NURSING 7105 Acute Care Nursing I


Bill McDonald, 65 years, is a male patient diagnosed with Chronic Obstructivepulmonary Disease (COPD).

He smoked one pack of cigarettes a day for 35 years.

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He has a long history with recurrent respiratory infections.

He has a chronic and productive cough, which produces copious amounts sputum.

On admission, the patient reports that he feels short of breath and has wheezed, productive coughing, lethargy, and is unable to breathe normally.

After a few days, Bill will be released from the hospital with home oxygen at 2L/min per nasal cannula.

The patient’s O2 saturation with room air was below 88% and his PaO2 underwent treatment at home.

The community nurse will need to arrange for the nurse to contact an agency to supply the oxygen equipment and to provide ongoing home care.

The supplier arranges for the delivery of an oxygen concentrator, portable tanks or concentrated oxygen, oxygen regulators, and other supplies including 20 meters lengths of tubing.

Analyse the case, and respond to all questions in this essay

Discuss the pathophysiology, symptoms and causes of COPD.

Analyze the management plans (medical & nursing) of a patient suffering from an acute exacerbation COPD.

Before Bill is discharged, consider home care considerations.

Identify resources in the community that can help Bill. Develop an education plan to address Bill’s learning needs, especially as it relates to his illness and discharge plans.

Answer to Question: NURSING 7105 Acute Care Nursing I

Different aspects of the pathophysiology for Chronic Obstructive Leukemia (COPD) can all be studied.

These include respiratory inflammation, structural changes in your respiratory tract and mucociliary malfunction.

COPD is often characterized by inflammation. This is due largely to cigarette smoking.

This inflammation affects the airways and respiratory tract, lung tissues, and pulmonary blood vessel.

Inhaling cigarette smoke triggers the recruitment of inflammatory and autoimmune cells like macrophages, CD8T cells, and neutrophils.

These inflammatory cell activation triggers an inflammatory cascade.

This causes the release of inflammatory cytokines including interferon gamma and tumor necrosis protein alpha (IFN g), interferon gamma and interleukin-1 (IL-1), IL-6 and IL-8. Also, there is release of other mediators like matrix-metalloproteinases such as MMP-6 and MMP-9, C-reactive protein (CRP) and fibrinogen.

COPD is characterized primarily by TH1-mediated inflammatory responses.

These inflammatory mediators trigger a prolonged inflammatory response in your respiratory tract, and cause structural changes in your respiratory tissues.

These inflammatory mediators also cause systemic effects (Bonini-Usmani, 2015, Ni, 2015).

Inflammation causes structural changes which lead to narrowing in the airways. Matrix-metalloproteinases such as MMP-6, MMP-9 and fibrinogen are responsible for the structural changes in the respiratory tract. Neutrophils, elastases and matrix-metalloproteinases act on the alveolar wall to induce wall destruction and act on epithelial cells to produce goblet cells hyperplasia resulting in mucus secretion.

Lung tissue loses its elasticity when parenchymal cells are destroyed in alveoli.

This causes the destruction or the support structure of alveoli (elastin) to be lost.

This condition is known as emphysema.

Tissue damage can cause small airways and obstructions during exhalation.

Hyperinflation occurs when the elastin is damaged and the airway becomes blocked. This can lead to air trapping and hyperinflation. Hyperinflation produces barrel shaped chest in COPD patients.

In the case of COPD patients, air trapping in the lungs results in a raised functional residual capability (FRC).

The destruction and entrapment of air in the lungs results in a reduction in O2 and CO2 exchange between the alveoli, capillary interface, and the alveoli.

These structural changes can reduce lung capacity.

The reduced lung capacity leads to a reduction of the volume ratio (FEV1) of lung volume and FVC (total volume of air lost) after forced expiration.

Fibrinogen plays an important role in the occurrence offibrosis.

The irritants in cigarette smoking cause epithelial cell release of transformative growth factor-b (TGFb).

TGFb is responsible for the production of fibroblast and finally, fibrosis in smooth muscle cells occurs (Gelb et. al., 2016; Hansel und Barnes, 2012).

Due to inflammation and smoking, the mucous glands along the walls of the respiratory tract get enlarged.

This metaplasia of the goblet cells results in the replacement and growth of normal cells with mucus-secreting ones.

Inflammation can also cause problems with the mucociliary transportation system. Additionally, mucus buildup in the respiratory tract can be caused by inflammation.

Guenette 2014: Goblet cell hyperplasia, mucus accumulation can interfere with the airflow.

Management Plans

Bill should receive care for any ineffective airway clearing.

A goal should be set by the doctor and nurse to maintain normal breathing sounds.

They should set goals to eliminate secretions and cough effectively.

They should listen for abnormal sounds in the air and record them.

They should track inspiratory and expiratory rates.

They should document the amount of dyspnea (or respiratory distress) and anxiety that may result from difficulty breathing or coughing.

They should remind Bill to breathe in a relaxed position.

The nurse can elevate the head of the mattress to achieve this comfortable position.

The nurse should also teach Bill to breathe through the mouth and stomach.

They should recommend that Bill consume as much water each day as possible to reduce secretions’ viscosity, which can facilitate expectoration.

They should monitor Bill with arterial blood gas measurement, spirometry, chest X-ray and chest oxygen.

They should also demonstrate to Bill effective techniques for deep breathing and coughing.

They should also perform chest physiotherapy.

They should also prescribe anti-inflammatory drugs to him and bronchodilator (Heffner, 2011, Howcroft et. al., 2016).

Bill should receive both medical and nursing care for impaired natural gas exchange.

A lack of oxygen inhalation or excess CO2 exhalation at an alveolar/capillary interface causes impaired gas exchange.

Both the nurse and doctor should agree on a goal for normal ventilation and sufficient oxygen supply to tissues.

ABG can evaluate oxygen supply.

ABG can be used to determine if Bill is experiencing respiratory distress.

They should also record the respiratory rate.

They should examine Bill’s skin, mucous membrane, and hair color.

They should be observant of Bill’s consciousness.

They should tell Bill to take frequent breaks and rest during activities.

They should closely monitor Bill for any changes in vital signs (Chow, 2015; Janssen., 2012).

Bill should receive treatment for an ineffective breathing pattern from both a doctor and a nurse.

They should agree on a goal to improve your breathing and keep your respiratory rate within the normal range.

They should ask Bill for his consent to remain dry.

They should also provide him with oxygen through a face mask.

Under doctor’s supervision, the flow rate of the supplemental oxygen supply and its duration should be monitored.

Doctor should prescribe Bill (Gulanick und Myers, 2011).

Dr. and nurse should both give him anti-inflammatory medication and bronchodilator medicine.

Bill should be seen by a doctor or nurse to assess for infection. Patients suffering from COPD are more at risk.

They should also monitor Bill’s temperature because of the potential for an increase in temperature in case of infection.

They should watch for color changes in sputum due to pulmonary disease.

They should advise Bill that he maintains a clean environment by washing his hands, using gloves, and disposing of sputum container.

They should recommend frequent rinsing the mouth.

They should order culture staining to sputum samples.

Bill should receive antimicrobial medication from his doctor.

Bill needs to be treated by a doctor or nurse for any imbalanced nutrition.

They should help Bill to lose weight.

They should be able understand Bill’s nutritional needs and prepare food accordingly.

They should also monitor Bill’s bowel sound as hypoxemia can lead to decreased gastric motility.

They should recommend that he eliminate all expectorated materials from his mouth.

They should remind him to eat frequently and to take breaks between meals.

They should warn him against carbonated beverages, as they can decrease hunger.

They should offer him supplements of vitamins, minerals, as well as antioxidants (Howcroft and colleagues, 2016; Chow and colleagues, 2015).

Considerations for Homecare:

Bill should be taught how to breathe properly.

A nurse can teach Bill lip breathing that can be used to decrease respiration.

Bill should be informed by his nurse that slow expiratory phases delay airway collapse, and minimize air trapping.

He should be instructed by the nurse to maintain a tripod posture as it allows for easier breathing.

He should be advised by nurse to get help with daily activities if he has trouble breathing.

A nurse should tell him to conserve his energy to avoid fatigue from improper breathing or coughing.

Nurse should remind him to take as much rest as possible and to take frequent breaks between activities.

Nurse should demonstrate how to use inhaler properly and show him how it is maintained.

Nurse should instruct him to use inhaler according to schedule.

Nurse should advise him not to increase the dose of his inhaler unless directed by a physician.

A nurse should inform him of the precautions that must be taken in case of serious condition like insufficient breath.

He should not panic or become anxious and should be calm.

If he has severe breathlessness, the nurse should tell him to call his doctor immediately (NealBoylan and Fromer, 2011).

A nurse should advise him that he drink enough water every day at home.

Nurse should remind him to eat small amounts at regular times.

The stomach won’t be empty and a little empty stomach could help with breathing.

He should eat foods that are richer in energy.

The nurse should show him how he can warm up his chest.

Massage his chest to warm it up. It can also help with breathing.

His nurse should tell him to take his long term medication daily.

His condition can be adversely affected by smoking, regardless of how much medication he’s taking.

He should stay away from smokers as passive smoking could also affect his condition.

He should stay away from strong odors.

The nurse should encourage him to do regular breathing exercises. They will be beneficial in clearing his airway passages, and would improve his breathing pattern.

Because COPD patients are more prone to infection, the nurse should tell him to keep clean.

He should wash and sanitize his hands frequently.

It is important for him to stay away from crowds. He should also ask his nurse to ensure that visitors use a face mask every time they enter his bedroom.

He should encourage him to exercise at home.

He should walk a bit each day, and not just when he feels unable to breathe.

The nurse should remind him to keep his strength up while he’s sitting.

He can strengthen his muscles by lifting small weights or doing light exercises (Brown and Fromer, 2015; Fromer and al. (2010)).

Education Plan

COPD can be treated by many organizations.

The following are a few of the organizations that deal with COPD.

These organizations are valuable for both healthcare providers as well patients.

These organizations give information to doctors about the most recent trends in COPD research.

These organizations also provide assistance to patients.

Before writing education plans for Bill, nurses should be aware of Bill’s learning needs.

Nurse should also ask Bill questions about COPD, and why it occurs.

Bill did not know about this, the Nurse was able to understand.

Nurse should also have an understanding of Bill’s current management approach to managing this chronic condition, as well as his previous experience with managing this condition.

Nurse knew that Bill was not very knowledgeable about managing diseases.

Bill cannot understand medical terminologies. Nurse should therefore make education plans in simple language.

Bill is on oxygen supplementation, 2 l per min oxygen level.

He wants information on how to increase oxygen flow. He wants to stop this from happening as quickly as possible.

The nurse should help him learn according to his learning goals.

It is impossible to speed up without expert supervision.

He should be explained by the nurse about oxygen saturation.

Therefore, nurse should show him various techniques to improve oxygen saturation.

These techniques include correct inhalation, proper breathing techniques, coughing out secretions, increased strength, exercise tolerable, and adequate nutrition.

Bill should be informed by nurse about side effects such as harshness and candidiasis.

The nurse should inform Bill that spacers and regular rinsing can prevent this.

Bill may feel depressed from a medical condition.

His nurse should help him feel mentally strong. He should also tell him that his illness condition can be improved if he follows all directions and takes his medication regularly.

Nurse should inform him that he needs behavioral changes and lifestyle changes to improve his breathing.

Nurse saw that he had lost appetite.

The nurse should recommend that he consume energy-enriched fluids to maintain a healthy nutritional balance (Scullion and Smeltze et. al., 2010).Conclusion:

Bill is suffering from COPD.

He is suffering from symptoms of COPD such as productive cough and wheezing.

He receives O2 to maintain a normal level of oxygen saturation.

Bill is experiencing these symptoms because of pathological changes in his respiratory system.

These pathological changes include inflammation and bronchoconstriction. Mucus deposition is also a factor.

Bill needs nursing and medical intervention to reduce inflammation and improve his breathing.

Bill needs home care. This includes improving breathing patterns, inhaler use, keeping hygienic conditions, quitting, and exercise.

A nurse should explain to Bill the causes of COPD, and how it can be managed.

Bill will be treated holistically if there is effective implementation of nursing interventions that incorporate medical, physical, person-centered and other aspects.References:

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