Chronic Obstructive Pulmonary Disease (COPD) is a leading cause of chronic morbidity and mortality burden in Australia after Cardiovascular disease and cancer (Lung Foundation Australia, 2016). WHO has estimated over 210 million unknown cases of COPD (COPD International, 2016). Mr. Patrick Johnson had a long history of smoking and was diagnosed with COPD. He had flu-like symptoms with malaise, nausea, anorexia, fever, vomiting, difficulty in breathing, and cough. Therefore, it is important to develop a holistic nursing care plan to help in managing and treating Patrick's condition to reduce future complications. Efficient care plan entails having a proper treatment, diagnosis, nursing assessments, managing exacerbations, and regular evaluation of the patient's outcome. The research examines the pathophysiology, assessment, and diagnosis of Patrick's case to ensure that he gets quality care.
Pathophysiology of the Case Study
According to Morton and Fontaine (2013), Chronic Obstructive Pulmonary Disease (COPD) is a progressive disease state characterized by airflow limitation; not fully reversible. This common lung disease usually makes it difficult for an individual to breathe. The primary conditions of COPD are Emphysema and Chronic Bronchitis, and they affect the lungs and result in difficulty in breathing (Morton & Fontaine, 2013). In understanding the lung's structure, when one inhales, air moves in the trachea through the bronchi. The bronchi then branch out into small tubes referred to as bronchioles. At the end of bronchioles, there are air sacs called alveoli, and at the end, there are capillaries that are tiny blood vessels. Oxygen usually moves from lungs to bloodstream through the capillaries. Additionally, carbon dioxide travels from blood to capillaries, then to the lungs, and exhaled.
Emphysema is a disease of the alveoli. Additionally, in the lungs, there are fibers that make alveoli walls to get damaged making them less elastic and not to work when one exhales (Kabesch & Adcock, 2012). If a person's bronchioles are inflamed, then they can produce mucus. However, these events may not be regarded as COPD.
Patrick experiences flu-like symptoms with malaise, fever, nausea, vomiting, cough, and anorexia. He was admitted to a local public hospital because the symptoms have not improved. Thus, he is unable to conduct simple activities. Patrick is currently suffering because he has a long history of smoking (63 years).
Analysing the sign and symptoms using NOPQRST
- Normal The patients experience pain when breathing
- Onset The causes of the pain are smoking which Patrick has done for 63 pack years.
- Provoking The pain exceeds when he speaks and breaths.
- Quality The pain can be described as burning, buzzing, lancinating, tingling, and zapping. The reason is that Patrick cannot perform even simple activities.
- Region/Radiation The pain radiates accessory muscles of Patrick
- Severity The patient's pain is severe. It is very critical because Patrick cannot get out of the bed. Furthermore, he is in high dependency unit.
- Time The patient feels the same pain at all time.
The above assessment helps health professionals to identify the early sign of deterioration (Peate & Dutton, 2017). It is imperative to gain consent before doing any procedure with the patient.
Aetiology / Causes
The main thing that causes COPD is smoking (Price at al., 2016). Breathing in chemicals and smoke may affect the air sacs and airways. Other things can result in lung diseases include chemicals, smoke, and use of cooking oils in poorly ventilated buildings. Furthermore, Baseline ABG provides essential information about the respiratory function and metabolic state (Jevon & Ewens, 2012). In this scenario, the primary responsibility is to conduct various assessment appropriately so that it helps multi-disciplinary team including nurse to plan further for the better health of Patrick (NMBA standard 4.1, 2016).
Chronic inflammation causes structural abnormalities due to repeated injury especially due to smoking in this case and also due to other noxious gas, smoke. Furthermore, inflammation of bronchial and bronchiolar wall, loss of cilia, and presence of mucus will limit airways (Prince et al., 2016). Thus, makes one have difficulty in breathing. Research pathophysiology related to forced expiratory volume and forced vital capacity demonstrated proper understanding of the staging of COPD. Additionally, COPD exacerbation is commonly appeared due to viral and bacterial infection of the bronchial tree [greenish thicker mucus] (Price et al., 2016).
Other Risk factors associated with Patrick's Condition
Age-related changes can be linked to Patrick's condition. The changes of COPD include decreased lung compliance and efficacy of ventilator exchange as age increases (Mannino & Buist, 2007)). A genetic factor which entails familial risk, smoking in the family, severe COPD sibling may also be associated with COPD. Improper development of lungs, exposure to noxious gasses, smoke and low socioeconomic condition and poverty, may make one suffer from COPD (Pillai et al., 2009).
Sign and Symptoms
Mr. Patrick has been experiencing Flu-like symptoms with a productive cough, purulent sputum, challenging to perform a task, abnormal breathing sound (crackle sound), dyspnoea, and high temperature (Burkhardt & Pankow, 2014). According to Morton and Fontaine (2013), the stages of COPD include 0) At risk, 1) Mild COPD, 2) Moderate COPD, and 3) Severe COPD. As the disease progresses, various health complications may follow, such as wheezing when one breathes.
Assessment and diagnosis
Assessment of the patients having COPD is significant to help in establishing an accurate diagnosis to assist in making the right therapeutic decisions. The chest computed tomography scanning helps the patients having the limitation of airflow and clinical characteristics that suggest one has COPD (Make & Martinez, 2008). Thus, the CT scan indicates there is another diagnosis. The distribution and amount of emphysema also identify the outcomes from the lung volume reduction surgery.
COPD assessment aims to evaluate the poor gas exchange and increase ventilator support if needed. Therefore, a nurse should implement NMBA standard one while providing quality nursing care including proper document (Ferrell, Coyle, & Paice, 2015). Other notable activities include assessing the level of consciousness, skin colour, respiration, and assessing ABCDE (Airway, Breathing, Circulation, Disability, Exposure/ Environment) system of Patrick (Price et al., 2016). The physical examination of the patient includes inspection, palpation, percussion, and auscultation of whole body system followed by neurological examination and vital sign (Price et al., 2016). AVPU (alert, verbal stimulation, pain, unresponsive) assessment is also essential, and it entails capillary reflex and SPO2 check (Price et al., 2016). Additionally, diagnostic investigation includes Arterial blood gases (ABG) interpretation, and the results show an increased level of PH, bicarbonate and decrease level of PaCO2, PO2, and SPO2.
In diagnosing COPD, the healthcare provider need to evaluate the symptoms, ask for complete health history, and conduct health test for the patient (Vestbo et al., 2013). In the case of Patrick, he had 63 years of smoking history. Additionally, he had symptoms including chronic cough and shortness of breath. Patrick has symptoms of COPD, thus, the test can be conducted through spirometry to show how his lungs work.
Holistic Nursing care
Promote ComfortThe discomforts can be easily observed due to difficulty in breathing. Therefore, the nurse should ensure that Patrick is comfortable when getting medication and care for him to recover quickly. In this case, the responsibilities of nurse include maintaining position, sitting upright, conducting AVPU assessment, ensuring that the capillary reflex, and checking SPO2 (Price et al., 2016). The nurse can contact the doctor and another medical team regarding the current condition of Patrick and the abnormal finding in a different test. It is also essential to perform oxygen therapy. The therapy includes treating hypoxia and administration of bronchodilator as order long-acting bronchodilator is usually prescribed to a patient with persistent symptoms (Allinson et al., 2016). Furthermore, the nurse should conduct close monitoring and continue to enhance Patrick's safety.
According to Price et al., (2016) non-invasive ventilation is a practical treatment option for COPD exacerbation. The reason is that it is useful and lifesaving treatment. The pulmonary rehabilitation offered to those who are prone to repeated exacerbations reduces dyspnoea and promote wellness (Price et al., 2016). Another alternative is conducting surgery that entails lung resection, general surgery, or organ transplant options available.
The patient's treatment can only be successful if healthcare providers have the required information about the patient. The patient and the family have to be educated on the effective treatment plan. In this case, Patrick is unable to perform even simple activities like getting out of the bed meaning he should have proper rest and perform the minimal physical activity. Having medication information is also significant to ensure that drug is not abused. The family is also taught on the deterioration sign of Patrick for them to know. An outsider should always be with Patrick to help him perform different activities. The nurse should also assess his or her knowledge regarding the bacteria, virus, and pathogens affecting Patrick as there is a high risk of infection (Baker & Fatoye, 2017). Moreover, the dietary food should be changed to a balanced diet, and Patrick should always avoid crowd as he has difficulty in breathing. It is also vital to discuss with the family about ACAT assessment to offer proper care.
In summary, this study aims to demonstrate holistic nursing care about the management of COPD of Mr. Patrick. It also involves hospital setting nursing care involving multidisciplinary team to reduce the symptoms of COPD. It includes Discharge planning and an alternative treatment option for the effective remedy. Patrick has a 63 years history of smoking and having difficulty in breathing shows that he has COPD. The best treatment recommended is non-invasive ventilation since it is useful and cost-saving.
Allinson, J. P., Hardy, R., Donaldson, G. C., Shaheen, S. O., Kuh, D., & Wedzicha, J. A. (2016). The presence of chronic mucus hypersecretion across adult life in relation to chronic obstructive pulmonary disease development. American journal of respiratory and critical care medicine, 193(6), 662-672.
Baker, E., & Fatoye, F. (2017). Clinical and cost-effectiveness of nurse-led self-management interventions for patients with COPD in primary care: A systematic review. International journal of nursing studies, 71, 125-138.
Burkhardt, R., & Pankow, W. (2014). The diagnosis of chronic obstructive pulmonary disease. Deutsches Arzteblatt International, 111(49), 834.
Ferrell, B. R., Coyle, N., & Paice, J. A. (2015). Oxford textbook of palliative nursing. Oxford: Oxford University Press.
Jevon, P., & Ewens, B. (2012). Monitoring the critically ill patient. John Wiley & Sons.
Kabesch, M., & Adcock, I. M. (2012). Epigenetics in asthma and COPD. Biochimie, 94(11), 2231-2241.
Lung Foundation Australia. (2016). Better Living with COPD: A Patient Guide (3rd ed.).
MacNee, W. (2005). Pathogenesis of chronic obstructive pulmonary disease. Proceedings of the American Thoracic Society, 2(4), 258-266.
Mannino, D. M., &...
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