Palliative Care and COPD Management

The assignment discusses palliative care for patients with chronic obstructive pulmonary disease (COPD) and other related health issues. It covers policies regarding informed decision-making, ethical decision-making, and capacity to make one's own decisions. The document also explores protocols for providing support systems, managing symptoms, and promoting high-quality care for patients. Additionally, it references relevant books and journals, as well as online sources, providing a comprehensive overview of palliative care and COPD management.

NURSING
PALLIATIVE CARE
CASE STUDY

TABLE OF CONTENTS
1. ......................................................................................................................................................1
2........................................................................................................................................................1
a)..................................................................................................................................................1
b) ................................................................................................................................................1
3. ......................................................................................................................................................2
a)..................................................................................................................................................2
b).................................................................................................................................................2
c)..................................................................................................................................................2
d).................................................................................................................................................3
e)..................................................................................................................................................3
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5........................................................................................................................................................4
6........................................................................................................................................................4
7. ......................................................................................................................................................4
REFERENCES................................................................................................................................6

1.
According to WHO (World Health Organization), palliative care is defined as the
approach to improve the condition of patients and their family who are facing problems related
to life threatening disease by providing treatment related to pain and other physical or
psychological problems (WHO Definition of Palliative Care, 2017). Similarly, in case of Moira,
she was also given a palliative approach by nurse practitioners. Early she was facing
emergencies once or twice in a year but due to this approach she was feeling better than before.
Hence, Moira would benefit from Palliative care as patients are able to overcome depression and
feelings of anxiety that helps in improving the quality of life. Nurses provide Moira with
medicines for breathing problem and hospital bed that solved the problem related to her
breathing and lower body pain.
2.
a)
Three important domains are physical, social and emotional domains. Special needs from
each of these domains are:
 Physical domain: The physical needs of patients suffering from last stage COPD is relief
from pain caused due to swollen lungs.
 Emotional domain: Due to lungs-related problems the patients of these diseases usually
sit around one place and are not able to participate in other work. Thus, they started
feeling lonely and suffer from feeling of depression (Scheewe and et.al., 2013).
 Social domain: Social needs of patients suffering from COPD is effective
communication and their spiritual fulfilment.
b)
Care strategies related to these domains are: Physical Domain: Proper pharmaceutical and non-pharmaceutical treatment helped them
to come up with chest pain. Various Bronchodilators and Glucocorticosteroids are used to
get relief from lungs related problems. Emotional Domain: Emotional distress like anxiety, depression, feeling of loneliness can
be eradicated by approach of proper palliative care (Nishino and et.al., 2015). In this
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approach, patients are provided by dedicated care and love from family, that help them in
coming up with problems in better ways.
 Social Domain: Social needs can be achieved by providing social supports to patient by
family, friends and practitioners. It can be achieved by discussing with them about their
progress and showing concern about their needs. Nursing practitioners also play a major
role in fulfilling the social needs through regular visits and telephonic classes.
3.
a)
In the last stage of COPD (Chronic Obstructive Pulmonary Disease) patients mainly deal
with situations like long term home oxygen, anxiety, cough, chest pain and fatigue. In COPD
patients, chest pain is the most common type of pain. Due to this, patients also experience pain in
shoulders, neck and upper arms. Also in some cases the sufferer with osteoporosis faces extreme
pain in back due to the thinning of bones and use of steroids.
In COPD lungs started blowing up like balloons and this creates pressure on chest and
diaphragm. Breathing problem and cough causes stretch in muscle and in severe cases may also
break the ribs. Frequency of pain due to cough is higher than breathing problem that may occur
in few days or weak. On the basis of information available, Global pain scale is the best option
for pain assessment. It is unique tool that can measure both physical pain and its effect on life of
patient. It also helps in tracking the pain on daily basis and treatment can be provided in more
efficient way.
b)
Side effects related to untreated pain includes:
 Lung infections which result in pneumonia.
 Increase rate of osteoporosis.
 Failure of heart.
 Pneumothorax i.e. crumpling of lungs.
 Due to problem of getting less supply of oxygen to lungs, may create sleep related
problems (Robleda and et.al., 2016).
c)
Pharmaceutical treatment generally consists of:
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 Bronchodilators: They can be used to dilate the bronchi and bronchioles to increase the
flow of air to lungs (Slack and et.al., 2013). Some common bronchodilators used to treat
the patients with last stage COPD are Ipratropium bromide via nebuliser QID and
Tiotropium bromide inhaler on the daily basis. Glucocorticosteroids: They help in reduction of inflammation. Common examples of
these drugs are betamethasone, cortisone, hydrocortisone and many more.
 Other medications: Other types of medications include Frusemide, it is a diuretic and
helps in treatment of fluid retention. Lorazepam is used to treat anxiety that arises due to
shortness of breath. Some pain killers that are used to reduce pain are paracetamol,
oxynorm and oxycontin.
These medicines are generally prescribed to patients having COPD to reduce the pain.
d)
Non-pharmaceutical treatments that are used in COPD includes pulmonary rehabilitation
to increase the exercise tolerance, long term oxygen therapies to increase survival, termination of
smoking and use of telemedicine. These methods can be used to control the situation from
deteriorating further and can enhance the quality of life of sufferers (Reddel, 2015).
e)
There are various side effects of using excessive analgesics that include condition of
confusion, sleep apnea, nausea and vomiting, depression, memory impairment and respiratory
problems (Domej, Oettl and Renner, 2014). These side effects can be treated by using antidote
medicines and therapies. Confusion and memory impairment can be treated by hiring psychiatrist
that can treat them by providing psychological therapies. Nausea and vomiting can be treated by
drugs like promethazine and diphenhydramine. Anti-depressant medicines can be used to come
up with situation of depression.
4.
The members of interdisciplinary team that can contribute in providing care to patient
and their family are: Pulmonologists are the trained physicians that provide care regarding lungs
and overall respiratory system. Advanced Practice Nurses helps in both patients and their family
by providing them with emotional and moral support. They help in reducing the stress from
family and provide patient with palliative care. Respiratory and Pulmonary rehabilitation
therapist helps patients to improve their symptoms and increase their quality of life.
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5.
Patients and families living in the ACT (Australian Capital Territory) are provided with
self-managements services for optimising proper physical, social, emotional and spiritual
functioning (Chronic Obstructive Pulmonary Disease, 2015). ACT help them by educating
family and patients regarding the illness and their improvement strategies. The services also
include weekly smoking cessation activities, education and methods of use regarding respiratory
and sleep medicines.
6.
Self-care means identifying the need of own and completing them (Bohanny and et.al.,
2013). It is necessary for nurses to have their social and emotional well-being before providing
patients with palliative care. Satisfaction with the social structure, having good social interaction
and receiving good experience after being in situation comprises the social well-being.
Emotional well-being can be achieved when the practitioners are free from burnouts, work stress,
psychological distress and anxiety from work place. This well-being improves the job
satisfaction, motivations and confidence regarding practices.
Various strategies are used by nurses and practitioners while providing palliative care to
COPD patients like: improvement in self-management by supporting patients to quit smoking,
increasing attentions towards inhalation medication techniques and providing exercises and
appropriate tools to cope up with illness. An additional support of other healthcare professional
can be taken to improve the condition of patients. Nurses or practitioners can seek training and
counselling regarding the particular problem to improve their treatment methods.
7.
Policies regarding palliative care: Capacity: This is policy for the patients' ability to make his/her own decision. Informed decision making: This policy is regarding the decision-making capacity of
person from family.
 Ethical decision making: These are decision required when questions regarding quality
of care are raised.
Procedure for palliative care:
 Optimize the symptom control and functional status.
 To promote high quality of care for patients.
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 Educating patient and family regarding the illness.
 History of patient’s disease and treatment procedures.
 Set up of environment that gives comfort to patients and helps in healing.
Protocols:
 Provide support system to patients to live their life happily till death.
 Do not encourage the process of hastening and postponing the death.
 Believe in dyeing as a normal process.
 Provide relief from pain and other symptoms.
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REFERENCES
Books and journals
Bohanny, W., & et.al. (2013). Health literacy, self‐efficacy, and self‐care behaviors in patients
with type 2 diabetes mellitus. Journal of the American Association of Nurse
Practitioners. 25(9). 495-502.
Domej, W., Oettl, K., & Renner, W. (2014). Oxidative stress and free radicals in COPD–
implications and relevance for treatment. International journal of chronic obstructive
pulmonary disease. 9. 1207.
NISHINO, T., & et.al. (2015). Poster-Gastroenterology. Journal of Gastroenterology and
Hepatology. 30(4). 28Н159.
Reddel, H. K. (2015). Treatment of overlapping asthma–chronic obstructive pulmonary disease:
Can guidelines contribute in an evidence-free zone?. Journal of Allergy and Clinical
Immunology. 136(3). 546-552.
Robleda, G., & et.al. (2016). Fentanyl as pre-emptive treatment of pain associated with turning
mechanically ventilated patients: a randomized controlled feasibility study. Intensive
care medicine. 42(2). 183-191.
Slack, R. J., & et.al. (2013). In vitro pharmacological characterization of vilanterol, a novel long-
acting β2-adrenoceptor agonist with 24-hour duration of action. Journal of
Pharmacology and Experimental Therapeutics. 344(1). 218-230.
Scheewe, T. W., & et.al. (2013). Exercise therapy improves mental and physical health in
schizophrenia: a randomised controlled trial. Acta Psychiatrica Scandinavica. 127(6).
464-473.
Online
Chronic Obstructive Pulmonary Disease. (2015). [Online]. Available through
<http://www.health.act.gov.au/our-services/chronic-disease-management/chronic-
disease-services/copd-service>. [Accessed on 12th September 2017].
WHO Definition of Palliative Care. (2017). [Online]. Available through
<http://www.who.int/cancer/palliative/definition/en/>. [Accessed on 12th September
2017].
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