Nursing Assessment
1. While preparing the care plan for Mr. Peter Newman, a 44 year old patient with COPD (Chronic Obstructive Pulmonary Disease), it will be necessary to consider the impact of the risk factors like smoking and social drinking on exacerbation of COPD. This will help to understand whether smoking and social drinking should be continued or not. Another aspect that needs to be reviewed while developing the care plan is to observe symptoms of COPD and changes in vital parameters of the Mr. Peter Newman. This will help to identify immediate care needs and any complications for which immediate intervention is needed. To promote holistic well-being, other physical health factor, psychosocial factor emotional factors and independence level of patient will be analyzed too. This will help to identify unmet needs of patient and find out the vital elements that is affecting holistic well-being for Mr. Peterman. Acknowledging interdependence between biological, psychological, social and spiritual aspects is an importance part of holistic care (Zamanzadeh et al., 2015).
2. Based on the review of Mr. Peter’s case scenario, three nursing assessments have been identified to be critical to prioritize nursing care plan for patient. The first nursing assessment that will be important includes complete assessment of signs and symptoms of Mr. Peter following exacerbation of COPD. Patient with COPD mostly experience symptom of breathlessness, cough and sputum production. As exacerbation of COPD is associated with shortness of breath and wheezing even with minimal activity, review of parameters like breathing rate, respiratory rate and accessory muscle use is important. As Mr. Peter Newman is particularly facing challenges in meeting his work responsibilities due to increased breathlessness, the strategy of assessing vital signs like respiratory and breathing rate needs to be prioritized to identify whether Mr. Peter need immediate hospital admission or changes in medication can control his condition.
The assessment of vital sign and symptoms can be done by doing the following activities:
- Measure breathing rate and respiratory rate of patient to identify signs of clinical deterioration
- Observation of Mr. Peter’s level of consciousness and position to evaluate work of breathing. The patient can be upright in a tripod position during severe respiratory distress and may feel drowsy during respiratory failure. Patient with severe COPD may also use pursed lip breathing technique to avoid small airways collapse during tidal breathing. Hence, review of consciousness and position can help to detect severity of symptoms
- Another nursing activity that will help to assess complication in Mr. Peter includes conducting auscultation of the lungs to identify wheezing sounds and evaluate quality of air movement through the lungs. Lung auscultation is an important part of physical examination as it can give vital information related to physiology of lungs and airway obstruction (Lange et al., 2016).
The second nursing assessment that will be important for patient includes assessment of oxygenation in patient by measuring pulse oximetry and observing skin colour of patient. Impaired gas exchange is a clinical issue in patients with COPD and it occurs because of bronchospasm, alveoli destruction and air trapping in the lungs (Kim, 2017). This needs to be prioritized to understand whether Mr. Peter needs oxygen therapy to eliminate the symptom of breathlessness or not. COPD patients with Pao2 ≤ 55 mm Hg or ≤ 59 mm Hg require supplemental oxygen to treat symptom of hypoxemia (Stoller et al., 2010). Pulse oximetry is an important clinical standard practice in monitoring oxygen level in the patient’s blood and diagnoses episodes of acute respiratory failure (Amalakanti & Pentakota, 2016).. Handheld pulse oximeters are easy to use and can support nurse to identity treatment need for patients like Mr. Peter.
Nursing Diagnosis
The third vital nursing assessment is to assess patient’s knowledge related to risk factor and cause of COPD and attitude towards management of the condition. This assessment is essential to reduce smoking rate and alcohol consumption for Mr. Peter. This is important because smoking is also one of the causes of COPD exacerbation and smoking can further deteriorate breathing rate for Mr. Peter as smoking damages air-sac and airways of the lungs (Riesco et al., 2017). The assessment of knowledge related to the disease will help to interpret patient’s ability to self-manage the disease and positive cope with negative symptoms during exacerbation. The assessment of knowledge and attitude towards COPD will also help to plan appropriate support interventions to motivate Mr. Peter to quit smoking for holistic health and well-being. Another importance of assessing patient literacy and attitude towards the disease is that it may help people to develop Mr. Peter’s capability for self-management of the condition. This will help to meet both physical as well as psychosocial needs of client. Better engagement in self-management behaviour will improve health outcomes and quality of life too (Huygens et al., 2016).
3. Based on review of Mr. Peter’s symptom and other psychosocial factors affecting his health, three nursing diagnosis that has been identified for Mr. Peter include increased breathlessness, presence of risk factors (like smoking and drinking) and lack of literacy on disease process and self-management. The care plan for Mr. Peter will focus on reducing the above three problems for patient.
Based on the nursing assessment of signs and symptoms by means of lung auscultation, consciousness and skin colour, increased breathlessness has been identified as one of the clinical priority while developing care plan for Mr. Peter. To reduce breathing related problem for Mr. Peter, it is planned to provide pharmacological intervention to patient. This will include use of bronchodilators and corticosteroids to reduce inflammation associated with COPD exacerbation and improve ventilation process for patient. Bronchodilators are effective in maintaining airway patency and it is a central part of the COPD treatment (Bryant & Knights, 2014). According to Cazzola and Page (2014), the main advantage of including bronchodilator as one of the medication for patient with COPD is that it can alleviate bronchial obstruction and airflow limitation and reduce hyperinflation. Hence, by providing bronchodilator to patient, Mr. Peter is likely to get relief from symptom of breathlessness and increased work of breathing. Another drug that needs to given to Mr. Peter for recovery and reduction in symptoms of COPD includes use of corticosteroids. Corticosteroids are particularly effective in the treatment of exacerbation. Evidence by Woods et al. (2014) suggests that corticosteroid is the mainstay of COPD therapy and optimal dosing regimen determines the success of the therapy. Inhaled corticosteroid is often used in combination with long-acting Beta-agonist to treat patient with COPD. The drug works to inhibit inflammatory process occurring during exacerbation of COPD. A nurse can play a role in giving the two medications on the prescribed time and teaching Mr. Peter regarding the appropriate way to take each of the medication.
Nursing Interventions
In relation to the problem of heavy smoking and drinking in Mr. Peter, the nursing care plan is to assess rate of smoking and drinking each day and implement smoking cessation intervention to promote long-term health and well-being of the client. As Mr. Peter is a heavy drinker and is experiencing exacerbation of COPD, smoking cessation needs to be prioritized both for physical and mental well-being of client. Heavy smoking can increase the risk or frequency of COPD exacerbation for patient as cumulative smoking can lead to airflow obstruction. High level of smoking increases the prevalence of COPD. For this reason, quitting smoking is targeted as part of primary care (Perez-Padilla, Thirion-Romero & Guzman, 2018). Hence, as this would lead to additional cost of care and unnecessary deterioration of symptoms, focussing on implementing interventions to encourage Mr. Peter to quit smoking is important. Mr. Peter can be supported to quit smoking by use of nicotine replacement therapy. Nurse can encourage Peter to replace cigarettes with other items like nicotine patches and inhaler nicotine. Evidence has revealed that nicotine replacement therapy is a strategy to reduce ill-effects of cigarette smoking in smokers with COPD and provide direction for later cessation in later life (Ellerbeck et al., 2018). This intervention is likely to promote health of Mr. Peter and reduce mental burden too by reducing medical cost and repeated hospitalization because of COPD exacerbation.
The third important care priority is to increase knowledge of patient in relation to COPD and optimal management of the condition. This is particularly important for Mr. Peter because he is currently experiencing increased breathlessness and this has affected hi participation in work. However, he is not aware that his active smoking and drinking habits are two risk factors that can deteriorate his condition. There might be other areas too where Mr. Peter might have poor knowledge regarding the cause of disease, risk factors, ways to use medication and cope with adverse symptoms. Hence, promoting health literacy in the area of COPD and its self-management is a vital step to promote holistic well-being for Peter. Appropriate nursing education can help Mr. Peter to plan his daily schedule and take care of his health. This will also help Mr. Peter to reduce symptom of anxiety and depression, which are common psychological co-morbidities in people with COPD. Evidence has also revealed that self-management education programs can reduce symptom of anxiety and promote psychological well-being in COPD patients (Pumar et al., 2018).
Bronchodilators and Corticosteroids Usage
As COPD has psychological impact on patient with COPD, nursing intervention related to education and increasing attitude of Peter towards self-management can empower patient and encourage him to avoid behaviours that can deteriorate his health. Hence, this intervention can serve as a motivating factor for Mr. Peter to quit smoking. This education can target giving Mr. Peter education regarding the physiology of COPD, vital organs affected by the condition and the impact of smoking and drinking on symptoms. Education can also support patient in seeking appropriate health care service for recovery (Sari & Osman, 2015).
4. Based on the development of nursing care plan for Mr. Peter, he will need to use bronchodilators and corticosteroid inhalers for a long time. In such situation, patient education is vital to increase awareness regarding the correct way to use inhalers. The common issue found for people with COPD is that they face challenge in using a metered-dose inhaler (MDI). This is the reason behind poor adherence to pharmacological treatment too. Hence, education can be given to Mr. Peter regarding proper administration of inhalers. This can be done by giving demonstration to Mr. Peter regarding the stepwise process to use inhalers. Before discharge, visual manuals with list of instructions can also be provided so that Mr. Peter can easily follow the steps while at home. In addition, the details regarding the number of puffs to be taken and things to avoid to prevent exacerbation are also necessary. Jolly et al. (2015) has revealed that prescribing inhalers without providing proper education regarding appropriate technique can result in suboptimal outcomes and wastage of medication. Hence, educating Mr. Peter regarding correct inhalation technique can enhance drug efficacy and promote recovery of patient.
Specific education can also be given to Mr. Peter regarding side-effects of each medication and adverse reactions likely to be observed after taking the medications. Education can also be given regarding continuity of care at home and following proper diet. To improve spiritual health, Mr. Peter can be encouraged to adapt positive coping skills such as book reading and participation in social activities to reduce the burden associated with the condition
The allied health care professionals who need to be involved in the care of Mr. Peter include nurses, psychologist, occupational therapist, nutritionist and physicians. Physicians can aid in diagnosis of the disorder during admission and respiratory physiotherapist can play a role in improving ventilation during hospitalization. In addition, nurse can play a role in providing holistic care to Mr. Peter by addressing physical as well as spiritual health needs. During the time of discharge, the role of dietician and respiratory technologist is critical. Dietician can play a role in developing appropriate diet charge for Mr. Peter and respiratory technologist can play a role in demonstrating techniques to use inhalers.
Smoking Cessation
References
Amalakanti, S., & Pentakota, M. R. (2016). Pulse oximetry overestimates oxygen saturation in COPD. Respiratory care, 61(4), 423-427. https://rc.rcjournal.com/content/respcare/61/4/423.full.pdf
Bryant, B., & Knights, K. (2014). Pharmacology for Health Professionals ebook. Elsevier Health Sciences. Retrieved from: https://www.elsevier.com/books/pharmacology-for-health-professionals/bryant/978-0-7295-3929-6
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