Case Study of Mr. Peter Newman with Infective Exacerbation of COPD

This case study explores the care plan, nursing assessments, nursing diagnoses, and nursing education for a patient with infective exacerbation of COPD. It emphasizes the importance of addressing breathlessness, promoting health quality, considering bacterial predisposition, and providing holistic care. The study also highlights the role of the hospital team in managing COPD patients.

Introduction.
This is a case study of Mr. Peter Newman, a 44-year old man admitted with infective
exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Infective exacerbation of
Chronic Obstructive Pulmonary disease is whereby the patients have increased episodes of
breathlessness and productive cough requiring more intensive treatment (Chhabra, & Dash,
2014). In addition, the patient may present with malaise, activity intolerance, body aches,
increased fatigue, and fluid retention. Exacerbation is mostly due to infection with a bacteria or
virus although noninfective organisms such as air pollution and other irritants may be trigger
factors (Edwards, Bartlett, Hussell, Openshaw, & Johnston, 2012). This episode makes the
prognosis of COPD poor due to increasing lung damage. Therefore, it is important to offer
holistic health care to this patient to reduce mortality and morbidity
1. What to consider while preparing a care plan.
Of priority in preparing the care plan of this patient is to address the breathlessness issue. The
health care professionals should plan on how to avoid further lung damage which could cause
breathing difficulty. Since smoking and exacerbation have a direct impact on COPD the care of
the patient should try and discourage smoking by providing health education to the patient. The
patient could also be enrolled in a smoking and drinking cessation program to help them stop
these habits (Thomsen, Villebro, & Møller, 2014).
In planning this patient care it is important to consider the health quality of this patient. The care
given should be geared towards helping the patient resume his activities of daily living normally.
The health care team should focus on reducing exacerbation periods in the patient which reduce

their quality of life. In promoting this patient care the health caregivers should encourage patient
to have more rest and avoid activities that exhaust him so much.
In planning care it is also important to consider the patient's predisposition to bacteria or viruses.
Some of the common bacterial pathogens associated with increased exacerbation episodes
include Klebsiella pneomonae, P.aeruginosa, S.aureus, and H.influenza.(Chhabra & Dash,
2014).These bacteria make the patient’s body to develop new strain-specific antibodies.
Therefore, it important that this patients care includes antibiotics.
2. Nursing assessments and why they are a priority.
At first, the nurse should assess the breathing patterns. Assess whether there is an inflammation
along the airway which would make breathing difficult. Expose the patient to a slight exercise
and assess the breathing patterns whether regular and rate. This patient will present with rapid
shallow breathing pattern which will result in hypercapnia and therefore the ventilator pump fails
to maintain adequate alveolar ventilation which results in decreased respiratory muscle capability
and/or increased mechanical load.
The nurse should also assess the respiratory rate of this patient. He should check if the patient
uses accessory muscles while breathing which is usually abnormal. The normal respiratory rate
of an adult should be between 12 -20 breath/minute (Fitzgerald, 2018). In this patient, it will be
increased but it expected as exacerbation episodes the respiratory rate should reduce steadily.
The nurse should assess the patient’s inability to perform activities of daily living (Nakken, et.al
2017). If the patient is involved in a heavy task as a nurse, you could advocate for change of task
or maybe the patient s should reduce the amount of time and effort they commit to the task. The

fact that this patient is working continuously for two weeks without an off and working in a
mining company the patient is exposed to a lot of pollution for long periods of time.
3. Three nursing diagnoses and their relevance
Impaired Gas Exchange related to decreased lung compliance and altered level of consciousness
as evidenced by dyspnea on exertion, decreased oxygen content, decreased oxygen saturation,
and increased PCO2. The patient will have impaired gaseous exchange because the infection
destroys the lung structures and thus affect their function. The diagnosis will help the nurse to be
able to respond to the patient's needs of maybe mechanical ventilation or administration of
oxygen by the mask as well as realize the need to monitor the patients PCO2 levels. The nurse
should keep environmental pollution to a minimum such as dust, smoke, and feather pillows,
according to individual situation and help patient assume a position where they lean forward to
enhance breathing by reducing pressure on the respiratory muscles.
Activity intolerance related to imbalance between oxygen supply and demand as evidenced by
getting breathless when exposed to work. This diagnosis enables the nurse to intervene in a way
that preserves the patient’s energy. The nurse should expose the patient to limited exercise and
more rest. Aerobic exercises help in metabolism. To provide more energy the nurse could also
advocate for a balanced diet for this patient. By making this diagnoses the nurse could educate
the patient on the need to change his working routine once discharged from the hospital.
Deficient knowledge on exacerbated COPD as evidence patient exposing himself to risk factors
as evidenced by a lifestyle of smoking and drinking. By this, the nurse identifies the gaps in the
patient’s knowledge of COPD. The nurse has the responsibility of educating on the need for
healthy lifestyle such as the need to stop smoking and using alcohol. It could be possible that the

patient is not aware of the health hazards at the place of work. The nurse is expected to educate
patient also on hygiene so as to reduce incidences of bacterial infection which increase
exacerbation episodes (Ko, et.al, 2016). It is at this stage that the nurse should educate the patient
on the need for medical checkups.
4. Nursing education post discharge
1. Teach the patient on how he should learn how he feels on a bad day when he is having a
sudden outburst of COPD symptoms, the patient should be able to notice changes in weather,
emotions, allergies and even altitude because these are some of the aggravating factors for
COPD. The most common signs of a sudden outburst of COPD include the following: more
mucus or mucus looks different in that it becomes stickier or thicker than usual, more wheezing
or coughing, tightness or pain in the chest and become irritable or anxious (Lumley, D'Cruz,
Hoballah, & Scott-Connor, 2016). He should also know of complications or new symptoms for
example edema and increased temperature. When these signs come up patient should know that
he should not hesitate more than 24hours to call a doctor.
2. Talk to the patient about drug adherence and how the success of medical intervention
influences their recovery rate. Ensure patient is understanding his illness and therapy, and the
complexity of the prescribed treatment regime. Adherence is a vital part of patient education and
therefore it should be well known to the patient, non-adherence can cause mortality. The patient
should also be taught on satisfactory use of inhalers, it should be demonstrated and understood
by the patient before discharge and also a follow up of the same should be done at their home to
ensure efficiency of administration of inhalers by the patient.

3. The patient should be educated on smoking cessation. Because our patient is a smoker,
smoking cessation assistance should be given as COPD patients must receive help in order to
quit smoking. Smoking cessation is counseling with a combination of varenicline and nicotine
replacement therapy. Smoking cessation is the most effective way of stopping the progression of
COPD and patient should be taught on its importance, this is why it should be number one
priority in the treatment of COPD.
4. Outpatient follow-up appointment. The patient should see a respiratory medical specialist and
also the nurse who has specialized in the same field within 1month of discharge. The patient
should the told about appointment schedule and he should be aware of the location, time and
date, proper follow-up help in monitoring patients progress and also early detection of
complications and treatment of new symptoms
5.
Hospital team for COPD patient ensures daily contact with the patient. If the patient has been
discharged they get to the patient either through telephone phone or even home visits. A
comprehensive response to the needs of severely affected COPD patients will be highly achieved
through the collaboration of relevant health providers in an effort to treat the exacerbation and
also to prevent readmission. The following team of health providers is involved:
1. Nurses. They take a big role in the management of the patient, they are involved in
diagnosis of patient, monitoring of new diagnostic and therapeutic procedures, they are
involved in almost all care programmers for COPD patients, they play a crucial and
specific role in care, education, and self-management of COPD patients by providing
total nursing care (Moorhead, Johnson, Maas, & Swanson, 2018). They ensure patients

adhere to agreed therapy. They are involved in early supervision of hospital discharge
and long-term care. They give nursing education about the nature of the illness and how
to manage it at home and also conduct a home visit and regular checkup for the patient.
2. Pulmonologist. This is a doctor who has special skills to treat patients with respiratory
diseases. They carry out a diagnostic test on the disease to get more information about the
persons COPD and they suggest the best treatment for the symptoms (Douglas, Nicol, &
Robertson, 2013). They also provide guiding and counseling to the patient and their
family on the nature of disease and lifestyle changes such as quitting smoking, improving
patients diet and starting a routine exercise for the patient they need to adhere which
contribute to the recovery of the patient.
3. Nutritionist. Because many people living with COPD have trouble maintaining a healthy
body, they, therefore, need a nutritionist to help patient eat a healthy diet. They are able
to provide advice on the right diet that provides the right amount of nutrition and also the
energy of the patient (Agarwal, Ferguson, Banks, Bauer, Capra, & Isenring, 2012).
4. Counselor. Patient with COPD have problems with depression or anxiety and living with
this condition is very stressful (Cafarella, Effing, Usmani, & Frith, 2012), the counselor
helps the patient treatment and manage the symptoms of their anxiety and depression.
This included individual and family therapy and also setting or finding a support group
for people living COPD.

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