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

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
1
Double click here to fill in this footer
Last name__ _student number_NUR250 S1 2019 Assessment 1

NUR250 Medical Surgical Nursing 2 Assessment 1 Semester 1 2019
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
2
Double click here to fill in this footer
Last name__ _student number_NUR250 S1 2019 Assessment 1

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
3
Double click here to fill in this footer
Last name__ _student number_NUR250 S1 2019 Assessment 1

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.
4
Double click here to fill in this footer
Last name__ _student number_NUR250 S1 2019 Assessment 1