Critical Evaluation Of COPD

This is a case study on a 76 year old man.Mr Alan Chari(pseudonym used to protect the identity of a patient),was admitted over night in my department.He is a divorcee who stays with son.He is a retired teacher and his son is permanently employed by a local company as an electrician.He is independent with activities of daily livings but is occasionally limited by his ill health.He used to be a heavy smoker .After realising the burden COPD has on general New Zealand population ,affecting about15% of the adult population over the age of 45 years according to asthmanz( 2010) ,l took this case study to gain in-depth understanding.

The ‘APIE’ framework consists of Assess, plan, implement and evaluate, the nursing process should include nursing diagnosis and recheck (Barrett et al 2009). Therefor the ‘ASPIRE’ framework was used to create Kora’s care plan, which is as follows assess, systematic nursing diagnosis, plan, implement, re-check and evaluate (Wilson et al, 2014). The problem of SOB had affected Kora’s oxygen saturation level assessment and this needed to be acted upon promptly as it could quickly be detrimental to the patient’s health. The nurse caring for Kora completed the local trust single assessment process (SAP) holistic assessment document to gather a range of information about Kora and her medical history, if the patient had any dependant relatives, “presenting complaint, concerns, current medications and social history” (Bennett et al, 2009). This enabled the nurse to gather information which could be incorporated into Kora’s care plan. Furthermore, it highlighted that the patient was worried about the care of dependant grandchildren, which could impact on the patient’s wellbeing. Treatment and care should take into account patients' needs and preferences. People with COPD should have the opportunity to make informed decisions about their care and treatment, in partnership with their healthcare professionals (Nice, 2010).The SAP 1 documentation the nurse involved in Kora’s care completed incorporated RLT

The study began with 32 patients having stages II to IV COPD. They had to meet the criteria pertaining to the Global Initiative for Chronic Obstructive Pulmonary Disease; total lung capacity >120%, (FEV1/FVC) <70%, FEV1 <80%, RV/TLC >140% and >40% of predicted values in stable conditions. Patients were removed from the study if they had asthma, heart failure, orthopedic impairments of the shoulder girdle, recent surgery, past thoracic fractures, pneumothorax, and claustrophobia.

History of Present Illness: Ms. Manock is a very pleasant 60-year-old woman with a history of severe COPD. She was previously seen by Elvira Aguila, MD. Her last office visit was in February 2015. Since that time, she states that over the last few weeks, she feels her dyspnea has worsened which is a result of increased humidity, which is normal for her. She has had a stable cough over the last six months, which is intermittently productive of sputum. She is using her supplemental oxygen at 2 L/minute with exertion and with sleep. She also notes postnasal drip, which is related to seasonal allergies.

Chronic obstructive pulmonary disease (COPD) is in the top five principal cause of death in the U.S. The disease is an abnormal inflammatory reaction in the lungs with limited airflow. COPD characteristically arises around the age 35. Smoking continues to be the main source of COPD, but is not the only known root cause. In many studies, smoking explanations for at least three fourths of COPD cases ("Chronic obstructive pulmonary disease | University of Maryland Medical Center," n.d.). Stopping smoking has been known to improve lung capabilities and help to prevent death from COPD. Genetic conditions and introductions to airborne toxins, irritants and gasses are correspondingly involved in the growth of the illness. A complete treatment plan could comprise of lifestyle changes, one or more medications, patient education, oxygen therapy respiratory rehabilitation, and surgery ("Chronic obstructive pulmonary disease | University of Maryland Medical Center," n.d.).

Complications surrounding life support can lead to legal and ethical issues. Ventilation support might not be the best options for everyone and some will get to the point where they may be considered ventilator-dependent, despite no improvement in signs and symptoms (ATS, 2015). Eventually, patients and caregivers need to deliberate the benefits and burdens in deciding to initiate life supportive care (ATS, 2015). In summary, it is important to educated patients about the challenges facing COPD and about lifestyle modifications needed to improve the quality of life. As stated previously, patients with COPD can live an independent and semi-active lifestyle as long as they are ready to make the necessary

History of Present Illness: Ms. Babula is a very pleasant 76-year-old woman who was previously seen in this office by Elvira Aguila, MD for moderate COPD by pulmonary function testing in 2010. She is currently on monotherapy with Atrovent p.r.n. and she has not used her bronchodilators for quite some time. She does have some stable dyspnea on exertion, which does not limit any of her activities. She does take care of an 18-month-old child as well. She denies any cough, though she does feel that she has some chest congestion in the morning. She denies any chest pain or wheezing.

In this reflective piece of writing I will be explaining how chronic obstructive pulmonary disease (COPD) affects the patient physically, psychologically ,and socially ,I will also explain how the disease affects his daily routine and how it impacts on his family life. I will give an overview of the clinical signs and symptoms, how the disease alters the pathphysiology of the lungs, and what these changes cause within the body.

Through the convenience sampling, 90 clients were recruited as research participants were in the waiting room of the respiratory clinic. 60 subjects agreed to attend a support group for socialization with each other. 30 of 60 clients were assigned to participate in the presentation and therapeutic exercises by the instructor. The instructor group divided into halves: 15 clients received instructions with family caregiver and the other clients without a caregiver. The second 30 clients received written materials and allowed to access the website for video presentation and exercises. Half of website group assigned to the family caregiver and the other half without a caregiver. The last 30 subjects were assigned as a control group, and half of these clients received usual care with family caregiver and other 15 clients without a family caregiver. The data was collected by the pulmonary functional status survey, 30 items, five points, Likert-type scale.

All over the world, chronic obstructive pulmonary disease (COPD) is a very significant and prevalent cause of morbidity and mortality, and it is increasing with time (Hurd, 2000; Pauwels, 2000; Petty, 2000). Due to the factor of COPD being an underdiagnosed and undertreated disease, the epidemiology (Pauwels, Rabe, 2004) is about 60 to 85 % with mild or moderate COPD remaining undiagnosed (Miravitlles et al., 2009; Hvidsten et al., 2010).

The audience to which the tool is directed is the general public, with a focus on individuals currently experiencing COPD. The families of these individuals could also benefit from the information presented in the brochure. The tone and readability of the text in the brochure is appropriate for the general public, as technical and scientific jargon is not used and the content is presented in a non-formal conversational tone. The content and presentation of information in no way is directed to any one race or cultural background. Individuals from all cultures would find the information in the brochure appropriate, understandable and accessible.

ReferencesAlexander, M. F., Fawcett, J. M., & Runciman, P. J. (Eds.). (2004). Nursing practice hospital and home - The adult (2nd ed.). Edinburgh: Churchill Livingstone.

Pathological changes characteristic of COPD are found in the airways , lung parenchyma and pulmonary vasculature .These include chronic inflammation, with increased numbers of CD8 lymphocytes in different parts of the lower respiratory system and structural changes which result from repeated injury . Inflammatory and structural changes increase with disease severity and smoking .(43)

Nurses are a vital component in patient care. The importance of conducting efficient nursing assessments is critical in order to provide both patient-centered care and safe, effective patient healing. Nurses are often responsible for taking care of patients with very complex disease processes. They frequently provide care to patients with illnesses such as Chronic Obstructive Pulmonary Disease (COPD). According to the Centers for Disease Control and Prevention, in 2014, approximately 6.8 million adults were diagnosed with COPD within the Unites States. The completion of proper assessments and initiation of interventions for these patients are crucial in order to prevent further complications of the illness.

Some of the laboratory testing used to identify COPD are arterial blood gas and increased hematocrit levels. Arterial blood gas testing will reveals hypoxemia and hypercarbia due to the retention