Patient Assessment and Care Plan for Chronic Obstructive Pulmonary Disease (COPD)

Medical Surgical Nursing
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Consider the patient:
In this essay, case of Newman is being discussed. He is a 44-year man admitted to the
hospital ward due to infective exacerbations of Chronic Obstructive Pulmonary Disease
(COPD). Mr. Newman is associated with risk factors of COPD like smoking and drinking.
He was experiencing activity intolerance due to augmented breathlessness. He lives with his
wife and 2 teenage children. Clinical reasoning cycle need to be used for carrying out holistic
assessment of Newman. With reference to the clinical reasoning cycle, information about the
patient should be gathered (Levett-Jones, 2017). Complete clinical assessment of Newman,
collected information should be processed (Levett-Jones, 2017). Collected and analysed
information indicated that he is associated with respiratory distress.
Patient assessment:
Complete clinical assessment of Newman, collected information should be processed (Levett-
Jones, 2017). Medial assessment for Newman needs to be carried for three conditions like
respiratory assessment, cardiovascular assessment and nutritional assessment. Information
about Newman was gathered from the case study. From the gathered information, it was
evident that he was associated with infective exacerbation of Chronic Obstructive Pulmonary
Disease (COPD). He was heavy smoker which is one of the significant risk factors for
COPD. As a result, he was experiencing breathlessness. Since, Newman was having COPD;
respiratory assessment should be performed in him. Respiratory assessment in Newman
should be performed through recording respiratory rate, measuring ABG levels (measurement
of pH, PaCO2, HCO3 and PaO2), and observing and noting breathing pattern. Moreover,
pulmonary function test should also be carried out in Newman for respiratory assessment
(Baroi, McNamara, McKenzie, Gandevia, and Brodie, 2018). Inflammation in COPD
produces augmented levels of secretions and hyperplasia of bronchial wall which results in
ineffective airway clearance. Impaired gaseous exchange occurs in patients with COPD with
decrease in the blood oxygen level. Since, COPD and cardiovascular disease occur together;
it is necessary to perform cardiovascular assessment in him. COPD and cardiovascular
diseases are linked together through pathophysiological link in the form of lung
hyperinflation, systemic inflammation and COPD exacerbations. Moreover, COPD treatment
proved effective in the improvement of cardiovascular conditions. Cardiovascular assessment
should be performed in Newman through monitoring heart rate, heart beat rhythm, heart
sound, peripheral pulses and blood pressure (George and Green, 2018). Patients with COPD
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might experience cardiovascular conditions like arrhythmia, myocardial infarction, or
congestive heart failure. Due to hypoxemia in the COPD patients, there would be
abnormalities in the right ventricle (RV).COPD patients are usually associated with the
nutrition associated changes like weight loss and malnutrition. Observed deviation from the
normal values in both respiratory and cardiovascular assessment would indicate respiratory
and cardiovascular dysfunction. Malnutrition usually occur in COPD patients mainly due to
resting energy expenditure, decreased food intake, the effects of certain drugs, and, perhaps
most importantly, a high systemic inflammatory response. Nutritional assessment should be
done in Newman through measurement of nutrient intake and measuring corresponding
height, weight, circumference and skinfold (Benoist and Brouquet, 2015). Food consumption
in COPD patients might decrease due to resistance in swallowing and chewing mainly due to
dyspnea, alteration in taste of food due to mouth breathing, excessive mucus production and
constant coughing (Rabe and Watz, 2017; Yang et al., 2017).
Care plan:
Collected and analysed information indicated that he is associated with respiratory distress
(Levett-Jones, 2017). Identified nursing diagnosis in Newman were ineffective breathing
pattern, ineffective airway clearance and activity intolerance. One of the priority nursing
diagnosis in case of Newman is ineffective breathing pattern. Main aim of the nurse is to
maintain normal and effective breathing pattern in Newman. Ineffective breathing pattern
would alter normal breathing rate in Newman. Nurse should be aimed to maintain normal
respiratory rate between 10 – 20 breaths per minute. Hence, nurse need to assess and note
breathing rate in Newman after every 6 hours. Insufficient breathing would lead to alteration
in ABG in Newman which produces lessened oxygen level and altered ventilation pattern.
Hence, nurse need to evaluate ABG levels in Newman on regular basis. Abnormal breathing
pattern indicate respiratory disease and dysfunction in Newman; hence, nurse should observe
and monitor breathing pattern in Newman. Nurse should auscultate breath sound for every 6
hours which would be helpful in noticing lessened breath sounds. Ineffective breathing
pattern would lead to reduced lung compliance which would produce increased work of
breathing. Hence, nurse should assess the use of accessory muscle by Newman. Ineffective
breathing pattern occurs due to respiratory muscle weakness. Hence, it leads to paradoxical
movement of the abdomen. Henceforth, it is necessary to monitor diaphragmatic muscle
weakness in Newman (Yang et al., 2017). Difficulty in breathing would lead to flaring of
nostrils due to heightened respiratory effort; hence, nurse should monitor nostrils retractions
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