Palliative Care: Strategies for COPD Patients

This essay explores the application of palliative care approach for COPD patients by analyzing a case study and discussing two high priority nursing strategies to manage symptoms. The first strategy focuses on addressing breathlessness through bronchodilator therapy, while the second strategy involves providing social support and implementing cognitive behavioral therapy to address depression and anxiety. These interventions aim to improve the physical and psychological well-being of COPD patients.

Running head: PALLIATIVE CARE
Palliative care
Name of the student:
Name of the University:
Author’s note

1PALLIATIVE CARE
Palliative care focus on providing care to people with life-limiting illness and addressing
physical, psychosocial, spiritual and cultural needs of people at end-of-life. It is a holistic
approach to care that focus on aggressive symptom management and psychosocial support
(Costello, 2018). This essay aims to define the application of palliative care approach by
analysing the case study of Mrs. Brown, a 62 year old retiree with repeated exacerbation of
COPD (Chronic obstructive pulmonary disease) and discussing two high priority nursing
strategies to manage Mrs. Brown. The essay also provides rationale to justify these strategies.
Mrs. Brown is a 62 year old patient who lives with her husband and suffers from acute
breathlessness which has affected her daily physical activity. Hence, breathlessness has been
identified as a high priority physical health issue for Mrs. Brown. Mrs. Brown has called an
ambulance due to feeling of shortness of breath for several days. Shortness of breath is a
commonly observed symptom in patients with COPD and it is often associated with limited
physical activity, risk of depression, low rate of survival and decreased quality of life (Anzueto
& Miravitlles, 2017). Therefore, prioritizing treatment of breathlessness is critical to reduce rate.
Hence, the first high priority nursing priority for the care of Mrs. Brown should be to address the
issue of breathlessness and reduce its impact on respiratory symptoms like dyspnoea.
One of the holistic palliative care provisions to address breathlessness in Mrs. Brown
includes initiation of bronchodilator therapy to relieve symptom of breathlessness and reduce
airflow limitation (O’Donnell et al., 2016). As the most immediate goal for patient is to relieve
dyspnea and chronic cough and protect patient against hypoxia with need for supplemental
oxygen, use of short-acting beta-agonist bronchodilators is the first line of treatment. This
strategy can avoid further complications in patient such as risk of respiratory compromise and
failure.

2PALLIATIVE CARE
Bronchodilators are the first line of treatment for patient with COPD as it provide relief
to patient and reduce risk of respiratory failure because of dyspnea. Research by Duong, Zeki
and Louie, S. (2017) gives the evidence that patients with COPD respond very well to
bronchodilator treatment. The main reason behind this is that use of bronchodilator is associated
with relaxation of bronchial smooth muscles, decrease in airway inflammation, reduced air
trapping and decrease mucous plugging. Hence, this is likely to improve lung function and
reduce symptom of chronic cough thus providing comfort to Mrs. Brown. Viniol and
Vogelmeier (2018) supports that severe airflow limitation is the main cause behind exacerbation
of COPD symptoms and bronchodilation reduce the risk of COPD exacerbation. Maintenance
therapy like broncholdilation with LAMAS is effective in reducing exacerbation rate annually by
20%.
The main rationale behind the use of bronchodilator drugs for the treatment of COPD is
also explained by Di Marco et al. (2019) which suggest that this drugs eases breathing process
and this occurs because of relaxation in the airway smooth muscle and improvement in ventilator
mechanics. It can also reduce Mrs. Brown’s capacity for physical activity by improving
emptying of the lungs and exercise performance. As Mrs. Brown was admitted twice before for
exacerbation of COPD, this treatment is found relevant for her too. The effectiveness of the use
of systemic corticosteroids is that it improves oxygenation rate and lung function thus decreasing
the recovery time and duration of hospital stay. This treatment is considered for patient with
history of exacerbation. The significance of this intervention in palliative care is that addresses
physical needs of patients and works to address psychological issues too by providing relief and
increasing comfort level of patient and capability for physical activity.

3PALLIATIVE CARE
The second high priority issue for Mrs. Brown includes risk of depression. This is seen
because due her acute breathlessness, she finds difficult to leave the house or even more around.
She lives with her husband and there is no other family member who comes to visit her regularly.
Hence, inability to go outside and restriction in mobility may have an impact on mental health of
client and lead to feeling of loneliness and risk of depression (Rivera et al., 2016). Furthermore,
as Mrs. Brown feels that she is a burden to her family, this feeling may further increase the
recurrence of depression for her. To address this issue, the second high priority nursing strategy
is to provide social support intervention to Mrs. Brown so that psychological health and well-
being of Mrs. Brown can be maintained. As part of palliative care, focussing on psychological
health outcome of patient is important because depression is highly prevalent in patient with
COPD. As this symptom can have impact on quality of life and mortality, addressing depression
is necessary to meet holistic care needs of client (Mi et al., 2017).
The second nursing strategy to address anxiety and depression for Mrs. Brown includes
the implementation of nurse led cognitive behavoioral therapy for her. The main rationale behind
cognitive behavioural therapy for Mrs. Brown is that it can help to address psychological needs
of client and provide a supporting environment to change negative thoughts. Yohannes (2018)
justifies cognitive behavioural therapy as an effective patient centred and personalized
intervention that can improve health behaviour and improve adherence to treatment. Participation
in such sessions reduces depression related symptoms, increases exercise, and improves quality
of life and lead to adherence to medication too. The ultimate benefit is reduction in frequency of
exacerbation. Another advantage of cognitive behavioural therapy is that it promotes disease
management behaviours in patient such as smoking cessation and participation in social
gathering (Baker & Fatoye, 2017).

4PALLIATIVE CARE
The research literature by Lenferink, van der Palen and Effing (2018) argues that life
stresses associated with COPD reduces mobility and lead to embarrassment, increased isolation
and disruption in social network for patient. Mrs. Brown was also experiencing all these issues
because of repeated exacerbation of COPD. Hence, cognitive behavioural therapy is vital for
such patient to enhance their mental health and increase capability for self-management
activities. Feeling of isolation reduces patient’s confidence in managing the disease and lead to
depression mood (Schuler et al., 2018). Therefore, social support from a care giver is associated
with adherence to self-management intervention and improvement in quality of life too. Hence,
this care strategy is useful in providing holistic palliative care to Mrs. Brown.
From the discussion on two high priority nursing care priorities for Mrs. Brown, it can be
concluded that providing palliative care is associated with improvement in symptoms as well as
psychological health of patient. The first strategy of pharmacological intervention is effective in
addressing physical health issues for client and reducing risk of respiratory failure due
breathlessness. Secondly, the second nursing strategy of cognitive behavioural therapy fulfils
holistic care needs of client by addressing anxiety, social isolation and adherence to treatment for
patient. The combination of two interventions can improve overall health outcome and improve
health status of Mrs. Brown.

5PALLIATIVE CARE
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