Case Study: Chronic Disease Management for Mrs. Betty White - NRS82005

This case study report focuses on the nursing care of Mrs. Betty White, a 76-year-old Italian woman admitted with exacerbated COPD and pneumonia. The report details her medical history, including COPD, osteoporosis, and a previous hip replacement, as well as her social history and lifestyle factors such as smoking. It analyzes her presenting symptoms, vital signs, and the need for proper pathological assessments. The nursing care section emphasizes the importance of patient assessment, communication, cultural sensitivity, and adherence to NMBA codes. The report outlines nursing interventions, including medication management, pain management, and education on healthy living, dietary intake, and exercise. Finally, it addresses discharge planning, including medication management, meal planning, exercise routines, and the involvement of family and community nursing services. The conclusion summarizes the key elements of effective nursing care, emphasizing patient-centered care and evidence-based practice. The report includes references to support its findings.

Running head: Chronic Disease Management
Chronic Disease Management
Name of the Student
Name of the University
Author Note

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Chronic Disease Management
Part 1
Introduction
Nursing care is an aspect of health care that includes many different factors and one
of those factors are the health education providence to the patients in order to provide the
improvement in the post care set up as well. The nursing care is the factor of the physical and
mental support providence to the patient as well and the nurse should be able to provide the
support to the patient by proper nursing diagnosis implementation. In the following section
the patient condition and the nursing care along with the health education and discharge
planning would be discussed based on Mrs Betty White’s case.
Aetiology
Mrs Betty White is a 76 year old Italian lady and admitted directly to the medical
ward from her general practitioner with the exacerbation of her COPD and pneumonia. Her
present condition highlights that she has 122/72 blood pressure which is low, respiratory rate
of 26 which is high, heart rate 99 which also is high, oxygen saturation rate 87 percent with
6L O2 supplementation by Hudson mask. Her condition also highlighted that she has shortage
of breath, peripheral oedema and productive cough. All these symptoms relates to the
severity of her COPD and also the pneumonia (Caramori et al., 2016). On the other hand her
medical history highlighted that she had experienced total replacement of left hip as well as a
severe and persistent ulcer on the right lower leg. She lives alone as her son lives in
Melbourne and meets with her 3 times a year thus she utilises community nursing facility for
her ulcer. On the other hand her pneumonia and the COPD condition is related to her past bad
habit of smoking 3 packs of cigarette every day (Wilkinson et al., 2017). She reported that
she has no appetite for food and do some exercises for her shortness of breath. Coversyl
2.5mg Daily, Spiriva x 1 daily, Combivent x 1 daily, Colecalciferol 800IU daily, Fosamax
70mg weekly, Panadol Osteo 1330mg TDS are the medication she takes on the basis of the

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general physician prescription as the admission process of the patient did not supervised by
the admitting physician. Other than all these the patient found to be attached to the Italian
community of her locality and they also check on her every now. Hence, it can be seen that
the bad habits of the patient and also the cultural beliefs affected her health condition. On the
other hand the prior to the admission the patient has not been assessed by the pathological
tests such as Spirometry, CXR, blood test and ECG. Thus the clear outline of the cause of the
patient’s condition could not be assessed properly. However, on the context of her vital signs
and the physical condition it can be seen that she has an issue of low blood pressure and also
the shortage of breath as a result of the fluid retention that is the peripheral oedema found in
Mrs White’s body (Sohal & Walters, 2017). On this context it can be stated that the
respiratory rate and the low blood pressure of the patient would be marked as the red flag
symptom as these are in severe condition. However, the lack of proper pathological
assessment of the patient would not let the GP and also the RN to conclude on the
pathophysiology of Mrs White’s condition and thus further assessment would be required in
order to provide proper care to the patient.
Part 2
Nursing Care
On the basis of the patient’s social history, medical history and the present vital signs
the RN should focus on the process of the care providence. The nursing care process should
assess the physical condition of the patient by utilising proper diagnosis process. The
diagnosis process would be dependent on inter professional communication with the patient
and on the basis of the communication the condition of the patient can be assessed that
includes the feelings of the patient, pain and others as well. On the basis of the assessment the
nurse should consult with the supervising doctor or the physician responsible for the patient
and also provide the support to the patient (Tobiano et al., 2015). The nursing care would be

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provided with the priority to the patient’s physical and mental condition. The communication
with the patient can be verbal or non-verbal however, the assessment of the patient’s
condition should be focused on the cultural belief of the patient and also providing her the
support needed for the proper care. On the other hand the context of the patient’s health
should be provided with the proper clinical ethics and also the conducts of nursing. The
NMBA code of nursing should be followed which states that the nurse should be able to
provide care to the patient without any discrimination and also prioritise the patient needs
over anything else (Nursingmidwiferyboard.gov.au, 2019). The factor of Mrs White’s care
the bad habits should be eliminated and also provide the proper support to her. On the other
hand the pathological tests should be commended for the better assessment of the patient’s
physical condition. On the basis of the assessment the RN would focus on the red flags of the
condition of the patient. Hence, it can be stated that the RN should focus on the proper
diagnosis of the patient and observe the changes in regular intervals and record the changes
of the patient (Weldam et al., 2016). The health records would be provided to the supervising
doctor. The RN should follow the instructions of the doctor and provide the patient with all
the care which can be provided. The care would focus on the vital sign assessment, pain
management and medication management as well. However, the nurse should provide the
patient with the education needed for the improved life style and also providing her with the
information about the proper practices that would help the patient to reduce the risks of the
COPD, peripheral oedema and also the pneumonia. However, the patient would be provided
with proper support for the required mobility in order to reduce the risk of oedema and
pressure ulcer development. Other than this the nurse would provide the proper care for the
leg ulcer as well which include the dressing, washing and moisture control of the ulcer
affected tissue.

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Education
Other than the above mentioned factors the nurse should provide the patient with
proper education about the healthy living. The patient and the nurse should communicate
properly for improvement of the physical condition of the patient. Thus the nurse should be
able to educate the patient on the factors of the dietary intake the proper medication to sustain
against the severity of COPD and also pneumonia. The patient should focus on the proper
meal intake and the nutritional aspect of the foods taken. The factor of the diet would one of
the aspect that would impact on the health condition of the patient (Hofmeyer et al., 2018).
As the patient do not intake food properly and her medication consists of high dosage thus the
health condition deteriorates without any improvement. Hence, it can be stated that the
patient should be educated about this factor and also motivated for the proper eating and
taking required nutrition. On the other hand the factor of the healthy habits of the exercise
also should be included in this education plan (Baldacchino, 2015).
Part 3
Discharge Planning
The discharge plan would be included with the aspects of the post discharge
considerations that would help the patient in maintaining her medication and other clinical
needs. The nurse should provide the patient with properly marked medication box which
would be marked with dose, timing and amount of the medicines to be taken. Meal timing
and also the required food for the patient’s nutritional requirement would be described in a
written chart. The nurse also should provide the patient with a detailed routine which include
the medication, food requirement and timing and also the exercise that would benefit the
patient with the timing and amount of the exercise (Roberts, Moore & Jack, 2019). The risks
of the bad habits would also be highlighted in this routine chart as well. The discharge plan
should be detailed and also communicated with the family members as well as the patient’s

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age and condition should be considered and the family members that is the son of the patient
should be able to provide all the support to the patient. Other than this if needed the patient
would be provided with home care nurse for the extended support and continuous care as
well (Gonçalves‐Bradley et al., 2016).
Conclusion
Based on the above discussion it can be concluded that the nursing care would be
included with the health education process, patient centred care, evidence based practice and
also consideration of the values and beliefs of the patient. On this context it also needed to be
considered that the doctor or the supervising physician prescription should be followed by the
RN in order to provide proper care to the patient. The nurse should also focus on the NMBA
codes of nursing which focuses on the patient priority.

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References
Baldacchino, D. (2015). Spiritual care education of health care professionals. Religions, 6(2),
594-613. doi:10.3390/rel6020594
Caramori, G., Casolari, P., Barczyk, A., Durham, A. L., Di Stefano, A., & Adcock, I. (2016,
July). COPD immunopathology. In Seminars in immunopathology (Vol. 38, No. 4,
pp. 497-515). Springer Berlin Heidelberg. Retrieved from
https://doi.org/10.1007/s00281-016-0561-5
Gonçalves‐Bradley, D. C., Lannin, N. A., Clemson, L. M., Cameron, I. D., & Shepperd, S.
(2016). Discharge planning from hospital. Cochrane database of systematic reviews,
(1). DOI: 10.1002/14651858.CD000313.pub5
Hofmeyer, A., Toffoli, L., Vernon, R., Taylor, R., Klopper, H. C., Coetzee, S. K., &
Fontaine, D. (2018). Teaching compassionate care to nursing students in a digital
learning and teaching environment. Collegian, 25(3), 307-312. Retrieved from
https://doi.org/10.1016/j.colegn.2017.08.001
Nursingmidwiferyboard.gov.au. (2019). Nursing and Midwifery Board of Australia -
Professional standards. Retrieved 6 August 2019, from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/
Professional-standards.aspx
Roberts, S., Moore, L. C., & Jack, B. (2019). Improving discharge planning using the re‐
engineered discharge programme. Journal of nursing management, 27(3), 609-615.
Retrieved from https://kb.gcsu.edu/cgi/viewcontent.cgi?article=1022&context=dnp
Sohal, S. S., & Walters, E. H. (2017). Essential need for rethink of COPD airway pathology:
implications for new drug approaches for prevention of lung cancer as well as small
airway fibrosis. International journal of chronic obstructive pulmonary disease, 12,
2677. Retried from https://dx.doi.org/10.2147%2FCOPD.S149092

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Tobiano, G., Bucknall, T., Marshall, A., Guinane, J., & Chaboyer, W. (2015). Nurses' views
of patient participation in nursing care. Journal of advanced nursing, 71(12), 2741-
2752. doi: 10.1111/jan.12740
Weldam, S., Zwakman, M., Lammers, J. W., & Schuurmans, M. (2016). Patient perspectives
on the COPD-GRIP intervention, a new nursing care intervention for Chronic
Obstructive Pulmonary Disease patients. Primary care nursing for COPD patients: a
biopsychosocial perspective, 129. Retrieved from
https://dspace.library.uu.nl/bitstream/handle/1874/340307/Weldam.pdf?
sequence=1#page=129
Wilkinson, T. M., Aris, E., Bourne, S., Clarke, S. C., Peeters, M., Pascal, T. G., ... & Staples,
K. J. (2017). A prospective, observational cohort study of the seasonal dynamics of
airway pathogens in the aetiology of exacerbations in COPD. Thorax, 72(10), 919-
927. Retrieved from http://dx.doi.org/10.1136/thoraxjnl-2016-209023