Palliative Care for Mrs. Brown: Nursing Priorities in COPD

This essay discusses the palliative care approach for Mrs. Brown, a patient with COPD, focusing on nursing priorities for managing dyspnea and fatigue. It explores non-pharmacologic and pharmacologic management strategies for dyspnea, as well as interventions for managing fatigue. The goal is to improve the quality of life for the patient.

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

and during activity. Rationale; abnormal physiological data may be associated with other
possible sources of the fatigue experienced by the patient. The nurse should keenly observe any
alterations of the observations as a result of activities. Rationale; increased physical exertion can
add to fatigue in COPD (Hill et al 2015). The nurse should assess the sleeping pattern of the
patient taking note of the quantity of sleep, the time taken to fall asleep, and the quality of the
sleep. The nurse should also observe for any alteration in the patient’s thinking processes.
Changes in the patient’s sleeping pattern could have a contribution to the development of the
fatigue. The nurse should assess how the patient reacts to fatigue emotionally. Depression and
anxiety are the common emotional responses associated with fatigue in COPD mostly (Pumar et
al 2014). The nurse should guide the patient in developing habits that promote effective rest or
sleeping patterns. Providing sufficient hours of uninterrupted sleep for the patient can contribute
to energy restoration. Social and psychological support is also key to palliative management.
Involving the client in every decision concerning her care will give her a sense of belonging.
Religious support can also be considered in which the religious leader will make her know that
death is not the worst thing that can happen to a patient but it is among the passages that every
human being created by God must pass through when the right time reaches.
Conclusion.
Palliative care is basically caring for the dying person and its an honor and a privilege
afforded the clinicians in the society. In palliative care, the clinicians aim at reducing the
suffering of the client while maintaining consciousness. Refractory symptoms of the chronic
disease the patient is suffering may increase the patient's suffering and the quality of life of the
patient reduced. An occurrence of such cases leads to palliative sedation offering a
compassionate and humane alternative to continued suffering for the patient and the family

members (Blinderman & Billings, 2015). When interventions are implemented for the two-
nursing priority of an advanced COPD client, the patient’s quality of life increases. The two
nursing priorities for and advanced COPD patient are dyspnea and fatigue.

References.
Anzueto, A., & Miravitlles, M. (2017). Pathophysiology of dyspnea in COPD. Postgraduate
medicine, 129(3), 366-374.
Aydin, H. T. (2014). Chronic Obstructive Pulmonary Disease and Sleep Quality. In COPD
Clinical Perspectives. IntechOpen
Blinderman, C. D., & Billings, J. A. (2015). Comfort care for patients dying in the hospital. New
England Journal of Medicine, 373(26), 2549-2561.
Gordijn B, Janssens R. Euthanasia and palliative care in
The Netherlands: an analysis of the latest developments.
Health Care Anal 2004; 12: 195/207
Hill, K., Gardiner, P. A., Cavalheri, V., Jenkins, S. C., & Healy, G. N. (2015). Physical activity
and sedentary behaviour: applying lessons to chronic obstructive pulmonary
disease. Internal medicine journal, 45(5), 474-482.
Lilly, E. J., & Senderovich, H. (2016). Palliative care in chronic obstructive pulmonary
disease. Journal of critical care, 35, 150-154.
Murray, S. A., Kendall, M., Mitchell, G., Moine, S., Amblàs-Novellas, J., & Boyd, K. (2017).
Palliative care from diagnosis to death. Bmj, 356, j878
Phillips, R. O. (2015). A review of definitions of fatigue–And a step towards a whole
definition. Transportation research part F: traffic psychology and behaviour, 29, 48-56

Pumar, M. I., Gray, C. R., Walsh, J. R., Yang, I. A., Rolls, T. A., & Ward, D. L. (2014). Anxiety
and depression—Important psychological comorbidities of COPD. Journal of thoracic
disease, 6(11), 1615.
Puntillo, K., Nelson, J. E., Weissman, D., Curtis, R., Weiss, S., Frontera, J., ... & Mulkerin, C.
(2014). Palliative care in the ICU: relief of pain, dyspnea, and thirst—a report from the
IPAL-ICU Advisory Board. Intensive care medicine, 40(2), 235-248