Service Delivery Management PDF

CARE DELIVERY AND MANAGEMENT
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CONTRIBUTING TO CARE DELIVERY AND MANAGEMENT OF A COPD PATIENT
By Student’s Name
Course + Code
Class
Institution
Date

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Patient Admission
Mr. James, a 69 years old man comes to St Bartholomew's (Bart's) hospital with his
wife complaining of difficulty in breathing and shortness of breath. James says “ever since
this cold weather started, I have been having a hard time breathing. I need my lungs to be
checked”. James wife explains that James has been having a hard time recently to the extent
that he could not do normal routines anymore. In addition to that, James stated that he had
had persistent coughs, especially during the night. Although a cough is productive, James and
his wife fail to give an estimate of the sputum produced. Sleeping in the bed has been a
problem in the previous night that he spent setting his back on his easy chair. James wife
further explained that it is by her effort that James was able to come to the hospital. James
wife came had come with the last medical records for review.
Past Medical/Surgical History
James reported having been admitted several times in the past years. The patient was
first diagnosed with Chronic Obstructive Pulmonary Disease(COPD) at the age of 65 years
and admitted for one month. One year later the patient was diagnosed with type 2 diabetes
and Osteoporosis of which the conditions were managed. James was on anti-diabetes
medication for one year at which the condition was later managed using diet and physical
exercises. From the past health records, the patient was put on biophoshates for the treatment
of osteoporosis. At the age of 67 years, the patient developed hypertension of which the
condition was managed using several antihypertensives. Patient has been on a proper diet and
physical exercises until recent days where he could not perform enough activities. The patient
has healthy siblings.

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Social history
James is married with four children of which three are girls and one boy. Patient has a
forty years history of smoking cigarettes. James used to smoke one pack of cigarette daily but
reduced to a quarter pack after being diagnosed with COPD. The patient explains he had not
been able to quit smoking, but he is working toward it. Patient has 35 years of taking alcohol
but entirely after diagnosed with diabetes and osteoporosis. Currently, the patient lives with
his wife only as all the children are grownups working at long distances from home. No
known allergies.
Current medication
James has been on prednisolone 30mg daily, Saltemerol inhaler 50 twice daily, Aspirin 81mg
daily and tiotropium inhaler only when needed.
Physical examination and Assessment data
Warm skin and dry with no rashes. BP170/87. RR 32, Temperature 37.5 celsius,
weight-76kilograms, 5’9, pulse rate80 beats per minute, oxygen saturation 85%.No skin
crackles, patient well nourished. The patient seems confused. Spirometry of FEV1 45% is
predicted that does not seem to change with the use of inhaled bronchodilators. The patient is
audible but unable to make full sentences. The patient has dyspnea with a productive cough
with grey sputum, audible wheezing, mild chest tightness. Patient seems to adopt tripod
sitting position .the use of accessory respiratory muscles and neck muscles while breathing is
noted.
Independent contribution of care by Assistant Practioner
As an assistant practitioner, the first line in managing the Patient is by detecting and
checking the presence of airway obstruction by performing the post-bronchodilator

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spirometry (Wise, 2016). James seems to have an air obstruction. His spirometry is FEV1 of
45 %, indicating his condition is severe(NHS, 2018). James will definitely need a formoterol
20 mcg inhaled via nebulizer in 12 hours or indacaterol 75 mcg inhaled orally daily(NHS,
2018). Musculonist agonist such as glycopronium one capsule inhaled per twelve hours using
a neon inhaler can be useful(NHS, 2018).
If Long-acting beta-agonist does not work, add an added dose of inhaled
corticosteroid can also be used if James continues to have shortness of breaths(NHS, 2018).
This includes drugs like a high dose of budesonide powder inhalation of about 1200ug (Wise,
2016). Since James seems to have developed exacerbations, pulmonary rehabilitation should
be advocated and made available to him (Wurst, Punekar, and Shukla, 2014).Management of
exacerbations should be minimized by giving advices to James and his wife. In addition, the
assistant practitioner should always respond immediately to any symptom of an exacerbation
(Resuscitation Council,2015). Other than that, appropriate use of inhaled corticosteroids,
vaccination with pneumococcal vaccine and bronchodilators should be enhanced. Try to use
noninvasive ventilation whenever indicated and advocating for the hospital at home can also
be used in the management of James condition(Resuscitation Council,2015).
In addition, giving James proper education and psychological support in order to help
him cease smoking completely can be one of the essential actions of James management.
James should be explained the need for quitting smoking encouraged to stop and even given
an offer in the process to promote positive results (Wurst, Punekar, and Shukla, 2014).
James who is at risk of having more COPD aggravating factors should be given a self-
management advise which will encourage him to respond promptly and call for help when
symptoms arise. James should be instructed to start oral corticosteroids whenever the
breathing start interfering with daily living activities(Resuscitation Council,2015). The