Role of Nurse in COPD Care

Living With Chronic Obstructive Pulmonary Disorder

Introduction
Role of nurse in providing high quality care to the patients is highly significant.
Nurses are also known for developing therapeutic relationship with patient in order to
improve health and well-being (Toney-Butler & Thayer, 2018). Nursing practice is
systematically influenced and guided by the nursing practice standards, guidelines
and codes. Nurses work closely with individual, families and communities to deliver
high quality care, improving service delivery and improving patient outcomes
(Bittencourt & Crossetti, 2013). Studies have also informed that nursing process
plays the role of a systematic guide to patient centred or client centred care in a
sequential step. Assessment, diagnosis, planning and implementation of care
strategies are the significant aspects of nursing practice. These processes require
critical thinking and problem-solving skills (Toney-Butler & Thayer, 2018). Nurses are
also required to apply the clinical judgment skills for evaluating patient’s condition,
understanding the pathophysiology of disease and implement effective care
strategies.
Therefore, this paper will focus on developing an evidence-based knowledge
regarding the role of nurse in conducting effective assessment, diagnosis and
implementation of evidence based care. This paper will discuss the case study of
Delroy, who is a 65 years old gentleman admitted to the hospital with the problem of
shortness of breath. Some of the other signs and symptoms that patient has been
experiencing are breathlessness, pain in mobility due to the presence of
osteoarthritis in the knees, malnutrition, constipation, low mood, BMI 42 and limited
mobility. Past medical history of the patient informs about the presence of chronic
obstructive pulmonary disease, osteoarthritis, acute renal failure, hypertension,
history of smoking and cardiovascular accident with residual left sided weakness.
This paper will inform about the link between the patient’s medical history and signs
and symptoms that he is experiencing with a detailed analysis of the
pathophysiology of disease, and will present a critical analysis of the Roper Logan
and Tierney (2000) framework and how the complex multiple co-morbidities can be
managed through effective nursing care.
Pathophysiology of COPD

According to the patient’s history, the main health issue that he suffers include
Chronic Obstructive Pulmonary Disease (COPD). This is a chronic lung disease,
which is also progressive in nature and makes the process of breathing very difficult.
Berg & Wright (2016) have defined COPD as the preventable and treatable
condition, which is characterised by the limitation of the airflow. This disease is often
progressive and can also be linked to the chronic inflammatory response in the
airway that makes the breathing process very difficult. The disease can also become
severe with the associated comorbidities and exacerbations (Berg & Wright, 2016).
This condition results in limiting the airflow and results in creating breathlessness.
In the healthy lungs, when the air is inhaled it travels from the wind pipe to airway in
to the lungs through the bronchial tube. Inside the human lungs the bronchial tubes
are divided in thousands of small branches that are called as bronchioles (Kim &
Criner, 2013). At the end of these small and thin branches are present the air sacks
that are called as alveoli. These alveoli are surrounded by the bunch of the
capillaries. When the oxygen is inhaled it passes from alveoli to the blood capillaries
and enter the blood to be transferred to the body (Kim & Criner, 2013). Therefore,
the elasticity of the airway and air sacs become significant for the appropriate flow of
air. In the patients suffering with COPD the walls of the alveoli are damaged and
they lose their elasticity and the walls of the airway also thicken and get inflamed
resulting in obstructing the air flow process (Tuder & Petrache, 2012).
Therefore, COPD is considered as the progressive chronic inflammatory condition, in
which the small airways and alveoli are mainly affected. The studies have identified
that a series of physiological changes occur that impact the well-being, quality of life
and makes the survival of the patient very difficult (Tuder & Petrache, 2012). The first
problem that occurs start with the elastin proteolysis that results in reducing the
elastic recoil pressure in the lungs. The movement and the integrity of bronchioles is
mainly dependent on the elastic recoil pressure of the lungs, which is mainly
facilitated by the elastic tissue. Therefore, due to damage of the elastin in COPD
results in narrowing the airway and reduce the air flow in bronchioles and the air gets
trapped in the lungs (Hogg & Timens, 2009). The second pathophysiological problem
that occurs is associated with the fibrotic remodelling of the airway. This problem
results in permanent narrowing of the airway resulting in increased airway

resistance, which do not even respond effectively to the bronchodilators (Berg &
Wright, 2016).
Pathophysiology associated with Breathlessness
One of the most common symptoms that is associated with COPD is breathlessness.
The sensation of breathless ness is also called as Dyspnea (Anzueto & Miravitlles,
2017). The patient suffering from COPD experience this symptom due to many
problems, such as reduced physical activity, increased level of anxiety and
depression and airway re-modelling due to the disease manifestation. Study
conducted by Antoniu (2010) has identified that dyspnea in COPD involves a very
complex pathophysiological mechanism that significantly involves “dynamic
hyperinflation, increased ventilatory demand relative to impaired capacity,
hypoxemia, hypercapnia, and neuromechanical dissociation” (p. 217). Antoniu
(2010) further informed that during the process of breathing, already damaged and
reduced pulmonary elasticity recoil, results in increasing the expiratory lung volume,
due to which dynamic hyperinflation (DH) starts occurring. Dynamic hyperinflation
(DH) is also associated with many pathophysiological mechanisms, such as
remodelling of the airway, reconfiguration of the rib cage (which mainly occurs in
order to contain the lungs that hjave become over inflated), increased pressure on
the respiratory muscles (which occurs to manage with the problem of reduced
elasticity) (Ko et al, 2016). During the process of any kind of physical activity or
exertion, it results in increasing inflammation and increasing impairment of dynamic
hyperinflation. This whole mechanism results in placing more pressure on the
respiratory muscles to increase the inspiratory capacity (Pavord et al, 2016).
Therefore, the increased ventilatory demand, which could not be fulfilled due to this
mechanism and results in increasing the problem of shortness of breath or
breathlessness.
Pathophysiology Associated with Malnutrition
Another symptom is malnutrition that is affecting the quality of life of the patient.
Studies have identified that malnutrition occurs as the common problem among the
patients suffering with COPD and considered as the most prevalent symptom that
affects the patient’s ability to conduct activities of daily life due to weakness ( Rawal,
& Yadav, 2015). Malnutrition results in reducing the ability of physical exercise. The

symptom of malnutrition in the COPD patients is also referred to as pulmonary
cachexia syndrome” (PCS), which is mainly character sided as the loss of the fat free
body mass and muscle wasting causing malnutrition (Rawal, & Yadav, 2015, p. 152).
The problem of weight loss is identified among 25% to 40% patients suffering with
COPD (Itoh, et al, 2013). The most significant pathophysiological condition
associated with COPD is emphysema, which results in causing breathing difficulty.
Under nutrition can also be caused due to the presence of depressive symptoms and
shortness of breath. The pathophysiology associated with the increased work of
breathing, such as the damage of alveoli, remodelling in the airway and inflammation
results in increasing pressure on the respiratory muscle and increased energy
expenditure (Mete et al, 2018). The process of systematic inflammation results in the
higher production of inflammatory cytokines such as interleukin (IL)-6, IL-8, and
tumor necrosis factor (TNF)-α, and also of chemokines (Itoh, et al, 2013). Studies
have also identified that increase in the production of TNF-α results in causing
malnutrition. Also, the increased production of IL-6 p results in affecting the patient’s
appetite. In the given case study, patient’s BMI has been found to be 42, which
indicates obesity. Therefore, in the obsess patients the level of serum IL-6 is
elevated, due to its production from the white adipose tissues. Although, the studies
have shown that clear reason of micturition or under nutrition in COPD patients has
not been identified (Itoh, et al, 2013).
The Role of Nurse
Studies have identified that role of nurses in healthcare is very prominent, as the
number of nurses is highest in the healthcare system in comparison to other
professionals and they are responsible for providing personalised care to the
patients (Bodenheimer & Bauer, 2016). Nurses are often the first person to interact
with the patient, conducting assessment, developing diagnosis and implementing
care plans (Allen, & Hughes, 2017). Therefore, the role of nurses is inevitable in
healthcare system. Nursing practice lead and influence public health on various
levels.
Roper-Logan-Tierney Model of Nursing is considered as the practice centred
theoretical model, which is “grounded in realism and accessibility” (Williams, 2015, p.
24). The main aspect of this nursing model is that it helps in the assessment,

diagnosis, planning, intervention and evaluation and throughout the process it serves
as the guide for the nurses to conduct a holistic patient assessment in order to
develop an appropriate and comprehensive care plan (Holland, & Jenkins, 2019).
This model of nursing is mainly applicable for the patient, who are functionally deficit
and require skilled and experienced nursing care for improving functional outcomes.
This model also helps the nurses to test the hypothesis amount the patient’s health
outcomes. Williams (2015) has also identified that this model can holistically
address the nursing care needs of the patients suffering with chronic obstructive
pulmonary disease.
Figure 1: R-L-T Model of Nursing Adopted from Williams (2015)
Assessment
The first step to provide care to the patient is to conduct a comprehensive
assessment (Toney-Butler & Thayer, 2018). Assessment of the patient requires the
application of critical thinking and applying the appropriate data collection process.
Assessment of the patient can include the subjective and objective data, in which
subjective data is the information that is verbally explained by the patient or
caregiver, while objective data is tangible and measurable, which includes vital