Chronic Obstructive Pulmonary Disease Illness

Discuss about the Chronic Obstructive Pulmonary Disease Illness.

Stan Reid is a 62 years old male NZ European. He is heavy smoker and drinker. His chronic obstructive pulmonary disease (COPD) was diagnosed 4 years ago. He has a productive cough and barrel chest due to his COPD. He came to the health center in a taxi all by himself and got admitted. He had increasing shortness of breath. Oxygen therapy, two hourly nebulized medicines, and IV in situ was recommended after his admission.

Nursing Diagnosis	Patient-centred outcome (SMART)	Nursing interventions and planning (Prescribing care)
Ineffective airway clearance	Maintain airway patency with sounds of breathing and demonstrate behaviors to improve airway clearance (Pauwels et al., 2012).	Assessment and monitoring of respiration, noting rate, breathe sounds, inspiratory and expiratory ratio. Assist patients to achieve a comfortable position (Liu et al., 2015).
Impaired gas exchange	Demonstrates enhanced ventilation and satisfactory oxygenation of tissues (Lemmens et al., 2013).	Assessment and recording of respiratory rate and depth, the colour of mucus membrane and palpate for fremitus (Pauwels et al., 2012).
Imbalanced nutrition	Display progressive health gain towards appropriate goal and demonstrate changes to be done in lifestyle pattern (Liu et al., 2015).	Assessment of dietary habits, the degree of difficulty to eat, recent food intake, evaluation of weight and body mass (Lemmens et al., 2013).
Sputum culture	It is a test to identify pathogenic bacteria that is infecting the lungs or breathing channels (Lemmens et al., 2013).	Appropriate treatment with antibiotics is recommended when culture results are available (Liu et al., 2015).
Knowledge deficit	Understanding of disease condition and treatment process, the relationship between signs and symptoms of causative factors (Pauwels et al., 2012).	Explanation of disease process can decrease anxiety and can lead to improved participation in the treatment plan (Liu et al., 2015).

Chronic obstructive pulmonary disease (COPD) is a progressive illness that distresses patient's capacity to breathe effortlessly. COPD has 4 progressive stages: patient's lifespan and airflow into the lungs become more limited with each successive stages. There is no hard and fast rule to predict the lifespan of a chronic obstructive pulmonary disease patient but there is no doubt that having progressive chronic obstructive pulmonary disease shortens patient’s lifespan (Divo et al., 2012). Stan Reid is a heavy smoker and drinker. He is now 62 years old and has smoked 30-40 cigarettes/day from his teenage. Cigarette smoking performs the key role in an assessed 90% of COPD cases (Divo et al., 2012). His house becomes draft and damp in the winter. Smoking is linked to about 80% deaths due to chronic obstructive pulmonary disease (Hodson & Sherrington, 2014). All these conditions have resulted in Stan’s chest infection with chronic obstructive pulmonary disease exacerbation. His progressing COPD is reducing his life expectancy. The chronic obstructive pulmonary disease is costly and results in a high rate of hospitalizations for people over age 60. COPD not only reduces the lifespan of patients like Stan Reid but also decreases their ability to work, quality of life, physical and social activities (Divo et al., 2012). Exacerbation of COPD can be life-threatening for Stan Reid. More than half of the patients with exacerbation of COPD whose FEV1 test result is lower than thirty percent usually do not live beyond 4 years after the assessment is conducted (Hodson & Sherrington, 2014). Many researchers concluded that for 65-year-old men in good physical shape with stage one COPD, lifespan ranges from fourteen to eighteen years, relying on whether the person was a former, existing or not- smoker. But for a heavy smoker like Stan Reid, COPD is much more complicated (Divo et al., 2012). For Stan Reid, his worsening COPD, and infected chest condition can negatively impact his quality of life and lifespan.  He is in a more advanced stage of COPD which is exacerbating. He needs to quit his smoking and it is the most importance step to improve is life expectancy. Preventing infection is vital for a COPD patient. But Stan Reid was diagnosed with a chest infection. His chest infection can worsen his chronic obstructive pulmonary disease and reduce his life expectancy. Treatments cannot reverse damages which are already done but treatments can slow down Stan Reid’s COPD progression.

Discharge planning for an utterly ill chronic obstructive pulmonary disease patients is a crucial matter in diminishing the effect of the acute event and inhibiting imminent deteriorations. The discharge procedure is a vital constituent of the healthcare system. Discharge planning includes the patient, professional caregivers, the com­munity healthcare group and the regular general physician of the patient. Discharge planning should be com­mence at the time of admission and be documented within 24–48 hours (Ersgard et al., 2014). Stan Reid’s discharge planning must include general information about the chronic obstructive pulmonary disease, advice on medication use and written instruc­tions on the use of inhalation and oxygen devices, along with a plan for management of deteriorating symptoms, must be provided (Ersgard et al., 2014). The general physician of Stan Reid should be informed during his discharge. A meeting including the multidisciplinary healthcare crew and the general physician may contribution effective transition to Stan Reid’s current condition and exacerbation of COPD.

The discharge planning of Stan Reid must include care at home supports. His discharge planning must include ventilation, oxygen therapies and other equipment to support any emergency condition. Healthcare at home is a safe substitute of hospitalization but it is not the solitary means of supporting care after discharge. Home care discharge planning, primarily reinforced by efficient nurses, have been recognized to be effective for a patient-centered care. Home care is also advantageous in the avoidance of frequent admissions in the hospital (Ersgard et al., 2014). Education for preventing infection, support and counseling for quitting cigarettes and pulmonary rehabilitation can be helpful for Stan Reid.

Stan Reid’s discharge planning must contain integrated care series. Integrated care is a comprehensive process which deals with the requirements of seriously ill COPD patients. Integrated care attained via models of collective care using all important health care providers and encouraging self-management. The outline for integrated maintenance is the chronic care model, focused on the holistic assessment of the patient, the advancement of self-management, the supreme strategy of healthcare supply responding efficiently to the necessities of the patient and a noble structure of shared and available information (Mukherjee et al., 2016). It has been observed that in many COPD cases self-management reduced numbers of hospital admissions (Jensen et al., 2015 and Mukherjee et al., 2016). Discharge planning of Stan Reid must incorporate education, support for behavioral motivation and modifications. Nurse educators must motivate Stan Reid to quit his smoking and drinking habit to slow down his exacerbation of chronic obstructive pulmonary disease.

The most vital information given in the scenario is that Stan Reid is a heavy smoker and drinker. It is well known that chronic obstructive pulmonary disease is mainly caused by smoking. Smoking during teenage years slows down growth and development lungs. This can increase the risk of developing COPD in adulthood (Hodson & Sherrington, 2014). Thus quitting smoking is vital for Stan Reid’s survival. His smoking history was important as his care planning must include programs and products that can help him to quit cigarettes. Research suggests that alcohol abuse alone does not lead to an acute lung damage but when heavy alcohol dose becomes combined with tobacco smoke and air pollution it leads to COPD. Stan Reid is a heavy drinker. This information was vital because his care planning must include strategies to abstain him from alcohol to improve the diffusing capacity of his lungs. Stan Reid’s home becomes damp and drafty in the winter. Cold and damp indoor environment adversely affects COPD (Donaldson, & Wedzicha, 2014). His home environment is also a causative element for his exacerbation of COPD. Care plan for his must be done considering the effects of his home environment.

Stan Rein has a productive cough usually worse in the mornings and a marked barrel-shaped chest. His COPD was diagnosed 4 years ago. He is also overweight. His physical features provide good information for appropriate care planning. With COPD advancement, intervals between serious exacerbations turn out to be shorter and each exacerbation may be more severe. The frequency of COPD exacerbations seems to reflect an independent vulnerability phenotype (Mackay & Hurst, 2012).

Chest infection is very common for COPD patients like Stan Reid. An exacerbation can more severe when chest infection occurs. In the situation of COPD, lower respiratory tract infections, both chronic and acute, arise with amplified rate of recurrence. As these infections contribute significantly to the clinical course of the COPD patient, they establish a substantial comorbidity in COPD (Wark et al., 2013). Stan Reid's infection diagnosis can provide an information about the pathogenesis of exacerbation and optimize antibiotic selection to treat his COPD exacerbation.

Stan Reid’s medical history was also important for his present care plan. His current medications are Salbutamol, Serevent and Flixotide inhalers and Augmentin antibiotic. All of them are effective against COPD. His care plan should include short-term bronchodilator as required, long-term bronchodilators, cardio-pulmonary rehabilitation, and inhaled glucocorticoids (Leuppi et al., 2013).

Conclusion

The chronic obstructive pulmonary disease is a debilitating illness. There are no such treatments that can repair the lung and airway damage that causes COPD. Stan Reid is a heavy smoker and drinker. His chronic obstructive pulmonary disease was diagnosed 4 years ago which is now advancing rapidly. His excessive smoking and drinking habit is causing exacerbation of his COPD. Appropriate treatment and care plan is essential to prevent further exacerbation of his COPD. He needs nursing guidance and support for quitting his smoking and reducing alcohol consumption. Adequate physical activities and nutrition chart must also be incorporated in his discharge planning.

References

Divo, M., Cote, C., de Torres, J. P., Casanova, C., Marin, J. M., Pinto-Plata, V., & Celli, B. (2012). Comorbidities and risk of mortality in patients with chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine, 186(2), 155-161.

Donaldson, G. C., & Wedzicha, J. A. (2014). The causes and consequences of seasonal variation in COPD exacerbations. Int J Chron Obstruct Pulmon Dis, 9, 1101-1110.

Ersgard, K. B., Pedersen, P. U., & Sørensen, T. B. (2014). Effectiveness of discharge interventions on readmissions for patients with chronic obstructive pulmonary disease: a systematic review protocol. JBI Database of Systematic Reviews and Implementation Reports, 12(12), 2-9.

Hodson, M., & Sherrington, R. (2014). Treating patients with chronic obstructive pulmonary disease. Nursing Standard, 29(9), 50-58.

Jensen, M. S., Overgaard, A., Hougaard, L., & Holm, E. (2015). Benefits of self-management education in COPD exacerbations. European Respiratory Journal, 46(suppl 59), PA3067.

Lemmens, K. M., Lemmens, L. C., Boom, J. H., Drewes, H. W., Meeuwissen, J. A., Steuten, L. M., & Baan, C. A. (2013). Chronic care management for patients with COPD: a critical review of available evidence. Journal of Evaluation in Clinical Practice, 19(5), 734-752.

Leuppi, J. D., Schuetz, P., Bingisser, R., Bodmer, M., Briel, M., Drescher, T., & Miedinger, D. (2013). Short-term vs conventional glucocorticoid therapy in acute exacerbations of chronic obstructive pulmonary disease: the REDUCE randomized clinical trial. Jama, 309(21), 2223-2231.

Liu, F., Zou, Y., Huang, Q., Zheng, L., & Wang, W. (2015). Electronic health records and improved nursing management of chronic obstructive pulmonary disease. Patient preference and adherence, 9, 495.

Mackay, A. J., & Hurst, J. R. (2012). COPD exacerbations: causes, prevention, and treatment. Medical Clinics of North America, 96(4), 789-809.

Mukherjee, D., Abbas, S., Minter, J., Whitfield, J., Field, S., Pearce, S., & Apps, S. M. (2016). A Chronic Obstructive Pulmonary Disease (COPD) Service Integrating Community And Hospital Services Can Improve Patient Care And Reduce Hospital Stays. In A41. THE SPECTRUM COPD CARE: FROM IDENTIFICATION TO POLICY (pp. A1523-A1523). American Thoracic Society.

Pauwels, R. A., Buist, A. S., Calverley, P. M., Jenkins, C. R., & Hurd, S. S. (2012). Global strategy for the diagnosis, management, and prevention of chronic obstructive pulmonary disease. American journal of respiratory and critical care medicine.

Wark, P. A., Tooze, M., Powell, H., & Parsons, K. (2013). Viral and bacterial infection in acute asthma and chronic obstructive pulmonary disease increases the risk of readmission. Respirology, 18(6), 996-1002.

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