Advanced Practice Nursing: Managing Declining Lung Function

Running head: ADVANCED PRACTICE NURSING
ADVANCED PRACTICE NURSING
Name of the Student
Name of the university
Author’s note

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Question 1
The subjective data that the patient will share are chest tightedness, difficulty in coughing. The
patient can also share that he faces difficulty while breathing, with wheezing sounds while
breathing (Abramson et al., 2016). The patient should also share whether he have to clear their
throat in the morning due to excess mucus in the lungs. The patient should also share whether the
patient suffers from chronic cough with whitish sputum (Bentsen, Rustøen & Miaskowski,
2012). The old man has also reported that he lacked energy.
Question 2
The case study reveals that the patient was suffering from declining lung function. It is necessary
to auscultate the breathing sounds. It is necessary to note adventitious breath sounds apart from
wheezing, like presence of crackles or rhonchi or noting rate. It is necessary to note the severity
and the degree of restlessness or presence of air hunger, or whether the person was having
difficulty while talking or is breathing with pursed lip (Slattery et al, 2017). It is necessary to
assess that the patient feels comfortable while sitting at the elevated position. It is also necessary
to observe and monitor and graph the serial ABGs, chest x-ray and oximetry (Abramson et al.,
2016). It is necessary to demonstrate the chest physiotherapy, such as the bronchial tapping when
in cough and proper postural drainage. Furthermore, it is also necessary to monitor the skin color
and the color of the mucous membrane, as cyanosis might indicate towards severe hypoxia
(Slattery et al, 2017). Again, it is necessary to monitor the level of consciousness and the mental
status of the patient. The activity tolerance level of the patient has to be evaluated. The sleep
patterns as well as the cardiac rhythms has to be monitored (Bentsen, Rustøen & Miaskowski,
2012). The case study reveals that the concerned individual feels fatigued and has less appetite
for food (Abramson et al., 2016). Hence, it is necessary to ascertain the understanding of the

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patient about the nutritional requirement and the dietary habits. In order to rule out the chance of
infection, it is necessary to monitor the body temperature, the odor of the sputum apart from the
color (Bentsen, Rustøen & Miaskowski, 2012).
Question 3
The National Action plan has been set with the aim to implement some proven strategies for
preventing or improve the lung function. The National Action plan is equipped with 5 goals that
has to be met. The initial strategy goal is to empower the patients, parents and the families. The
health care professionals has to be properly equipped in order to provide a comprehensive care to
the people suffering from declined lung function. The COPD research has to be increased and
sustained. As per the goal four, it is necessary to facilitate and encourage the translation of basic
science COPD aetiology and the pathogenesis studies in to epidemiology and the clinical
research involving patients. The American lung association had also set up some strategies in
order to manage with a declined lung function. Guidelines contain tips for increasing the lung
functions, the preventive measures that needs to be adhered, life style that can be followed.
Question 4
The lung function can be measured by the help of spirometry. The variables of the pulmonary
function can be assessed from spirometry. Furthermore, is also used to determine the alterations
in the lung function over time. There are several processes for determine if decline in the
FEV1over time is more (Redlich & Tarlo, 2015). One of the easiest way to determine to
determine whether the observed decline in FEV1 from initial baseline spirometry to follow-up
is>15% (Redlich & Tarlo, 2015). There are other pulmonary function tests that are non-invasive
tests that will show how the lungs had been working. The tests are used to measure the capacity,

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volume, rates of flow and the percentage of gas exchange. Plethysmpgraphy is a method where
the [patient can be asked to stand inside an air tight box that looked like a short telephone square
booth for conducting the tests (Redlich & Tarlo, 2015). Pulmonary function tests are used for
measuring the tidal volume, which is the amount of air inhaled or exhaled at the time of the
normal breathing process. The functional residual capacity is also measured, which is the amount
of the air exhaled per minute. A breathlessness scale can be used for determining the rate of
breathing difficulty by the help of American Thoracic society. In order to find out if there is any
infection, it is recommended to collect the sputum that is obtained by deep coughing and they
will be subjected to gram stain and cultured for finding out the type of microorganisms.
Question 5
A consultation is required in this case, as last year the problem was managed with the
prescription of an albuterol inhaler, but it is evident from the case study, the symptoms of the
patient had worsened in a year. This can be due to the fact, that patient had not quit smoking
even after repeated intimation to quit smoking (COPD.NIH.GOV. 2018). Furthermore, it is
necessary to investigate whether the patients had contracted any lung infection that requires
treatment. As airway infection might accelerate the deterioration of the lung function. It has
already been recognised that patient with the COPD develops bacterial colonisation in the lower
part of the airways. About 20-25 % of the people suffering from COPD have been found to be
suffering from airway infections (COPD.NIH.GOV. 2018). The colonisation of bacteria further
exacerbates the symptoms of COPD. In order to evaluate the risk factors of lung declination,
consultation is required. Another reason behind consultation is to re-educate the patient about the
life style that has to be followed. The patient needs to be educated about the ill effects of
smoking, as the patient still continues to smoke, even after a comprehensive decline of the lung