Palliative Care for Mrs. Brown: Nursing Priorities in COPD

Mrs. Brown case study.
Introduction
The essay will describe palliative care for Mrs. Brown, a 62-year-old retiree who is living
with her husband that works part-time. She has got acute breathlessness which makes her find it
difficult to leave the house or even moving around. She has a history of three times hospital
admissions in the past year with the exacerbations of her Chronic Obstructive Pulmonary
Disease. She also has a past medical diagnosis of depression. At the time she was poorly
nourished and was experiencing panic attacks. Mrs. Brown has called an ambulance due to the
feeling of shortness of breath and coughing for the past two days. The onset of the symptoms
was 3 days ago and the symptoms were accompanied with rhinorrhea. Mrs. Brown reported a
chronic morning cough with productive white sputum. The chronic morning cough had been
increasing for the last two days prior to hospital presentation. The essay will, therefore, describe
two high nursing priority strategies to manage Mrs. Brown. There are values that the nurse
providing the palliative care will have to consider as they will guide him/her when giving out the
care and they are four of them. The first one is the nurse focuses on the need for reducing
suffering undergone by the patient and the family, secondly is the dislike for the technical
medicalization of the end of life and in this the nurse should be concerned that care towards the
end of life should not reduce the human being to the biological and neglect the human dying as a
person. The third value, the nurse should focus on the importance of control by the patient at the
end of life. Finally, in palliative care, the patient should be made to realize that death is not the
worst thing that can happen to a patient always (Gordijn & Janssens, 2004).

A palliative approach incorporates increasing recognition of the need to provide disease
management activities and at the same time incorporating supportive care for patients with an
advanced chronic disease such as the COPD for Mrs. Brown.
Nursing priorities.
The aim of the palliative care approach is improving the quality of life of the patient, for
their progressive illness that is life-limiting. (Murray et al 2017). It aims in reducing their
suffering by early identification of pain, early assessment of pain and holistic treatment of pain.
It also aims to reduce, physical needs, psychological needs, social needs, cultural needs, and
spiritual needs.
The two nursing priorities for the advanced chronic obstructive chronic disease will,
therefore, be Dyspnea and fatigue. Dyspnea is difficult or labored breathing. (Anzueto &
Miravitlles, 2017). Dyspnea manifests in advanced COPD patient. the nurse, therefore, has to
assess its quality, intensity, distress caused by the dyspnea and dyspnea psychologic factors.
Management of the dyspnea may include, non-pharmacologic management and pharmacologic
management (Puntillo et al 2014). The non-pharmacologic management may include general
measures, therapy for pulmonary and respiratory rehabilitation. Oxygen should be administered
to the hypoxic patient. Non-invasive ventilation can be used, airway debulking and stents can
also be used in management. The pharmacologic management of COPD include administration
of opioids which can be systemic or nebulized opioids, the nurse can also administer
promethazine, benzodiazepines, bronchodilators, diuretics, and glucocorticoids (Lilly &

Senderovich, 2016). They should be administered as instructed by the physician. The last
palliative care for the dyspnea is palliative sedation to decrease anxiety and depression since
Mrs. Brown has a history of depression.
The second nursing priority in an advanced COPD patient is fatigue. Fatigue is a sustained
sense of exhaustion that is overwhelming and decreases the capacity for physical and mental
work in the normal state (Phillips, 2015). In this case, the fatigue is not removed by rest. Social
effects of fatigue occur when the patient decrease her participation in social liveliness and
movement. Management, therefore, focuses on the conserving the patient’s energy, promoting
exercises, providing sufficient nutrition and increased amount of sleep. The factors related to
fatigue for Mrs. Brown could be due to malnutrition and poor physical state physically,
psychologically can be due to anxiety, depression, and stress. Fatigue can be characterized by
decreased performance, inability to recover or restoring energy even after sleep, failing to
maintain the usual routines, Mrs., she is Brow also feels guilty for not keeping up with the
responsibilities. The main goal for implementation of the interventions to manage goal is that
Mrs. Brown will demonstrate energy saving techniques that help in decreasing the fatigue. hat
Mrs. Brown will discuss what worsens fatigue worse according to her understanding. After the
client has been assessed fully including how the patient reacts emotionally to fatigue, various
nursing interventions will be implemented to manage the advanced COPD. The nursing
interventions may include, restricting stimuli such as noise from the surrounding environment
during times for rest and sleep. Limited relaxation and disturbing rest and sleep can contribute to
fatigue in advanced COPD (Aydin, 2014). The nurse can also emphasize the importance of
frequent periods of rest. The nurse can also review the laboratory results of diagnostic tests such
as the percentage of oxygen saturation, the blood glucose levels, hemoglobin levels when resting