On palpation there were no crepetations on neck and chest so no subcutaneous emphysema. 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. Understanding patient’s perception of their illness is an important first step to providing comprehensive, multifaceted care for patients with long term conditions Overall, evidence supports the use of a screening tool when undertaking a nutritional assessment. 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). Cabi publishing, Oxford. Both have overlapping features with damage at acinar level (emphysema) and bronchial level (bronchitis) and most commonly occur in smokers. Lunney J.R, Lynn J, Hogan C. (2002). So, they will typically present at the Emergency Clinic complaining of shortness of breath, coughing and feeling anxious. The patient is living alone, unable to cope at home and confused. However, malnutrition patients who are obese is more likely to be related to a diet deficient in essential nutrients, such as vitamins, and minerals, rather then protein energy undernutrition. SAGE: London, Blamires S, Hodson M (2015) Malnutrition in COPD: meeting patients’ nutritional needs. Teach patients and family members early signs and symptoms of infection and other complications so that they seek appropriate health care promptly. 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). Expanding nursing practice in COPD: is it key to providing high-quality, effective, and safe patient care? The aim is to maintain PaO2 level of 7 kPa or more to reduce hypoxaemia and hypercapnia. The aim of management is to treat infection, reduce cyanosis, increase oxygen saturation in blood, decrease carbon dioxide saturation in blood and provide symptomatic relief to patient. References: It will prioritise this health need with a specific focus on a holistic approach to nursing assessment, when assessing patients with Chronic Obstructive Pulmonary Disease, known as COPD. Performing ADL’s can help to gather as much information as possible, for example, does the patient live alone, is the patient is able to carry out basic tasks (washing, dressing, etc.). The patient is eighty four years old elderly black male of average built sitting forward in hunched-over position on bed and breathing through pursed lips. 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 … Random Blood Glucose level was 120mg/ dl. Nothing in the environment appears harmful for the patient or ambulanc… His wife died in a car accident ten years back. Nursing Diagnosis (list 3 … Ambulance crew decide to transport the patient to the hospital for in-hospital treatment. Case study patient with copd 1. General Practice of Nursing Vol 1, pp1-3. VAT Registration No: 842417633. Expected outcomes. On auscultation breath sounds are reduced and rhonchi are present in the chest. Assessment and management of an exacerbation of COPD Written by: Beverley Bostock-Cox | Published: 15 April 2013 Matthew is a 72-year-old retired policeman with a complex medical history, including type 2 diabetes, a myocardial infarction eight years ago and moderate/severe COPD … The crew gets consent from the patient and approaches patient for quick Primary Survey. However, accurate predictions of life expectancy for individual patients with COPD remains extremely difficult. Any lung irritant can cause COPD and also exacerbate it. Chronic obstructive pulmonary disease is one of the main causes of morbidity and mortality worldwide. In healthy patients their levels are usually between 95%- 100%. Company Registration No: 4964706. Current complaint is a direct result exacerbation of previously existing COPD (Longmore, Wilkinson & Rajagopalan, 2007). Palliative care in chronic obstructive pulmonary disease: a review for clinicians. Understanding a patient’s perception of their illness is an important first step to providing comprehensive, multifaceted care for patients with long term conditions. Zero you don’t cough at all. Nothing in the environment appears harmful for the patient or ambulance staff. Available at: https://lunginstitute.com/blog/stage-3-copd-severe-copd. *You can also browse our support articles here >, Ashelford S, Raynsford J, Taylor V. Pathophysiology and Pharmacology for Nursing Students. Int J Gen Med. Patients with Chronic Obstructive Pulmonary Disease can have a tendency to have low oxygen saturation levels, usually around 88% on air. They were also talking with each other during history taking and physical examination. Because smoking has such a detrimental effect on the lungs, the nurse must … ASSESSMENT Jeff Harris, RN, admits Mrs. Mercurio to the medical unit. There are no fractures or wounds in extremities. 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. Cardiovascular system and other body system examination, There is right ventricular heave, ankle oedema, raised JVP and increased diastolic blood, pressure (90mmHg) showing right ventricular failure called cor- pulmonale (Sam, Baker &. When risk is identified accurately can also relay on previous knowledge (if present) of the patient and information gained from the patient and information gained from the patient or their carer. The Council of Europe (2003) developed a resolution on food and nutritional care in hospitals, which identified ten characteristics of optimal nutritional care in hospital, including the requirement for screening for malnutrition on admission and weekly thereafter, and the development of a care plan which highlights the patient’s nutritional requirements and how to put them in live. The patient is alert and responds to verbal stimulus. The sputum has gradually become purulent. The medication is prescription only and the patient been taking it since three years. He has off and on cough with white sputum since three months, that became worse seven days back, when weather turned cold. All work is written to order. Nevertheless, these patients will also sustain end-organ damage or cardiac arrest if their blood oxygen tensions are allowed to decrease. Malnutrition Universal Screening Tool. It causes 115,000 admissions to hospital every year. Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. It is estimated between 10-45% of those with COPD within the community are at risk of malnutrition (Stratton et al, 2003). Saturations of 95 per cent or above are normal. Nursing and Midwifery Council (NMC), 2018. Global Strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Breathing problems tend to get gradually worse over time, limiting everyday activities, although treatment can help to keep the condition under control. Health Improvement Scotland, Edinburg. I. He is eighty four years old male migrant from Jamaica living alone in a two bed room flat with no one looking after him. If the patient has COPD and a history of CO 2 retention you should use a venturi mask and titrate oxygen appropriately. Then crew then exposes patient from head to toe examination. Edinburgh: Churchill Livingstone. COPD patients often need supportive treatment of 2 litres of oxygen to maintain oxygen saturations normally acceptable for that specific patient. Good assessment, getting background information on a patient’s breathlessness, daily activities it’s important to maintain good nutrition status. It is very important to inform the patient about the reason for that procedure as well as obtain consent and using appropriate communication methods. Assessment is a key component of nursing practice, required for planning and provision of patient and family centred care. This project is based on the nursing care provided to a patient with Chronic Obstructive Pulmonary Disease (COPD), with specific focus on holistic assessment and identification of patient care needs. Essence of Care 2010. 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. Assessment and management of an exacerbation of COPD Written by: Beverley Bostock-Cox | Published: 15 April 2013 Matthew is a 72-year-old retired policeman with a complex medical history, including type 2 diabetes, a myocardial infarction eight years ago and moderate/severe COPD … This nutrition screening was carried out so that changes in her weight can be identified immediately and dietary changes can be started … Chronic obstructive pulmonary disease in over 16s: diagnosis and management. Churchill Livingstone Elsevier, Edinburg. The PBC group COPD lead developed a nursing protocol for management of acute COPD exacerbations and a review protocol consistent with NICE guidance. Nursing care planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. Patient gives Family history of no significant disease in his parents and two children. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD… The patient has a chronic productive cough with dyspnea on excretion. Available at: https://www.nice.org.uk/guidance/qs10/chapter/Quality-statement-5-Pulmonary-rehabilitation-after-an-acute-exacerbation Accessed. He checked capillary refill by pressing finger nails of the patient and found it normal <2 sec. Roper, N. Logan, W.W. and Tierney, A.J. Activity Intolerance. He quickly percusses and auscultates chest and finds it hyper-resonant all over. Copyright © 2003 - 2021 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. Jump to search results. 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. J Am Geriatr Soc. Many patients with COPD have acute exacerbations that lead to acute respiratory failure and require hospitalization. Registered Data Controller No: Z1821391. This is a preliminary assessment of the patient. Chlorthalidone dose may be increased if oedema is not relieved Physiotherapy of chest help expectorate and clear bronchial recreations (Haslett, Chilver, Boon & College, 2002). Most patients with COPD receive outpatient treatment, the nurseshould develop a teaching plan to help them comply with the therapy and understand the nature of this chronic disease. It will prioritise this health need with a specific focus on a holistic approach to nursing assessment, when assessing patients with Chronic Obstructive Pulmonary Disease, known as COPD. A study by Lunney et al (2002) introduce End of Life as its own phase, divided int four distinct trajectories varying in length and rate of decline in functionality. National Institute for Health and Care Excellence (2016). The Global Initiative for Chronic Obstructive Lung Disease (2019) states that COPD is a preventable and treatable disease. 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. Protein energy undernutrition develops when nutritional intake is not enough to meet demand; for example, when patients has a difficulty to access food. The medication was working up to some extent till ten days back when current symptoms started. The patient is able to identify coping mechanisms that are effective and those that are ineffective. Symptoms include increased breathless, especially when people are active, a persistent cough with phlegm, frequent chest infections and wheezing. Health history. It will locate the point of the trajectory of the disease, as well as the care environment the assessment takes place with, and why these are important in relation to the relevance of the chosen assessment. This essay may contain factual inaccuracies or out of date material. Nursing. West Sussex: John Wiley & Son Ltd. Department of Health (2010). ABC Of COPD. We're here to answer any questions you have about our services. Symptoms include cough and breathlessness. Holistic Nursing Practice. Assessment of the Patient — Your Evaluation as a Possible COPD Patient. The radial pulse rate is 100 per minute, regular but bounding; blood pressure 125/90. A patient is presenting with chronic obstructive pulmonary disease. 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. 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. Exacerbations are a common problem amoungst patient with COPD. 1. The nurse should obtain a thorough health history from patients with known or potential COPD. 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. Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plan Salbutamol is bronchodilator (Haslett, Chilver, Boon & College, 2002). Conclusion. Being able to self-manage, not least because COPD is specific to the individual and can change on daily base, because of that educating a patient is key. Low oxygen therapy (24-28% of O2) was given to the patient by using nasal cannulae to deliver 1-2 litres of oxygen per minute. Make an accurate diagnosis, Assist in making decisions and choices of the most appropriate therapeutic interventions, It lists all the potential symptoms of COPD. Protein-energy malnutrition among the elderly: implications for practice. Young, A.M, Kidstone, S, Banks, M.D et al (2013). British Lung Foundation (2019). There is no injury or deformity but ankle oedema is present and patient is using accessory muscles of respiration. Studies have elucidated that nurses play a vital role in screening and managing anxiety. Available at: https://www.bapen.org.uk/pdfs/must/must_full.pdf Downloaded 22st May, 2019. COPD has often been misdiagnosed as asthma due to similar symptoms, presentation, lack of knowledge, training and understanding around the disease its symptoms and causes study shows those who are undiagnosed or misdiagnosed often causes a delay in treatment at the earliest stage of disease trajectory. He is a pensioner and poor man. COPD is a long-term medical condition, but it is both preventable and treatable. Heterogeneity and Personalized Treatment. All these signs are due to increased air-trapping in the lungs, narrowing of bronchi and use of accessory muscles of respiration (Talley & Connor, 2006). Search results. In COPD there is chronic inflammation of airways, lung parenchyma and pulmonary vasculature. 2011; 4:729-739. doi: 10.2147/IJGM.S21387. 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. they are at risk of hypercapnic respiratory failure - often referred to as type 2 respiratory failure). (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. Breathing problems tend to get gradually worse over time, but there are many different medicines and therapies that can help people keep these under control for longer” (NICE, 2016). Hameed, 2003). Pulmonary function studies. COPD Nursing Care Plan 5. It helps to identify areas of risk, as well as highlight person own individual health, needs to support a patient’s journey. Info: 4639 words (19 pages) Essay Company Registration No: 4964706. 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. 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. COPD patients often need supportive treatment of 2 litres of oxygen to maintain oxygen saturations normally acceptable for that specific patient. Pink puffers (primarily having emphysema) have mild hypoxia and normal PCO2. Chronic obstructive pulmonary disease (COPD) is a long-term lung disease characterised by breathlessness, cough and sputum production. 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