Chronic Obstructive Pulmonary Disease - Research Proposal Example

Running Head: Nursing Care & Management Nursing Care & Management [Institute’s Nursing Care & Management Introduction Chronic Obstructive Pulmonary Disease COPD is a respiratory disorder that results in problems in breathing process. As time passes, patients’ situation worsens. Experts believe that smoking is one of the most significant factors for the occurrence of COPD along with few other factors, such as air pollutants, dust, chemicals that cause irritation in the lungs (National Heart Lung and Blood Institute, 2009). Lung functions to take in oxygen from the atmosphere in the form of air and facilitates in the removal of carbon dioxide. When a person breathes and takes in the air, it goes into bronchial tubes, which has many branches with air sacs at their end and is elastic. Thus, when a person inhales, lungs expand and they contracts at the time of exhalation. In COPD, flow of air lessens due to destruction of the walls of these airways, as they become thick, and make mucus more than usual (Chadwick et al, pp. 19-22, 2001). COPD is not a single disease; it includes four conditions: chronic bronchitis, chronic asthma, emphysema, and small airways disease amongst which Emphysema and Chronic Obstructive Bronchitis are two main conditions. Emphysema involves a condition in which air sacs wall damage and become floppy which leads many tiny air sacs into few larger ones. In Chronic Obstructive Bronchitis, the airways lining become thick which makes mucus in larger quantity leading to breathing problem. Seventy-five percent people are unaware that they are suffering from COPD. Thus, they are not taking any precautions to stop the progress of this disease (Lavelle, 2008). In this regard, it is very imperative for healthcare and nursing management organizations to take effective steps for alleviation of this chronic disease that is very frequent in people older than sixty to sixty-five years. Specifically, this paper will attempt to identify factors that play a crucial role in the management and care of patients suffering from chronic obstructive pulmonary disease. In addition, the paper will endeavor to discuss few studies associated with the effectiveness of available care facilities for COPD patients. Moreover, the paper will try to recognize significance of health education and promotion for patients with such disease. Literature Review According to World Health Organization, the total number of COPD patients at a specific time is 600 million worldwide (Stockley, pp. 83-89, 2007). The fifth greatest cause of mortality worldwide is COPD. Chronic diseases such as cancer, strokes, and coronary artery disease will decrease by 2020 whereas COPD will become the fifth major cause of morbidity and death. People at the age of 45 years with COPD symptoms if screened to evaluate, and if they quit smoking at that stage, it can save them from developing symptomatic COPD. This will save million of government funds that they sanction for COPD patients, and will lessen burden from the healthcare and nursing management organizations (Stockley, pp. 83-89, 2007). Studies indicated that breathlessness is the key symptom of COPD. Problem in running involves one of the symptoms of COPD. However, with the passage of time, COPD leads to a worsen condition limiting the patient’s capabilities, and individuals are often unable to perform daily chores, such as cooking, washing, cleaning, getting dressed, etc (Petty & Hodgkin, pp. 66-68, 2003). This can lead to many problems in a person’s life ranging from early retirement to social isolation. Other symptoms involve coughing, heart failure, pneumonia, hypoxia in which, organs do not get enough oxygen that can damage them. Coughing is also one of the frequent symptoms of COPD patients (Bellamy & Booker, pp. 27-33, 2004). In this regard, healthcare organizations are endeavoring to aware people, especially adults above age of sixty years to control these symptoms, in order to stop the growth of COPD. These steps include quitting smoking, in taking of healthy diet, regular checkups, becoming a part of support group. Analysis of the literature related to COPD indicated that proper care and nursing during early symptoms of COPD improves the lifestyle of the patient. If a patient quits smoking during early stages of COPD, they save themselves from the devastating effects of this irreversible illness. Optimal bronchodilator therapy that is very important and useful for breathlessness and empowering tolerance helps patients (Pearson et al, pp. 47-50, 2003). This therapy involves relaxing the bronchial muscles through medications making larger airways so that a person can breathe easily (National Heart Lung and Blood Institute, 2009). Many kinds of bronchodilators are available, which are short term as well as long term. Thus, bronchodilators are grouped together to provide the maximum benefit to the patient. People having breathing problem take bronchodilators regularly known as maintenance medication, whereas reliever medications solve temporary breathing problem (American Thoracic society, 2009). Professional healthcare professionals have specified that beta–agonist helps the airways muscles to relax when airways narrow down making it difficult for the person to breath. Inhalation is the way beta–agonist helps patient other than pills and intravenous injections as they have side effects. Within 3 to 5 minutes, short–acting beta-agonist works; however, has an effect not more than 46 hours. Whereas, long-acting beta-agonist lasts for 12 hours (Cherniak, pp. 55-59, 2002). The side effects of beta- agonist include affecting the muscles of heart, airways, and bones. Heart starts pumping faster causing palpitation whereas cramps may take place in legs and feet due to which a person encounters nervousness that eventually leads to breathlessness. These side effects may last for few minutes and stay for few days after which, they go away. Sometimes, side effects last for longer period due to which patients need to change their medicine (Halpin, pp. 99-100, 2004). Nursing care and management professionals are endeavoring to provide all such information to people suffering from COPD, or smokers aged above 45 years of age, and prospective patients of COPD above sixty-five years. In this regard, experts are attempting to recognize the significance of awareness and they make patients understand that exercise is useful along with changing their lifestyle as if they should become health conscious to overcome excess weight. There are numerous negative effects of the disease on the patient including social and psychological aspects. Thus, positive measures to overcome such effects help the patient to lead a normal life (Bames & Page, pp. 49-51, 2004). In primary nursing care, diet intake makes a lot of difference in the health of the patient. Food having antioxidants protects the patient from the harmful effects of smoking. Thus, diet consisting of vitamin C is very useful for COPD patients according to studies related to nursing care and COPD (Quinn, pp. 51-52, 2005). Analysis of the literature specified that coal mining, cotton ginning, welding fumes, dusty environment are occupations along with adverse effects of smoking that lead to COPD, and healthcare organizations are focusing specifically on adult persons belonging to these professions (Hunter & King, pp. 603-612, 2001). Air pollution may also lead to COPD as it has various fumes of petrol, sulphur dioxide, and photochemical pollutants produced by ozone depletion. Indoor air pollution from the charcoal burned for cooking may also be risky (The Australian Lung foundation, 2009). Healthcare studies suggested oxygen as the efficient natural treatment for hypoxemic patients in COPD. Other than this, Methylxanthine therapy and Antibiotic therapy is a preferable treatment that facilitates COPD patients in treating this chronic disease. In particular, antibiotics help to fight with bacteria since respiratory infections with the passage of time worsens. Infectious signs may start from coughing, increased level of mucus and phlegm production. Mucolytic drugs help to break sputum and clear up the mucus from the airways, N- acetylcysteine is a drug that is useful in overcoming this problem. It comes in liquid as well as in tablet form. Antibiotics are not useful unless there is infection. It is an observation during the analysis that health promotion related to COPD involves awareness of the side effects of antibiotics that include diarrhea, skin rash, stomachache, and serious allergy. Older broad-spectrum antibiotics involve the treatment of COPD patients who have exacerbation from mild to moderate level. However, the treatment of patients with more severe condition involves third generation amino glycosides or cephalosporin. Regular monitoring and oxygen therapy helps to reduce complications in COPD. Combination drugs are also useful for COPD patients in which two medicines like steroid and beta-agonist work together. This can help patient more effectively while each medicine separately would. Very few types of combination medicines are currently in the use amongst which the most common combination is of short acting anticholinergic, short acting beta- agonist, and inhaled corticosteroid (Jenkins, pp. 20-24, 1999). The side effects of these combination medicines depend upon the medicines that are in collaboration. Surgery is beneficial for patients who have no change in their condition via different suggested therapies (Bellamy & Booker, pp. 11-18, 2004). In specific to COPD, lung function tests (NICE, pp. 1-232, 2004) are major developments in the diagnosis of COPD. Literature indicated that COPD may exacerbate with deterioration of respiratory systems, and thus, lung function tests help healthcare professionals in reducing the risks of such exacerbation. In this regard, lung function tests attempt to identify any factors showing increased frequency of bronchodilators, and then, include Corticosteroids and stimulants (Hunter, pp. 105-120, 2009) to manage exacerbation of COPD in a pharmaceutical manner. As earlier mentioned that oxygen is a natural treatment, so Oxygen therapy has now become an effective treatment to manage COPD along with pharmaceutical processes according to the reports of Care Committee of the British Thoracic Society (pp. 192-211, 2002). However, organizations (Royal College of Physicians et al, pp. 1-10, 2008) are training nurses and professionals, as careful monitoring of gases levels is an important task in oxygen therapy, and lack of optimization during the therapy may result in adverse outcomes (Lynes, pp. 54-55, 2003). In addition, studies indicated requirement of another complicated step: interpretation of arterial blood gas that helps nurses in the comprehensive understanding of blood gases (Allen, pp. 42-45, 2005). Experts believe that all such steps can be lifesavers in the cases of chronic obstructive pulmonary disease; however, efficient assessment of nurses is critical for the success of these interventions. Besides therapies, surgeries and pharmaceutical treatments, studies (Morgan, pp. 46, 2003) specified the existence of palliative nursing care for various diseases, especially cancer. However, palliative care is not available for COPD patients that results in a very deprived and painful quality of life for patients with severe conditions of chronic obstructive pulmonary disease. In comparison of patients suffering from lung cancer and patients experiencing COPD, the former group enjoys a number of advantages due to availability of palliative care; however, COPD patients belong to a disadvantaged sector in the society. Experts believe that evaluation of needs for palliative care can be practical in the presence of a healing relationship, and thus, nursing care management professionals always try to create such relationship in a therapeutic manner with COPD patients. Review indicated that experts and patients could manage this disease with early interventions of supportive and analgesic care. In addition, such early interventions play a crucial role in the development of coping strategies, essential for the improvement of quality of patient’s life. In this regard, nursing care professionals and organizations are introducing a number of programmes for the improvement of patients’ quality of life, such as pulmonary rehabilitation programme and courses (Morgan, pp. 46, 2003) that provide outreach nurses facilitating in the process of developing coping strategies. In this regard, specialized nurses are playing a vital role by participating in palliative nursing and supportive programmes to enhance quality of life of COPD patients. However, there is shortage of these specialist nurses, and thus, a number of organizations are offering courses and trainings that may increase their quantity. For instance, the British Lung Foundation is one of the organizations that have significantly contributed for the cause of COPD and other lung diseases. The foundation has a specific ‘Breathe Easy Club’ (Morgan, pp. 46, 2003) that offers provision of practical support to people with lung disease and particularly COPD. Besides courses, a comprehensive range of brochures, booklets, and information sheets are available from the foundation that helps people in preventing and dealing with COPD in an efficient manner. As earlier mentioned that COPD has now become a major root cause of mortality and morbidity in different parts of the globe, and thus, healthcare organizations are putting efforts to provide effective treatments and provided appropriate guidelines to nurses for efficient clinical practice. One of the significant characteristics of these guidelines is their evidence-based perspective that allows application of learnt theories in practical manner. In the United Kingdom, the National Institute of Clinical Excellence (NICE, pp. 1-232, 2004) is playing a significant role in the development and provision of such guidelines with the collaboration of the World Health Organization (Hunter, pp. 105-120, 2009). These guidelines have indicated that ten percent people above sixty-five age experience chronic obstructive pulmonary disease, and thus, it is imperative that to take proper steps to reverse the process and mitigate the factors that contribute in worsening of this disease. NICE (NICE, pp. 1-232, 2004) and WHO have predicted that COPD will one of the five death-taking diseases in the United Kingdom by the year 2020 (Hunter, pp. 105-120, 2009) unless healthcare organizations nursing management professionals endeavor to treat patients and aware them of the consequences. During the identification of literature related to COPD, the researcher recognized an imperative study (Cydulka & Emerman, pp. 1807-1812, 1997) that focused on the effects of COPD and asthma diseases on utilization of healthcare facilities with case study of elderly patients. For this study, beneficiaries aged sixty-five or above of the Healthcare Financing Administration were selected that received diagnosis for the abovementioned diseases. Experts noticed that the group of 1984 consisted of more than 150,000 patients that experienced worsening situations of COPD. Data for the 1991 indicated 131,974 patients with similar cases (Cydulka & Emerman, pp. 1807-1812, 1997). Results of the study pointed out that as patients’ age increased, their length of stay in hospital increased. Moreover, discharge rate decreased with the increment in age factor. Moreover, statistics for the year 1984-1991 specified that patients utilized healthcare centers and nursing homes after their discharge from hospitals, and such utilization increased significantly every year (Cydulka & Emerman, pp. 1807-1812, 1997). In this regard, nursing care and management plays a crucial and significant role in the treatment of COPD, especially in elderly patients aged sixty-five or above. In the year 2005, another group of experts (Reyes & Merino, pp. 189-95, 2005) focused patients suffering from COPD and attempted to analyze the effectiveness of PPV (pneumococcal polysaccharide vaccine) in such patients. Study selected approximately 600 patients aged above sixty-five years, and results indicated that only 300 patients received PP vaccines. Studies (Reyes & Merino, pp. 189-95, 2005) have specified greater effectiveness of PPV in the prevention of CAP in individuals experiencing COPD conditions. Study (Reyes & Merino, pp. 189-95, 2005) noted that hospital admission was an essential process in COPD patients, even if they received PP vaccines, and expensive medical costs was one of the major factors of avoiding such effective vaccines by 300 patients. In this regard, experts (Reyes & Merino, pp. 189-95, 2005) concluded that it is very imperative for healthcare organizations and state to provide cost-effective vaccines to the patients that will increase the utilization and efficacy of this treatment. Moreover, the study suggested utilization of PPV by COPD patients, especially in the situation of rigorous obstruction in the airflow process. Lastly, experts (Reyes & Merino, pp. 189-95, 2005) indicated the need of further researches with bigger groups related to efficacy of COPD treatments and PP-vaccines that will allow concrete results. In another study, experts (Nishimura, pp. 588, 2009) selected patients experiencing COPD above seventy years of age. In specific, chronic respiratory disease, survey along with another questionnaire allowed the evaluation and analysis of pulmonary functions, as well as health status of the participants. During the 6-month analysis, approximately fifty participants suffered from exacerbations and their scorecard of symptoms showed a noteworthy decline; however, no such clinical decline appeared in the cases of participants that experienced no worsened situations. Results of the study showed that fatigue and mastery factors were outcomes of worsened conditions of the patients, and thus, concluded that one should take such steps to prevent regular frequency of severe exacerbations in COPD patients, which will allow minimization of weakening and decline of patients’ health status (Nishimura, pp. 588, 2009). Literature review identified a recent research (Kaul, pp. 1081, 2009) carried out in London city of the United Kingdom on the COPD. In addition to COPD, the study focused on non-invasive ventilation that is playing a significant role in treating COPD patients, and a number of UK national healthcare organizations are recommending its utilization for COPD patients. Specifically, these non-invasive ventilations facilitate patients in dealing with COPD exacerbations. For such purpose, the study attempt to evaluate the implementation of national guidelines in different parts of the London. During the year 2003, the Royal College of Physicians along with the British Thoracic Society carried out a national audit related to COPD, indicated that approximately eight percent of hospitals were not offering non-invasive ventilation, and thus, were not following national guidelines. Moreover, the audit ruled out that thirty-nine percent of hospitals had no availability of NIV in their intensive care units, followed by thirty-six percent of hospitals with no NIV in their general wards. Only thirty-percent of London hospitals had availability and access to NIV in all three units (Kaul, pp. 1081, 2009). The research concluded that unavailability of NIV has caused problems for nursing care and management, and it is essential for hospitals to offer NIV facilities, as its utilization will lessen burden on healthcare and nursing professionals. Conclusion Conclusively, the paper discussed and analyzed literature related to the Chronic Obstructive Pulmonary Disease, and it is an observation that although it is one of the significant causes of morbidity and mortality; however, it is irreversible. In this regard, it is very imperative for nursing care and management professionals to take efficient steps by the provision of health education and promotion to the prospective patients of chronic obstructive pulmonary disease. Immediate steps include smoking cessation and utilization of various treatments available for COPD that will allow specialist nurses and healthcare professionals in treating COPD patients in an efficient manner. It is an expectation that the paper will be beneficial for students, teachers, and professionals in better understanding of the topic. References Allen, K. (2005). “Four-step method of interpreting arterial blood gas analysis.” Nursing Times. 101: 1, 42–45. American Thoracic society. (2009). “What kind of medications are there for COPD.” American Thoracic Society. Retrieved on Aug 26, 2009: http://www.thoracic.org/sections/copd/for-patients/what-kind-of-medications-are-there-for-copd/ Bames, Peter J. & Page, C. P. (2004). Pharmacology and therapeutics of asthma and COPD. Springer. Bellamy, David & Booker, Rachel. (2004). Chronic obstructive pulmonary disease in primary care. Class Publishing. pg 3, 8, 10, 11. British Thoracic Society Standards of Care Committee. (2002). “Non-invasive ventilation in acute respiratory failure.” Thorax. 57: 3, 192–211. Chadwick, Derek. Goode, Jamie, & Novartis Foundation. (2001). Chronic Obstructive Pulmonary Disease. The University of Michigan Press. Cherniak, Neil S. (2002). Chronic Obstructive Pulmonary Disease. Saunders. Cydulka, Rita K. & Emerman, Charles L. (1997). “Patterns of Hospitalization in Elderly Patients with Asthma and Chronic Obstructive Pulmonary Disease.” American Journal of Respiratory and Critical Care Medicine. Volume 156, Issue 6, pp. 1807-12. Halpin, David M. G. (2004). COPD. Elsevier Health Sciences. Hunter, M. H, & King, D. E. (2001). “COPD.” Journal of American Family Physician. Volume 64, Issue 4, pp. 603-612. Hunter, S. (2009). “Holistic assessment of patients with COPD before the use of non-invasive ventilation.” Nursing Times. Pp. 105: 20. Jenkins, Mark. (1999). Chronic Obstructive Pulmonary Disease. Hazelden Information & Educational Services. Kaul, S. (2009). “Chronic Obstructive Pulmonary Disease.” Health & Medicine Week. Issue of Sep 07, 2009, pp. 1081. Lavelle, Peter. (2008). “COPD.” ABC Health & Wellbeing. Retrieved on Aug 25, 2009: http://www.abc.net.au/health/library/stories/2008/08/12/2317968.htm Lynes, D. (2003) “An introduction to blood gas analysis.” Nursing Times. 99: 11, 54–55. Morgan, Sarah. (2003). “Supportive and palliative care for patients with COPD.” Nursing Times. Volume 99, Issue 20, pp. 46. National Heart Lung and Blood Institute. (2009). What is COPD. Retrieved on Aug 24, 2009: http://www.nhlbi.nih.gov/health/dci/Diseases/Copd/Copd_WhatIs.html NICE (2004) “Management of Chronic Obstructive Pulmonary Disease in Adults in Primary and Secondary Care.” Thorax. 59: 3, 1–232. Nishimura, K. (2009). “Chronic Obstructive Pulmonary Disease.” Biotech Week. Issue of Sep 09, 2009. Pp. 588. Pearson, Michael, Pearson, Mike, & Wedzicha, Jadwiga Anna. (2003). Chronic Obstructive Pulmonary Disease. Wiley-Blackwell. Petty, Thomas L., Hodgkin, John Elliott. (2003). Coping with COPD. St. Martin’s Griffin. Quinn, Campion. (2005). 100 questions & answers about chronic obstructive pulmonary disease. Jones & Bartlett Publishers. Reyes, N & Merino, M. (2005). “Clinical efficacy of anti‐pneumococcal vaccination in patients with COPD.” Thorax. Volume 61, Issue 3, pp. 189-95. Royal College of Physicians et al (2008) Concise Guidance to Good Practice. Non-invasive Ventilation in Chronic Obstructive Pulmonary Disease. RCP. Stockley, Robert A. (2007). Chronic Obstructive Pulmonary Disease. Wiley-Blackwell. The Australian Lung foundation. (2009) Better living with COPD. Retrieved on Aug 24, 2009: http://www.lungfoundation.com.au/content/view/252/275/ Word Count: 3078 Words Read More