Nursing Practice COPD

Question: Discuss about the case study Nursing Practice for COPD. Answer: Introduction: The essay is a nursing practice case study that will give detail about medical conditions and social history about the patient in the case study. From the perspective of a primary registered nurse, it will analyze the etiology of the chronic diseases in patient and the medications that the patient is taking. It will describe the initial nursing care for the patient on admission and the education related to exacerbation that the nurse has to give to the patient. The nursing care for the patient will be based on the COPD guidelines provided by the Nursing and Midwifery Board of Australia, and the competency standards set by The Australian Nursing Midwifery Federation (ANMF) and the Australian Clinical Practice Guidelines. The essay will provide detail on the recommendation by a nurse for ongoing treatment and what services help the nurse will take from the community to give adequate care to the patient. The case study is about Mrs. Betty White, a 76-year-old Italian female who has been admitted to a medical ward for acute exacerbation of her COPD (Chronic Obstructive Pulmonary Disease) following a bout of pneumonia. She was never admitted before for her condition and has no known allergies. She had a lip replacement in 1997, a gallstone surgery in 2005 and a long term ulcer on her lower leg. When she was admitted, no medical findings were done related to spirometry test, blood test, blood pressure, check, ECG, etc. She has only one son living in Melbourne who visits her thrice a year, and she lives alone utilizing community nursing services. As the patient is suffering from COPD, it is necessary to know about the etiology of the disease. COPD is a progressive lung disease characterized by emphysema, chronic bronchitis, emphysema, and asthma (Fletcher Dahl, 2013). The symptoms of COPD include wheeziness, tightness in chest, frequent coughing and increased breathlessness. According to (Pauwels et al., 2012), the symptoms often develop in the advanced stage of the disease. According to the clinical COPD guidelines established by the Australian Clinical Practice, it is necessary for patients with COPD to monitor the symptoms and get the spirometry test done to confirm the condition so that timely treatment could be provided (Australian Clinical Practice Guidelines", 2015) According to (Joo et al., 2013), the primary cause of COPD is long-term exposure to lung irritants that damages the lungs and airways. The common irritants include cigarette smoke, cigar, second-hand smoke, etc. and environmental pollutants like chemical fumes and dust. These are the major contributing factors leading to COPD in patients (Budhiraja et al., 2015). According to the exploratory study by (Hodson Sherrington, 2014), rare genetic condition like alpha-1 antitrypsin deficiency also leads to the development of disease in patients even when they have never smoked or had ever been exposed to lung irritants (Fletcher Dahl, 2013). People with this condition have the low level of alpha-1 antitrypsin (AAT) protein in the liver which causes lung damage and COPD. In very rare cases people with asthma also has a chance of developing COPD (Pauwels et al., 2012). Therefore top three factors identified in Etiology of COPD are smoking, environmental factors and Genetic factors (Hodson Sherrington, 2014). About 90% patients diagnosed with COPD were found to be smokers (Vestbo et al., 2013). The WHO has also recommended that people with COPD should also be tested for Alpha-1. However, there may be other genetic predisposition to the development of COPD (Domenech et al., 2013). Apart from COPD, she also suffers from Osteoporosis and hypertension. As per the clinical COPD guidelines provided by the "Nursing and Midwifery Board of Australia", the primary care will comprise checking and monitoring the medications that Mrs. White had been taking (Lee Thomas Annie Butler, 2016). She has never been admitted to hospital before, so it is necessary to perform the required clinical tests such as lung function test, spirometry, chest CT scan, arterial and blood gas test (Australian Clinical Practice Guidelines", 2015). Lung function test will measure how air patient can breathe in and out. Spirometry is also a means to determine how fast one can blow out air. It will help in detecting the severity of the disease (Domenech et al., 2013). According to the guidelines of The Australian Nursing and Midwifery Federation (ANMF) related to COPD, the goal for primary care will include making Mr. White to be aware of ways of preventing bacterial, viral, bacterial, and parasiti c and lung infection (Lee Thomas Annie Butler, 2016). The next step is to manage all her medications that she has been taking for COPD, osteoporosis, hypertension, ulcer, and gallstone after hip replacement surgery (Australian Clinical Practice Guidelines", 2015). The patient will be explained about the procedure of spirometry and how it will be carried out. Patients with COPD face severe discomfort and embarrassment due to coughing. Therefore, a sympathetic approach to convince Mrs. White for a clinical test is needed. Once COPD is confirmed, the focus will be to provide care to the patient by marinating her vital functions and minimizing her symptoms as far as possible (Nurse Practitioner standards for practice 2016). COPD is a collective term for chronic bronchitis and emphysema. Comorbidities associated with the disease include cardiovascular disease, malnutrition, osteoporosis, and depression (Hodson Sherrington, 2014). Mrs. White was an active smoker for the past 50 years smoking about three packs which are reflected in the disease severity. As per the The Australian Clinical COPD guidelines, to manage symptoms and reduce complications bronchodilators like beta 2-agonist, anticholinergics, and methylxanthines is prescribed (Nurse practitioner standards for practice 2016). This will help in relaxing her airway muscle, and Hudson mask is also used. The client will be supported to maximize her essential functions and enhance self-care, to carry out her daily life activities. Mild COPD can be treated with short-acting bronchodilators, whereas severe COPD patients will require long-term oxygen therapy or surgical intervention (Australian Clinical Practice Guidelines", 2015). As this is Mrs. Whites first admission for her exacerbations due to COPD, the primary care includes client education related to keeping airways clear, nutritional therapy and pulmonary rehabilitation to adjust to her condition (Australian Clinical Practice Guidelines", 2015). According to the ANMC competency standards she must be taught as to when to contact the GP. As exposure to environmental pollutant is the major risk factor for the disease, it will be necessary for Mrs. White to develop good infection control habits such as frequent hand washing and avoiding crowded places (Nurse practitioner standards for practice (2016). According to Domenech et al., (2013), the treatment plan of COPD patients often have to take drugs via inhalers, so it is necessary for them to know the correct sequence of each medication to maximize its efficacy and know its adverse effects. COPD patients often have to take drugs via inhalers, so it is necessary for them to know the correct sequence of each medication to maximize its efficacy and know its adverse effects. Patients should also be aware of the amount of inhalers left so that they do not run out of them when it is required in an emergency. They must be cautious while taking medicines for other ailments (Nurse practitioner standards for practice 2016). It is necessary to teach her ways to reduce or control dyspnea. She can learn techniques of pursed-lip breathing which will reduce respiration by increasing the laminar flow of expired air (Australian Clinical Practice Guidelines", 2015). Proper positioning exercise will also be necessary for Mrs. White. It is essential to provide training tripod positioning (Australian Clinical Practice Guidelines", 2015). This will involve making Mrs. White sit or stand to lean forward with support on arms, telling her to force her diaphragm down and stabiles the chest while breathing at a controlled rate. The COPD patients require training related to energy conservation techniques. Therefore, Mrs. White is advised to manage her activities by taking frequent rest, using assisting devices and dividing her activities into the small task so that it reduces the chance of dyspnea. According to The Australian Clinical COPD guidelines she will be provided nutritional guidance and monitoring hemoglobin and serum albumin levels (Lee Thomas Annie Butler, 2016). It will also be necessary for her to take frequent meals high in protein. The patient is advised to avoid any gas producing foods and to monitor her weight regularly (Australian Clinical Practice Guidelines", 2015). The recommendation about the ongoing treatment option for Mrs. White is pharmacological management. She has developed edema which is a serious complication of COPD. It occurs due to pulmonary hypertension meaning her blood pressure is higher than normal in heart and lungs. She is taking Coversyl medicines, and it is useful for treating high blood pressure. I will make her aware of side effects of medications like a cough, diarrhea, drowsiness, weakness, etc. (Agusti, 2014). Oxygen therapy will also be a necessary treatment for Mrs. White. This therapy will improve survival rate in hypoxemic patients. The prescription for Oxygen is determined by patient's arterial blood gas values and nocturnal desaturation rates. Oxygen therapy is delivered by liquid oxygen, compressed gas, etc. Portable oxygen concentrator will be highly beneficial for Mrs. White as it will not require her to carry oxygen (Australian Clinical Practice Guidelines", 2015). Another treatment option is pulmonary rehabilitation. It will reduce the disability and quality of life of Mrs. White. This multidisciplinary program is tailored according to individual patients health care needs and based on the The Australian Clinical COPD guidelines. As per the literature evidence, very few patients require surgical interventions after assessment by experienced thoracic medical and surgical team. Some need lung volume reduction surgery or lung transplantation (Philpott, 2015). Patients like Mrs. White will also need detailed medical and psychological assessment to prevent the chronic exacerbation of the disease (Australian Clinical Practice Guidelines", 2015). COPD may also have the effect on patients sleep efficiency, and intranasal oxygen administration is helpful in improving sleep patterns (Philpott, 2015). Osteoporosis is also a comorbidity associated with COPD. Mrs. White was also diagnosed with osteoporosis due to lifestyle changes, genetic factor, treatmen t with corticosteroids and impairment of skeletal muscles. Such patient has more chance of fractures, and this will lead to the economic burden of the disease (Polit Beck, 2013). The possible treatment procedures for osteoporosis will include a use of bisphosphonates, hormone replacement and calcium supplementation to prevent fracture in COPD patients (Australian Clinical Practice Guidelines", 2015). To ensure that Mrs. White get continued care even after discharge, certain health services in the community will be helpful for her. More than half of the Australian population is expected to suffer from the burden of the disease (Nordn et al., 2015). It is the fourth highest cause of death in Australia. Mrs. White may seek the option of home care services and community care in Australia to manage her complications related to COPD. The Australian Lung Foundations project better living with COPD is also a COPD national program in Australia that ensure improved quality of life for such patients (Johnston et al., 2013). It is a joint venture by COPD Respiratory Network, Clinical Practice, and Australian Lung Foundation. This program guides to patients on how to live well with a chronic lung condition and giving support to people living in remote areas too (Nordn et al., 2015). The Queensland Health is also committed to providing care to patients. Hospital and community health services i n Australia will help Mrs. White to get continued care for her condition even after discharge (Philpott, 2015). Conclusively, COPD is a major health concern in many parts of the world. Through the analysis of a case study on Australian women, Mrs. White, the essay gave detail about the etiology of the clinical conditions and the risk factors associated with the disease. It gave useful insight into the role of registered nurse in the primary care of such patients. The essay explained the key client education that nurse gives to the patient for exacerbation of COPD. 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