(NUR250)-Nursing Care Plan for COPD Patient with Risk Factors

In this case study we will discuss about medical surgical nursing and below are the summaries point:- Mr. Peter Newman, a 44-year-old man with COPD, admitted to the hospital with infective exacerbation. Smoking and social drinking as risk factors for COPD exacerbation need to be considered in the care plan. Priority nursing assessments include complete assessment of symptoms, breathing rate, respiratory rate, and level of consciousness.

NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
Mr. Peter Newman is a 44-year-old man admitted to the ward with infective
exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Mr Newman is a heavy
smoker and social drinker. Mr Newman is a Fly-In-Fly-Out (FIFO) truck driver with a
remote mining company and is finding it difficult to meet work responsibilities due to
increasing breathlessness.
Mr Newman lives with his wife Marcy and 2 teenage children in a southern capital city and
works a 2 weeks on/2 weeks off roster.
Based on the information provided in the above case scenarios complete the following
tasks.
Task 1. Consider the patient
What will you consider when preparing the care plan for your chosen patient?
While preparing the care plan for Mr. Peter Newman, a 44 year old patient with COPD (Chronic
Obstructive Pulmonary Disease), it will be necessary to consider the impact of the risk factors like
smoking and social drinking on exacerbation of COPD. This will help to understand whether smoking
and social drinking should be continued or not. Another aspect that needs to be reviewed while
developing the care plan is to observe symptoms of COPD and changes in vital parameters of the Mr.
Peter Newman. This will help to identify immediate care needs and any complications for which
immediate intervention is needed. To promote holistic well-being, other physical health factor,
psychosocial factor emotional factors and independence level of patient will be analyzed too. This
will help to identify unmet needs of patient and find out the vital elements that is affecting holistic
well-being for Mr. Peterman. Acknowledging interdependence between biological, psychological,
social and spiritual aspects is an importance part of holistic care (Zamanzadeh et al., 2015).
Task 2. Nursing assessments
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Identify three (3) nursing assessments you will conduct and explain why they are a
priority for you.
Based on the review of Mr. Peter’s case scenario, three nursing assessments have been
identified to be critical to prioritize nursing care plan for patient. The first nursing assessment that
will be important includes complete assessment of signs and symptoms of Mr. Peter following
exacerbation of COPD. Patient with COPD mostly experience symptom of breathlessness, cough and
sputum production. As exacerbation of COPD is associated with shortness of breath and wheezing
even with minimal activity, review of parameters like breathing rate, respiratory rate and accessory
muscle use is important. As Mr. Peter Newman is particularly facing challenges in meeting his work
responsibilities due to increased breathlessness, the strategy of assessing vital signs like respiratory
and breathing rate needs to be prioritized to identify whether Mr. Peter need immediate hospital
admission or changes in medication can control his condition.
The assessment of vital sign and symptoms can be done by doing the following activities:
 Measure breathing rate and respiratory rate of patient to identify signs of clinical
deterioration
 Observation of Mr. Peter’s level of consciousness and position to evaluate work of
breathing. The patient can be upright in a tripod position during severe respiratory distress
and may feel drowsy during respiratory failure. Patient with severe COPD may also use
pursed lip breathing technique to avoid small airways collapse during tidal breathing. Hence,
review of consciousness and position can help to detect severity of symptoms
 Another nursing activity that will help to assess complication in Mr. Peter includes
conducting auscultation of the lungs to identify wheezing sounds and evaluate quality of air
movement through the lungs. Lung auscultation is an important part of physical examination
as it can give vital information related to physiology of lungs and airway obstruction (Lange
et al., 2016).
The second nursing assessment that will be important for patient includes assessment of
oxygenation in patient by measuring pulse oximetry and observing skin colour of patient. Impaired
gas exchange is a clinical issue in patients with COPD and it occurs because of bronchospasm, alveoli
destruction and air trapping in the lungs (Kim, 2017). This needs to be prioritized to understand
whether Mr. Peter needs oxygen therapy to eliminate the symptom of breathlessness or not. COPD
patients with Pao2 ≤ 55 mm Hg or ≤ 59 mm Hg require supplemental oxygen to treat symptom of
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
hypoxemia (Stoller et al., 2010). Pulse oximetry is an important clinical standard
practice in monitoring oxygen level in the patient’s blood and diagnoses episodes of acute
respiratory failure (Amalakanti & Pentakota, 2016).. Handheld pulse oximeters are easy to use and
can support nurse to identity treatment need for patients like Mr. Peter.
The third vital nursing assessment is to assess patient’s knowledge related to risk factor and
cause of COPD and attitude towards management of the condition. This assessment is essential to
reduce smoking rate and alcohol consumption for Mr. Peter. This is important because smoking is
also one of the causes of COPD exacerbation and smoking can further deteriorate breathing rate for
Mr. Peter as smoking damages air-sac and airways of the lungs (Riesco et al., 2017). The assessment
of knowledge related to the disease will help to interpret patient’s ability to self-manage the disease
and positive cope with negative symptoms during exacerbation. The assessment of knowledge and
attitude towards COPD will also help to plan appropriate support interventions to motivate Mr.
Peter to quit smoking for holistic health and well-being. Another importance of assessing patient
literacy and attitude towards the disease is that it may help people to develop Mr. Peter’s capability
for self-management of the condition. This will help to meet both physical as well as psychosocial
needs of client. Better engagement in self-management behaviour will improve health outcomes and
quality of life too (Huygens et al., 2016).
Task 3. Care planning
Identify three (3) priority nursing diagnoses for your chosen case scenario and explain why they are
relevant.
Based on review of Mr. Peter’s symptom and other psychosocial factors affecting his health, three
nursing diagnosis that has been identified for Mr. Peter include increased breathlessness, presence
of risk factors (like smoking and drinking) and lack of literacy on disease process and self-
management. The care plan for Mr. Peter will focus on reducing the above three problems for
patient.
Based on the nursing assessment of signs and symptoms by means of lung auscultation,
consciousness and skin colour, increased breathlessness has been identified as one of the clinical
priority while developing care plan for Mr. Peter. To reduce breathing related problem for Mr. Peter,
it is planned to provide pharmacological intervention to patient. This will include use of
bronchodilators and corticosteroids to reduce inflammation associated with COPD exacerbation and
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
improve ventilation process for patient. Bronchodilators are effective in
maintaining airway patency and it is a central part of the COPD treatment (Bryant & Knights, 2014).
According to Cazzola and Page (2014), the main advantage of including bronchodilator as one of the
medication for patient with COPD is that it can alleviate bronchial obstruction and airflow limitation
and reduce hyperinflation. Hence, by providing bronchodilator to patient, Mr. Peter is likely to get
relief from symptom of breathlessness and increased work of breathing. Another drug that needs to
given to Mr. Peter for recovery and reduction in symptoms of COPD includes use of corticosteroids.
Corticosteroids are particularly effective in the treatment of exacerbation. Evidence by Woods et al.
(2014) suggests that corticosteroid is the mainstay of COPD therapy and optimal dosing regimen
determines the success of the therapy. Inhaled corticosteroid is often used in combination with long-
acting Beta-agonist to treat patient with COPD. The drug works to inhibit inflammatory process
occurring during exacerbation of COPD. A nurse can play a role in giving the two medications on the
prescribed time and teaching Mr. Peter regarding the appropriate way to take each of the
medication.
In relation to the problem of heavy smoking and drinking in Mr. Peter, the nursing care plan
is to assess rate of smoking and drinking each day and implement smoking cessation intervention to
promote long-term health and well-being of the client. As Mr. Peter is a heavy drinker and is
experiencing exacerbation of COPD, smoking cessation needs to be prioritized both for physical and
mental well-being of client. Heavy smoking can increase the risk or frequency of COPD exacerbation
for patient as cumulative smoking can lead to airflow obstruction. High level of smoking increases
the prevalence of COPD. For this reason, quitting smoking is targeted as part of primary care (Perez-
Padilla, Thirion-Romero & Guzman, 2018). Hence, as this would lead to additional cost of care and
unnecessary deterioration of symptoms, focussing on implementing interventions to encourage Mr.
Peter to quit smoking is important. Mr. Peter can be supported to quit smoking by use of nicotine
replacement therapy. Nurse can encourage Peter to replace cigarettes with other items like nicotine
patches and inhaler nicotine. Evidence has revealed that nicotine replacement therapy is a strategy
to reduce ill-effects of cigarette smoking in smokers with COPD and provide direction for later
cessation in later life (Ellerbeck et al., 2018). This intervention is likely to promote health of Mr. Peter
and reduce mental burden too by reducing medical cost and repeated hospitalization because of
COPD exacerbation.
The third important care priority is to increase knowledge of patient in relation to COPD and
optimal management of the condition. This is particularly important for Mr. Peter because he is
currently experiencing increased breathlessness and this has affected hi participation in work.
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
However, he is not aware that his active smoking and drinking habits are two risk
factors that can deteriorate his condition. There might be other areas too where Mr. Peter might
have poor knowledge regarding the cause of disease, risk factors, ways to use medication and cope
with adverse symptoms. Hence, promoting health literacy in the area of COPD and its self-
management is a vital step to promote holistic well-being for Peter. Appropriate nursing education
can help Mr. Peter to plan his daily schedule and take care of his health. This will also help Mr. Peter
to reduce symptom of anxiety and depression, which are common psychological co-morbidities in
people with COPD. Evidence has also revealed that self-management education programs can
reduce symptom of anxiety and promote psychological well-being in COPD patients (Pumar et al.,
2018).
As COPD has psychological impact on patient with COPD, nursing intervention related to
education and increasing attitude of Peter towards self-management can empower patient and
encourage him to avoid behaviours that can deteriorate his health. Hence, this intervention can
serve as a motivating factor for Mr. Peter to quit smoking. This education can target giving Mr. Peter
education regarding the physiology of COPD, vital organs affected by the condition and the impact of
smoking and drinking on symptoms. Education can also support patient in seeking appropriate
health care service for recovery (Sari & Osman, 2015).
Task 4: Patient education
Identify specific education your chosen case scenario will require to effectively manage their
condition post discharge.
Based on the development of nursing care plan for Mr. Peter, he will need to use
bronchodilators and corticosteroid inhalers for a long time. In such situation, patient education is
vital to increase awareness regarding the correct way to use inhalers. The common issue found for
people with COPD is that they face challenge in using a metered-dose inhaler (MDI). This is the
reason behind poor adherence to pharmacological treatment too. Hence, education can be given to
Mr. Peter regarding proper administration of inhalers. This can be done by giving demonstration to
Mr. Peter regarding the stepwise process to use inhalers. Before discharge, visual manuals with list
of instructions can also be provided so that Mr. Peter can easily follow the steps while at home. In
addition, the details regarding the number of puffs to be taken and things to avoid to prevent
exacerbation are also necessary. Jolly et al. (2015) has revealed that prescribing inhalers without
providing proper education regarding appropriate technique can result in suboptimal outcomes and
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wastage of medication. Hence, educating Mr. Peter regarding correct inhalation
technique can enhance drug efficacy and promote recovery of patient.
Specific education can also be given to Mr. Peter regarding side-effects of each medication and
adverse reactions likely to be observed after taking the medications. Education can also be given
regarding continuity of care at home and following proper diet. To improve spiritual health, Mr.
Peter can be encouraged to adapt positive coping skills such as book reading and participation in
social activities to reduce the burden associated with the condition
Task 5: Team care
Identify and define the Allied Health team members that should be involved in the patient’s care
during admission and in preparation for discharge
The allied health care professionals who need to be involved in the care of Mr. Peter include
nurses, psychologist, occupational therapist, nutritionist and physicians. Physicians can aid in
diagnosis of the disorder during admission and respiratory physiotherapist can play a role in
improving ventilation during hospitalization. In addition, nurse can play a role in providing holistic
care to Mr. Peter by addressing physical as well as spiritual health needs. During the time of
discharge, the role of dietician and respiratory technologist is critical. Dietician can play a role in
developing appropriate diet charge for Mr. Peter and respiratory technologist can play a role in
demonstrating techniques to use inhalers.
References
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NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
Amalakanti, S., & Pentakota, M. R. (2016). Pulse oximetry overestimates oxygen
saturation in COPD.
Respiratory care,
61(4), 423-427.
http://rc.rcjournal.com/content/respcare/61/4/423.full.pdf
Bryant, B., & Knights, K. (2014).
Pharmacology for Health Professionals ebook. Elsevier Health
Sciences. Retrieved from: https://www.elsevier.com/books/pharmacology-for-health-
professionals/bryant/978-0-7295-3929-6
Cazzola, M., & Page, C. (2014). Long-acting bronchodilators in COPD: where are we now and where
are we going?.
Breathe,
10(2), 110-120. DOI: 10.1183/20734735.014813
Ellerbeck, E. F., Nollen, N., Hutcheson, T. D., Phadnis, M., Fitzgerald, S. A., Vacek, J., ... & Richter, K. P.
(2018). Effect of Long-term Nicotine Replacement Therapy vs Standard Smoking Cessation
for Smokers With Chronic Lung Disease: A Randomized Clinical Trial.
JAMA network
open,
1(5), e181843-e181843. doi: 10.1001/jamanetworkopen.2018.1843.
Huygens, M. W., Vermeulen, J., Swinkels, I. C., Friele, R. D., van Schayck, O. C., & de Witte, L. P.
(2016). Expectations and needs of patients with a chronic disease toward self-management
and eHealth for self-management purposes.
BMC health services research,
16, 232.
doi:10.1186/s12913-016-1484-5
Jolly, G. P., Mohan, A., Guleria, R., Poulose, R., & George, J. (2015). Evaluation of metered dose
inhaler use technique and response to educational training. Indian J Chest Dis Allied
Sci, 57(1), 17-20. Retrieved
from:https://www.researchgate.net/profile/George_Jolly4/publication/
283904683_Evaluation_of_Metered_Dose_Inhaler_Use_Technique_and_Response_to_Educ
ational_Training/links/5a67bd67aca2720266b5dd11/Evaluation-of-Metered-Dose-Inhaler-
Use-Technique-and-Response-to-Educational-Training.pdf
Kim, E. K. (2017). Pathophysiology of COPD. In
COPD (pp. 57-63). Springer, Berlin, Heidelberg.
Retrieved from: https://link.springer.com/chapter/10.1007/978-3-662-47178-4_5
Lange, P., Halpin, D. M., O’Donnell, D. E., & MacNee, W. (2016). Diagnosis, assessment, and
phenotyping of COPD: beyond FEV1.
International journal of chronic obstructive pulmonary
disease,
11(Spec Iss), 3. doi: 10.2147/COPD.S85976
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Perez-Padilla, R., Thirion-Romero, I., & Guzman, N. (2018). Underdiagnosis of
chronic obstructive pulmonary disease: should smokers be offered routine spirometry
tests?. https://doi.org/10.1080/17476348.2018.1419868
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), 1615-31. doi: 10.3978/j.issn.2072-1439.2014.09.28
Riesco, J. A., Alcázar, B., Trigueros, J. A., Campuzano, A., Pérez, J., & Lorenzo, J. L. (2017). Active
smoking and COPD phenotype: distribution and impact on prognostic factors.
International
journal of chronic obstructive pulmonary disease,
12, 1989-1999.
doi:10.2147/COPD.S135344
Sari, N., & Osman, M. (2015). The effects of patient education programs on medication use among
asthma and COPD patients: a propensity score matching with a difference-in-difference
regression approach.
BMC health services research,
15(1), 332. Retrieved from:
https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-015-0998-6
Stoller, J. K., Panos, R. J., Krachman, S., Doherty, D. E., Make, B., Long-term Oxygen Treatment Trial
Research Group (2010). Oxygen therapy for patients with COPD: current evidence and the
long-term oxygen treatment trial.
Chest,
138(1), 179-87. doi: 10.1378/chest.09-2555
Woods, J. A., Wheeler, J. S., Finch, C. K., & Pinner, N. A. (2014). Corticosteroids in the treatment of
acute exacerbations of chronic obstructive pulmonary disease.
International journal of
chronic obstructive pulmonary disease,
9, 421-30. doi:10.2147/COPD.S51012
Zamanzadeh, V., Jasemi, M., Valizadeh, L., Keogh, B., & Taleghani, F. (2015). Effective factors in
providing holistic care: a qualitative study.
Indian journal of palliative care,
21(2), 214-24.
doi: 10.4103/0973-1075.156506
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Needs development Satisfactory Excellent
Ability to interpret &
address tasks 1-5
(25)
5 marks per task
0 – 9 marks
Poor interpretation of most if not all, of the
case scenario tasks. Does not demonstrate
safe practice, knowledge for care planning,
assessment, and/or patient education.
Unsatisfactory rationales or explanations for
care planning and assessments and/ or limited
ability to explain and justify nursing actions
and education.
Demonstrated limited critical thinking using
the clinical reasoning cycle to address case
scenario tasks.
10 - 19 marks
Satisfactory interpretation of the case
scenario tasks. Demonstrates sound
knowledge of safe practice, knowledge for
care planning, assessment and patient
education.
Rationales demonstrate satisfactory ability to
explain or justify nursing action and
education.
Demonstrates an emerging level of critical
thinking using the clinical reasoning cycle to
address case scenario tasks.
20 - 25 marks
Excellent interpretation of the case scenario
tasks. Demonstrates excellent knowledge of safe
practice, knowledge for care planning,
assessment and patient education.
All rationales demonstrate high level ability to
explain or justify nursing action and education.
Demonstrates a high level of critical thinking
using the clinical reasoning cycle to address case
scenario tasks.
Academic Integrity -
referencing (5)
0 – 2 marks
Demonstrates little or limited ability to
acknowledge the work of others.
No or limited in-text citations
and/or
incomplete reference list
and/or inaccurate
and/or incomplete referencing details
and/or
inconsistent referencing format.
3 – 4 marks
Demonstrates a developing ability to
acknowledge the work of others. Most ideas
supported with appropriate in-text citations
and there is a complete reference list. Some
inconsistency, inaccuracy
and/or incomplete
details in CDU APA 6th format.
5 marks
Demonstrates high level ability to acknowledge
the work of others. All ideas supported with
appropriate and accurate in-text citations and
there is a complete and accurate reference list.
Minimal direct quotes (<3)
No errors detected in CDU APA 6th format.
Academic integrity standards met at a high level.
Evidence for practice 0 – 2 marks 3 – 4 marks 5 marks
10
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- research (5)
Less than 7 peer reviewed journals/evidence
for practice and/or
More than 2 current text books cited.
Some journals or texts are more than 10 years
old.
Numerous inappropriate resources in
reference list.
7 - 10 relevant peer reviewed
journals/evidence for practice.
No more than 2 current text books cited.
Journal articles and textbooks are no more
than 10 years old.
May have occasional inappropriate resources
in reference list.
Minimum of 10 peer reviewed journals/evidence
for practice.
No more than 2 current text books cited.
Journal articles and textbooks are no more than
5 years old.
No inappropriate resources in reference list.
Presentation &
Academic Writing (5)
0 – 2 marks
Assignment is not on required template
and/or not submitted as a word document.
Font is not; Arial, Calibri or Times New Roman
size 11 or 12 and/or
Line spacing is not 1.5
Use of dot points or tables
Does not demonstrate an appropriate level of
written communication for nursing practice.
Thoughts and ideas are disorganised, or
content does not flow in a coherent manner.
Frequent spelling and/or grammatical errors
and/or
OR
Assignment is more than 20% over or under
the stated word count
3 – 4 marks
Less than 1-2 presentation guidelines not
adhered to: -
Assignment is not on required template
and/or not submitted as a word document.
Font is not; Arial, Calibri or Times New Roman
size 11 or 12 and/or
Line spacing is not 1.5
Use of dot points or tables
Demonstrates an appropriate level of written
communication for nursing practice.
Content is generally well organised with
coherent flow.
Occasional spelling or grammatical errors
and/or
OR
Assignment is 10 – 20% over or under the
stated word count
5 marks
Assignment is on required template and
submitted as a word document.
Font is either; Arial, Calibri or Times New Roman
size 11 or 12
Line spacing is 1.5
No dot points
Within the stated word count +/- 10%
Meets written communication standards for
nursing practice and academic literacy at a high
level.
Content is well organised with a coherent flow.
Assignment is free from spelling and /or
grammatical errors.
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