Palliative Care: Strategies for 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.