Andrews et al., 2020). As the disease progresses, patients require more intensive health care that includes home-based care, medications, more frequent and prolonged hospital admissions, and lung transplantation in half of these patients. This can be devastating to the family that is not prepared to tackle the annual costs. Despite the advancements in medicine, two of the key medications for CF dornase alfa (Pulmozyme) and tobramycin (Tobi) can cost $10,000 annually. This is apart from other medications in the CF regimen such as pancreatic enzymes, inhaled corticosteroids, bronchodilators, salt tablets, antihypercalcemics, and other medications.

The overall median health care cost for CF is $6,233 per year and ranges from $2,269 for children to $16,704 for patients in their 20s (Van Gool et al., 2013). Annual health care costs decline somewhat after age 2, generally rising until patients reach their early thirties and then plateau around $20,000-$25,000 per year (Van Gool et al., 2013). Rubin et al. (2017) conducted a study of over 500 patients regarding costs incurred with CF exacerbation with 88% of the participants having at least one episode a year. The annual costs for managing and treating cystic fibrosis exacerbations averaged about $37,025 and that number rose, depending on the stage of lung disease, from $30,066 among patients with mild disease to $119,862 for patients with severe disease (Rubin et al., 2017). Most of the medical costs in these studies are incurred by hospitalizations by at least half with pharmaceuticals being the next with financing while primary and specialty care is the least. This makes it important for both providers and families to manage CF appropriately to maximize comfort and wellness for the patient.

Apart from frequent clinic primary care visits, testing, pulmonary specialist visits, hospitalizations, and numerous drugs, parents are also key to performing physiotherapy on their child to clear mucus in the airways. Unlike asthma, where exacerbations can be relieved with a short-acting bronchodilator or using a nebulizer machine, children with cystic fibrosis require daily manual chest physiotherapy to keep their lungs clear. This affects the psychological well-being of the parents and child with reports of anxiety and depression occurring within the family (Andrews et al., 2020). The home-care requirements for these children will also impact the parents’ work which can lead to loss of wages that go towards affording medical treatment for the child. One parent might have to stay at home more frequently to care for the child to avoid exacerbations and hospitalizations, another heavy cost, which can place added stress on losing another wage earner in the home. In the end, patients living with cystic fibrosis will eventually require palliative care which is another incurred cost.

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