Health Issues of Adult with Chronic Obstructive Pulmonary Disease - Case Study Example

Adult with Chronic Obstructive Pulmonary Disease or COPD Student’s Name Institution of Affiliation Adult with Chronic Obstructive Pulmonary Disease or COPD Introduction A 72-year old male admitted with infective exacerbation of Chronic Obstructive Pulmonary Disease or COPD despite being on 2L/min of Oxygen. David’s COPD is linked to his teenage-initiated smoking and consists of night coughing with thick green sputum and two days starvation prior to admission. The tongue was white, lips cracked and dry, and dark amber urine. On admission, David weighed 55kgs and was 176cm tall. In the ward, says he can’t get his breath despite receiving 3rd hourly nebulised ventolin coupled with 2lL/min of Oxygen through nasal prongs. The observations include HR 90/min, 92% Oxygen saturation, RR 26, and 37.80 C temperature. David also has IV Cannula and 6 hourly IV hydrocortisone and IV antibiotics. David still coughs, uses his shoulders and upper chest to breath, chest has coarse crackles, minimized air entry into lower lobes, and with prolonged expiratory phase. The two problems are ineffective airway clearance and imbalanced nutrition and fluid. COPD Problem one: Ineffective Airway Clearance According to Vestbo, et al [Ves13], COPD patient assessment must revolve around the assessment of symptoms, airflow limitation severity, exacerbations limitations, and comorbidities. The major cause of COPD in David is his smoking which he began since teenage and only quite three years ago. COPD symptoms demonstrated by David include poor lung function characterized by coughing more especially during the night and too much spectrum which has turned thick green in colour [Gar11]. Additionally, David’s respiratory rate is at 26, coughs using his shoulders and upper chest, and has lungs characterized by sound coarse. Furthermore, he has a noticeably prolonged expiratory phase. According to Hollandl & Bottonl [Hol06], COPD is predominantly in small airways and lung parenchyma which then prompts the need to clear the airways. The two interventions for the problems are corticosteroids and administration of fluids. The first intervention for COPD is corticosteroids administration to David. Corticosteroids are anti-inflammatory drugs the decrease the inflammation in the airways for asthmatic or COPD patients. They work by reducing the swelling of the airways and reduce the production of mucus thereby making breathing easier. Corticosteroids are an effective collaborative nursing management of COPD with a doctor and are applicable especially when the symptoms get worse rapidly due to increased production of mucus. According to Raissy, Kelly, & Harkins [Rai13] inhaled corticosteroids are extensively used in the treatment of COPD given their anti-inflammatory effect’s ability to improve the functioning of the lungs, quality of live, symptoms, and reduction of exacerbations. Cigarette smoke exposure results to progressive obstruction of the airways, and propensity of colonization by bacteria contributes to disease worsening. However, the use of long acting bronchodilators suppresses chronic inflammation involved in the disease pathophysiology[Bar13]. Normally, corticosteroids are delivered using a metered-dose inhaler or MDI although there are dry powder inhalers or DPI available as well. Inhaled corticosteroids mostly benefit patients when used in low to medium doses and are preferred for management of COPD across all ages[Rai13]. This is because at lower doses, the involved risks are few and combining them with long-acting beta2-agonist results to improved function of the lungs, breath shortness, and reduced use of relief medicine compared to when used alone or in to a placebo. The use of corticosteroids with long acting bronchodilators will result to opening of the airways by removing sputum hence demonstration of effective cough, breath sounds are cleared, easing of breath, respiratory frequency gets to normal range, and no pursed lips. Despite the ability to clear the airways, and reduce exacerbations, corticosteroids have associated risks. Corticosteroids are extremely toxic and their prolonged use could result to complications like increased blood sugar level associated to diabetes, adrenal insufficiency and osteoporosis. Since David is under bronchodilators, combining them with corticosteroids will manage his condition especially in airways mucus clearance. Corticosteroid administration to David will assist in clearing the mucus in the airways and reducing the swellings thereby facilitating normal flow of air. The use of corticosteroid on David will involve closely monitoring of drug use for side effects and taking any necessary immediate action where needed and ensuring drugs are taken on time. The second intervention for David’s COPD’s ineffective airways clearance condition is administration of fluids[Kee08]. This is an independent nursing management scheme aimed at loosening the mucus in the lungs. Fluid administration in COPD patients required informed findings from evaluation of fluid balance on the patient and involves providing the patient with 8-12 glasses of caffeine-free liquids daily or providing decaffeinated coffee or tea. The intervention process ensuring that patient takes the recommended amount of water daily on reasonable intervals to fight dehydration, assist the immune system and clear the lungs. Mucus-free lungs facilitate the patient’s effective coughing, slow and deep breathing for pulmonary secretions mobilization and prevention of further complications[Kee08]. Thinning and clearance of pulmonary secretions is essential for patients under supplemental oxygen which dries mucus membrane and cause irritation. For David, fluid administration is essential given that he is under oxygen therapy and lung sound coarse crackles and decreased air entry into both lobes. Through fluids administration, the lungs will be cleared of mucus with no sounds; expiratory phase will be shortened, while breathing will not require the use of shoulders and upper chest. Like other interventions, the associated benefits are the thinning and clearance of pulmonary secretions and mucus in the chest and keeping patient hydrated[Kee08]. However, for patients with fluid retention, fluid intake would worsen the situation. For David, fluid intake will normalize expiratory phase and mucus-free lungs that will facilitate easy breathing. Fluid administration to COPD patients results to mucus clearance and hydration in COPD patients. Best results are achieved by educating the patient on the right sitting position, and educating family for association and help in case of emergency as well as providing them with a plan after discharge[Kee08]. Problem II: Imbalanced nutrition and fluid-less than body requirements For most COPD patients, loss of appetite results to malnutrition which plays a significant role in patient’s physical performance, development of complications and general prognosis[Swe12]. In the case of David, he says he has not eaten or drunk much within the last two days. Malnutrition is evident in his look which presents him as pale and very unwell. Additionally, at a height of 176cm, David only weighs 55kgs and is aged 72 years. Closer monitoring also reveals cracked and dry lips with a white tongue. David’s urine is also Dark amber in colour and very small in amount. The diminished body weight is correlated with dramatic reduction in the size and strength of the respiratory muscle[Swe12]. As result, balanced diet and right fluid intake are essential in the maintenance or improvement of nutritional status and energy metabolism. The first intervention involves selection of a nutritional supplement to provide nutritional benefits to the patient in between meals like bread sticks with cheese sauce, eggs, cookies, and super shake among others. This is a collaborative nursing management given that it involves a dietician or nutritionist to work with the patient during and after discharge [Swe12]. The nutrition intervention process will involve exploration of the patient’s and family’s dietary practices and offering the patient with high-protein, high-energy, nutritious snack and drink. The selection of high calorie diets should focus more on high fat foods other than high carbohydrates given that patients with COPD are unable to exhale excess carbon dioxide which is the nature end product of carbohydrates metabolism. Additionally, high energy fat foods are readily consumed hence provide sufficient energy and protein whose consumption does not also need much effort[Gul13]. Additionally, the nurse also offers and advices patient to take supplemental vitamins and pre-packaged food supplement like snack bars or milk shakes between meals since they are a perfect source of proteins and calories. Since large meals require more energy to digest, patient is advised to focus on taking small meals more frequently since these can be tolerated better. This intervention is suitable for COPD patients given that they have to maintain adequate nutrition to improve their energy metabolism and nutritional status. Additionally, nutrition intervention is essential in maintaining optimal weight for gender, age, and height. For David, this intervention will mean that at his age and height, his weight will be within the right BMI requirements. Additionally, he will no longer look pale and so unwell despite hic COPD condition since he will have the right food and drink requirements plan to achieve daily diet requirements. The benefits linked to proper nutritional planning include improved physical performance, rare or no development of clinical complications and general prognosis[Swe12]. However, Gulanick [Gul13] highlights those large food intakes could slow response given that they require longer time and effort to consume, while high carbohydrate supplements could results to increased carbon dioxide production. For David, proper nutritional intake will result to less clinical complications and better physical performance. Nutritional supplements for COPD patients are provide additional protein and energy required to keep the patient physically active, thereby preventing clinical complications. The second intervention involves monitoring fluid ingestion and calculating the amount of fluid intake to determine adequacy. This is an independent nursing management scheme intended at ensuring that the patient remains hydrated at all times. This intervention involves the patient keeping their fluid levels at the right level through frequent monitoring and replacing them especially after meals while ensuring distribution during the day. This is because too much fluid intake during meals results to a tendency of getting fuller much quickly and could also cause bloating. When filled up quickly, the result is less food intake and breathing difficulties. Although fluid intake is essential for pushing food down, the main reason for regular fluid consumption is to thin the mucus in the lungs and making it easy for the body to cough it up. For David, monitoring fluid ingestion and calculating amount of fluid intake will ensure that the adequate fluid intake is adhered to ensure that the airways remain moist hence thinning the mucus produced and easing its clearance. The volumes used in the replacement of fluid for David should be calculated individually with respect to factors like age and the possibility of possible accompanying clinical conditions. According to NICE clinical Guidelines [NIC13], monitoring includes measuring heart rate which should not be more than 90 beats per minute, respiratory rate of less than 20 beats per minute, current trends in weight, fluid balance charts, and trends in urine colour. The resulting benefit is the maintenance of adequate total body water in patient to allow mucus thinning and clearance. However, too much fluid accumulation in the body would result to interference of normal body activities like breathing[Wal11]. For David, monitoring fluid ingestion and calculating the best intake amount will mean that the body remains well hydrated, urine colour changes to clear, lips no longer dry and cracked, and tongue whiteness reduced. Evaluation Criteria With ineffective airways clearance, the evaluation data revolves around capturing side effects resulting from drug use to allow necessary action if needed, and timely drug administration. Evaluation also involves teaching the patient on the right position to sit during fluid administration and educating family on how to assist. Conversely, evaluation on imbalanced nutrition and fluid below body needs will involve data on nutritional adequacy, and on weight subject to height and age for appropriate body mass index. For David, improvement will involve, rare or no exacerbations, normalized breathing, less sputum production coupled with eased coughing with the right drug administration. Additionally, the respiration rate will be lowered. Additionally, correct fluid administration will indicate chest clear from coarse sounds and shortened expiratory phase, and breathing does not use shoulders and upper chest. Adherence adequate nutrition will result to sufficient energy and protein intake thereby demonstrating improved physical performance and less clinical complications. Additionally, fluid ingestion and calculation will facilitate the acquisition of the right body mass index in terms of weight subjected to height and age. References Ves13: , (2013), Gar11: , (Garcia-Aymerich, et al., 2011), Hol06: , (2006), Rai13: , (2013), Bar13: , (Barnes, 2013), Rai13: , (Raissy, Kelly, & Harkins, 2013), Kee08: , (Kee & Polek, 2008), Swe12: , (Swearingen, 2012), Swe12: , (Swearingen, 2012), Gul13: , (Gulanick, 2013), Gul13: , (2013), NIC13: , (2013), Wal11: , (Walter-Kroker, Kroker, Mattiucci-Guehlke, & Glaab, 2011), Read More