NURS2006 Chronic Illness and Nursing Care

Introduction

Nursing plays a vital role in the management of the chronic condition. A nurse needs to promote the healthy practice to improve the health of the patient. Evidence suggests poor lifestyle is associated with the occurrence of chronic disease (Chapman et al., 2016). According to this case study, Mr David Freeman was diagnosed with chronic obstructive pulmonary disease (COPD). This is a chronic disease condition that obstructs the airways, causing breathing problem also, this disease can cause structural damage to the lung. It can rupture the walls of alveoli causing emphysema (Yang et al., 2017). COPD mainly developed due to smoking and other environmental factors. Here Mr David developed COPD due to his smoking. Also, he has volunteered as a fireman, hence there is a chance of occupational risk that can cause COPD (Hoy & Brims, 2017). Therefore, the following section will discuss the role of the nurse to manage his COPD condition, proper patient education for disease management and self-management strategies for Mr David to improve his condition.

Role of A Registered Nurse

A registered nurse plays an important role in disease management for COPD patients. Here, Mr David is referred to a local pulmonary rehabilitation centre. Nursing management of COPD includes proper assessment of the patient, creating a treatment plan and patient education in discharge. Assessment is important to know the cause of the symptoms. Poor social determinants of health can increase the chance of chronic disease development (Terry et al., 2019). Such as patient history, diet, education, and activity play an important role in the development of COPD (Terry et al., 2019).  Nursing management to treat the COPD condition of Mr David will include adequate oxygenation. According to the evidence, oxygenation can increase the level of oxygen in the body (Yang et al., 2017). Long term oxygen therapy (LTOT) can be used to improve the oxygen saturation in the patient. This therapy can reduce the hypoxia condition in a patient (Yang et al., 2017). McDonald et al., (2016) mention LTOT can be used in the management of emphysema, chronic bronchitis and severe hypoxia condition. According to a comparative study, Heraganahally et al., (2020) mention development of COPD in aboriginal Australian people is very common. About 32% of these COPD patients are suffered from co-existent bronchiectasis and productive coughing. Therefore, the author mention use of LTOT can promote the health condition of these patients. According to the guidelines of Australia, McDonald et al., (2016) mention use of LTOT for 15 hours per day is important to promote the oxygen level. Hence, a nurse needs to provide LTOT to Mr David to improve his oxygen level. Also, the use of bronchodilators is important to manage the condition of a COPD patient (Visser et al., 2019). According to Yang et al., (2017) use of short-term (SABA and SAMA) and long-term bronchodilators (LAMA and LABA) can give a better result in COPD management. So, here an RN nurse needs to promote the use of bronchodilators to manage the condition of Mr David. Also, deep breathing exercise can be helpful to improve the breathing condition of Mr David (Patman et al., 2017).

Patient Education

Patient education is necessary to help a patient to understand his current condition. According to the National Strategic Framework for Chronic Conditions “Strategic Priority Area 2.1: Active engagement” (health.gov.au, 2019) establishing goals and providing knowledge to the patient can improve the health condition. According to the case study, several cues can be identified which may facilitate the development of his COPD condition. Here, it was mention that Mr David belongs to the indigenous community. According to the evidence, the rate of smoking among indigenous people is high compared to non-indigenous people (Schubert et al., 2019). Also, evidence suggests this group of people has a low level of education, so their perception of health is poor (Schubert et al., 2019). Mr David smoke 10-15 cigarettes per day for the last 20 years. Smoking is one of the main causes to develop COPD, as this inhaled gas can rupture the walls of alveoli (Yang et al., 2017). Also, due to his occupation, he has to face hazard-reduction burns for bushfire management in his local area. This smoke can also facilities his development of COPD. So, the nurse needs to educate Mr David about these two risk factors. A nurse needs to educate Mr David about the cessation of smoking. Smoking cessation reduces the severity of the COPD condition. For this purpose, the nurse needs to actively motivate Mr David to stop smoke (Erku et al., 2019). Motivation can change a person's mind and will help him to stop smoke. According to a prospective study among Australian people, Schoenaker et al., (2018) mention disapproval from family or friend and embarrassment may change a person's mind to quit smoke. Hence, here a nurse needs to educate Mr David’s family about the importance of smoking cessation.  A nurse can influence the attitudes and mental condition of Mr David via behavioural therapy to prevent smoking (Yang et al., 2017). The nurse needs to tell Mr David about his occupational risk which may promote his COPD development. Other than this nurse needs to educate Mr David about the proper use of inhalers. The different inhaler has a different technique. Such as Short term bronchodilators have the first action and can be used in only emergency cases and long term bronchodilators have a slow action and mainly used to prevent COPD flare-up. Also, Long term bronchodilator does not require frequent use as compared to short term bronchodilators (Yang et al., 2017). COPD mainly caused by poor lifestyle factors (Terry et al., 2019). So, a nurse needs to educate Mr David to follow a good diet and perform daily physical activity. Following a good diet and performing physical activity can reduce the chance of cardiovascular disease and diabetes. Also, it will promote a better lifestyle for the patient. According to the case study, it was mention that he sometimes get a chest infection. Evidence suggests COPD condition can increase the chance of chest infection such as pneumonia (Yang et al., 2017). Therefore, a nurse needs to educate Mr David about maintain good respiratory hygiene. The nurse needs to tell him about hygiene management and cough etiquette. Other than this, a nurse needs to advise Mr David to take his medication timely, this will reduce the symptom of his COPD condition. Medication will prevent the flare-up of COPD condition and improve his overall lifestyle. The nurse needs to tell Mr David to take appropriate rest and if possible then change his occupation, as it can cause his COPD condition. Additionally, the nurse needs to educate Mr David about the deep breathing exercise. Performing breathing exercise will increase the oxygenation in his blood; this will improve his fatigue symptoms. Also, the nurse needs to educate the patient for a timely follow-up. Doing so and regular check-up will prevent his COPD condition from getting worse, thus it can help to improve his overall condition.

Self Management Strategies

Self-management strategies of a patient can improve their health condition. As the development of chronic disease is mainly associated with poor lifestyle factors, improving these lifestyle factors via self-management can improve the condition of a patient (Terry et al., 2019). According to a study conducted in Western Sydney, the use of the Chronic Disease Self-Management Program (CDSMP) can improve the condition of a chronically ill patient. The focus of this program was to improve the health literacy of the patient (Muscat et al., 2020). Self-management strategies that Mr David can follow are smoking cessation, improving lifestyle factors, routine exercise, the practise of deep breathing exercise, research and improving knowledge to help him identify COPD exacerbation, following medication and routine follow up (Yang et al., 2017). However, a nurse needs to actively support Mr David in his self-management program. Evidence suggests education can increase self-management knowledge among COPD patient (Muscat et al., 2020). Mr David needs to take proper self-care of himself. He also needs to follow proper hygiene, such as washing hand before eating or after touching something can reduce the chance of infection. As he has COPD, maintaining proper hygiene will reduce the chance of respiratory infection. Also, chronic disease can cause depression problem (Callander, Corscadden & Levesque, 2017). Therefore, performing some mental; relaxation technique such as meditation will improve his mental condition. Additionally, in the case of Mr David taking his medication at right time is important. For this, he must follow the timing of his medication as prescribed by a doctor. Mr David can create a SMART goal for his self-management. Also, self-management will improve his self-awareness, which will eventually help him to understand his medical condition. Additionally, he needs to follow a proper follow-up routine as prescribed by his doctor. Regular assessment of his condition will prevent the chance of any adverse effect. Also, many mobile app tools can be used by Mr David for his self-management purpose (Thornton et al., 2017).

Conclusion

From this case study, it can be concluded that Mr David is suffering from COPD condition mainly due to his smoking habits and occupational hazard. Both of these conditions have facilitated the progression of COPD development which is causing his occasional chest infection. Also, he belongs from an indigenous community which makes him more vulnerable to COPD. Here an RN nurse needs to promote adequate oxygenation via oxygen therapy. Also, a nurse needs to encourage him to smoking cessation, following a good diet and proper exercise. Breathing exercise can be helpful to improve his condition. Additionally, a nurse needs to promote the patient education about his health condition. This will help Mr David to better understand COPD disease. Proper education will help him to improve his lifestyle factors and self-management. Self-management is a key factor to improve the condition of a COPD patient. Hence, Mr David should cease smoke, follow a good diet and perform regular exercise. Also, he needs to take his medication and attain follow up to improve his condition. 

References

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