Nursing Intervention for Congestive Pulmonary Disease - Research Paper Example

? Nursing Intervention for Chronic Obstructive Pulmonary Disease School Introduction Chronic obstructive pulmonary disease(COPD) is defined as a progressive pulmonary disorder caused by persistent exposure to pulmonary irritants such as air pollution, chemical fumes, dust, and cigarette smoke (Torpy, et. al., 2008; GOLD, 2008; National Lung Heart and Heart Blood Institute, 2009). COPD is a clinical syndrome that results to excessive production of mucous, wheezing, continual dyspnea, and chest tightness associated with progressive obstruction of expiratory airflow secondary to persistent inflammation of the airways and lung (Woodley and Whelan, 1992; Sutherland and Cherniack, 2004; Fabbri, et al., 2008). National Heart Lung and Blood Institute (2010) reported that COPD is irreversible with no known treatment to date making it as the leading cause of disability and ranked as the third contributing factor of mortality in the United States. National Heart Lung and Blood Institute added that emphysema and chronic bronchitis are the two most common conditions referred to by physicians as COPD since the two characteristically coexists. Unfortunately, healthcare practitioners focus their treatment approach to COPD mainly on the pathophysiology not knowing that psychological impact that follows the physical decline also play a great role in shaping the experience of COPD patients (Simpson and Rocker, 2008). Therefore, to effectively address the management of COPD, a holistic approach must be carried out. To achieve this, an individual nursing care plan of treatment must be conducted by a healthcare practitioner. This include: modification of lifestyle, optimization of pulmonary status through pharmacotherapy, exercise, nutritional and metabolic intervention strategies, and psychotherapy (van der Valk, 2004). As mentioned previously, COPD ranked as the number one cause of irreversible morbidity in the United States to date. As a nurse, it is my utmost desire to help my patients from suffering from this debilitating illness by learning more about the disease itself through continuing medical education and by adopting the latest updates in managing COPD and learn more on its intervention. Nursing Interventions Nursing Assessment: The client is a 40 – year old construction worker, who was admitted to the hospital with difficulty and labored breathing, elevated temperature, and easy fatigability. The nursing history revealed that the patient had difficulty in breathing for two weeks that was relieved temporarily with medication. The client mentioned that he worked full – time as a construction worker since he was 18 years old. He started smoking two packs of cigarettes per day since he was 16 years old. Chest x- ray revealed hyperinflated and hyperlucent lungs with flattened diaphragm. It confirms the diagnosis of chronic obstructive pulmonary disease (COPD). Nursing diagnosis reveals: A. Ineffective clearance of airways, secondary to destruction of the ciliary lining of the epithelium of the lungs caused by excessive chronic smoking as evidenced by difficulty in performing activities of daily living, difficulty in sleeping, nasal flaring, and rapid respirations. Desired outcome: Short - term goal: After 4 – 8 hours of nursing intervention, the client will exhibit signs of improvement in airway clearance, as evidenced by normal respiratory rate. Long – term goal: After 3 – 4 days of nursing intervention, the client is expected to perform simple tasks as evidenced by standing, walking, sitting, taking a bath, and taking care of himself without the help from others. Nursing Intervention and Rationale: 1. Nursing Intervention: Assist the patient to a semi – fowler’s position with upper trunk in 45 degree position. Rationale: Elevation of the head facilitates expansion of the lungs, and efficient respiration by reducing abdominal pressure. The abdominal organs shift towards the chest when the client is lying in a flat position, crowding the lungs and results to an increase in breathing difficulty (Kozier, et al., 2004). 2. Nursing Intervention: Encourage the patient to take deep breathing. Rationale: Deep breathing promotes oxygenation (Kozier, et al., 2004). 3. Nursing Intervention: Encourage patient to drink more than 8 glasses of water per day Rationale: Adequate intake of fluids enhances pulmonary secretion liquefaction and facilitates mucus expectoration (Kozier, et al., 2004). B. Impaired/poor exchange of gases related to changes in alveolar and capillary lining as evidenced by shortness of breathing and restlessness. Desired Outcome: After 4 – 8 hours of nursing intervention, the client will show some signs of improvement in breathing, and will now begin to relax. Nursing Intervention and Rationale: Nursing Intervention: Nebulize the client every 4 hours, and facilitate chest tapping after nebulization. Rationale: Viscid mucous secretion is reduced by nebulization and facilitates pulmonary secretion (Kozier, et al., 2004). C. Frustration, anxiety, worthlessness, impatience, changes in lifestyle, altered role in the family, anger, denial, irritability, and loss of intimacy secondary to COPD. Desired Outcome: After 4 - 8 hours of nursing intervention, the client can verbalize his feeling towards his situation and begins to relax. Nursing Intervention and Rationale: Nursing Intervention: Help the family create a calm environment that boost positive outlook, worthiness, patience, and sense of belongingness and acceptance. Strategies that include relaxation techniques are demonstrated to the client (Torpy, 2011). Rationale: Anxiety Increases respiratory rate, while a calm environment can ease anxiety attacks of the client (Kozier, et al., 2004). Relaxation techniques improve the client’s health in general (Torpy, 2011). Current Research and Trends A longitudinal study which proposes to recognize the ultimate risk of men and women to acquire COPD and its association with tobacco consumption was followed for 25 years from the general population. The primary objective of this study was to determine the absolute risk of men and women from the general population from developing COPD in 25 years (Lokke, et al, 2006). During the study, 8045 men and women with age ranging from 30 – 60 years were included in the Copenhagen City Heart Study. Baseline measurement of normal lung function was collected from these patients and the mortality secondary to COPD were analyzed within the 25 year period of observation. Results revealed that among those men who initially have normal lung function, 96% of them were not smokers and 56% were tagged as chain smokers. On the other hand, 91% of women in the study never smoke and 69% of them were smoking continuously. From the study, it was noted that moderate to severe COPD was developed during a 25 – year study. Out of which, 20.7% and 3.6% came from men and women, respectively. In the early follow – up period, it was observed that a decreased risk of developing COPD was accounted when smoking was stopped compared to the population who never stopped and continued smoking. There were 2912 mortality reported during the follow – up period, and out of which, 109 cases were secondary to COPD. At the end of the study, it was noted that 92% fatalities were secondary to COPD, and these were followed through among the subjects who smokes from the start until the end of follow up period (Lokke, 2006). Lokke, et al (2006) concluded in their study that a 25% chance of developing COPD was equally observed among men and women who continuously smoke in 25 year period. Another research on COPD was done by Foster, et al (2007) in Enhancing COPD Management in Primary Care Settings, which aimed to examine primary decision making, perceptions, and the need to educate patients in relation to COPD. In this study, Foster, et al. (2007) developed and distributed a survey centered on COPD case vignettes to a random sample of physicians specializing in adult primary care specialties. Results had shown that 784 practicing primary care physician from 943 respondents were utilized in analysis (Foster, et. al., 2007). From the results of the participating physicians, it was reported that twelve percent of their patients were estimated to have COPD. However, only 25% of these physicians were using COPD guidelines in their decision making notwithstanding that 55% of them were aware of the major of COPD guidelines. Self identified guidelines have shown that spirometry was more likely ordered by users for subtle symptoms and to initiate mild symptom therapy. Moreover, long acting bronchodilators were preferred for unrelenting dyspnea (Foster, et. al., 2007). Foster, et al. (2007) concluded in their study that clinical guidelines for physicians that may influence their decision making and programs for continuing medical education are resources that are highly valued in the medical practice but still remained unreached by majority of the physicians. As a result, Foster, et al recommended that COPD assessment algorithm tailored to primary care settings, and is designed to assess and strengthen skills in interpretation of spirometry, and discuss an approach reasoned to management of medication must be presented in the future continuing education. Also, patient – centered guidelines that affect accurately the nature of practicing primary care may enhance the learning experience of the physicians. In conclusion, internet – based and distance formats of learning are necessary to reach physicians in many “high – need areas.” Conclusion In this study, we found out that COPD management is a holistic approach that need not only provide the pharmacologic therapy, but most importantly, to distinguish and address the emotional and psychosocial needs of the patients. It is also important that a healthcare practitioner must submit and update himself in the recent studies and developments related to the treatment of COPD to deliver an effective approach to treatment. References American Thoracic Society. (2009). Anatomy and Function of the Normal Lung. Retrieved 18 November 2011, from http://www.thoracic.org/sections/copd/for-patients/anatomy-and-function-of-the-normal-lung.html Barnes, P. (2000). ‘Chronic Obstructive Pulmonary Disease’, The New England Journal of Medicine, 343 (4), pp. 269-280. Fabbri, L., Luppin, F., Beghe, B., and Rabe, K. (2008). ‘Complex Chronic Comorbidities of COPD’, European Respiratory Journal, 31(2008), 204 – 212. Foster, J., Yawn, B., Abdolrasulnia, M., Jenkins, T., Rennard, S., and Casebeer, L. (2007). Enhancing COPD Management in Primary Care Settings. Retrieved 17 November 2011, from http://www.medscape.com/viewarticle/558990 Global Initiative for Chronic Obstructive Pulmonary Lung Disease, GOLD. (2008). Pocket Guide for COPD Diagnosis, Management, and Prevention. Retrieved 15 November 2011, from http://www.goldcopd.org/uploads/users/files/GOLD_AtAGlance_2010.pdf Kozier, B., Erb, G., Beerman, A., and Snyder, S. (2004). Fundamentals of Nursing, 7th Edition. Upper Saddle, New Jersey: Prentice Hall. Lokke, A., Lange, P., Scharling, H., Fabricius, P., and Vestbo, J. (2006). ‘Chronic Obstructive Pulmonary Disease’, THORAX, an International Journal of Respiratory Medicine, 61(2006), pp. 935 – 939. Available at: http://thorax.bmj.com/cgi/content/full/61/11/935 National Heart Lung and Blood Institute. (2010). COPD. Retrieved 15 November 2011, from http://www.nhlbi.nih.gov/health/health-topics/topics/copd/ Simpson, A. and Rocker, G. (2008). ‘Advanced Chronic Obstructive Pulmonary Disease: Rethinking Models of Care’, Oxford Journals, 101(9), pp. 697 – 704. Sutherland, R and Cherniack, R. (2004). ‘Management of Chronic Obstructive Pulmonary Disease’, The New England Journal of Medicine, 350(26), pp. 2689 – 2697. Torpy, J. (2011). Generalized Anxiety Disorder. The Journal of the American Medical Association, 305(5):522. Available at: http://jama.ama-assn.org/content/305/5/522.full.pdf Torpy, J., Burke, A., and Glass, R. (2008). ‘Chronic Obstructive Pulmonary Disease’, JAMA, 300(20), 2408. Available at: http://jama.ama-assn.org/cgi/reprint/300/20/2448.pdf (Accessed: November 18, 2011). van der Valk, P., Monninkhof, E., van der Palen, J., Zielhuis, G., van Herwaarden, C. (2004). ‘Management of Stable COPD’, Patient Educ Couns, 52(3), 225 – 9. Woodley, M. and Whelan, A. (1992). Manual of Medical Therapeutics. 27th Edition. Boston: Little, Brown, and Company. Read More