Nursing Problems In Patient With COPD Example Paper
Nursing Problems And Fundamental Care For A Patient With COPD
Case: Meet Neville
Shift handover:
Neville is a 62 year old man with moderate, established chronic obstructive pulmonary disease (COPD) and a long history of smoking.
He was admitted 2 days ago with worsening dyspnoea, cough and increasingly purulent sputum production. He reports he developed a cold a few days before admission but his usual preventative medications didn’t relieve symptoms and he is now unable to take more than a few steps before having to rest.
Since admission, his upper respiratory symptoms have improved but he reports his dyspnoea and shortness of breath on exertion have not yet returned to what is normal for him. He remains tachycardic and his blood pressure is slightly elevated. Nasal prong oxygen remains in place.
Medical orders are for nasal prong oxygen @ 2L/min to maintain oxygen saturations 88-92%; spirometry before and after nebulisers; high protein, high carbohydrate diet; push oral fluids, fluid balance chart, food chart and second daily weighs.
Current medications are ipratropium bromide and salbutamol nebulisers, oral prednisone, oral amoxicillin, prn paracetamol and coloxyl. Pneumococcal and flu vaccines have been ordered to be administered before discharge once his condition has improved.
Neville has tried to stop smoking on a number of occasions. He has cut down to 10 cigarettes per day but is having difficulty stopping completely. He lives with his wife who continues to be very supportive.
Based on the handover you received at the beginning of your shift today, other information included below and current reliable evidence for practice, address the following 5 tasks. Nursing Problems In Patient With COPD Example Paper
Do not make up or assume information in relation to or about Neville, the photo is not an indication of his age or appearance. Only use what you know from the information you received today.
After handover you consider and plan the nursing care that Neville requires today.
You recognise that there are 5 key nursing problems for Neville today:
- Ineffective airway clearance
- Impaired gas exchange
- Risk of impaired ventilation
- Imbalanced nutrition: less than body requirements
- Risk for infection
In grammatically correct sentences and topic paragraphs and using current, reliable evidence for practice
- Explain the specific underlying cause/s (aetiology) or reason/s for each of the nursing problems above.
In addition to the nursing problems above, you also recognise that Neville requires fundamental nursing care today and your role and responsibility as the nurse caring for Neville today is to keep him:
- Safe
- Clean and dressed
- Warm and comfortable
- Fed
- Hydrated
- Rested
- Mobile
- Toileted
Based solely on the handover you have received select five (5) fundamentals of care from the list above and develop a plan of care for each one identifying:
- The related nursing problem
- The underlying cause or reason (ie, what the problem is related to)
- Goal of care
- Specific bedside nursing interventions you will do
- The rationales for your nursing interventions and actions
- Indicators that your plan is working
Three important aspects of medication management by registered nurses is for the nurse to understand why a patient has been prescribed specific medications, the nursing responsibilities associate with administering each medication and how to monitor the patient to ensure they are responding to prescribed medications as they should.
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In grammatically correct sentences and topic paragraphs and using current, reliable evidence for practice,
- Briefly explainwhy Neville has been prescribed: o Oral prednisone
- ipratropium bromide via nebuliser oOral amoxicillin
And
- Identify and explain
- The specific nursing responsibilities associated with administering each medication and monitoring Neville for expected, side and adverse effects
During Neville’s hospital admission, it is part of the nurse’s role to review his current knowledge and understanding related to his condition and to update or provide new information.
Topics that need review/updating or new information are:
- How to effectively use a metered dose inhaler (MDI) and spacer
- Why he needs to stop smoking
- Early indicators that his COPD is deteriorating that require medical review
- Promoting adequate nutritional intake to meet his metabolic needs
- Energy conservation strategies
Identifythe specific information you will need to explain to Neville about the topic
And
- Explain
- Why the topic is an important aspect of Neville’s care
- How you will ensure that Neville knows and understand why it is important and, if appropriate to the topic, what he needs to do
Task 5: Clinical judgement and handover
Part A:
When you come back from your meal break, a colleague tells you that they have given Neville a prn salbutamol nebuliser as he requested it because he was short of breath.
The first thing you do is to check on Neville to find out if his breathing is more comfortable now. On checking Neville you notice:
Neville is
- Restless, anxious and mumbling incoherently
- Plucking randomly at his bed linen
- Dyspnoeic and, his
- Skin is flushed and diaphoretic and
- Nasal prong oxygen is still in place
On further assessment you find:
- Oxygen saturations are now 98% on nasal prong oxygen @ 2L/min
- Heart rate elevated to 110 beats/minute
- Respiratory rate has dropped to 8-10 breaths/minute
- The nebuliser mask and tubing is connected to the oxygen outlet
- Identify
- What you think is happening
- Your immediate nursing actions and interventions oThe reason for your actions and interventions
An important legal requirement of nursing practice is to effectively and succinctly communicate relevant information, actions and outcomes related to patient care and provide an accurate reflection of the health status of the patient, their responses to care and the patient’s perspective.
Once Neville’s condition has been stabilised, the doctors arrange to transfer Neville to the High Dependency Unit for bipap and closer monitoring. Nursing Problems In Patient With COPD Example Paper
Using the ISBAR format, information from the handover you initially received and the additional information above:
- Write a handover that clearly and succinctly outlines the important information the high dependency unit needs to know about Neville
Your handover must:
- Demonstrate person-centred care
- Adhere to the legal and professional standards for documentation
- Be in appropriate professional language
- Contain NOabbreviations or nursing jargon
Nursing Problems In Patient With COPD
Ineffective airway clearance:
The patient under consideration has been admitted to the health care facility due to a chronic case of obstructive pulmonary disorder. In this disease hyper secretion of mucous from the goblet cells due to excessive exposure to cigarette smoke causes accumulation of cough and sputum in the bronchial airways (Donner & Carone, 2006). The inflammatory immune response to the excessive noxious particles due to disables the ciliary transport that is responsible for airway mucous clearance causing airway blockage.
Impaired gas exchange in clinical terms can be described as the deficit of excess in the oxygen supply or carbon dioxide elimination in the respiratory airways, specifically in the alveolar-capillary membrane (Roche et al., 2013). Passive diffusion between the pulmonary capillaries and the alveoli facilitates the successful exchange of oxygen and carbon dioxide in the respiratory system. COPD and repercussions of excessive smoking can cause severely distressful conditions that cause the collapse of alveoli-capillary barrier and impair gaseous exchange in turn.
The successful air ventilation within is facilitated by the passive diffusion of the oxygen and carbon dioxide across the alveoli-capillary barriers. Faulty gas exchange and mucous accumulation in the air ways can cause severe damage to the ventilator perfusion balance and cause impaired ventilation (Roche et al., 2013).
Neville is suffering from COPD coupled with dyspnoea that can make swallowing and chewing difficult. Apart from that extreme mouth breathing and coughing can also alter food taste and cause extreme fatigue in the patients which leads to faulty food intake and imbalanced nutrition (Loerbroks et al., 2012).
Risk for infection:
Excessive mucous production and accumulation in the respiratory tract can become the breeding ground for a multitude of bacteria and can lead to severe pulmonary and extra-pulmonary infection in Neville (Donner & Carone, 2006)
Nursing Care Plan: Neville
Note: Dot points recommended in care plan. Click and type in each cell, click enter in a cell to make it longer
A reminder that all information must be referenced
Oral prednisone:
Prednisone is a respiratory distress medication belonging to the group of corticosteroid drugs. Oral corticosteroid drugs are prescribed in COPD as it is exceptional in decreasing the inflammation in the respiratory airways and reducing the excessive secretion of mucous. This medication is tremendous in improving lung functions and reduces the risk of endotracheal incubation in the patients hence is prescribed in case of severe COPD (Rosenberg, 2011)
Fundamental Nursing Care For Patient With COPD
Ipratropium bromide via nebuliser:
Ipratropium bromide is a bronchodilator and is used to dilate the airways and is a integral medication for treatment of COPD. This medication acts as the inhibitor of acetylcholine effect of cholinergic nerves on the bronchial airways and revives the ventilation balance in the patient (Ferguson Gt, Dai & Dunn Lj, 2013). This medication is mostly available in liquid form and is prescribed via a nebulizer for Neville as a nebulizer changes the liquid into a spray that travels directly to the airways and is not absorbed too much in the body.
Oral amoxicillin:
Amoxilin is an antibiotic that is prescribed in case of COPD to reduce the risk of infection in the respiratory tract that can complicate the condition of the patient further. Taking a broad spectrum antibiotic will reduce the risk of Neville experiencing acute exacerbation or COPD flare ups that are generally caused due to infection (Mueller et al., 2017).
Nursing precautions and side effects:
- Corticosteroids can affect the blood glucose levels so the nursing professional must ensure to check the blood glucose levels o the patient (Prazma et al., 2017).
- It can have a repercussion involving urinary functions of the patient so it necessary for the nurse to ensure that the patient is in low salt diet or in a high potassium diet.
- Inhalation of bronchodilators through a nebulizer can cause drying and irritation of throat and mouth, hence the nurse assigned to Neville must ensure that the patient takes sips of water and either rinses and gargles after each administration (Ferguson Gt, Dai & Dunn Lj, 2013)
- Amoxicilin can cause nausea and vomiting in the patients as well.
A metered dose inhaler (MDI) and spacer is an important clinical tool for the patients dealing with chronic obstructive pulmonary disorder (Ehtezazi et al., 2010). It is imperative that the patient understands how to properly use the device to ensure that he can use in times of need.
The correct manner to use an inhaler device is to shake the device properly, remove the cap and place the inhaler into the spacer. Next the patient has to breathe away from the spacer and then bring the spacer near mouth and put the mouthpiece of the MDI between his upper and lower teeth. The patient is then advised to slowly breathe in and hold it for ten seconds briefly and then breathe out slowly. It is imperative that the patient breathes slowly, if hearing a whistling sound, it indicates the patient is breathing too fast, it is advised to slow breathing down at that point. The patient will also be need to be educated on how to clean the MDI properly and all the precautionary measures like sipping water and rinsing the mouth after each use (Ehtezazi et al., 2010).
I would demonstrate the right manner to use a metered dose inhaler and educate him how to use the spacer. Moreover I will ensure teaching him how to clean a MDI as well and carefully educate him about all the safety precautions. I will ensure his clear understanding on the administration and claiming procedure using ask-tell-ask approach.
Medication Management For Patient With COPD
Part A:
Salbutamol, being a β agonist drug also reacts to corticosteroid medication and causes symptoms of tremor, restlessness, incoherence, shortness of breath and myocardial contractions (Lima et al. 1999). The patient in this case was experiencing a strong hypersensitivity reaction to salbutamol after being on oral prednisone which is a corticosteroid, and without immediate action the patient has the risk to cardiac arrest.
The nursing intervention at this point should focus on anaphylaxis and adminstrtaion of epinephrine (Kennedy, 2011). It will aid in decreasing the hypotension reaction in the patient and will help in stabilizing him.
References:
Donner, C., & Carone, M. (2006). Clinical Challenges in COPD (Clinical Challenges). Oxford: Atlas Medical Publishing.
Ehtezazi, Saleem, Shrubb, Allanson, Jenkinson, & O’Callaghan. (2010). The Interaction Between the Oropharyngeal Geometry and Aerosols via Pressurised Metered Dose Inhalers. Pharmaceutical Research, 27(1), 175-186.
Ferguson Gt, Ghafouri M, Dai L, & Dunn Lj. (2013). COPD patient satisfaction with ipratropium bromide/albuterol delivered via Respimat: A randomized, controlled study. International Journal of COPD, 2013(Default), 139-150.
Kennedy, S. (2011). Caring for a patient newly diagnosed with COPD: A reflective account. Nursing Standard (through 2013), 25(49), 43-8.
Lima, John J., Thomason, Donald B., Mohamed, Mohamad H.N., Eberle, Louis V., Self, Timothy H., & Johnson, Julie A. (1999). Impact of genetic polymorphisms of the [beta].sub.2 -adrenergic receptor on albuterol bronchodilator pharmacodynamics. Clinical Pharmacology & Therapeutics, 65(5), 519.
Loerbroks, Adrian, Jiang, Chao, Thomas, G., Adab, Peymané, Zhang, Wei, Lam, Kin-bong, . . . Lam, Tai. (2012). COPD and Depressive Symptoms: Findings from the Guangzhou Biobank Cohort Study. Annals of Behavioral Medicine, 44(3), 408-415.
Mecklin, Minna, Paassilta, Marita, & Korppi, Matti. (2012). Salbutamol with metered dose inhalers with spacers – an established emergency treatment for preschool wheeze.(Report). Acta Paediatrica, 101, 1161.
Mueller, Wilke, Bechtel, Punekar, Mitzner, & Virchow. (2017). Non-persistence and non-adherence to long-acting COPD medication therapy: A retrospective cohort study based on a large German claims dataset. Respiratory Medicine, 122, 1-11.
Odencrants, S., Ehnfors, M., & Grobe, S. (2007). Living with chronic obstructive pulmonary disease (COPD): Part II. RNs’ experience of nursing care for patients with COPD and impaired nutritional status. Scandinavian Journal of Caring Sciences, 21(1), 56-63.
Prazma, Wenzel, Nelsen, Gunsoy, Cockle, Albers, . . . Yancey. (2017). Perception of oral corticosteroid side effects in patients with corticosteroid-dependent asthma. The Journal of Allergy and Clinical Immunology, 139(2), AB96.
Ray, Shaunta M., & Barger Stevens, Amy R. (2013). Choosing the right inhaled medication device for COPD.(Editorial). American Family Physician, 88(10), 650.
Roche, Nicolas, Chavannes, Niels H., & Miravitlles, Marc. (2013). COPD symptoms in the morning: Impact, evaluation and management. Respiratory Research, 14, 112.
Rosenberg, J. (2011). Lack of pretreatment cost-effectiveness and side effects of omalizumab versus prednisone/montelukast on tolerability of immunotherapy. Journal of Allergy and Clinical Immunology, 127(2), 548.
Teixeira, Lopes, Martins, Diniz, De Menezes, & Alves. (2016). Validation of Clinical Indicators of Imbalanced Nutrition: Less Than Body Requirements in Early Childhood. Journal of Pediatric Nursing, 31(2), 179-186.
Valente, M., Moura, E., De Oliveira Lopes, M., De Castro Damasceno, A., & Evangelista, D. (2012). Clinical Indicators of the Nursing Diagnosis of “Imbalanced Nutrition: More than Body Requirements” in Pregnant Women. Public Health Nursing, 29(3), 276-282.
Weldam, Lammers, Zwakman, & Schuurmans. (2017). Nurses’ perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: A mixed method study. Applied Nursing Research, 33, 85-92. Nursing Problems In Patient With COPD Example Paper
