Nursing Care of a Patient with Chronic Obstructive Pulmonary Disease - Assignment Example

NUR250 Assessment 1 S1 2017 Assignment template Task 1: Understanding nursing problems Ineffective airway clearance The inability to remove obstructions and discharges from the respiratory tract is one of the most common problems that COPD patients experience. The constriction of bronchial muscle walls, which is referred as bronchial spasm is a major cause of ineffective airway clearance. Instances of increased secretion production, as well as the presence of a viscous and thick secretion, may also result in ineffective airway clearance (Hill, Patman, & Brooks, 2010). Impaired gas exchange Deficit or excess carbon dioxide elimination and oxygenation of blood at the alveolar-capillary membrane also ranks as a common problem affecting COPD patients. Impaired gas exchange results from the variation of oxygen supply which occurs due to airway obstruction due to the presence of secretions. Destruction of the alveoli as we well as changes in the capillary membrane in the alveoli can also result in imbalanced gas exchange; therefore, lead to instances of impaired breathing (Strickland, et al., 2013). Risk of impaired ventilation COPD is a progressive disease with the severity of the disease increasing with time. As the disease progresses instances of emphysematous destruction and airflow limitation may result in ventilation mismatch; therefore, an increased risk of developing alveolar hypoxia (Kent, Mitchell, & McNicholas, 2011). Reduced muscle function in the alveoli may also result in an increased risk of impaired ventilation. Imbalanced nutrition: less than body requirements People with COPD also experience problems in nutrition, which occurs due to insufficient intake of nutrients. Imbalanced nutrition results in reduced metabolism; therefore, a patient appears weak. Instances of imbalanced nutrition may occur as a result of dyspnea which results in difficulties in chewing or swallowing food (Alibakhshi & Shirvani, 2015). Cough secretion and fatigue as a result of breathing difficulties also affect food intake; therefore, may result in imbalanced nutrition in COPD patients. Risk for infection Patients with COPD also experienced an increased risk of pathogenic organism invasion. This increased risks of infection occur due to different reasons including instanced of malnutrition, which is quite common in COPD patients (Alibakhshi & Shirvani, 2015). The increased risk of infection may also be due to disease progression. Instances of insufficient primary defenses caused by slowdown or stoppage of secretions may also lead to an increased risk of infections in COPD patients. Task 2: Care planning (704) Nursing Care Plan: Neville Note: Dot points recommended in care plan. Click and type in each cell, click enter in a cell to make it longer A reminder that all information must be referenced Nursing problem: Dehydration Underlying cause or reason: Reduced Fluid volume in the respiratory track Goal of care Nursing interventions/actions Rationale Indicators your plan is working Improve patient hydration levels Help improve mucus clearance from the respiratory track Keep and Maintain a fluid balance chart monitoring the patient’s fluid input vs. output. Increase Neville’s fluid intake to achieve a minimum of 2500 ml per day. Keeping a fluid balance chart allows assessment of the patient’s hydration levels; therefore, preventing instances of dehydration. Intake of water and other oral fluids helps maintain a balance between fluid loss and intake; therefore, ensuring hydration. The patient should not complain of thirst; therefore, indicating adequate hydration. The patient will experience better mucus clearance; therefore, indicating adequate hydration within the respiratory track Nursing problem: Impaired Mobility Underlying cause or reason: The patient is experiencing problems with mobility due to issues of fatigue, and shortness of breath. Goal of care Nursing interventions/actions Rationale Indicators your plan is working Help improve Neville’s mobility rates without putting his body through unnecessary strain. Assist the patient to move around the ward towards the bathroom by either providing support or providing patient with a wheelchair. Encourage the patient to walk several steps in the hospital room while at the same time encourage regular rest periods between the walks. A walking stick may be provided to aid in patient mobility. Providing support while the patient is walking will promote reduced use of oxygen. Maintaining a balance between activity and rest allows reducing instances of fatigue. The patient should be able to walk for several steps without requesting for rest. Energy conservation through activity rest balance will result in instances of less fatigue. Nursing problem: Fatigue and decreased energy Underlying cause or reason: Fatigue and decreased energy may also result in Neville experiencing impaired ventilation. Goal of care Nursing interventions/actions Rationale Indicators your plan is working Ensure the patient attains enough rest; therefore, fewer instances of fatigue. The provision of respiratory support using oxygen inhalation is one intervention that will assist in improving Neville’s ventilation; therefore, assist in reducing the amount of energy spent during breathing. (Kent, Mitchell, & McNicholas, 2011). The provision of a pillow while sleeping or during rest will help in reducing promoting comfortability; therefore, ensure the patient is achieved rest. Introduce resting periods after every activity will also help in ensuring the patient achieves acceptable levels of rest. Provision of Naval prone oxygen will assist in relieving dyspnea; therefore, reduction of fatigue due to less energy being spent during the respiratory process. Provision of a pillow will allow comfort; therefore, promote rest. Neville should also report feelings of rest at the end of the shift; therefore, illustrate the reduced difficulty in breathing. Nursing problem: Imbalanced nutrition: less than body requirements Underlying cause or reason: Sputum production and dyspnea result in difficulties in chewing and swallowing food; therefore, result in imbalanced nutrition. Fatigue due to spending energy during breathing may also affect food intake. Goal of care Nursing interventions/actions Rationale Indicators your plan is working Promote progressive weight gain to achieve normal weight for Neville. Ensure lifestyle change to ensure the patient achieves and maintains the appropriate weight. Assess the patient’s nutritional habits including information on food intake. This involves evaluating the patient's weight as well as assessing the degree of difficulty experienced by the patient in chewing and swallowing food. Use a food chart to ensure [patient achieves acceptable nutrition levels. (Rutten, Wouters, & Franssen, 2013). Dyspnea and sputum production results in poor eating habits. Assessment will allow planning on how to improve the patient’s diet to ensure nutritional goals are met (Rutten, Wouters, & Franssen, 2013). Resting before meals allow reduced fatigue; therefore, allowing increased intake of meals. Small frequent feedings also promote higher intake of calories. An indicator that the care plan is working will involve an increased intake of food by Neville at the end of the shift due to reduced fatigue. Another indicator will be weight gain as will be noted by the Daily weighs. Nursing problem: Risk of infections Underlying cause or reason: Infections can arise due to decreased patient safety Goal of care Nursing interventions/actions Rationale Indicators your plan is working Top ensure the patient is warm and comfortable; therefore, promote faster recovery. Ensure the patient's room is properly ventilated; therefore, reduce the number of irritants in the air. Ensure the patient's head is elevated at 30 degrees always to ensure the patient is comfortable. Provide patient with warm clothing, or a blanket to ensure the patient is always warm. Proper ventilation ensures the patient’s surroundings are clean and free of infectious substances. Proper ventilation also results in easier breathing; therefore, ensuring the patient is comfortable. Elevating the patient's head will result in improved comfort levels. The patient should report instances of improved health as well as comfort during the shift. Task 3: Medication management Oral prednisone Prednisone is an anti-inflammation drug that stops the production of inflammatory substances in the body. The corticosteroid is used to treat a range of ailments including breathing problems. Lung irritation is quite common in COPD patients, with its intensity increasing due to disease progression (Oh-Young & Sin, 2012). Lung inflammation negatively affects the amount of oxygen absorbed by the body. Neville is experiencing an imbalance in Carbon dioxide—oxygen exchange which may be due to irritation of his lungs. Oral Prednisone has been prescribed to aid in lung inflammation. Prednisone, however, works by weakening the body’s immune system to a different illness. Nurses administering oral prednisone should consider ensuring the patient is kept away from any infections. Ipratropium bromide via nebulizer Patient with COPD experience diverse symptoms with the most common being shortness of breath and wheezing. Health practitioners prescribe Ipratropium to COPD patients to assist in the prevention and control of COPD symptoms. According to Cheyne, Irvin-Sellers, and White (2013) ipratropium assists in relaxing airway muscles; therefore, allowing a patient to breathe easily. Neville’s symptoms include shortness of breath; therefore, ipratropium bromide via nebulizer has been prescribed to aid in the control of this symptom. The use of ipratropium bromide, however, results in side effects including dizziness and stomach upsets. Severe symptoms may include worsening problems in breathing especially immediately after use. When administering this medication, nurses should ensure the availability of quick-relief medication to assist the patient with the breathing problems that may result due to administering of ipratropium bromide Oral amoxicillin Amoxicillin is a penicillin-type drug used to treat diverse bacterial infections. Patients with COPD often experience increased bacteria concentration in the airway. Bacteria including Streptococcus pneumoniae and Mycoplasma pneumoniae are common infectious agents that attack COPD patients (Evensen, 2010). Amoxicillin is mainly prescribed to patients experiencing moderate and severe exacerbation. Neville is currently in the moderate stage of illness; therefore, the main reason for the oral Amoxicillin prescription. The prescription is meant to help prevent failure of treatment methods as well as prevent further infection in the respiratory track. The use of antibiotics, however, may result in increased risk of developing resistance against microbial (Evensen, 2010). A nurse should ensure that antibiotics use is guided by patient symptoms; as well as data on microbial resistance patterns. Such considerations will help in the reduction of the risk of developing resistance. Antibiotics should also not be used on a continuous basis as continuous use increases microbial resistance. Task 4: Patient Teaching Breathlessness is one of the most common and frightening symptoms of COPD. Patients with COPD experience challenges when breathing, which results in fatigue. Educating a patient on energy conservation techniques assists in managing the issue of breathlessness. One major technique that patients should learn is those that aim at controlling breathing. Breathing techniques including diaphragmatic breathing and pursed lip breathing are crucial in conserving energy. These techniques assist in fighting shortness of breath as well fatigue. Another breathing technique that patients should learn to conserve energy is exhaling while performing the hardest part of any action. Another energy conservation technique that Neville should learn is avoiding unnecessary activities that may result in using more energy. An example of an unnecessary activity may include drying off using a towel as well standing up while doing activities that can be done while sitting. Rather than using a towel, Neville can use a terry cloth to dry after a shower. Sitting down while performing activities such as shaving allow conservation of up to 25% of energy. Organizing daily activities is another energy conservation technique that COPD patients should learn. An activity organization routine that Neville should learn is the performing of strenuous activities early in the day. Neville can also learn about the need to alternate easy and difficult tasks to ensure he does not use all his energy early in the day. Another daily planning skill to teach Neville is the need to include rest periods while performing activities. Neville should also learn the need to balance between rest and activities to ensure energy conservation. Task 5: Clinical judgment and handover During the meal break, the patient started experiencing some complications with breathing, which prompted a fellow nurse to give Neville prn salbutamol nebulizer to help regulate the breathing. However, further inquiry into the patient’s condition revealed other problems including an elevated heart rate, increased oxygen saturation, and drop in the respiratory rate. In my diagnosis, I believe the patient is experiencing pulmonary hypertension. Increase in the blood pressure results in a shortness of breath, as well as increased instances of sweating. The immediate interventions to take would be taking a test to assess Neville’s blood pressure levels. The second step would involve lowering his blood pressure using medication such as Sodium nitroprusside. According to Belani (2014) the use of sodium nitroprusside allows reduction in blood pressure to normal levels within a short time. However, the use of this drug results in a need for constant observation of the patient as the use of Sodium nitroprusside can result in excessive lowering of the blood pressure. Patient Hand over The patients name is Neville, a 62 year old man suffering from moderate COPD. Neville was admitted to the hospital for the past two days due to problems with breathing as well as a worsening cough that was characterised by increased sputum production. During his stay at the hospital, Neville’s condition has improved but has not returned to normal. His heart rate and blood pressure are still elevated and he still reports shortness of breath and dyspnoea. Neville is receiving nasal oxygen at 2L/min. He also uses a nebulizer to enhance his breathing. His diet mainly involves proteins and carbohydrates,. Neville is also required to take oral fluids at certain times to maintain hydration levels. Recent issues with his health include recent rise in blood pressure which was controlled using Sodium nitroprusside. Neville should receive constant attention to ensure he does not experience any more incidents involving his blood pressure. Neville’s breathing should also be constantly observed. References Alibakhshi, E., & Shirvani, H. (2015). Nutritional Status in Patients with Chronic Obstruction Pulmonary Disease (COPD) - Review Article. EC Nutrition, 267-274. Belani, K. G. (2014). Sodium nitroprusside in 2014: A clinical concepts review . Journal of Clinical Pharmacology, 462-471. Cheyne, L., Irvin-Sellers, M. J., & White, J. (2013). Tiotropium versus ipratropium bromide for chronic obstructive pulmonary disease. The Cochrane Collaboration, 1-39. Disler, R., Gallagher, R., & Davidson, P. (2012). Factors influencing self-management in chronic obstructive pulmonary disease: An integrative review. International Journal of Nursing Studies, 230-242. Evensen, A. E. (2010). Management of COPD Exacerbations. American Family Physician, 607-613. Hill, K., Patman, S., & Brooks, D. (2010). Effect of airway clearance techniques in patients experiencing an acute exacerbation of chronic obstructive pulmonary disease: A systematic review. Chronic respiratory disease, 9-17. Kent, B. D., Mitchell, P. D., & McNicholas, W. T. (2011). Hypoxemia in patients with COPD: cause, effects, and disease progression. International Journal of COPD, 199-208. Oh Young, J., & Sin, D. D. (2012). Lung inflammation in COPD: why does it matter? BMC Journal, 4-23. Rutten, E. P., Wouters, E. F., & Franssen, F. M. (2013). Malnutrition and obesity in COPD. European Respiratory Monogr, 80-92. Strickland, S. L., Rubin, B. K., Drescher, G. S., Haas, C. F., O’Malley, C. A., Volsko, T. A., . . . Hess, D. R. (2013). AARC Clinical Practice Guideline: Effectiveness of Nonpharmacologic Airway Clearance Therapies in Hospitalized Patients. Respiratory care, 2187-2193. Read More