Palliative Care: Strategies for COPD Exacerbation Management

This essay analyzes the case study of Mrs. Brown, a retiree with acute exacerbation of chronic obstructive pulmonary disease (COPD), and discusses two high priority nursing strategies to manage her condition. The strategies include the use of corticosteroids to address physical symptoms and social support interventions to alleviate anxiety and emotional distress. The combination of these interventions provides holistic palliative care for the patient.

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

1PALLIATIVE CARE
Palliative care is a care provision that involves providing holistic care to people with life
threatening illness and focusing on fulfilling the unique physical, social, psychological and spirit
needs of patients. It is a type of care that involves optimization of quality of life for patient as
well as their family members using special measured to promote comfort and prevent suffering
(Seow & Bainbridge, 2017). The main purpose of this essay is to analyse the case study of Mrs.
Brown, a 62 year old retiree with acute exacerbation of chronic obstructive pulmonary disease
(COPD) and discuss two high priority nursing strategies to manage Mrs. Brown. These two
strategies give an idea regarding how palliative care is implemented for particular patient.
Mrs. Brown lives is a retiree who works with her husband. The current health issues
experienced by Mrs. Brown includes increase in coughing and shortness of breath. She has been
admitted to the hospital thrice before too because of increase in exacerbation of her COPD. The
difficulty for her has increased over the past 2 days because of chronic productive cough with
white sputum. Hence, as these symptoms are indicative of recurrence of COPD exacerbation, the
first nursing priority is to address these physical symptoms in patient by means of
pharmacological intervention. Focussing on addressing the physical health issues related to
COPD exacerbation is important to reduce the risk of respiratory failure and any further
complication in patient (Osadnik et al., 2017). Taking prompt action will also reduce the need for
supplemental oxygen for Mrs. Brown.
The first nursing strategy that will help to address the physical symptom of chronic
cough and breathlessness includes the use of corticosteroid for Mrs. Brown. The research by
Viniol and Vogelmeier (2018) supports that increase in inhaled corticosteroid in COPD patient is
associated with a decrease in rate of COPD exacerbation. Systemic corticosteroid is a standard
part of treatment of exacerbations and the main factors that leads to such benefits for COPD

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patient like Mrs. Brown includes improve in lung function and oxygenation rate thus
contributing to faster recovery time and time in hospital stay. Oral corticosteroid is beneficial for
COPD patient and nebulized corticosteroid may be needed only during severe exacerbation. The
research by Sethi and Desai (2016) argues that oral corticosteroid is recommended for treatment
of exacerbation. Another advantage associated with the use of corticosteroid treatment is that is
that it has good bioavailability and greater ease of administration. Hence, the main benefit of
initiating corticosteroid treatment for Mrs. Brown is that it will address the symptom of
breathlessness and chronic cough as well as reduce social and economic burden associated with
frequent hospitalization.
The research literature by Walters et al. (2018) gives the evidence that patients with acute
exacerbation must be treated with systematic corticosteroid for 7-14 days. The duration of
treatment also determines the outcome or risk of adverse effect for patient. The research study
investigating about the impact of short or long duration corticosteroid treatment revealed that
there is less likelihood of adverse effect for patient because of short course of systematic
corticosteroid compared to longer course of the same. Hence, it is planned to implement a short
course of systemic corticosteroid treatment for Mrs. Brown so that her physical symptoms
related to COPD exacerbation can be addressed and she can get physical comfort thus providing
her mental and emotional relief too.
As part of palliative care provision, it is also important to address physiological or
spirityal need of Mrs. Brown to ensure that she care experience is enhanced during hospital stay.
However, one of the mental health issues that can affect her overall health includes increase in
risk of anxiety due to illness. This is said because due to continue difficulty in breathing, she is
not able to mobilize or move around the house. She cannot take care of physical and domestic

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needs and is dependent on her family for daily care needs. Hence, these limitations in daily life
due to COPD have resulted in anxiety and emotional distress for her. She feels that she is a
burden to her family. Hence, the first nursing priority is to alleviate the symptom of anxiety
and emotional distress in patient as this would increase her risk of depression and lead to poor
mental health outcomes (Miravitlles & Ribera, 2017). Mrs. Brown’s medical history reveals that
she has been previous diagnosed with depression before too. Hence, addressing her anxiety and
emotional distress is also important to prevent depression.
According to holistic care provision, the second nursing strategy that is necessary to
reduce anxiety and emotional distress for Mrs. Brown includes providing social support to her.
The main rationale behind social support is that it will provide Mrs. Brown an opportunity to
positively cope with her illness and get in touch with appropriate social network that would
reduce her isolation and emotion distress due to poor self-management of COPD. Social support
intervention is relevant for Mrs. Brown because of presence of COPD symptoms like cough and
dyspnea is associated with serious impact on daily living, social isolation and psychological
distress (Miravitlles & Ribera, 2017). Lenferink, Avan der Palen and Effing (2018) supports that
social support related to optimizing physical health, reducing functional impairment in life and
emotional and social well-being is necessary to improve an individual’s capacity to cope with
their disease. Social support can reduce feelings of low mood and social isolation. The study
gives when a carer is involved in providing social support to patients with COPD, this is
associated with increase in physical activity and reduction in anxiety. Social support can be
provided to Mrs. Brown by means of group sessions with other COPD patients or partner
involvement.

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Another advantage of socials support is that instead of directly reducing anxiety, it works
to improve outcomes of patient by reducing loneliness and increasing contact with groups that
reduces negative perception related to COPD self-management among patients. By providing the
opportunity for meaning social exchange, social support interventions in palliative care helps to
improve health status of patient and increase disease management behaviours like participation
in social events and engaging in physical activity (Bradley, Lloyd‐Williams & Dowrick, 2018).
This works to reduce the likelihood of depression for Mrs. Brown. The research study by Mi et
al. (2018) justifies that anxiety due to illness is associated with more co-morbidities like social
isolation and depression. As Mrs. Brown also experiences psychological morbidities like anxiety
and emotional distress, this can impair her ability to acquire new skills and reduce confidence in
self-management of disease. Hence, social care support intervention works to address unmet
supports needs for Mrs. Brown and reduce disease burden.
To conclude, the essay analysing the two high priority nursing care strategy for
management of Mrs. Brown, a patient with COPD exacerbations revealed that COPD is
associated with deterioration in physical as well as mental health outcomes of patient. As chronic
cough and breathlessness could lead to respiratory failure for Mrs., the first nursing care strategy
that was prioritized for Mrs. Brown includes initiation of systematic corticosteroid therapy. The
main rationale behind this intervention was that it works to reduce the rate and frequency of
future exacerbations. Secondly, the nursing care strategy of social support was prioritized for
Mrs. Brown to address emotional, psychological and social support needs of Mrs. Brown. The
combination of both of these interventions is effective in providing holistic palliative care to
patient.

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References:
Bradley, N., Lloyd‐Williams, M., & Dowrick, C. (2018). Effectiveness of palliative care
interventions offering social support to people with life‐limiting illness—A systematic
review. European journal of cancer care, 27(3), e12837.
Lenferink, A., van der Palen, J., & Effing, T. (2018). The role of social support in improving
chronic obstructive pulmonary disease self-management. Retrieved from:
https://www.tandfonline.com/doi/pdf/10.1080/17476348.2018.1489723
Mi, E., Ewing, G., Mahadeva, R., Gardener, C., Butcher, H. H., Booth, S., & Farquhar, M.
(2018). Associations between the psychological health of patients and carers in advanced
chronic obstructive pulmonary disease.
Miravitlles, M., & Ribera, A. (2017). Understanding the impact of symptoms on the burden of
COPD. Respiratory research, 18(1), 67.
Osadnik, C. R., Tee, V. S., Carson‐Chahhoud, K. V., Picot, J., Wedzicha, J. A., & Smith, B. J.
(2017). Non‐invasive ventilation for the management of acute hypercapnic respiratory
failure due to exacerbation of chronic obstructive pulmonary disease. Cochrane Database
of Systematic Reviews, (7).
Seow, H., & Bainbridge, D. (2017). A Review of the Essential Components of Quality Palliative
Care in the Home. Journal of palliative medicine, 21(S1), S37–S44.
doi:10.1089/jpm.2017.0392
Sethi, S., & Desai, H. (2016). Exacerbations of Chronic Obstructive Pulmonary Disease.
In Respiratory Infections (pp. 63-79). CRC Press