Client Education for COPD Patient: A Case Study

This paper reviews a case study of a COPD patient and discusses topics for client education, appropriate educational strategies, and evaluation of patient satisfaction. It also provides an overview of COPD and its treatment.

Introduction
Patients’ education in controlling and treating any disease is very much assistive.
Proper education about controlling any chronic disease helps a patient to live a better life by
managing it. Various chronic diseases are there and one of them is COPD. It stands for
Chronic Obstructive Pulmonary Disease. In this physical condition patients find difficulty in
breathing and completely emptying the air from the lungs (Sin et al. 2016). It is very common
health issue but can be very dangerous and it is considered as one of the biggest disease that
causes massive illness and deaths among the patients (Karrasch et al., 2016). This paper is
going to review a case study of a COPD patient. Considering the main health concern, topics
for client education will be discussed in the paper. Different appropriate educational
strategies to educate patient about the disease will also be described. Finally, the paper will
conclude with the evaluation of patient’s satisfaction and reflection on the study.
Overview of the patient
In the case study, the patient, Mr. George Polaris is an Italian who has been diagnosed
with Chronic Obstructive Pulmonary Disease and he has been admitted to the chest infection
department with fever and shortness of breath along with some productive cough. Due to his
illness he has lost several kilograms from his body and he is depressed that he might have got
old and will no longer be able to work anymore as he works as a labourer in a construction
industry. George is having a background of gastro-oesophageal reflux disease (GORD) and
he has been prescribed intravenous antibiotics, IV therapy as well as bronchodilators. George
is a smoker since when he was 14 years old and even he used to smoke 20 cigarettes per day.
However, he is not alcoholic and has no known allergies. From the assessment of his
condition, it has been found that his body temperature is 36.7 degree Celsius, his blood
pressure is 135/88 mmHg, pulse rate is 100 beats/min, and respiratory rate is 22 breathe/min.

He takes Esomeprazole magnesium (Nexium) 40 mg PO OD and now he has been prescribed
for Salbutamol (Ventolin)100 micrograms MDI, 2 puffs when required up to 4 times daily
and Tiotropium (Spiriva) 18 mcg inhaled by mouth OD.
Health concern
It is important to identify the primary health concern of any patient in order to begin
or prepare a proper nursing care strategy. From the various health issues, the main issue is
identified and after that, the nursing plan is set as per the priority. The client in this case has
different types of health problems and he is already under medication for his gastro-
oesophageal reflux disease. But, the main issue, for which he has been admitted to the
hospital, is his shortness of breath along with fever and cough. He has been diagnosed with
COPD. His smoking pattern is mostly associated with his disease and his professional life can
also be hampered if it is not controlled properly (Marks, 2018). He has also been prescribed
with many new medicines which needs some knowledge about how to use that. So, keeping
the main health concern regarding the COPD in mind, some topics of client education will be
provided.
Treating COPD
Removing the root cause of lung inflammation is the main method of treating COPD.
For most of the people, the main cause of COPD is smoking cigarettes. There is no good way
to recover the lung damage, but stopping the bad habit of cigarette can slower down the loss
of lung function (Corsonello et al., 2015). It is important for all the patients of COPD to stop
smoking as soon as they have been diagnosed with the disease. Medicines can also help a
COPD patient to control the disease and in such case, medicines are provided in the form of
inhaler which directly helps to reach the medication at a good amount in the lungs. Several
types of medications are used in this disease and they are bronchodilators, steroids,

phosphodiesterase , antibiotics, oxygen therapy, and others. Apart from that, vaccination,
pulmonary rehabilitation program can help a COPD patient in managing the disease
(Mendoza & Cooper, 2016). In some extreme cases, lung volume reduction surgery and
transplantation can be helpful in the condition of the patients with severe COPD. However,
the condition of COPD worsens slowly and it causes permanent lung damage and even heart
failure which can take the lives away too (Von Nussbaum et al., 2016). So, controlling COPD
is highly recommended and it helps a patient to live a better life. Simultaneously, with the
medication process some self-management techniques are required too. These techniques can
be achieved with a proper knowledge and education. In this case, topics of client education of
George as per his condition will be described.
Two topics of client education
George has been admitted to the ward of chest infection and he is suffering from the
issues of COPD and considering his health condition, two different topics of client education
can be included. These topics can be helpful in the self-management process for this disease
and it can provide knowledge to the patient which will be helpful in getting some relief also.
From many studies, it has been found that COPD patients are educated with various programs
and plans that can address the primary health concern (Melzer et al., 2017). These topics
generally form the education component of a pulmonary rehabilitation program and at the
very beginning of the programs the topic are included. However, various factors are
associated with the disease which requires knowledge and education to control but from those
the main issues are chosen as per their priority and effectiveness. So, for this patient, two
different topics for client education can be,
1. The role and correct use of medication
2. Breathing techniques to manage breathlessness.

The following section discusses how these topics can address the health concern for the client
with COPD and how this can assist the patient in the self-management for his chronic illness
will also be discussed (Melzer et al., 2017).
Role of each topic in addressing the health concern
Breathing techniques
Pulmonary rehabilitation program is highly beneficial for the COPD patients. In this
multidisciplinary approach, breathing exercise training and education about the proper usage
of medicines can be extremely helpful for the patients in improving functional capacity and
lowering the mortality rate of the disease (Hyland et al., 2016). The breathing exercise
technique includes pursed lip breathing and diaphragmatic breathing.
In pursed lip breathing, the patient will be more focused and stay calm which should
be used during and after any action or exercise (de Araujo, Karloh, Reis, Palú & Mayer,
2015). In this method, a patient needs to blow out through the lips pursed as if he is blowing
out a candle (Damle, Shetye & Mehta, 2016). In a study that compared health-related
equality, it has been found that after eight to twelve weeks of training and execution, pursed
lip breathing showed a significant improvement among the patients in the dyspnea domain
(Roberts, Schreuder, Watson & Stern, 2017). Diaphragm breathing technique helps the
patient to use their abdominal wall instead of using the chest wall (Lee, Cheon & Yong,
2017). Studies revealed that, after four weeks of training, the method improved dyspnea and a
six minute walk test also proved that this technique improves the functional capacity among
the patients (Roberts, Schreuder, Watson & Stern, 2017).
Usage of inhaler devices

Inhaler devices are used in the medication of COPD patients, but assessing correct use
of inhaler can be problematic among patients. So, education is a critical factor to distinguish
the use and the misuse of the inhaler devices. With the proper use of inhaler devices, a patient
gets relief in a faster way (Jolly, Mohan, Guleria, Poulose & George, 2015). Studies related to
this revealed that patients who cannot use inhaler properly, are more likely to suffer from the
affects of the disease (Pothirat et al., 2015). Therefore, patients’ education about the proper
usage of inhaler devices is highly necessary.
Two education strategies
In order to educate George about the topics which are addressing the main health
concern two different education strategies can be chosen. Considering the condition of
George, he can be educated individually and in group session. Educating the patient about the
proper usage of inhaler devices will be done in individual training and in order to educate the
patient about the methods of breathing exercises, he will be participating in a group session
along with his family.
Principles of patient education
In order to motivate the patients who are suffering from COPD and their families to
adopt the behaviours to address and improve their health, an effective education and teaching
is necessary (Arora et al., 2014). To achieve effective teaching, the educator must learn the
necessity of the patient and educator must acquire some appropriate methods to motivate the
patients and their families to learn the change process. So, it is actually a guiding process that
helps in the acquisition of knowledge and adopting new behavioural practices (Arora et al.,
2014).
Individually

George will be taught about the usage of inhaler devices during an individual training
session. In this method, some inhaler devices will be used for demonstration. The registered
nurse will demonstrate the optimal usage of inhalation devices. In this case, the patient has
been prescribed Salbutamol and Titropium which consists of inhalation devices and these are
new for patient. Considering the prescribed medicines, demonstration devices will be
collected from the manufacturers. Some relevant videos will be shown to the patient to
visually describe the patient about the way of using that. Some free handouts will be provided
to the patient that will describe the process in a step-by-step method. The language will be
understandable to the patient. After the demonstration, the patient will be asked to show how
he will use the device to crosscheck if he has acquired the technique effectively or not. It will
also reflect if he is having any difficulty while using the device.
In group session
In order to teach the patient about the breathing techniques, he will be called for a
group discussion session along with his family members. In the group session, many COPD
patients will participate. Some videos and charts will be shown. There will be lecture about
the effectiveness of the usage of breathing techniques. Group education is very much helpful
in the intervention of COPD patients (Sanchis, Gich, Pedersen & Team, 2016). Flip-board
with large sheets of paper, erasable markers, and some materials relevant to the group session
such as copies of the action plans for COPD, brochures to give the patients and their families
etc. will be used in the group session. Discussing important practical experiences will also be
included in the group session. At the closing of the session, patients will be suggested for
some homework exercises to integrate the learned skills.
Evaluation patients’ satisfaction

At the end of the sessions, patient will be asked some questions regarding the whole
learning procedure to assess how it has helped to acquire the knowledge to manage COPD.
Reflection using Gibbs Cycle
Being a registered nurse, I believe that my culture, language and behaviour can
influence the whole interactive session as Mr. George Polaris was from Italy. Even,
mismanagement can hamper the education session too.
Feelings
I was alarmed with the existence of cultural differences that could slower down the
teaching process. So, I assured the patient about the language. Even, my attitude and
behaviour also differs from the patient’s culture.
Evaluation
Teaching George was extremely challenging for me as the main barrier was the
language difference. So, I tried to arrange the whole session in a language, which will be
clearly understandable by both of us. Stopping the patient from smoking was also difficult so
I used some practical examples to describe the negative outcomes of cigarettes.
Analysis
COPD is a common health issue and the education strategy to provide knowledge
about the self-management technique is very useful. Teaching patients with cultural
difference is challenging but nurses learn to value all the cultures while providing care.
Conclusion

Looking back at the incident, I can see that valuing all the cultures is very much
important. Patients can be sensitive about their cultural beliefs so while providing care,
nurses should be highly attentive.
Action Plan
In future, I will try to develop my assertive skill in this regard in order to ensure the
patients’ satisfaction and I will try to discuss with my mentors to learn more strategies while
dealing with such COPD patients.

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