Care Planning For Patients With Dementia And Chronic Obstructive Pulmonary Disease

Registered nurses are a valuable asset to the healthcare sector. They act as front liners who address the issues of a patient. As they come in direct interaction with the patient, they need to understand their needs, be it physical or emotional support, to help the patient in his/her speedy recovery. They prioritise the needs of the patient before their own and strive to provide the best care for them. Each patient has different needs and requirements. So, care planning is necessary to cater to their needs. They work with other healthcare experts to chalk out suitable plans for patient recovery. Care planning can help them assess the risk factors to which a vulnerable patient can be exposed, and can recommend suitable interventions to tackle the issue. In this essay, I have used the Driscoll model of reflection, to express my reflection on the provided scenario.

Mark, an 80 years old man, was diagnosed with chronic obstructive pulmonary disease (COPD), which is a chronic inflammation of the lungs that obstructs airflow into it. He was admitted to the emergency department of a hospital when he collapsed on the bathroom floor. On admission, his condition was evaluated and I found that he was panting and out of breath. I also noted aspiration, a common phenomenon occurring in older people due to inhalation of a foreign substance in the lungs. Recurrent infection in the chest was also noted. He was also diagnosed with dementia, which means impairment of cognitive functions. Thus, he was not allowed to take responsibility and make his own decisions. His family and his brother took decisions for him. The Respiratory Team of the healthcare facility assessed his health conditions. Another team of healthcare expert suggested to send him to a care home, as he was incapable of taking his responsibilities and also, he had a brother who had a full-time job. He needed assistance with daily functioning like personal care, shopping, cooking and medication. Role Of Registered Nurses In Patient Care Example Paper  He was prescribed antibiotics for his lung infection. He has also suggested the continuation of treatment therapy even if he was transferred to a care home.

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After examining him, I analysed Mark’s immediate physical problems, that is aspiration and breathlessness. His brother reported that he often noticed symptoms of confusion in Mark, than normal people. I also considered his medical history of dementia and chronic obstructive disease and I drew a conclusion about the entire scenario. Studies have shown that dementia can cause severe lung problems and lung infections. Pneumonia is the most common lung problem that is found in people with dementia [1]. While analysing the cause of death in dementia patients, it was found that pneumonia reported 50% of deaths in such patients [2]. This is due to the fact that the brain ceases to function properly. Generally, exposure to antigens or infections results in the formation of specific antibodies for the disease. But as people with dementia lose their ability to produce proper antibodies, the affected patients are more vulnerable to infections with the slowdown of functioning of the immune system. Studies have stated that pneumonia can cause delirium in the elderly [3]. Delirium is a critical mental illness which shows symptoms like confusion, reduction in thinking capacities and reduction in awareness of the surrounding environment. Aspiration pneumonia is common in patients having mental health disorders [4]. As these patients face loss of almost all 5 senses, it is inevitable that they would have problems in every aspect. As Mark collapsed in bathroom, I considered the situation of aspiration due to swallowing saliva. COPD also has a relationship with dementia and reduced cognitive functioning [5]. COPD may cause shortness of breath as it often causes respiratory infections. For administering interventions to the patient, I took into account the law by the UK and Wales government, Dementia and the Mental Capacity Act (2005), which aims at protecting the rights of the patients with dementia or other mental health disorders [6]. This act states that the carers of the patient can make decisions for the patient in his best interest. To avoid any ethical and legal issues, I consulted Mark’s brother and his family and took their permission before performing any diagnostic tests on him. The patient required immediate attention as he was unable to breathe properly. So, as per his symptoms, we, the healthcare expert team, decided to perform chest X-ray [7]. The chest X-ray confirmed pneumonia and chest infection and its location in the lower part of the lungs. As Mark had dementia, he was not authorized to make any decisions for himself. So, we asked his brother and other members of his family for permission to treat the infection. We made them understand the complications of the disease and the life-threatening consequence it might have on the patient. For aspiration pneumonia, I suggested his treatment with antibiotics [8]. I also kept the mechanical ventilator at hand, in case his situation turns into a life-threatening complication. The Respiratory team assessed him and found him fit for release but made proper treatment plans for him. Based on his mental condition, the other healthcare professionals and myself decided that Mark should continue his treatment therapies- Reminiscence therapy and Music therapy [9], when he is released from the hospital, as these have proven to be quite effective to stimulate response in such patients. Reminiscence therapy is aimed at making the patient reminisce his previous life events and music therapy can help have a positive impact on the patient’s mind and can provide behavioural and emotional benefits as the part of the brain which is linked to such memory remains undamaged by the disease [10]. Anticholinesterase drugs were also recommended which have proven effects on dementia patients [11]. Fluids like warm beverages were recommended to him. Routine check-ups have to be done to track the progress of the condition of pneumonia and dementia. Mark was scheduled for chest X-ray after a week to view the lung condition after administering antibiotics. He was also scheduled for cognitive behavioural therapy which is aimed to reduce anxiety and depression, which are commonly found in dementia patients.

Case Study: Providing Care For An 80-Year-Old Man With COPD And Dementia

I did learn a lot from treating Mark in an emergency condition. Taking proper decisions in emergency situations have boosted my confidence. Emergency situations always develops the skill of reasoning and questioning a situation and then offer medical help to the patient. Clinical experience is required to become efficient in nursing. As different patients have different needs and requirements, we need to keep learning new skills and interact with the patient more. It helps in creating a proper roadmap for a patient with similar health conditions based on the previous experiences. Such experiences also help us to determine the consequences and effects of a certain health issue. Nursing is often considered as a high stress job. Clinical experience also exposes us to the environment of high stress which we need to take on later in our career. As nurses, we are considered as the front liners in providing medical treatment and they come in direct contact with the patients, we have an obligation to meet the patients’ needs. Communication is a vital part in nursing as it helps them to understand the patient’s needs and act accordingly. It also prevents inaccuracies and misunderstandings in treatment. Communication with Mark and his family enhanced my knowledge and it also has given me exposure to take decisions and make appropriate healthcare plans. It has improved my skill of handling patients under distress and require immediate attention. As I recall my steps of treating Mark, I found that the treatment could have been better if we included oxygen therapy in his treatment plan. It could provide supplemental oxygen to lungs and improve his quality of life. I will make sure to improve myself from the mistake I have done here. This experience also taught me the procedure of working with a multidisciplinary team. Coordination and exchange of knowledge among the team members has helped me grow in my career. We made comprehensive strategies for the patient targeting his speedy recovery. Support from his family members encouraged us to a great extent.

In conclusion, I can say that the Driscoll model has provided an easy guideline to express my reflection on the case study relating to a nurse’s assessing needs and planning care. I have learnt a lot about the specific medical conditions and have examined ways to deal with those. It has boosted my confidence and put me in a better position to handle such situations. Dementia and chronic obstructive pulmonary disease are very common among the elderly. Hence, learning about its symptoms and planning their care regime has helped me enhance my knowledge on this subject. Treating patients in emergency situations is a critical task as a nurse stands between life and death of a person. So, planning care for a patient in such a critical condition has boosted my confidence. It has also helped me learn to cooperate with other healthcare experts as well, while taking a decision for the patient.

References

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Manabe T, Fujikura Y, Mizukami K, Akatsu H, Kudo K. Pneumonia-associated death in patients with dementia: A systematic review and meta-analysis. PLoS One. 2019 Mar 14;14(3):e0213825.

Kuswardhani RT, Sugi YS. Factors related to the severity of delirium in the elderly patients with infection. Gerontology and geriatric medicine. 2017 Nov 8;3:2333721417739188.

Payne M, Morley JE. Dysphagia, dementia and frailty. The journal of nutrition, health & aging. 2018 May;22(5):562-5.

Kakkera K, Padala KP, Kodali M, Padala PR. Association of chronic obstructive pulmonary disease with mild cognitive impairment and dementia. Current Opinion in Pulmonary Medicine. 2018 Mar 1;24(2):173-8.

Marshall H, Sprung S. The Mental Capacity Act:‘Best interests’—a review of the literature. British Journal of Community Nursing. 2017 Aug 2;22(8):384-90.

Ayan E, Ünver HM. Diagnosis of pneumonia from chest X-ray images using deep learning. In2019 Scientific Meeting on Electrical-Electronics & Biomedical Engineering and Computer Science (EBBT) 2019 Apr 24 (pp. 1-5). Ieee.

Thomson J, Hall M, Ambroggio L, Berry JG, Stone B, Srivastava R, Shah SS. Antibiotics for aspiration pneumonia in neurologically impaired children. Journal of Hospital Medicine. 2020 Jul;15(7):395-402.

Fusar-Poli L, Bieleninik ?, Brondino N, Chen XJ, Gold C. The effect of music therapy on cognitive functions in patients with dementia: a systematic review and meta-analysis. Aging & Mental Health. 2018 Sep 2;22(9):1103-12. Role Of Registered Nurses In Patient Care Example Paper