Institutional affliation Assignment 2022

Student’s name;
Institutional affliation

Mr. Viktor 63-year-old man is suffering from chronic obstructive pulmonary disease was discharged from
a hospital three weeks ago following treatment for lower lobe pneumonia. Four days ago, a diagnosis of
viral infection was made. Viktor has a medical history of hypertension and obstructive sleep apnea. He is
not for any antihypertensive medication and he smokes cigarettes. Viktor states that he gets breathless
with minimal exertion and cannot attend to is activities of daily living with ease, and he generally feels
unwell. Viktor has an advance health directive stating that he is not for resuscitation. He has been
prescribed anti asthmatic drugs to manage his clinical condition. This assignment will help the reader
understand the application of the registered nurse standards of practice. Especially the 6th and 7th standard,
standards on medication management. The task will incorporate the clinical reasoning cycle in explaining
how Viktor (the patient) will be supported with his medication self-management.
According to Walters et al., 2014, Chronic obstructive pulmonary disease is a group of diseases affecting
the lungs leading to blockage of the airway thus difficulty in breathing. lung diseases that block the
airway leading to difficulty in breathing. It is usually characterized by airflow limitation that is persistent
and is associated with an enhanced chronic inflammatory response in the airways and the lungs. Once the
infection sets in, inflammation sets in as well as a result of lymphocytes recruitment to kill the invaded
microbes (Barnes, 2016). The acute exercerbation of the chronic obstructive pulmonary disease normally
contribute to long-term deterioration in lung function, physical capacity and quality of life. This is
evidenced by Viktor complaining of obstructive sleep apnea, breathless with minimal exertion, inability
to attend to his activities of daily living with ease and the feeling of being generally unwell.
Chronic obstructive pulmonary disease can be managed medically using two types of drugs; relievers and
the controllers. Using the ABCDE assessment model some cues will be prioritized when it comes to
effective management of Viktor’s condition (Kram et al., 2015). In this, the cues will be collected,
information will be processed, the nurse will come to an understanding of a patient problem or situation,
plan and implement interventions, evaluate outcomes, and reflect on and learn from the process (Levett-
Jones et al., 2010). During the collection of cues the ABCDE tool will be used. It involves assessment
done on airway, breathing, circulation, disability and exposure.
Medication self-management applies to the elderly suffering from chronic diseases. The patient should
therefore take the medication as prescribed taking note of dose correctness, frequency, and spacing and
continued safe use over time (Cashin, 2014). The priorities of medication self-management involve action
plan and education as well. Action plan; the priorities in here will be the management of exacerbation
which involving symptom monitoring and medical management. Education involves acquittance of the
knowledge required in decision making. A research done by Federman et al., 2014, showed that the
elderly asthmatic patients don’t adhere to medications and inhaler technique. Clinicians should routinely

assess controller medication adherence and inhaler technique. The use of low literacy communication‐
strategies can be implemented.
While collecting cues, Viktor presents with obstructive sleep apnea, breathless with minimal exertion, and
his SpO2 is 87% when he is not on oxygen. Considering our model of assessment, we will start with
airway obstruction, and in our case study, it is associated with ineffective airway clearance due to the
inflammation (Pascoal et al.,2016). In this case study, the airway obstruction is manifested by the
decreased levels of SpO2 lower than the normal levels of 94 to 100% saturation. In this case, the nurse
will ensure that Viktor clears secretions to maintain a clear airway by auscultating breath sounds and
noting wheezes and crackles. This helps in monitoring bronchospasm; some degree of bronchospasm is
presented with obstructions in the airway and may or may not be manifested in adventious breath sounds.
Apart from auscultation the nurse can administer 2L of oxygen per min in 18 hours a day to maintain
oxygen saturation.
Breathless in minimal exertion is a sign of Viktor’s lungs, getting insufficient oxygen and can be
managed by administering oxygen and maintaining the SpO2 saturation in the expected normal range.
The third que is the general weakness and lethargy. The breathless on minimal exertion leads to hypoxia.
Anaerobic metabolism will, therefore, take place leading to the production of lactic acid that is deposited
onto the body tissues leading to lethargy. Lethargy can be managed by getting plenty of sleep and
drinking a lot of fluids. The general body weakness can be as a result of imbalanced nutrition less than the
daily body requirements (Gordon, 2014). This can be managed by giving the client foods that increase
appetite, and this will increase his daily food intake requirement.
Education involves the knowledge that is to be acquired to ensure adherence of medication and self-
administration of the inhalational asthmatic drugs. In this Viktor will be taught on the importance of
adhering to medication and when to administer which drug during exacerbation. This is because some
drugs are for long-term management for the chronic condition and not for acute exacerbation. Examples
of that is the Trelegy drug medication.
Conclusion.
The assignment has covered the case study of Mr. Viktor, an old man aged 63 years suffering from
chronic obstructive pulmonary disease. A group of lung diseases that leads to difficulty in breathing due
to inflammatory reactions resulting on the walls of the bronchioles. The patient, therefore, requires
nursing and medical management for that case. The assignment has, therefore covered the intervention
on medication self-management of Viktor. The priorities of medication self-management have been
Identified and include an action plan and education and have been elaborated. The clinical reasoning

cycle have been incorporated and on the part of the ques the ABCDE assessment model has been used to
prioritize the care that Viktor is to receve.

References.
Barnes, P. J. (2016). Inflammatory mechanisms in patients with chronic obstructive pulmonary
disease. Journal of Allergy and Clinical Immunology, 138(1), 16-27.
Cashin, A., Heartfield, M., Bryce, J., Devey, L., Buckley, T., Cox, D., ... & Fisher, M. (2017). Standards
for practice for registered nurses in Australia. Collegian, 24(3), 255-266.
Gordon, M. (2014). Manual of nursing diagnosis. Jones & Bartlett Publishers.
Kaptein, A. A., Fischer, M. J., & Scharloo, M. (2014). Self-management in patients with COPD:
theoretical context, content, outcomes, and integration into clinical care. International journal of
chronic obstructive pulmonary disease, 9, 907.
Kram, S. L., DiBartolo, M. C., Hinderer, K., & Jones, R. A. (2015). Implementation of the ABCDE
bundle to improve patient outcomes in the intensive care unit in a rural community
hospital. Dimensions of Critical Care Nursing, 34(5), 250-258.
Pascoal, L. M., de Oliveira Lopes, M. V., da Silva, V. M., Chaves, D. B. R., Beltrão, B. A., Nunes, M.
M., & de Moura, K. K. M. (2016). Clinical differentiation of respiratory nursing diagnoses among
children with acute respiratory infection. Journal of pediatric nursing, 31(1), 85-91.
Walters, J. A., Tan, D. J., White, C. J., Gibson, P. G., Wood Baker, R., & Walters, E. H. (2014). Systemic‐
corticosteroids for acute exacerbations of chronic obstructive pulmonary disease. Cochrane
Database of Systematic Reviews, (9).