Medical Surgical Nursing Care Plan for COPD Patient

UR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
Description/Focus: Care of the person with a medical condition
Value: 40%
Due date: Friday 12th April 2019 by 1300 ACST
Length: 1800 - 2000 words
This assignment requires you to focus on the holistic care of a patient admitted to
hospital with an acute presentation of a chronic condition and to demonstrate your
ability to apply the clinical reasoning cycle to develop and plan nursing care.
Select one of the following case scenarios:
Mr. Peter Newman is a 44-year-old man admitted to the ward with infective
exacerbation of Chronic Obstructive Pulmonary Disease (COPD). Mr Newman is a heavy
smoker and social drinker. Mr Newman is a Fly-In-Fly-Out (FIFO) truck driver with a
remote mining company and is finding it difficult to meet work responsibilities due to
increasing breathlessness.
Mr Newman lives with his wife Marcy and 2 teenage children in a southern capital city and
works a 2 weeks on/2 weeks off roster.
Or
Miss Violet Paterson is a 77-year-old woman admitted to the ward following an Acute
Myocardial Infarction (AMI). Miss Paterson is currently in a stable condition. She has a
history of primary hypertension and longstanding osteoarthritis. Over the last few
months the arthritic pain has increased significantly, and both her blood pressure and
osteoarthritis are impacting on her ability to meet her daily living needs. Miss Paterson
lives alone in an apartment on the 3rd floor (with no lift access) with her cat Molly and
has no extended family.
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UR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
Based on the information provided in the above case scenarios complete the following
tasks.
Task 1. Consider the patient
What will you consider when preparing the care plan for your chosen patient?
Clinical reasoning process can be explained as the cognitive process where the healthcare
professionals are seen to utilize both the formal as well as the informal thinking strategies for
gathering as well as analysing the patient information. Studies opine that this study is reliant on the
healthcare professionals that use both the intuition as well as the knowledge that influence the
decision-making for individual client circumstances (Weldam et al., 2017). The first step would be
collecting important cues and analyzing the symptoms presented to the healthcare center by Peter.
Peter is a 44 year old man who lives with his wife and two teenage children and has the occupation
of a Fly-In-Fly-Out (FIFO) truck driver on 2 weeks on/2 weeks off roster. He had been admitted to the
ward with the condition of exacerbated Chronic Obstructive Pulmonary Disease (COPD). He is a
heavy smoker as well as a social drinker and works in the remote mining company. He is presently
suffering issues at work because of the symptoms of increased breathlessness.
Studies are of the opinion that excessive smoking can be one of the most important risk
factor that increases the chance of occurrence of COPD among the patients (Weldam et al., 2015).
Peter is suffering from symptoms of COPD and he is also a smoker. Hence, nurses would first need to
know how Peter’s habit of smoking is exposing him to COPD occurrence. Under abnormal condition,
during the time of breathing, oxygen from the air is seen to travel through the windpipe and
ultimately into the bronchioles from which it moves to the alveoli. These are minuscule clusters of
air sacs, which allow the oxygen to get diffuse into its capillaries and from this region to different
parts of the body (Kaufman, 2013). Accordingly, carbon dioxide is seen to be transported from the
capillaries into the alveoli by being collected from different parts of the body from which it is
removed during exhalation. The elasticity of the air sacs mainly helps in the exchange to occur in a
smooth manner. However, in people like Peter, who are regular smokers, cigarette smokes affect the
physiology of the lungs affecting this entire process of gaseous exchange. Cigarette smokes contain
of harmful toxins that affect the lung functionality as they result in severe lung irritation that triggers
the onset of the disorder and hence Peter is also seen to be suffering from the symptoms of COPD.
With time, the lung becomes more and more damaged causing inflammation as well as degradation
affecting respiration (Rodgers et al., 2018). Hence, Peter was seen to suffer from breathless as easy
exchange of gases was disrupted in him. This allows less air in and out of the airways because of four
important occurrences. These are stiffening of the air sacs, deterioration of the walls between the air
sacs, inflammation as well as thickening of the airway walls and increased production of mucus in
the airways causing air obstruction (ANMJ, 2018). Studies also opine that occupational exposure to
dusts as well as chemicals also increase the risk for COPD. Long term exposure to different types of
chemical fumes, vapors as well as dusts in the workplace can irritate as well as inflame the lungs
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UR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
(Kyngas et al., 2017). He works in a mining company and thereby he might be also exposed to coal
dusts and other fumes that have added to the exacerbation of the condition.
Task 2. Nursing assessments
Identify three (3) nursing assessments you will conduct and explain why they are a priority for you.
The nursing diagnosis should try to identify the highest nursing priorities so that the
professional can provide direct care to the patients. For Peter, the nurse should first try to measure
his respiration rate. The respiration rate measurement as a part of the vital sign measurement also
needs to be conducted. The respiration rate is the number of breaths taken by the patient in one
minute. This rate is mainly measured when an individual would be at rest. This would simply involve
counting the total number of times the chest would rise (Fitzsimmons et al., 2016). Normal
respiration rate for the adult persons are usually 12 to 16 breaths per minute. Changes in the
respiratory rate is found to be associated with asthma, anxiety, congestive heart failure, pneumonia,
lung disorder as well as the use of narcotics. Therefore, this should be the first assessment needed
to find out whether any such disorders are present in Peter or not. If the rate is found to be high in
Peter, then the following assessments are to be done.
For Peter, Spirometry test should also be conducted to develop about his conditions of the
lungs as Peter is suspected to be suffering from COPD. Spirometry is one of the diagnostic tools of
choice and helps in measuring the obstruction of the airflow. These tests are seen to include forced
expiratory volume in the first second (FEV1) and forced vital capacity (FVC). These have been found
to help in reflecting the changes in the lung volume from that of the total lung capacity through the
sustained expiration to residual volume (Moreira et al., 2017). The nurse would then try to calculate
the ratio of expired volume to vital capacity (FEV1/FVC). The normal ratio of FEV1/FVC should be
about 705 of greater than this. A lower ratio is mainly seen to indicate the airflow obstruction and is
considered to be the sensitive indicator for the COPD. Studies have also stated that the absolute
FEV1 found in the setting of that of the reduced FEV1/FVC ratio is mainly expressed as a percentage
of the predicted value. This can be helpful of the professional in assessing the severity of the
disorder (The Lung Foundation, 2018). Hence, the nurse attending Peter should first conduct the test
that would show the change the lung volume from total lung capacity and assess its severity.
Another diagnostic test that should be also conducted for Peter is the arterial blood gas
measurement. This measurement can help by providing information about the alteration of Ph as
well as hypercapnia, hypocapnia as well as hypoxia in Peter. This test is found to be useful in the
evaluation of acute dyspnea. They are also found to be helpful in the cases of diagnosis of patients
who have gradually become dyspneic or who suffer from chronic dyspneic. This blood test would be
helpful in measuring how well the lungs are bringing oxygen into the blood and removing the carbon
dioxide (Mulpuru et al., 2017). The patient named Peter is showing symptoms of dyspnea and hence,
this assessment would help nurses to develop an idea about how the lung is functioning.
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UR250 Medical Surgical Nursing 2Assessment 1 Semester 1 2019
Task 3. Care planning
Identify three (3) priority nursing diagnoses for your chosen case scenario and explain why they are
relevant.
The nurse should set the
first nursing priority. It is importance for the nurse to help Peter
achieve airway clearance as he is facing breathlessness, which might be because of mucus
formation, and blocking of the airways by the mucus. Then
interventions need to be set. The nurse
must initiate medication therapy for appropriately administering the bronchodilators as well as
corticosteroids and thereby become alert for any potential side effects for Peter. Bronchodilators
mainly help in relieving bronchospasms mainly by alteration of the smooth muscles tones and
thereby reducing the airway obstruction by allowing increased oxygen distribution throughout the
lungs thereby improving alveolar ventilation (Weldam et al., 2017). Corticosteroids on the other
hand can also be also initiated. Studies are of the opinion that for people who have moderate or
severe acute exacerbation, short courses of oral corticosteroids like that, for five days can help in
preventing the worsening of COPD. Even nowadays, evidence based studies have opined the
application of the phosphodiesterase-4 inhibitor to relieve people from reducing the symptoms of
COPD. The nurse should also teach Peter about the concept of direct as well as indirect
coughing. The nurse should be instructing Peter in direct as well as controlled coughing. This
is found to be more effective and would help in the reduction of fatigue associated with
undirected forceful coughing (Korpenshoek et al., 2016). Then
evaluation needs to be done.
The nurse should ausculate the breath sounds and no down the adventitious breath sounds.
The nurse should also assess and monitor respirations as well as breath sounds, noting the
rate and other sounds in Peter. This would help nurses to understand the efficiency of
interventions in maintaining clearance of the airways in Peter.
The nurse should set the
second nursing priority. The second goal of the nurse would be to
develop the breathing pattern of Peter. Then
interventions need to be set. The nurse should first
integrate inspiratory muscle training, as this would help the patient in developing the breathing
pattern in Peter. The nurse can also undertake diaphragmatic breathing. This form of breathing helps
in education of the respiratory rate and increases the alveolar ventilation. It also sometimes helps in
expelling as much air as possible during the time of expiration (Sobeh et al., 2019). The nurse may
also introduce pursed lip breathing to Peter. This form of breathing can help in slowing down the
expiration and helps in preventing the collapse of the small airways. It would also help in controlling
the rate as well as depth of the respiration. The nurse can introduce oxygen therapies. When
there is not enough oxygen in the blood, supplemental oxygen can be provided to the
patients through different devices like delivering oxygen to your lungs, including lightweight,
portable units. Studies suggest that this therapy helps in extending the lives and developing
the quality of lives (Hazizadeh et al., 2015). Then
evaluation needs to be done. Vital signs
should be done from time to time which would also help the nurse to undertake
assessments for saturated oxygen level and this would help them in understanding the
breathing pattern.
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