Chronic Respiratory Disease - Case Study Example

Chronic Respiratory Disease Introduction Chronic conditions are one of the most difficult conditions to overcome and manage for any patient and for any health profession. These conditions often cause much discomfort and the manifestation of various symptoms sets forth difficulties in the management of daily activities. These conditions often impact significantly on patients and health professionals, making them vulnerable to further health deterioration. This paper shall discuss the case of Carissa, a 79 year old female, admitted for lower back pain, for chronic respiratory disease, and for cognitive impairment. Carissa was admitted two days prior to consultation due to a worsening cough attributed to chronic respiratory disease. She has been afflicted with the condition for three months now and has been seeking medical help, but with limited success as to efficacy of medical care. This paper shall discuss this chronic condition and its impact on the patient as well as the experiences of the patient in relation to the chronic illness. First, chronic respiratory disease shall be defined and described. Second, the experience of the patient with her chronic condition, shall also be discussed, including a comparison to the typical lived experience of those afflicted with this condition. Differences in the perceptions held by patients and their family members concerning their chronic condition shall also be compared to that of the general community. Finally, it shall discuss the self-management education the patient requires, including the discharge plan and community referrals. This paper is being carried out in order to establish a clear comprehension of chronic conditions, their impact on patients, and on outcomes which significantly relate to their overall health and well-being. Body Chronic respiratory disease: chronic obstructive pulmonary disease The patient has been diagnosed with chronic bronchitis. As defined by the World Health Organization (WHO, 2011), chronic bronchitis is included under the umbrella of diseases known as chronic obstructive pulmonary diseases (COPD) which limit the airflow in the lungs. Chronic bronchitis is no longer used as a diagnosis and instead is termed COPD. For purposes of this essay, these two terms shall be used to refer to the same disease afflicting the patient. This disease is mostly known for symptoms like breathlessness, excessive sputum production, as well as a cough which persists for more than 2 weeks. It is potentially life threatening when untreated and unmanaged. COPD gets worse over time and can cause shortness of breath, chest tightness, and wheezing (National Heart Lung Blood Institute, 2010). Many smokers and former smokers are liable to be afflicted with COPD, and other irritants, including air pollution, chemical fumes, and dust may also lead to COPD. As described further by the National Heart Lung Blood Institute (2010), normally, the air enters the lungs through the bronchial tubes; and the end branches of the bronchial tubes are the air sacs known as the alveoli, where the oxygen passes through and enters the capillaries. Carbon dioxide is a by-product of this gas exchange (NHLBI, 2010). The airways and air sacs become inflated during inhalation and become deflated during exhalation. In COPD cases, there is a reduced air flow into and out of the airways due to the airways losing their elasticity, the walls between air sacs being structurally compromised, the walls of the airways being inflamed, and the airways having more mucus, which tends to clog the passages, making it difficult for the air to enter and to complete the respiratory process (NHLBI, 2010). Chronic obstructive pulmonary disease is one of the leading causes of morbidity and mortality in the world (Salvi and Barnes, 2009). Cigarette and tobacco smoking is one of its primary causes, however, among developing countries, other risk factors have emerged throughout the years. For which reason, about 25-45% of COPD sufferers have never actually smoked, but they have been exposed to other factors including second-hand smoke, dust, gases, pollution, and chronic asthma. These factors are all liable to impact on a patient’s health especially those who are already at risk for being afflicted with the disease. Experience of patient with COPD This patient living with COPD has been a smoker for thirty years. This seems to be the main cause of the patient’s chronic bronchitis. In itself, smoking can lead to inflammation; and it can also impact on the bone marrow, causing peripheral leukocytosis, and a dominance of CD8 (T-suppressor), instead of T-helper cells (Gamble, et.al., 2007). Among patients without any lung afflictions, explanations to establish the cause of lung afflictions have to be based on further lung examinations. Nevertheless, smoking is the most common consideration among COPD patients. The patient expressed that for the past thirty years since she has started smoking, she has had numerous respiratory diseases. In a year, she would often have five to ten separate incidents of respiratory afflictions, often lasting more than two weeks and being very difficult to treat. For the past ten years since she experienced other diseases like lower back pain, she also started having more bouts of bronchitis. Her bronchitis caused her to wheeze and sometimes experience productive cough. At the peak of these bouts of bronchitis, she would often experience difficulties in breathing and shortness of breath. At these times, she often also experienced chest pains, fatigue, and she often felt out of breath while carrying out activities which required exertion. She recalls that last year, her COPD manifested at its worse and she observed: bluish discoloration of her lips and fingernails, rapid breathing, laboured breathing, and sometimes she felt like passing out. She also expressed that the quality of her life has been disrupted by her illness because she often had difficulty playing with her grandchildren and even carrying out her simple activities which required exertion. She was easily out of breath while carrying out these activities. As for medications, due to her years of antibiotic use, she has developed a resistance for most antibiotics and so it is taking her even longer to manage or treat any incidence of bronchitis. For which reason, her condition has managed to get worse over the years and her bronchitis has progressed to its chronic stage. Carissa also expresses that she often felt embarrassed by her condition because while walking or going up stairs, she would cough and the sound of her coughing was obviously filled with phlegm and she felt the eyes of people on her; she even could see them visibly trying to avoid her vicinity, she assumed, because of fear of being contaminated by her bacteria. This made her feel like a social outcast, and in order to avoid awkward situations with other people, she has more or less resorted to avoiding interactions with other people. The experiences of Carissa are typical of chronic bronchitis patients. Research indicates that most chronic bronchitis patients are or have been chronic smokers throughout their lives and they have had frequent bouts of respiratory diseases as smokers (Moran-Mendoza, et.al., 2008). These patients also usually manifest with shortness of breath, difficulties in breathing, wheezing, and get easily out of breath while carrying out activities which require exertion. These patients are can only participate to a limited degree, or not at all in sports activities, as well as in work which calls for physical exertion (Ofir, et.al., 2007). The more extreme cases of chronic bronchitis appear with bluish lips and nails and sometimes faint or lose consciousness due to decreased oxygen supply (Dains, et.al., 2007). Their bluish tinge is primarily caused by their compromised oxygen supply; oxygen cannot sufficiently get to the capillaries via the clogged and congested air sacs (Dains, et.al., 2007). The gas exchange process of compromised, hence the decreased oxygen supply, the greater exertion in breathing, the shortness of breath, and the painful chest expansion. Differences in perceptions between patients/family members and general community There are differences in the perceptions of patients/family members concerning chronic bronchitis as compared to the general community. The patient perceives her disease as a significant inconvenience in her life because it interferes in so many ways with her normal activities, including her social activities. However, she also believes that her disease can be eventually managed with adequate care and treatment. In a study by Kaptein, et.al., (2008) the authors sought to establish results on illness perceptions among COPD patients which provide clinicians with data in relation to potential utility in the management of COPD. The authors established that incorporating illness perceptions in the clinical care for patients having COPD is crucial to patient care. In effect, the assessment of illnesses must be routine and very much carried out in terms of pulmonary functions. Consequently, there may be differences in patient and practitioner perception about the disease and its treatment which impact on the efficacy of treatment, as well as the patient’s eventual recovery. The perceptions of chronic illness among patients are based on treatment considerations; however, among the general public, it is based on the lack of remedies for their condition, as well as the stigma against their disease. The general community has a stigma against chronic disease sufferers. They perceive these individuals as different and treat them accordingly. These patients are also ostracized by society, and discriminated against because of their condition. They are perceived as unable to function socially or in the work-setting because of their condition (Larsen and Lubkin, 2009). They are not given enough credit in terms of work capability because their illness is associated with their other activities and capabilities. Due to these perceptions, chronic care patients are often prompted to withdraw from society and to stop working altogether (Larsen and Lubkin, 2009). For the most part, their chronic conditions can be valid grounds for dismissal, especially when the illness interferes with the quality of their work; however, when their ability to perform their work is not affected by their chronic illness, then their dismissal can be considered against the law. Patients perceive that their COPD impacts negatively on their general emotional welfare. They feel that they are unable to do the things they would like to do because of their bronchitis; and that their illness often cripples them and will eventually kill them (Miravitlles, et.al., 2007). They consider that coughing as a part of their disease has the strongest impact on their lives and they desire more than anything to be relieved of this symptom. They feel therefore that health professionals need to address their issues in relation to their coughing in order to ensure a better quality in their life (Miravitlles, et.al., 2007). The general public or community more or less agrees with this perception as they see the patient’s COPD as an extremely debilitating and crippling disorder, one which might eventually kill them. The standard practice in the health practice must therefore be based on relieving patient’s symptoms and quality of life. Self-management education Self-management education for the patient includes education to improve health behaviour. The self-management skill which can be taught to the patient is for her to stop smoking and to remain a non-smoker (Hylkema, et.al., 2007). Avoiding second-hand smoke can also assist in ensuring that she would gradually recover from her COPD. Proper prescription for her medication as well as its use is also an appropriate self-management measure. Teaching the patient to take his medication properly and to comply with the doctor-prescribed dose and advice on medication intake is also part of the self-management process (Hanania and Sharafkhaneh, 2010). In relation to breathing techniques and position, it is appropriate to teach the patient the pursed-breathing technique and the forward body position as a means of improving gas exchange and of easing breathing difficulties (Raupach, et.al., 2008). Teaching regular exercise as well as physical activities is also an important aspect of self-management (Hanania and Sharafkhaneh, 2010). This would include daily physical activities like walking, jogging, climbing stairs, and similar activities as tolerated by the patient. A plan for regular exercise and activity can also planned with the assistance of the physician and of a physical or rehabilitation therapist where appropriate (Hanania and Sharafkhaneh, 2010). Such therapist can assist in ensuring that the exercise or activities of the patient would be well-tolerated and appropriate for the patient’s condition. Finally, it is also important to teach the patient early recognition of exacerbation of symptoms and consequently, to promote early treatment. In this regard, self-management would include getting a flu and pneumonia; identifying the triggers for the COPD; and contacting resource person who can lend support to the program (Hanania and Sharafkhaneh, 2010). Discharge plan Close monitoring for this patient must be secured. Bronchodilator treatments are needed every four hours, and stability must be seen within 12-24 hours before discharge; the patient’s arterial blood gas must register at normal levels as well (Skolnik and Albert, 2008). The patient must also be able to eat and sleep without finding it hard to breath; moreover, as she is mobile upon admission, she should still be mobile upon discharge. Home oxygen needs must be provided as well, and the patient as well as the caregiver must be properly instructed as to the appropriate application of oxygen therapy (Rabe, et.al., 2007). After about a month from the discharge, the patient must be assessed in relation to oxygen use, inhaler use, and his general ability to care for her needs. Needs arising from this follow-up must be addressed. An exacerbation of symptoms must also be addressed and must be closely monitored (Skolnik and Albert, 2008). She must also be referred to the community health centre for the necessary follow-up and monitoring. The social workers, as well as administrators in the community setting would have to regularly deploy health personnel to monitor the patient for exacerbation of symptoms and to make the necessary recommendations for further care, when appropriate (Paganelli and Giuli, 2007). Conclusion Clarissa has COPD or more specifically, chronic bronchitis, as disease she developed mostly because of her years of chronic smoking. Chronic bronchitis is an affliction commonly associated to smoking, with most of its sufferers having had a previous history of smoking. This disease presents mostly with difficulty in breathing, productive coughing, shortness of breath, and in severe cases, loss of consciousness, and a bluish discoloration of one’s nails and/or lips. The symptoms displayed by the patient are similar to those displayed by COPD bronchitis patients. The patient perceived his illness as manageable through adequate treatment; this is different form community perceptions which put a stigma to chronic patient sufferers. In order to manage the patient symptoms, self managed education includes the promotion of a health lifestyle with adequate exercise, cessation of smoking, medication compliance, flu shots, pneumonia vaccination, planning of exercise with the assistance of a trained expert, and establishment of early detection tips to prevent exacerbation of symptoms and ensure early treatment. The discharge of the patient is based on close monitoring, with the assistance of the community services and other monitoring tools. The patient must be discharged based on improved health conditions, especially on breathing and oxygenation. Works Cited Dains, J., Baumann, L., & Scheibel, P. (2007). Advanced health assessment and clinical diagnosis in primary care. Sydney: Elsevier Mosby. Gamble, E., Grootendorst, D., Hatttotuwa, K., O’Shaughnessy, T., Ram, F., Qiu, Y., & Zhu, J. (2007). Airway mucosal inflammation in COPD is similar in smokers and ex-smokers: a pooled analysis. ERJ, volume 30(3), pp. 467-471. 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