Nursing Assessment for COPD Exacerbation

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Part 1: Case description
As the case study is related to a patient with COPD (Chronic Obstructive Pulmonary
Disease) exacerbation, the assessment framework that will utilized to identify health concerns for
the patient includes the GOLD (Global Initiative for Chronic Obstructive Lung Disease)
assessment framework. It is an evidence based and multi-dimensional assessment approach that
focus on combined assessment of the impact of patient’s symptoms in quality of life. This form
of assessment is done by the use of several tools like the COPD assessment questionnaire or the
COPD assessment test (CAT) and evaluation of the possibility of developing future events of
exacerbation (van der Molen, Miravitlles & Kocks, 2013). The significance of using this
assessment framework is that it helps in the classifying patients based on severity and identify
whether patients come under low risk, less risk or high risk group. Another rationale behind the
use of GOLD assessment framework is that it is an evidence based tool that has been widely
used for assessment of patients with COPD. Hernández et al. (2018) gives the evidence that the
new GOLD classification is effective in identifying patients who come under high risk category
and plan appropriate care plan accordingly. The GOLD assessment framework will be used to
perform thorough health assessment for a patient admitted to hospital with acute COPD
exacerbations.
Case description:
The case is about Williams, a 55 years old male who presented to the emergency
department with acute shortness of breath and fever. He was experiencing shortness of breath
since the past there days. However, his symptoms progressively worsened leading to extreme
discomfort and he was unable to sleep too. His initial physical examination revealed heart rate of

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74 bpm, BMI of 40.2, BP of 130/ 90 and respiratory of 24. The patient was found to be in
hospital bed with signs of discomfort. I was assigned to the care of the patient post 2 hour of
patient’s admission and I engaged in thorough health assessment of patient based on the Gold
assessment framework. This was necessary to diagnose the disorder and understand future risk of
COPD exacerbation for patient. Before starting the thorough health assessment to identify
number of symptoms that William was experiencing, I introduced myself to the patient and took
consent from the patient before performing the thorough health assessment. This made patient
clear about the purpose of health assessment. Grace et al. (2017) justifies that before undertaking
any health care intervention such as history taking, it is a responsibility for health care staffs to
gain informed consent from the patient.
Physical assessment data:
The main goal of completing assessment on patient is to identify the severity of the
condition for patients, analyse it impacts on patient’s health status and risk of future admission to
the hospital. After completing the comprehensive Gold assessment on Mr. Williams, the
following data was collected from patient:
 Details regarding severity of spirometric abnormality in patient
 Nature and severity of patient’s symptoms
 History of moderate to severe exacerbations
 Future risk of recurrence of the symptoms
 Presence of other co-morbidities
Characteristics of airflow limitation:

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COPD is a chronic and progressive lung disease associated with severe airflow limitation
because of chronic inflammation of the airways. The primary index for assessment of airflow
limitation includes ratio of forces expiratory volume (FEV) and forced vital capacity (FVC).
According to the GOLD classification, FEV1/FVC value of less than 70% signifies COPD
(Culver, 2015). For Mr. Williams, the FEV value was less than 50% indicating presence of
severe airflow limitation.
Assessment of physical symptoms (Review of physical indicators of COPD):
Primary symptoms and characteristics:
Acute shortness of breath since the past 2 days and based on assessment of severity of dyspena
using the MRC dyspnea scale, Mr.William dyspnea is classified to Grade 2. This is because due
to breathlessness, he has to stop and he cannot walk for long time.
CAT assessment:
Based on the assessment of patient using the CAT, the following symptoms were found to
be present in Mr. Williams:
 Intermittent and chronic sputum production since the past 1 week
 Chest is full of phlegm
 Chest tightness experiences
 Acute and worsening shortness of breath
 Inability to walk up the stairs since two day and lays mostly on bed
 Restricted to bed
 Difficulty in sleeping since the past two days