Study for free with our range of nursing lectures! British Journal of Community Nursing. 3. Salbutamol is bronchodilator (Haslett, Chilver, Boon & College, 2002). tion of COPD. The neighbor once or twice a week visits him and gives him some company. Patient developed mild fever two days back, before that he gives no history of fever. Many patients with COPD have acute exacerbations that lead to acute respiratory failure and require hospitalization. In more advanced disease, physical features com­monly found are hyperinflation of the chest, reduced chest expansion, hyperresonance to percussion, soft breath […] Global Initiative for Chronic Obstructive Lung Disease (2011). 2002;50(6):1108–12. According to Currie (2017), malnutrition is associated with the severity of airflow obstruction. It’s a scale that goes well beyond just the symptoms of shortness of breath. COPD patients often need supportive treatment of 2 litres of oxygen to maintain oxygen saturations normally acceptable for that specific patient. Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan (Longmore, Wilkinson & Rajagopalan, 2007). Nestle Nutrition Institute (2009). SL (2016). Chronic Obstructive Pulmonary Disease (COPD) exacerbations play a central role in the natural history of the disease, affecting its overall severity, decreasing pulmonary function, worsening underlying co-morbidities, impairing quality of life (QoL) and leading to severe morbidity and mortality. This is a preliminary assessment of the patient. Stopping smoking slows down average rate of decline in FV1 from 50-70ml/ year to 30ml/year that is equal to non-smokers (Warrell, Cox & Firth, 2005). Chronic obstructive pulmonary disease is a progressive lung disease characterised by airflow destruction and destruction of the lung parenchyma (GOLD, 2019). For Penicillin sensitive patients Clarithromycin 250 mg 12-hourly is used. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD… On assessment, the patient has cyanosis in the lips and edema in the abdomen and legs. COPD patients often need supportive treatment of 2 litres of oxygen to maintain oxygen saturations normally acceptable for that specific patient. This article discusses the causes, clinical features, current approach to diagnosis and management, and nursing management. Filter Toggle filter panel Evidence type Add filter for Guidance and Policy (386) Add ... Health Technology Assessment (1) Each long term condition comes with a set of challenges. Raised JVP and oedema of lower legs show right heart failure thus a thiazide diuretic Chlorthalidone 25 mg once daily, which is minimum daily dose, is started as initial therapy. The ambulance crew recorded four basic vital signs consisting of pulse, respiration. Company Registration No: 4964706. Evidence-based information on nursing of copd patients from hundreds of trustworthy sources for health and social care. *You can also browse our support articles here >, Ashelford S, Raynsford J, Taylor V. Pathophysiology and Pharmacology for Nursing Students. With spirometry the disease is mild when FEV1 was 60-79%, moderate when FEV1 40-59% and severe when FEV1 is lesser than 40%. Available at: https://goldcopd.org/wp-content/uploads/2018/11/GOLD-2019-v1.7-FINAL-14Nov2018-WMS.pdf Downloaded 22st May, 2019. *You can also browse our support articles here >. The medication was working up to some extent till ten days back when current symptoms started. Acute respiratory tract infection makes situation worse and signs and symptoms of infection with hypoxia and hypercapnea and right heart failure (at latter stage of COPD) become apparent and patient need urgent treatment (Talley & Connor, 2006). Stratton RJ, Green CJ, Elia M (2003) Disease related malnutrition and evidence-based approach to treatment. As an observer with the ambulance crew I have gained useful knowledge about safely driving an ambulance, safe arrival at the scene, safety equipments used by the ambulance crew and how to approach the patient safely. Zero you don’t cough at all. References: Health Improvement Scotland, Edinburg. However, Young et al (2013) also found little significant variation between nutritional screening tool, which shown that no single tool used, is more important to enable accurate assessment of patient’s nutritional status .Therefore, the continued  use of the MUST (BAPEN, 2011) in the UK can be recommended, although the use of alternative such as the MNA ( Nestle Nutrition Institute, 2009), or BMI can also adequately identify nutritional risk. In a subgroup of patients with COPD, high concentrations of oxygen may depress breathing (i.e. Patient is a heavy smoker, smoking one pack of twenty cigarettes a day. Nurse care and patient education is vital to prevent episodes of panic in COPD patients (Willgoss et.al, 2011). Kidneys of elderly patients have reduced drug clearance so toxic effects of drugs appear with minor overdose. This head-to-toe nursing assessment video is useful because it presents the assessment in a realistic-seeming care setting with a patient who asks questions. If the patient is conscious, sit them upright as … Accessed 18th May 2019. The aim is to maintain PaO2 level of 7 kPa or more to reduce hypoxaemia and hypercapnia. The patient is able to identify stressors, and threats to his role. The nurse should obtain a thorough health history from patients with known or potential COPD. (MNC, 2018). Nursing Older People. Assessment is a key component of nursing practice, required for planning and provision of patient and family centred care. The EKG also is not useful in evaluating patients with COPD. 11th Feb 2020 There is no injury or deformity but ankle oedema is present and patient is using accessory muscles of respiration. Transitions theory identifies important nursing therapeutics to support patient role transition, such as readiness assessment; preparation for transition, including provision of education; and role supplementation as patients transition. A patient profile will be provided, along with a description of COPD, including epidemiological data on incidence and prevalence and information on the causes and prognosis of the condition. This factors at an early assessment will help improve a patient’s quality of life and help preventing from condition getting worsted (Former, 2011). Activity Intolerance. Mild wheezing was present since one month but it became more prominent four days back. They are wearing personal protective equipment including safety boots, high visible clothing and vest and a portable two-way radio is in the hand of one of the staff. SAGE: London, Blamires S, Hodson M (2015) Malnutrition in COPD: meeting patients’ nutritional needs. Available at: https://www.bapen.org.uk/pdfs/must/must_full.pdf Downloaded 22st May, 2019. COPD Mr. Whaley is a 65-year-old man with a history of COPD who presents to his primary care provider’s (PCP) office complaining of a productive cough off and on for 2 years and shortness of breath for the last 3 days. Edinburgh: Churchill Livingstone. In this essay this process is described. Next he examines patient’s breathing. Nursing and Midwifery Council (NMC), 2018. Currie, G.P. In this case both FVC and FEV1 are reduced and ratio FEV1/FVC is decreased to 1.1 L / 3.0 L (Costanzo, 2007). But this is my first experience and I think I need to have more experiences similar to or different from this experience to learn more about dealing with different kind of patients and different situations. Registered Data Controller No: Z1821391. Then ambulance crew examines patient’s airway, and find lips and tongue blue due to cyanosis and secretions in the throat. His wife died in a car accident ten years back. On inspection ambulance crew noted a number of signs including pursing of lips, tachypnia, accessory muscles of respiration in use, tracheal tug and shortening of trachea, deepening of supraclavicular and suprasternal fossa, decreased movement of chest wall, audible wheeze and barrel shaped chest. Available at: https://www.mna-elderly.com/forms/mini/mna_english.pdf Downloaded 22st May, 2019. The content within this essay is generalised across a patient group and does not relate to any specific patient, staff member or trust (NMC, 2018). (2002). In addition, looking at nutrition it also important to select an appropriate nutritional screening tool   to be used during the assessment, for example the Malnutrition Universal Screening Tool, known as MUST (BAPEN, 2011). Cough. Existing reviews identify important aspects of managing life with COPD with which patients may need support”. In addition, nurses must take an interactive and team approach to the care and management of patients with COPD who have acute respiratory failure. Blue bloaters (primarily having chronic bronchitis) have severe hypoxia with cyanosis and have hypercapnia. Do you have a 2:1 degree or higher in nursing or healthcare? Study for free with our range of university lectures! It is commonly caused by distinct disease processes such as Emphysema and Chronic Bronchitis. References: they are at risk of hypercapnic respiratory failure - often referred to as type 2 respiratory failure). COPD is diagnosed through a combination of patient history, physical assessment, and spirometry. Introduction About half of patients discharged after a hospital admission for COPD will die within two years. 29,1,101-106. I have also learned how to conduct primary survey in two minutes and then detailed secondary survey and plan to manage the case. There is no injury. Disclaimer: This essay has been written by a student and not our expert nursing writers. This documentation was used to deliver a consistent standard of … This essay should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date. Some laboratory signs for this patient include Glasgow Coma Score; level of consciousness is 14/15, with patient little confused. Nutrition. Booker, C. Nicol, M. and Alexander M.F (2011). Diagnosis and assessment of COPD must be done carefully since the three main symptoms are common among chronic pulmonary disorders. For respiratory tract infection broad spectrum antibiotics were started after taking sputum sample for culture and sensitivity. Search results. temperature and blood pressure(Warrell, Cox & Firth, 2005). (Currie,2017) When screening with the MUST tool it may still show as a healthy weight, it wouldn’t show factors such as unexplained weight gain, shortness of breath, whether a person is able to still undertake their normal activities at their normal level of exertion, MUST also doesn’t identify factors such as age related changes in posture, ratio of body mass Index (BMI) and breathlessness. Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality worldwide. Free resources to assist you with your university studies! Assessment of patients with chronic obstructive pulmonary disease (COPD) is important to establish an accurate diagnosis, assist in making therapeutic decisions, measuring outcomes for clinical and research purposes, and determining prognosis. Teach patients and family members early signs and symptoms of infection and other complications so that they seek appropriate health care promptly. Patient gives Family history of no significant disease in his parents and two children. He is cyanosed and has peripheral oedema indicating chances of co-morbidity like heart disease (Simon, Everitt & Kendrick, 2005). So, they will typically present at the Emergency Clinic complaining of shortness of breath, coughing and feeling anxious. He is a smoker since last sixty years but did not consume any alcohol or habit forming drug. The patient is alert and responds to verbal stimulus. Patients with Chronic Obstructive Pulmonary Disease can have a tendency to have low oxygen saturation levels, usually around 88% on air. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Some common questions often asked by doctors or nurses to help evaluate the patient are listed in Tables 1 and 2. Wallington. It helps to identify areas of risk, as well as highlight person own individual health, needs to support a patient’s journey. View professional sample essays here. Promoting Home- and Community-Based Care Teaching Patients Self-Care Provide instructions about self-management; assess the knowledge of patients and family members about self-care and the therapeutic regimen. The nurse may need to ask whether the patient can remember the initial symptoms of angina, which will help him to predict the potential coming of angina. . Young, A.M, Kidstone, S, Banks, M.D et al (2013). No plagiarism, guaranteed! Reference this. This essay may contain factual inaccuracies or out of date material. This oxygen therapy is aimed to reduce a cyanosis, pulmonary hypertension, cerebral hypoxia, hypotension and tachycardia. With this essay, the names and setting will not be disclosed in order to protect confidentiality. West Sussex: John Wiley & Son Ltd. Department of Health (2010). Although this assessment tool is commonly used for those with COPD, it doesn’t identify if a person had lost or gained weight and become malnourished. Food, Fluid and Nutritional Care. In the past three decades, a number of important advances have been made in the treatment of patients with chronic obstructive pulmonary disease (COPD) 1.For example, supplemental oxygen therapy and smoking cessation have resulted in improved traditional outcome measures, such as mortality 2 and rate of forced expiratory volume in one second (FEV 1) decline 3. The crew use sucker and clear secretions to ensure patency of airway. At this first contact with the patient it is essential that appropriate history taking is performed to clarify presenting symptoms, past history and the patient's expectations to focus and plan person centred nursing care … He checked capillary refill by pressing finger nails of the patient and found it normal <2 sec. The general condition of patient is poor, his disease is getting worse and he is confined to bed. ASSESSMENT Jeff Harris, RN, admits Mrs. Mercurio to the medical unit. Chronic Disease. Exacerbation can often be caused by viruses and bacterial infection, patient with frequent exacerbation have an increased risk of decline in their lung function what and consequently impairs quality of their life, as well as putting a pressure on family, carers (Lung Institute,2017). This nursing diagnosis for COPD may be related to the patient’s anxiety, depression, lack of socialization, low levels of activity and inability to work. Nursing Assessment: Note for the number of times the patient has experienced such exacerbation in a year. It is important to understand the pathophysiology of COPD and what leads to acute respiratory failure in these patients. 1. Benchmarks for food and drink. He is eighty four years old male migrant from Jamaica living alone in a two bed room flat with no one looking after him. Good assessment, getting background information on a patient’s breathlessness, daily activities it’s important to maintain good nutrition status. COPD risk increases when those e… The ambulance crew has considered a number of psychosocial and disease factors. In addition, looking at the effects of nutrition it’s also important to consider the effects of involving patients’ friends, family and care givers when assessing and planning future care. Shape and movements of chest are symmetrical; no flail segment and no injury present. We're here to answer any questions you have about our services. The diagnosing and assessing copd path for the chronic obstructive pulmonary disease pathway. VAT Registration No: 842417633. He quickly percusses and auscultates chest and finds it hyper-resonant all over. When completing an assessment and planning care for patients it is important to consider and maintain patient confidentiality, valid consent must be gained from the patient before any information I shared outside of the nurse patient relationship. When the saturation drops to 92 per cent or less the patient is likely to be significantly hypoxic and assessment of arterial blood gases (ABG) is indicated. Rate how much you cough on a scale of 0-5. Frailty: a term with many meanings and a growing priority for community nurses. In this case study patient is an eighty four year old man with COPD who has got respiratory tract infection and his disease has become severe. It is estimated between 10-45% of those with COPD within the community are at risk of malnutrition (Stratton et al, 2003). The social history of patient is important. Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD): 1. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on UKEssays.com then please: Our academic writing and marking services can help you! The ambulance crew behaved quite professionally with few exceptions. He used to prepare food for himself but buying from a take away shop since last three day as he does not feel good to prepare it at home. Nursing care planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Nursing. Anti-smoking program started that have anti-smoking advice and encouragement of change of attitude towards quit smoking. COPD is a clinical syndrome representing a spectrum of lung pathologies associated with systemic comorbidities and exacerbations, which contribute substantial morbidity and mortality. What is COPD? With the use of the nursing care plans above, the patient will have an improved oxygenation and will be able to perform his/her activities of daily living optimally. Essence of Care 2010. The term ‘health trajectory’ describes changes in health over period of time, defending the stage a patient is at in their health trajectory allows for effective intervention and care planning ( Seamark et al, 2007).The patient group for purpose of that assignment are within the   severe stage of their illness with long term limitation of function and well-being with intermittent serious episodes of COPD progression .Disease trajectory during the third stage of COPD patients experience exacerbation which can have a big impact on life quality (limitation) and often requiring hospital admission (Curie,2017). Wills. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. Saturations of 95 per cent or above are normal. If this is not possible, calculate the patient’s mid-upper arm circumference by measuring the ulna length an upper arm circumference with a tape measure, as described in the MUST (BAPEN,2011). Int J Gen Med. Lee SD. Profiles of older Medicare decedents. Copyright © 2003 - 2021 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. Respirology 18(4): 616-29. His history of these presenting complaints spans to last three months. You with your nursing essay, our professional essay writing service is here to any. Function studies are used to diagnose and monitor disease progression and it ’ s,. Head to toe examination presenting with chronic, progressive conditions in this so... Saturations of 95 per cent or above are normal consistent with NICE guidance when weather turned cold runs families. Disease severity, and other complications so that they seek appropriate health care.! Remains extremely difficult the activities of living Parental and Enteral nutrition ( 2011 ) when symptoms. Understand the pathophysiology of COPD is diagnosed through a combination of patient is able to identify stressors, and disease! 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