Medical Surgical 1

This essay discusses the case of a patient with infective exacerbations of Chronic Obstructive Pulmonary Disease (COPD) and provides a care plan and patient education. It also emphasizes the importance of a team approach in providing integrated care. References are included.

Medical surgical 1
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Task 1 : Consider the patient
Case of Newman is being discussed in this essay who is 44 years old. He was admitted to the
hospital ward as a result of his condition of infective exacerbations of Chronic Obstructive
Pulmonary Disease (COPD). He is experiencing COPD exacerbations because he used to
smoke and drink which are significant risk factors of COPD. He is unable to perform
activities and experiencing activity intolerance as a result of increased breathlessness. He is
staying with his wife and 2 teenage children. According to clinical reasoning cycle;
information about Newman should be gathered (Levett-Jones, 2017).
Task 2 : Nursing assessment
Clinical assessment for Mr. Newman should be performed for three conditions like
nutritional, cardiovascular and respiratory assessment. Clinical reasoning cycle is a useful
tool for performing assessment in Newman. First step in the clinical reasoning cycle in
gathering of information. Information related to the clinical condition of Newman was
gathered from the provided clinical study. He was associated with the infective exacerbation
of Chronic Obstructive Pulmonary Disease (COPD). He was associated with COPD because
he is a heavy smoker. Breathlessness is one of the prominent symptoms of COPD which was
evident in him. According to clinical reasoning cycle gathered information need to be
processed (Levett-Jones, 2017). COPD is evident in Newman; hence, respiratory assessment
needs to be carried out in him. Moreover, COPD and cardiovascular dysfunction are
comorbid; hence, it is mandatory to carry out cardiovascular assessment in Newman. Lung
hyperinflation and systemic inflammation are the pathophysiological connecting link between
COPD and cardiovascular disease. COPD produces nutrition related alterations like weight
loss and malnutrition in the COPD patients. COPD patients are associated with malnutrition
prominently due to expenditure of resting energy, reduced food intake and systemic
inflammation. Respiratory assessment in Newman should include assessment of respiratory
rate, breathing pattern and measurement of ABG levels. Furthermore, pulmonary function
test is one of the important tools for respiratory assessment (Baroi, McNamara, McKenzie,
Gandevia, and Brodie, 2018). Cardiovascular assessment in Newman include assessment of
cardiovascular parameters like blood pressure, heart rate, heart sound and heart beat rhythm
(Studziński, Tomasik, Krzyszton, Jóźwiak, and Windak, 2017). Alteration in the baseline
values of cardiovascular and respiratory systems would specify dysfunction in cardiovascular
and respiratory system. Nutritional assessment in Newman include nutrient intake
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measurement and measurement of related weight, height and circumference (Nas, Nimf,
Hamid, and Ismail, 2017).
Inflammation in COPD patients is marked by excessive secretions and bronchial wall
hyperplasia which produces ineffective airway clearance. Reduced blood oxygen level in
COPD patients occur due to impaired gaseous exchange. COPD condition also produces
cardiovascular abnormalities like congestive heart failure, myocardial infraction and
arrhythmia. COPD patients experiences less food consumption as a result of resistance in
swallowing and chewing due to dyspnoea, change in food taste following mouth breathing
and constant coughing (Yang et al., 2017; Rabe and Watz, 2017).
Task 3 : Care plan
Gathered and analysed information indicate respiratory distress as clinical problem in
Newman. Hence, nursing diagnosis like ineffective breathing, ineffective airway clearance
and activity intolerance were made for him.
Ineffective breathing: Evaluate and record respiratory rate, ABG levels in Newman because
deviation from the normal breathing rate of 10 – 20 breaths per minute indicate respiratory
dysfunction. Moreover, ABG level monitoring helps in oxygen level and ventilation
efficiency (Ladwig, Ackley, and Makic, 2016). Observe and record breathing pattern; since,
patients with respiratory distress, abnormal breathing pattern is prominent sign. Auscultate
breath sound in frequent intervals as lessened breath sounds can be detected in COPD
patients. Observe nostrils retractions because there would be respiratory effort due to
ineffective breathing. Evaluate oxygen saturation and pulse rate in Newman through using
pulse oximetry because pulse oximetry is important toll for monitoring alteration in oxygen
saturation. Assess sputum of Newman for quantity, color and consistency; since, alteration in
sputum quality is one of the important indicators of respiratory distress like ineffective
breathing (Swearingen, 2015). Encourage and monitor deep breathing in Newman because it
is helpful in increased oxygenation and preventing atelectasis. Controlled breathing facilitates
slow respiration. Extended expiration is useful in preventing air trap (Ladwig, Ackley, and
Makic, 2016). Encourage and observe Newman for diaphragmatic breathing; since, it is
helpful in relaxing muscles and improving oxygenation. Under physicians monitoring,
administer respiratory medicines and artificial oxygen to Newman as respiratory medications
produces airway smooth muscle relaxation and produces bronchodilation which is useful in
opening air passage (Swearingen, 2015). Prevent administration of oxygen with high
concentration as high concentration of oxygen would result in the sudden augmentation of the
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PaO2 which would lead to apnea (Swearingen, 2015). Ensure Newman clear his airway by
secretions mobilization through coughing which would be helpful in clearing all the
secretions from the airway. Ensure Newman is using correct techniques for breathing,
coughing and splinting methods which would be useful in complete mobilization of the
secretions. Educate Newman for medication use for its efficacy and side effects; moreover
train him to use metered-dose inhaler and nebulizer because it is helpful in in correct use of
medications in Newman (Gulanick and Myers, 2016).
Ineffective airway clearance: Evaluate and monitor airway for obstruction because optimum
functioning of the respiratory tract depends on the airway without obstruction (Gulanick and
Myers, 2016). Recognize normal or adventitious breath sound through auscultating lungs as
fluid and mucus deposition in the airway results in the abnormal breath sound which reflects
ineffective airway clearance (deWit, and Kumagai, 2014). Observe respiration for different
parameters like breathing rate, breathing pattern, deep breathing, use of accessory muscle and
splinting because alteration in the breathing rate and rhythm would occur due to airway
constriction (Gulanick and Myers, 2016). Note and monitor HR, BP and temperature in
Newman; since, increased work of breathing is responsible for hypertension and tachycardia.
Moreover, COPD is an inflammatory disease and susceptible for infection which produces
raised temperature in COPD patients (deWit, and Kumagai, 2014). Observe cough for
efficacy and productivity as cough is a reflux phenomenon for clearing secretions. Moreover,
ineffective cough results in the ineffective airway clearance and hindrance in the mucus
expulsion. Furthermore, different mechanisms like fatigue of respiratory muscle, thick mucus
secretions and bronchospasm are responsible for the ineffective cough (deWit, and Kumagai,
2014). Assess sputum of Newman for quantity, color and consistency because alteration in
sputum quality is one of the important indicators of respiratory distress like ineffective
breathing (deWit, and Kumagai, 2014). Submit sputum sample of Newman for microbial
culturing and sensitivity testing; since it is evident that Newman is having infectious COPD.
Alteration of breathing pattern indicate respiratory infection which would be helpful in
ordering appropriate antibiotic administration (deWit, and Kumagai, 2014). Educate and train
Newman to practice correct coughing and breathing method; since, correct coughing
improves secretions removal and deep breathing helps to improve oxygenation (deWit, and
Kumagai, 2014). Perform nasotracheal suctioning if essential because it is useful for the
removal of thick mucus plugs.
Activity intolerance: Measure physical activity and mobility level of Newman along with
measuring resting pulse, BP, HR, heart rhythm and pulse quality in Newman because
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assessment of these parameters is useful in planning intervention for Newman. Alteration
from the normal values of these parameters are helpful to direct to discontinue from the
activity (Gulanick and Myers, 2016). Assess nutritional status; since, adequate amount of
energy is required for carrying out activities. Assess sleep quality in Newman; since,
adequate sleep is an important factor for doing certain activities (Ladwig, Ackley, and Makic,
2016). Measure baseline cardiopulmonary parameters like HR and orthostatic BP in
Newman; since, there should not be alteration in the normal heart rate while performing
regular activities (Gulanick and Myers, 2016). Provide assistance to Newman for carrying out
activities and encourage Newman to improve activities gradually because it helps in activity
tolerance in Newman. Moreover, exertion can be reduced through gradually increasing the
activities (Ladwig, Ackley, and Makic, 2016).
Task 4 : Patient education :
Nurse should inform Newman about the significance of medication consumption for the
management of COPD. Moreover, nurse should make him aware of the adverse and side
effects of medications. Education related to the medications would be helpful in improving
adherence of Newman for the medication consumption. Nurse should educate and train him
for use of metered-dose inhaler and nebulizer which would improve self-care in him. Nurse
should give him training related to various breathing techniques like slow breathing and deep
breathing (Ng and Smith, 2017). Breathlessness in Newman can be effectively improved by
practicing various breathing techniques. Nurse need to advise him to avoid smoke, fumes and
dust; since, these factors are the prominent risk factors for the exaggeration of COPD in
Newman. Nurse should make him aware of proper eating behaviour and exercise because
these health-related aspects produce impact on COPD condition in Newman. Nurse need to
warn Newman about psychological effects of COPD exacerbations because breathlessness
and coughing produce stress in Newman (Howcroft, Walters, Wood-Baker, and Walters,
2016).
Nurse should advise him not to smoke because smoking is prominent risk factors for
advancement of COPD and its exacerbations. Cigarette smoke chemicals plays important role
in COPD exacerbations. Nurse should inform him that cigarette smoke chemical worsens
lung function in gradual manner. Nurse should inform him that smoking produces
bronchoconstriction which affects both inspiration and expiration. Hence, nurse need to
instruct him to quit smoking to avoid further exaggeration of COPD. Nurse should make him
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aware that COPD can be recovered in non-smokers at faster rate as compared to smokers
(Wang, Tan, Xiao, and Deng, 2017).
Task 5 : Team care:
Professionals from diverse disciplines like physician, nurses, pharmacist, physical therapist,
occupational therapist, dietician and psychologist need to be incorporated to provide
integrated care to Newman. Professionals from different professionals need to work in
integrated manner for providing holistic treatment and care to Newman. Integrated care needs
to be initiated by physician and nurse by collecting past medical history; followed by
performing holistic assessment of Newman. Physician and nurse need to use basis of
assessment for developing appropriate care plan for Newman. Pharmacist should convince
him significance of medication consumption and provide information related to medicines
use, its adverse and side effects. (Titova et al., 2017).
Physical therapist and occupational therapist need to work in coordination with medical and
nursing staff to plan and implement exercise for Newman because exercise would improve
breathing pattern in Newman (Carron et al., 2017). Dietician should provide diet plan for
Newman which would be useful in improving muscle strength in Newman. Diet plan
provided for Newman should be able to tolerate exercise. Diet plan prepared for Newman
should manage weight loss and low fat-free mass (FFM) index in Newman. Newman’s diet
plan should maintain optimum body weight in Newman. Pharmacist and dietician should
work in integration to eliminate possibility of food-drug interaction. Psychologist need to be
incorporated in his care for performing psychological assessment in him. Since, as a result of
breathlessness and activity intolerance; he would experience stress (Van Dijk-de Vries et al.,
2016).
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