Nursing Case Study on COPD

This nursing case study explores the management of a patient with chronic obstructive pulmonary disease (COPD), including medication, self-management, and anxiety management.

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Name of the student:
Name of the university:
Author note

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NURSING CASE STUDY
Consider the patient situation:
The case study represents pulmonary disease (COPD) of a 63 years old person who is a
chain smoker. His medical history includes pneumonia for which he was discharged from
hospital. He was diagnosed with a viral infection which facilitated acute exacerbation of the
disease. He had sleep apnoea and had hypertension. The currently he was experiencing
breathlessness and failed to manage his daily activities which are affecting her quality of life.
Collecting cues:
He had a history of hypertension, he takes trelegy ellipta 1 puff /day and prn salbutamol
which were breathe in with a spacer. He takes Nicorette patches 15mg/16 hours daily mane. He
had increased dysphonia and requires oxygen. His HR 90 bpm, Bp 132/88, RR is 34 bpm and
SpO2 92% on 2lpm of O2. His coughing was green and sputum tenacious sputum.
Process the information:
Chronic obstructive pulmonary disease (COPD) is considered as a condition where
irreversible airflow obstruction, as well as an abnormal inflammatory response in the lungs,
observed (Kelly et al., 2018). These are the innate and adaptive immune response for the long
term exposure to the toxic agent such as smoking cigarettes as observed in this case study
(Mitchell et al., 2017). The pollutants irritate the airway which further facilitates the production
of the sputum. The patient had a history of hypertension (BP 132/88) where the heart failed to
pump which clogs the blood into the lungs (Mitchell et al., 2017). On the other hand, airway
obstructions causes’ pulmonary vasoconstriction followed by hypoxia lungs tissues failed to gain
adequate oxygen-rich as observed in this case study. The patient had an oxygen saturation of
92% whereas for the normal patient it is 95%, indicated heart failed to pump adequate blood

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(Yang et al., 2017). Consequently, the heart rate of the patient also increased (90 bpm) whereas
for normal individuals, it is 60 to 100bpm. The obstructed airway also affect the breathing rate
observed in this case study where the patient had RR is 34 bpm (for the normal patient is 12 to
24 bpm). The patient is experiencing anxiety due to the COPD which is quite common as it is
associated with nervousness and shortness of breath (Jones et al., 2016).
In this case, while considering the self-management of the patient regarding the
medication, the first priority would be bronchodilator for improving breathing (trelegy ellipta)
along with salbutamol for improving the breathing in patients. For the management of his
infection Augmentin tablets along with immunosuppressant. The other priorities would the
management of his anxiety, frequent smoking, and medication adherence.
Identify the problem:
The patient is chain smoker which further increases his risk of execration of COPD as it can
cause respiratory failure. In this case, potential problems that are required to identify by nurses
include dysphonia, hypoxia, non-adherence to the medication and anxiety. The patient also had
poor self-management skills which further require improvement in order to improve decrease
prognosis of COPD and adherence to the medication that was provided him.
Establish goals:
The established first nursing goals in this case which was developed in the collaboration of
nurse include improvement of his shortness of breath by improving airflow and decreased air

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trapping within 8 hours and providing education to him. The second nursing goal would be to
decrease the severity of the exacerbation with the assistance of medication within the next 24
hours. The third nursing goal would be the improvement of the management of anxiety and self-
management skills within the next 6 months.
Take action:
To manage to improve airflow , the nurses are required to provide him with trelegy ellipta
that was prescribed and provided him with the education of when to consume it as he frequently
forgets about it. Bronchodilator decreases the resistance in the respiratory airway as well as
increase airflow (Barjaktarevic et al., 2016). For treating shortness of breath in patient, the
prescribed salbutamol is required to provide to the patient for opening up the airway and improve
breathing. The patient is required to provide with Augmentin which is immune suppressant
where it will reduce the immunes’ response while exposed to an allergen (Stringer et al., 2019).
The nurses are required to manage his anxiety with the reexamination technique such as yoga.
Yoga is one of the most effective techniques in the management of anxiety (Cramer et al., 2018).
Moreover, the client would be provided with cognitive behavioral therapy which will improve
the anxiety symptoms by improving the thought process (Trauer et al., 2015). To improve self-
management and medication adherence, the patient can be provided with the education regarding
self-management and small exercises for breathing improvement.
Evaluation:
In order to improve the efficiency of the intervention in the patient, the nurses are required
to assess the certain outcome such as breathing sound of the patient for gathering the

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understanding that patient was not suffering from shortness of breath. The nurse must assess the
vital signs of the patient such as heart rate, blood pressure and oxygen saturation. The nurses are
required to monitor the signs and symptoms of the COPD so that no risk of reoccurrence present
in the patient. The nurse must assess the medication adherence of the patient and must gather the
understanding of the mood with the support of the hospital anxiety and depression scale.
Reflection:
Before conducting the study I was unaware of the interventions and nursing goals for
management of COPD. However, involving myself in this assignment further facilitate the
knowledge of managing patient with COPD. It will further provide me an opportunity to provide
health literacy regarding the decision and self-management. Consequently, it will facilitate my
nursing practice of providing safe and responsive care to the patient.

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References:
Barjaktarevic, I., Kaner, R., Buhr, R. G., & Cooper, C. B. (2018). Bronchodilator
responsiveness or reversibility in asthma and COPD–a need for clarity. International
journal of chronic obstructive pulmonary disease, 13, 3511.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6207394/
Cramer, H., Lauche, R., Anheyer, D., Pilkington, K., de Manincor, M., Dobos, G., & Ward, L.
(2018). Yoga for anxiety: A systematic review and meta‐analysis of randomized
controlled trials. Depression and anxiety, 35(9), 830-843.
https://researchportal.port.ac.uk/portal/files/10153314/Yoga_for_anxiety.pdf
Jones, R. L., Noble, P. B., Elliot, J. G., & James, A. L. (2016). Airway remodelling in COPD:
it's not asthma!. Respirology, 21(8), 1347-1356.
https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.12841
Kelly, A. M., Holdgate, A., Keijzers, G., Klim, S., Graham, C. A., Craig, S., ... & Laribi, S.
(2018). Epidemiology, treatment, disposition and outcome of patients with acute
exacerbation of COPD presenting to emergency departments in Australia and South East
Asia: An AANZDEM study. Respirology, 23(7), 681-686.
https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.13259
Mitchell, A. B., Mourad, B., Malouf, M., Benzimra, M., Morgan, L. C., Oliver, B. G. G., &
Glanville, A. R. (2017). The human respiratory virome after lung transplantation for
COPD: A single centre, prospective, longitudinal study. Respiratory Medicine, 132, 276-
277. https://www.resmedjournal.com/article/S0954-6111(17)30243-3/abstract
Stringer, W. W., Porszasz, J., Bhatt, S. P., McCormack, M. C., Make, B. J., & Casaburi, R.
(2019). Physiologic Insights from the COPD Genetic Epidemiology Study. Chronic

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obstructive pulmonary diseases (Miami, Fla.), 6(3), 256-266.
https://europepmc.org/abstract/med/31342731
Trauer, J. M., Qian, M. Y., Doyle, J. S., Rajaratnam, S. M., & Cunnington, D. (2015). Cognitive
behavioral therapy for chronic insomnia: a systematic review and meta-analysis. Annals
of internal medicine, 163(3), 191-204.
https://www.researchgate.net/profile/David_Cunnington/publication/
277892977_Cognitive_Behavioral_Therapy_for_Chronic_Insomnia_A_Systematic_Revi
ew_and_Meta-analysis/links/56e9277d08ae166360e69818.pdf
Yang, I. A., Brown, J. L., George, J., Jenkins, S., McDonald, C. F., McDonald, V. M., ... &
Dabscheck, E. (2017). COPD‐X Australian and New Zealand guidelines for the diagnosis
and management of chronic obstructive pulmonary disease: 2017 update. Medical
Journal of Australia, 207(10), 436-442.
https://espace.curtin.edu.au/bitstream/handle/20.500.11937/59403/257564.pdf?
sequence=2