Development of a Person-centred Care Plan Assignment 2022

NURS2004
Assignment 2: Development of a Person-centred Care Plan
Man Yu Tsoi (2210192) Class No: NS1
Introduction:
The patient's name is Mr Clarke, a 72-year-old man who is
presented with respiratory distress and anxiety. The patient was
admitted to the respiratory ward of the hospital as he was suffering
from an acute exacerbation of Chronic Obstructive Pulmonary
Disease (COPD). The patient showed symptoms of shortness of
breath, coughing and his body temperature 39 degrees which
meant he had a fever. The subject was diagnosed with acute
exacerbation of Mr Clarke had a history of the past medical history
of hypercholesterolemia, myocardial infarction (MI) and chronic
obstructive pulmonary disease. Mr Clarke has a surgical history of
coronary artery stent insertion and appendectomy. In addition, he
has allergies of Micropore tape – blisters.
The first step is discussing what assessment information should be
collected and how would it be collected. Then, I will focus on
discussing two nursing diagnoses that are ineffective breathing
pattern problems and activity intolerance problems. The third step is
planning the nursing intervention of care patients and goal
outcomes based on the diagnoses. The fourth step is to plan the
implementation of the planned interventions. Evaluation of the
outcomes to check whether the intervention is effective is the
critical step (Toney-Butler, 2019). Moreover, the respiratory nurse,

nutritionist, physical therapist and other health professionals from
the multidisciplinary team (MDT) can deliver patient-centred care,
showing compliance with the bioethics. The law and ethics are an
important part of the nursing profession and it was vital to address
all the aspects in the care process to offer a high quality of care to
the patient. Moreover, the duty of care is taken into consideration
which is stated to be a moral or legal obligation that ensures
patient’s safety by adhering to the standards of care while
performing the act and prevent any harm to the patient. Thus,
identification and assessment of all the vital signs and acting
according is a crucial task for the healthcare professionals in order
to save the life of a patient.
Body 1: (Ineffective breathing pattern)
1) Assessment
According to the record and nursing notes on day 0, Mr Clarke felt tired
and appeared breathless when he was sitting out. In addition, the CT
scan showed and confirmed bilateral lower lobe pneumonia. This above
information can help nurses effectively to carry out the intervention
planning process (Terry, Bowman & West, 2019). In addition, patients
who are unable to breathe properly and who cannot inhale adequately
are shown by improper lung expansion and contraction. Unequal and
strenuous breathing on the sides of the chest, rendered the abdomen
shifted, and attributed to the ineffective breathing patterns (Gil, 2019).
The ineffective breathing patterns signified dyspnea, cough, decreased
total vital capacity, decreased partial pressure of Oxygen (PO2) and

decreased oxygen saturation (SaO2) as per the case study. The partial
pressure of carbon dioxide (Pco2) was also very much raised in the
case of Mr Clake that heightened the risk of cyanosis (Gil, 2019). The
nurse must continuously evaluate the patient, using the Finger pulse
oximeter to assess and record the breathing rate regularly. The average
breathing rate for adults is 10 to 20 breaths per hour and the subject
had 23 breaths per minute that indicates that the breathing rate of Mr
Clake was slightly higher than normal. Nurses can obtain the Arterial
Blood Gas (ABG) level assessments in order to monitor oxygenation
(Ciampoli Botti & Hutchinson, 2017).
2) Diagnosis
Expiration will be reducing the level of Pco2. Otherwise, holding the
breath will cause a large amount of Co2 to be retained in the body,
thereby increasing the level of Pco2 and in the subject, the partial
pressure of carbon dioxide is increased. Chronic Obstructive pulmonary
disease decreases the rate of oxygenation, thus increasing the Pco2
levels. The main cause of the disease is the connection between alveoli
and Co2 accumulates which increase Pco2 levels (Salvatore et al.,
2017). Blocked alveoli can also cause excess Co2 to remain in the
lungs. In other words, hypoxia, anxiety can lead to a decrease in Pco2
levels (Aitken, Marshall & Chaboyer, 2016). Accodring to the diagnosis
of Dr Tara Linee is not speaking in full sentences, was leaning over his
tray table in bed; thus, require support in getting up, appeared to be
diaphoretic and lethargic. After chest X-ray, it was confirmed that he
had bilateral lower lobe pneumonia and the possibility of inhalation of

foreign body was ruled out.
3) Planning
According to the record and nursing notes of Mr. Clarke, the patient
has chronic COPD disease. Based on the above assessment and
diagnosis, the nursing goals are the betterment of breathing issues and
normalizing of the cardiovascular signs. His breathing has to be
normalized with the proper breathing exercises. In case, if their severe
shortness of breath issues, then ventilation can be given to the patient.
Sleep and relaxation should be promoted in the patient. A proper diet
with low fat should be given as the subject has high cholesterol issues.
The subject has anxiety issues for which the talk therapy has to be
given. In addition, the goal of activity intolerance is to increase the
tolerance and endurance of the activity (Williamson 2017).
The nurse attending the patient should start with the patient needs
breathing exercises such as pursed-lip breathing, diaphragm breathing
and Pranayama breathing training is a good way to help the patient.
The pharmacological management with the bronchodilators,
glucocorticosteroids is very much effective as a treatment for COPD’s
patients. The same will be started. Psychotherapy will be administered
in collaboration with a nurse, to reduce anxiety and depression when
they are admitted to the hospital.
4) Implementation
The breathing exercises shall be given in collaboration with a
respiratory therapist. The nurses can directly observe the patient’s vital