Nursing Assignment: COPD Case Study

This nursing assignment focuses on a case study of a patient with Chronic Obstructive Pulmonary Disease (COPD) and discusses the nursing practice, health surveillance, and health promotion aspects of managing the condition. It also explores the sociological and psychological aspects of COPD and the role of nurses in patient education and support.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student
Name of the university
Author’s note

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Introduction
This assignment will focus on the case study of a 55 years old patient Mr, X, who had
been suffering from Chronic Obstructive Pulmonary Disease , has been admitted in to the
emergency department with severe respiratory distress. The patient had past history of
hospitalization due to asthmatic symptoms. He had worked in a mining company for many years
and has retired from the post, due to his increasing incidence of the respiratory distress with time.
COPD is a progressive lung disease that is often used as an umbrella term to describe the
inflammatory lung disease like chronic bronchitis, emphysema and refractory asthma. The main
clinical manifestation of the disease is breathlessness, chest tightness, frequent coughing both
with and without mucus and wheezing (Nici et al., 2017). Approximately 1.2 million of people in
United Kingdom are living with diagnosed COPD. COPD is the second most important lung
disease and the lung patients with COPD have increased by 27 % since the last decade. Higher
proportion of the people with COPD has been diagnosed in Scotland and North East and North
West of England (Nici et al., 2017).
This report will focus on the health surveillance and the health promotion aspect of the
nursing care with respect to this clinical condition. This will also provide a theoretical
understanding of the nursing practice related specifically to this patient suffering the COPD. The
report would also focus on the psychological and the sociological aspect of the disease.

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Nursing practice
The nursing practice related to the management of the interventions includes Assessment,
planning, Implementation and evaluation.
Assessment- NICE has recommended curtained guidelines for assessing the signs and symptoms
of COPD. The patients should be assessed for the signs and the symptoms like an increased
respiratory rate, especially whether the patient is using accessory muscles or not or the presence
of pursed lip breathing, state of the acute confusion, that can be related to conditions like
hypoxia. The patient should also be assessed for new onset cyanosis or the presence of peripheral
edema that might indicate new onset or pulmonale or if the patient is unable to carry out the
activities of daily living.
Planning – The nurses should aim to maintain the airway patency with clear breath sound or
assist the patients to cough effectively and expectorate the secretions. The nurses should aim to
an improved ventilation and adequate oxygenation of the tissue by ABGs within the normal
range of the patient (Fletcher & Dahl, 2013). The patient will be able to participate in the
treatment regimen. The nurses would plan to improve the breathing pattern in the patient and the
respiratory limit would be maintained within normal limits.
Implementation- For improving the breathing the pattern in patient, the patient should be place in
patient in semi –fowler’s position for promoting maximum expansion of the lungs. Patients back
should be kept dry to avoid the stasis of secretions and to prevent further complications. For
maintaining the patent airway, the suctioning of the secretions might be done as ordered. Nurses
can also administer he prescribed cough suppressant and analgesics.

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Evaluation – Evaluation of the interventions can be evidenced by the desired outcomes like
effective management of the clinical condition. The patients would exhibit clear airways and will
be able to verbalize the distress. The arterial blood gas values displayed would be normal.
Evaluation of the conscious level can be assessed by monitoring the level of consciousness and
mental status. The patient can also provide feedback regarding the effectiveness of the treatment.
Self-management of COPD is the most important strategy in controlling the symptoms.
In relation to the self-management of the disease, the nursing theory – “health promotion model”
by Nola Pender can be referred to. The health promotion model focuses on main three areas-
individual characteristics and experiences, behavior specific cognitions, affects and behavioral
outcomes. According to the assumption of the health promotion model and individual seeks to
actively regulate their own behaviors. It is necessary to teach patients like Mr X to maintain
certain precautionary measures to get relief from the symptoms of COPD. Practices like the use
of inhalers or nebulizers and to avoid the triggers that might cause the exacerbation of respiratory
distress.
Health surveillance and Health promotion
Before discussing about the health promotion model it is necessary to discuss about the
health surveillance that has to be carried out by the nurses or by the primary health care
professionals. Early screening of the condition and understanding the trigger actins help in
chalking out the effective care plan for the patients. The health monitoring would involve and
that would determine the working condition of the patients. It is known from the case study that
the patient had been working in mines for quite a long time that had subjected to prolonged
exposure to obnoxious smoke and chemical fumes. Health monitoring would also involve the

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identification of the economic condition of the patient, whether the patient will be able to get
access to the treatment options quite easily.
This section will focus on the health promotion model developed by Nola J. Pender, who
has defined health as a dynamic positive state rather than only the absence of disease, which
similar to that of the definition of health proposed by World Health Organization. According to
this theory each person has unique personality hence experiences that affects subsequent actions.
Hence, each of the care plan has to be patients specific. It is the duty of the nurses to enhance the
functional ability the patient. Health promoting behaviors can be termed as the desired behavior
that makes it the end point in the `Health promotion model. There are four main assumptions of
the health promotion model. Patients seek to regulate their own behavior. The individuals in all
their biopsychosocial complexity interact with the environment, progressively transforming the
environment as well as well as being transformed over time. Heath professionals like the nurse
and the other health care workers consists of a part of an interpersonal environment that exerts
influence on people throughout the life span.
In that it can be said that since that the aged patient in 55 year’s old, self-management is
an important option for controlling the symptoms of COPD. Collaboration between the health
care professional and the patient in the disease management of COPD. Self-management is
considered as an important part of the chronic care model of the disease management (Bentsen,
Langeland & Holm, 2012). It allows the patient to acquire knowledge and skills that are required
to follow those medical therapies and the health behavior changes required to achieve the
outcomes. Some of the self-management techniques that is used by the patients are the use of the
nebulizers or inhalers, using face masks, avoiding the exposure to smokes and refraining from
smoking, maintenance of adequate diet.

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Sociological aspects of health and ill health
In order to discuss this, we will have to understand the social aspect of COPD. According
to Lenferink et al.,(2017) stigma is a social construction that defines people in terms of a
distinguishing characteristics of mark and devalues the as a consequence. Many have stated that
COPD is a condition that has several social consequences (DiNicola et al., 2016). . The valuing
and the devaluing of the individuals within the society are social judgements that have their roots
in the socio-cultural values and beliefs. Although COPD might not be considered as a disease
that can be stigmatising. However, the health professionals were taught to differentiate between
the patients with `COPD who were considered to be “pink puffers” from those who are
considered as the “blue bloaters”. These terms naturally stigmatised the patients. Again he
various signs and the symptoms of COPD can mark the patients such as the one with
“wheezing”. Literary sources have shown that Individuals with COPD have reported to be
experienced stigma stemming the visible effects of condition including the struggle to breathe
and the use of supplemental oxygen around other people that can lead to the feeling of social
isolation and embarrassment (Pumar, et al., 2017). Individuals with COPD are also stigmatised
due to the linkage of COPD with smoking and some other self –inflicted” nature of the condition
(Jankowska-Polańska et al., 2016). The impact of stigmatisation can be can be significant and
affects various aspects of illness such as stigmatisation with the friends and the families. Stigma
from the health care professionals that affects the health care access. Patients who are stigmatise
are found to be hesitant to seek care for the fear of getting judged. Small number of literatures
are there that considers the topic of gender. As per the researchers, patients suffering from COPD
might feel stigmatised by people surrounding them, or the family members or the health care
professionals. Patient suffering from COPD have a decreased quality of living that might lead to

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negative outcomes like the body shaming and others self-inflicted stigma. The most effective
intervention for the addressing these sociological issues is to provide adequate education to the
patient and the families. Nurses can also take part in the health promotion campaigns for raising
mass awareness for mitigating the stigma. Instead education should be given regarding the
maintenance of an awareness campaign.
Psychological aspects of health and ill health
Several psychological comorbidities has been found to be associated with COPD.
Anxiety and depression are the two common psychological condition in patients suffering from
COPD. The occurrence of anxiety and the depression in the in COPD patients has been found to
be associated with the exacerbation rates , increased rate of mortality, increased length of
hospital stay and decreased quality of life (von Leupoldt & Kenn, 2013). If such conditions are
left untreated that it might lead to serious conditions like clinical depression. Clinical depression
might cause significant impairment in life processes, leading to delusional thoughts and suicidal
ideation (von Leupoldt & Kenn, 2013).
UK’s National Institute for Health and Care Excellence (NICE) has recommended that
low to high level of psychosocial interventions can be given to the patients depending upon the
mood of the patient. Again nurses can also provide relaxation therapy for the promotion of
psychological change through the techniques that can create a relaxed state. Some of the
techniques that are largely used are a range of breathing exercises, hypnoses , body positioning,
sequential relaxation of the muscles, mild form of exercises and visualization techniques
(Rosenberg et al., 2016). Innovative interventions like singing classes have also been used as an
intervention of COPD. The underlying reason behind this is that singing enhances the quality of

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life of people and functional status by offering specialized techniques addressing both the
sensory component of dyspnea and effective components (Rosenberg et al., 2016). Again self-
management techniques can also be useful in improving the patient care by the provision of the
resources and the guided health behavioral change, empowering an individual (Cafarella et al
2016). Again, pharmacotherapy is the mainstream treatment that can be used for treating anxiety
and depression. Although there had been various controversies regarding the effectiveness of the
treatment, it is still in use in case of severe conditions. Antidepressants are the main medicines
that are normally used to treat conditions like anxiety and depression (Rosenberg et al., 2016).
Some of the treatment options for addressing the breathing trouble as well as the
psychological issues are application of psychotherapy along with pharmacological interventions
that would help in mitigating the severity of the exacerbations.
Conclusion
The report span around a case study of an old man who had been admitted in to the
emergency department and had been suffering COPD. The clinical manifestation of COPD
involved respiratory distress, chest tightness, wheezing. A health promotion model has been used
to determine the nursing practice in managing the symptoms of COPD. The paper has mentioned
how the health promotion program can be helpful in the early screening and the self-management
of the disease. Early screening and planning of goals like effective airway clearance and
effective gaseous exchange are some of the nursing goals that have to implemented. The paper
has also mentioned about the sociological and the psychological aspect of disease and the
probable nursing actions to mitigate the issues. The paper has also emphasis upon the role of the

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nurses in patient’s education regarding the use of the nebulisers and providing psychotherapies
for the associated psychological processes.

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References
Bentsen, S. B., Langeland, E., & Holm, A. L. (2012). Evaluation of self‐management
interventions for chronic obstructive pulmonary disease. Journal of nursing management,
20(6), 802-813.
Cafarella, P. A., Effing, T. W., USMANI, Z. A., & Frith, P. A. (2012). Treatments for anxiety
and depression in patients with chronic obstructive pulmonary disease: a literature
review. Respirology, 17(4), 627-638.
DiNicola, G., Julian, L., Gregorich, S. E., Blanc, P. D., & Katz, P. P. (2013). The role of social
support in anxiety for persons with COPD. Journal of psychosomatic research, 74(2),
110-115.
Fletcher, M. J., & Dahl, B. H. (2013). Expanding nurse practice in COPD: is it key to providing
high quality, effective and safe patient care?. Primary Care Respiratory Journal, 22(2),
230.
Jankowska-Polańska, B., Kasprzyk, M., Chudiak, A., & Uchmanowicz, I. (2016). Effect of
disease acceptance on quality of life in patients with chronic obstructive pulmonary
disease (COPD). Advances in Respiratory Medicine, 84(1), 3-10.
Lenferink, A., Frith, P., van der Valk, P., Buckman, J., Sladek, R., Cafarella, P., ... & Effing, T.
(2013). A self-management approach using self-initiated action plans for symptoms with
ongoing nurse support in patients with Chronic Obstructive Pulmonary Disease (COPD)
and comorbidities: The COPE-III study protocol. Contemporary clinical trials, 36(1), 81-
89.

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Nici, L., Bontly, T. D., ZuWallack, R., & Gross, N. (2014). Self-management in chronic
obstructive pulmonary disease. Time for a paradigm shift?. Annals of the American
Thoracic Society, 11(1), 101-107.
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), 1615–1631. doi:10.3978/j.issn.2072-1439.2014.09.28
Rosenberg, D. E., Bombardier, C. H., Artherholt, S., Jensen, M. P., & Motl, R. W. (2013). Self-
reported depression and physical activity in adults with mobility impairments. Archives
of Physical Medicine and Rehabilitation, 94(4), 731-736.
von Leupoldt, A., & Kenn, K. (2013). The psychology of chronic obstructive pulmonary disease.
Current opinion in psychiatry, 26(5), 458-463.