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

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