Best Medical Surgical Nursing Assignment

Medical Surgical Nursing
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Consider the patient:
Patient is a 57 yer lady, who is currently experiencing exacerbations of COPD. Hence, she
gets admitted to the CDU medical ward. Cigarette smoking is the primary reason for the
occurrence of COPD. Noxious agents present in the cigarette smoke are responsible for the
injury to the airway epithelium which lead the cascade of events resulting in airway
inflammation and airway structural changes. It results in the bronchial and lung matrix
degradation. In addition to the cigarette smoke, other inhaled irritants and bacterial infections
are also responsible for the inflammatory state in the COPD patients. Th1 cells are primarily
involved in the inflammatory process of COPD. Major inflammatory cells involved in the
COPD are neutrophil granulocytes and macrophages. This inflammatory response is
specifically brought by the inflammatory mediators such as chemotactic factors. Free radicals
and protases are also responsible for the breakdown of the lung tissues. This destruction of
the lung tissue results in the emphysema which lead to the poor airflow. Hence, imbalance in
the partial oxygen pressure and partial carbon dioxide pressure occur in patients with COPD.
Muscle wasting in COPD patients primarily occur due to the inflammatory process.
Inflammation in the airways results in the scarring of the airways which lead to the narrowing
of the airways. Narrowing of the airways is attributable to the restriction to the airflow.
Hence, COPD patients exhibit inability to breathe out to the full extent. More reduction in the
air flow occurs during breathing out because chest compresses the airways during breathing
out. It results in the more amount of air trapping in the lungs from the previous breath. It
results in the increased volume of air in the lungs which is termed as hyperinflation or air
trapping. It leads to shortness of breath in COPD patients because lungs remain already
partially filled in COPD patients (Eapen, Myers, Walters, and Sohal, 2017). COPD patients
are usually associated with low oxygen levels and high carbon dioxide levels which mainly
occur due to the poor gas exchange. Poor gas exchange mainly occurs due to reduced
ventilation due to airway obstruction, hyperinflammation and reduced desire to breath. Rose
is associated with exacerbations of COPD. In patients with exacerbations of COPD, there is
increased airway inflammation, increased hyperinflammation, decreased expiratory airflow
and impaired gas transfer. COPD patients are associated with low oxygen levels for the
longer duration of time. It results in the narrowing of the arteries in the lungs. Moreover,
emphysema condition of the COPD results in the breakdown of the capillaries in the lungs.
Both these conditions are attributable to the augmented blood pressure in the pulmonary
arteries. It might result in the development of cor pulmonale. Rose is associated with
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dyspnoea which is most common feature of the COPD due narrowing of the airways which
mainly occur due to inflammation and deposition of the inflammatory cells and mucus in the
airways. In COPD patients, there is excess production of mucus. Hence, COPD patients are
usually associated with cough to loosen the deposited cough. COPD patients might get fever
due to lung infection. Rose is also associated with cough and fever (Ko et al., 2016).
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