Clinical Decision-Making base on Case Study

Running head: CASE STUDY
Clinical Decision-Making base on Case Study
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1CASE STUDY
This essay aims to describe the clinical decisions one can act upon for a specific case.
The case highlights a patient, TONY with serious chronic obstructive pulmonary disease
(COPD), which was diagnosed three years back. The patient has habits of regular smoking,
and hence the case of COPD worsened, which enhanced his problems of breathing. When the
patient was brought to the ward, his blood pressure had fallen to 100/64 mmHg, which is
considered as mild hypotension and also had a respiratory rate of 36 with 86 percent of
specific oxygen content. The signs thus have shown mild cyanosis as the patient also shows
Glasgow Coma Scale (GCS) of 15/15, which states that the patient's consciousness is at alert
and can take turn any moment to return to consciousness (BrainLine, 2019).
The essay also identifies the stage the patient is in and follows up with the proper
diagnosis of the disease to treat it properly and to have proper nursing interventions to
provide a better lifestyle for the patient. In order of doing so, it also discusses the certain
model of Coleman transition to overcome COPD. It also discusses Cognitive Behavioural
Therapy (CBT) as a trial to reduce readmissions of COPD patients as happened in this case.
Chronic pulmonary obstructive disease and its signs of Exacerbation
Chronic Obstructive Pulmonary Disorder (COPD) collectively describes the
uncontrolled lungs infection usually triggered by emphysema, chronic bronchial infection and
uncontrolled and irreversible asthma (Copdfoundation.org, 2019).
Emphysema is the state where the alveoli gets impacted as a result of which the inner
membranes of the sac starts disappearing to form a large sac. However, the large sacs fails to
carry the adequate amount of oxygen and hence fails to meet the oxygen requirement of the
body (Copdfoundation.org, 2019).
Whereas the chronic bronchitis refers to the negative impact over the bronchial tube
that reching the lungs. In general, bronchitis is the uneasiness and swelling of the bronchial

2CASE STUDY
tract which reaches the clungs. This irritation causes frequent coughing and inadequate
breathing. When such conditions last for more than three month or more can result in chronic
bronchitis. The bronchial channels are lined with cilia and upon having chronic bronchitis
these cilia gets destroyed and hence becomes unable to push out the mucous in the channels
of bronchial tract (Copdfoundation.org, 2019).
The symptoms those prevail upon having chronic COPD are rough and dry chough,
wheezing, breathing shortness, phlegm and rusty mucoid sputum production and tightness in
the chest. To overcome these certain symptoms measures of pulmonary rehabilitation,
therapy with oxygen, quitting of smoking and specific medications are applied to enhance
tolerance towards exercise and to reduce urges of smoking (Cleveland Clinic, 2019).
The diagnosis was made with a run of scan using the method of Computed
Tomography (CT), an x-ray of the chest, blood tests, spirometry and by culturing the sputum.
When the patient was brought to the ward, the individual has shown serious
exacerbation. Exacerbation is the state of COPD where the condition gets worsened than in
normal state due to serious breathing problems. Chances for a COPD patient always prevails
for having serious exacerbations although it remains in a normal condition but can trigger at
any point of time. Signs, which shows chances of exacerbation are, continued mild fever,
enhanced rescue medication usage, increase in swelling of ankles, change in colour, odour
and thickness of mucus and nausea (Copdfoundation.org, 2019).
In addition, other risks to exacerbation are unrested body, dizziness during verbal
communication and early morning headaches, rapid breathes and intense heart rate.
Exacerbation is mostly caused out of lung infection caused by the impacts of viruses.
Infection by viruses are ineffective toward antibiotics, thus helps in creating an atmosphere

3CASE STUDY
suitable for the bacterium mycobacterium tuberculosis to put impact over the lungs
(Copdfoundation.org, 2019).
In Case of TONY the certain diagnosis were among which CT scan was done to
understand the body functions with tha help of an X-ray imaging via computer. Moreover,
blood tests and chest X-ray was done to understand the conditions of body fluid and
conditions of the lungs and lungs capacity.
Later on spirometry test was done and resulted in chronic asthma as the patients lung
capacity was too weak due to regular smoking. Spirometry test is a mechanism which
measures the lung capacity and answers either the individual is an asthma patient or not.
Social, Cultural and Spiritual beliefs of Care
The variety in faith among the inhabitants of the nation provides medical care
professionals and programs with difficulties for delivering culturally relevant medical help.
Cultural competence is the capacity that will provide medical services to fulfil patients '
cultural, social, and religious requirements and their family members by health professionals
and associations. Social skills can help enhance the quality of treatment and the efficiency of
care. Strategies for pushing medical professionals and programs towards these objectives
require instruction in cultural expertise and the implementation of policies and procedures
that reduce the obstacles to cultural patient safety. If healthcare professionals and programs
collaborate to supply culturally sensitive services, the client may have adverse health effects,
be under-supported and disappointed with the treatment he or she provides. The level of
competent patient-health experiences has plummeted. Improved patient-health experiences in
the medical provider are linked to lower satisfaction. Yes, the consistency of their focus has
been decreased because of the African Americans, Asian Americans, Latinos and Muslims.
The Joint Commission (JCP) calls for the protection of patient privacy rights and economic