Clinical Decision-Making in COPD: A Case Study Analysis (NS5004)

This case study focuses on a 65-year-old male, Tony, diagnosed with COPD, whose condition worsened due to continued smoking. Upon admission, he presented with mild hypotension, a high respiratory rate, and low oxygen saturation, indicating an exacerbation of his condition. The assignment delves into the diagnosis, signs of exacerbation, and the application of clinical decision-making frameworks. It explores the use of CT scans, blood tests, and spirometry for diagnosis and discusses the patient's social, cultural, and spiritual beliefs in relation to care. The study highlights the Coleman Transition Model to support the patient in managing his condition and reducing readmissions, alongside Cognitive Behavioral Therapy (CBT). Furthermore, it emphasizes holistic patient care, including the significance of cultural awareness and the integration of spiritual support. The clinical management section addresses integrated health care networks and the importance of effective communication and understanding of cultural beliefs in providing comprehensive care. The assignment provides insights into nursing interventions and the application of various models to improve patient outcomes.

Running head: CASE STUDY
Clinical Decision-Making base on Case Study
Name of the Student:
Name of the University:
Author Note:

1CASE STUDY
This essay aims to describe the clinical decisions one can act upon for a specific case.
The case highlights a patient, TONY with serious chronic obstructive pulmonary disease
(COPD), which was diagnosed three years back. The patient has habits of regular smoking,
and hence the case of COPD worsened, which enhanced his problems of breathing. When the
patient was brought to the ward, his blood pressure had fallen to 100/64 mmHg, which is
considered as mild hypotension and also had a respiratory rate of 36 with 86 percent of
specific oxygen content. The signs thus have shown mild cyanosis as the patient also shows
Glasgow Coma Scale (GCS) of 15/15, which states that the patient's consciousness is at alert
and can take turn any moment to return to consciousness (BrainLine, 2019).
The essay also identifies the stage the patient is in and follows up with the proper
diagnosis of the disease to treat it properly and to have proper nursing interventions to
provide a better lifestyle for the patient. In order of doing so, it also discusses the certain
model of Coleman transition to overcome COPD. It also discusses Cognitive Behavioural
Therapy (CBT) as a trial to reduce readmissions of COPD patients as happened in this case.
Chronic pulmonary obstructive disease and its signs of Exacerbation
Chronic Obstructive Pulmonary Disorder (COPD) collectively describes the
uncontrolled lungs infection usually triggered by emphysema, chronic bronchial infection and
uncontrolled and irreversible asthma (Copdfoundation.org, 2019).
Emphysema is the state where the alveoli gets impacted as a result of which the inner
membranes of the sac starts disappearing to form a large sac. However, the large sacs fails to
carry the adequate amount of oxygen and hence fails to meet the oxygen requirement of the
body (Copdfoundation.org, 2019).
Whereas the chronic bronchitis refers to the negative impact over the bronchial tube
that reching the lungs. In general, bronchitis is the uneasiness and swelling of the bronchial

2CASE STUDY
tract which reaches the clungs. This irritation causes frequent coughing and inadequate
breathing. When such conditions last for more than three month or more can result in chronic
bronchitis. The bronchial channels are lined with cilia and upon having chronic bronchitis
these cilia gets destroyed and hence becomes unable to push out the mucous in the channels
of bronchial tract (Copdfoundation.org, 2019).
The symptoms those prevail upon having chronic COPD are rough and dry chough,
wheezing, breathing shortness, phlegm and rusty mucoid sputum production and tightness in
the chest. To overcome these certain symptoms measures of pulmonary rehabilitation,
therapy with oxygen, quitting of smoking and specific medications are applied to enhance
tolerance towards exercise and to reduce urges of smoking (Cleveland Clinic, 2019).
The diagnosis was made with a run of scan using the method of Computed
Tomography (CT), an x-ray of the chest, blood tests, spirometry and by culturing the sputum.
When the patient was brought to the ward, the individual has shown serious
exacerbation. Exacerbation is the state of COPD where the condition gets worsened than in
normal state due to serious breathing problems. Chances for a COPD patient always prevails
for having serious exacerbations although it remains in a normal condition but can trigger at
any point of time. Signs, which shows chances of exacerbation are, continued mild fever,
enhanced rescue medication usage, increase in swelling of ankles, change in colour, odour
and thickness of mucus and nausea (Copdfoundation.org, 2019).
In addition, other risks to exacerbation are unrested body, dizziness during verbal
communication and early morning headaches, rapid breathes and intense heart rate.
Exacerbation is mostly caused out of lung infection caused by the impacts of viruses.
Infection by viruses are ineffective toward antibiotics, thus helps in creating an atmosphere

3CASE STUDY
suitable for the bacterium mycobacterium tuberculosis to put impact over the lungs
(Copdfoundation.org, 2019).
In Case of TONY the certain diagnosis were among which CT scan was done to
understand the body functions with tha help of an X-ray imaging via computer. Moreover,
blood tests and chest X-ray was done to understand the conditions of body fluid and
conditions of the lungs and lungs capacity.
Later on spirometry test was done and resulted in chronic asthma as the patients lung
capacity was too weak due to regular smoking. Spirometry test is a mechanism which
measures the lung capacity and answers either the individual is an asthma patient or not.
Social, Cultural and Spiritual beliefs of Care
The variety in faith among the inhabitants of the nation provides medical care
professionals and programs with difficulties for delivering culturally relevant medical help.
Cultural competence is the capacity that will provide medical services to fulfil patients '
cultural, social, and religious requirements and their family members by health professionals
and associations. Social skills can help enhance the quality of treatment and the efficiency of
care. Strategies for pushing medical professionals and programs towards these objectives
require instruction in cultural expertise and the implementation of policies and procedures
that reduce the obstacles to cultural patient safety. If healthcare professionals and programs
collaborate to supply culturally sensitive services, the client may have adverse health effects,
be under-supported and disappointed with the treatment he or she provides. The level of
competent patient-health experiences has plummeted. Improved patient-health experiences in
the medical provider are linked to lower satisfaction. Yes, the consistency of their focus has
been decreased because of the African Americans, Asian Americans, Latinos and Muslims.
The Joint Commission (JCP) calls for the protection of patient privacy rights and economic

4CASE STUDY
rights, social and moral interest harmony in the institutions. Medical practitioners and
programs must look after all people, including the body, mind and soul. The cultural and
religious interests of the individual must be taken into account in medical care. Medical
professionals must be capable of responding to clients and their family in an incredibly
stressful period with the knowledge and abilities needed. Health services and healthcare
providers create methods and techniques to meet individuals and communities ' spiritual and
religious desires for a variety of reasons. In order to promote systemic tolerance to civic
diversity, the response to the TJC, local and state legislation. Such approaches are vital to the
goal of preventing racial and cultural health inequalities by the state government's healthy
individuals initiative (Swihart and Martin., 2019).
The views, attitudes and values of patients are influenced by influences like ethnic
group, sex, culture, mental capability, gender, job, education, religion, sexual orientation and
socioeconomic status. Cultural knowledge is a resource and program capable of
understanding and incorporating cultural wisdom into healthcare provision. The goal of
delivering culturally sensitive healthcare services is to provide every individual, regardless of
social, national, racial or religious status, with a reliable standard of care (Swihart and
Martin., 2019).
Information Processing Theory using Coleman Transition model
With the enhanced risk of COPD, the patient used to smoke regularly though he faced
chronic hamper of his health three years after diagnosis and the present conditions state that
his admission in the ward is due to non-cessation of smoking. Thus, to provide support to the
patient, it was necessary to provide him with Cognitive continuum theory, which can be done
with the help of the Coleman Transition model, which can turn out to help reduce COPD for
the patient. The Coleman Transition Interventions (CTI) helps the patient to manage their
medication by themselves; this also helps the patient to acquire a care process to carry upon

5CASE STUDY
by having a guide through their reports and hence helps in building up patient-centered care
for the patient. In addition, it also provides a care provider for primary help and also a
specialist to follow up with the care. It also helps in indicating the patient in developing a
deadline indicator of worsening condition to understand the upcoming steps (www.chcf.org,
2019).
The use of CTI in a monitored randomised controlled trial resulted in better
readmission rates in hospitals: on average, one rehospitalisation is avoided in every 17
patients who work with a transition trainer. Experts estimate that medical costs will be
decreased by about $300,000 for every 350 patients receiving the treatment. All who are
using the model or such intervention for patient transitions had a good or exceptional
complete medical experience (www.chcf.org, 2019).
The holistic approach to Patient Care
For healthcare, holistic patient evaluation is used to guide the clinical mechanism and
provide pillars for the care of the patient. The nurses are able to offer patients better
individual focused treatment through holistic evaluation, therapeutics interaction and ongoing
collection of objective and subjective data. The patient's physiological, sociological,
developmental, moral and cultural concerns are understood and addressed by a holistic view.
The article discusses briefly the significance of holistic evaluation's developmental, moral
and cultural influences and how they can be integrated into the nursing cycle. Gaining
holistic care for the patients, positive health gain for the patient and safety for the patient is
the prime goal for a nurse as their leadership quality has also been discussed (Wallace. 2013).
When part of the patient's initial evaluation, the nurse will inquire about a person's
spiritual support by arranging visits by the patient's local Minister from the healthcare
system, such as a visit to the medical professional or from the neighborhood. Spiritual

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demands can also be evaluated by examining and active listening and by observing religious
iconography or artifacts in the room of the individual. Nurses must embrace the religious and
spiritual needs of their patients strongly as the evidence demonstrates that spirituality can
help patients respond to physical changes after events like strokes by offering attachment,
optimism and strength to confront the possibilities (Wallace. 2013).
Awareness towards culture and clinical understanding of the way that how culture
affects an individual’s health is another view of providing holistic culture during nursing
evaluation. Cultural values can have a direct effect on the health of individuals and nurses are
responsible for being aware of the cultural background of each individual and insure that
"practices remain responsive and address cultural issues". The significance of this strategy is
evident in the interest of cultural wellbeing and technical integrity in undergraduate nursing
in many countries. Cultural values can have a direct effect on the health of individuals and
nurses are responsible for being aware of the cultural background of each individual and
insure that "practices remain responsive and address cultural issues". The significance of this
strategy is evident in the interest of cultural wellbeing and technical integrity in
undergraduate nursing in many countries. Cultural traits of patients can be apparent by family
dynamics, habits, traditions, attitudes, intelligence and social behavior (Wallace. 2013).
Consideration of cultural beliefs in an early appraisal may recognise the need for a
further in-depth conversation on cultural factors and how they might influence the medical
care team's: diet, social networks, health environments and attitudes to the person's room and
patient contacts. For all patients receiving treatment, particularly patients of diverse cultural
backgrounds, efficient, caring, and appropriate professional interaction is crucial. The basis
of a comprehensive psychological assessment is direct interaction. Ensuring that
communications are appropriate for a person, as demonstrated by ANMC Competence 9'
establishes, maintains and concludes therapeutics relationships' is an important part of

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interpersonal and clinical practice. Awareness of the cultural beliefs of an individual is an
essential part of clinical examination (Wallace. 2013).
Generation of health needs for COPD patients had been required, and Integrated
health care networks have made it possible in doing so. Integrated health care networks
(IHN) are encouraged by delivering a coordinated continuum of services to a given
population in several countries as a solution to fragmented health care provision.
Nevertheless, there is little evidence of their efficacy and performance, especially given the
consistency between the various levels of care; this is the experience of the patient with the
linked and reliable treatment provided over the years from clinicians from different levels of
care (Waibel et al. 2015).
Clinical Management
To clinically manage the case provided A-E nursing system was used. Here, A:
Airway, B: Breathing, C: Circulation, D: Disability and E: Exposure.
Airway obstruction is considered among emergency care cases as it requires expert
support or else it can lead to intensive damage to brain, lungs, heart, kidneys and even can
cause cardiac arrest and death. Such obstuctions are treated as clinical emergency and treated
with oxygen therapy using airway opening manoeuvres as done in this case of TONY
(Resus.org.uk, 2019).
Evaluation of patient’s breathing was done in order to diagnose and take care of the
situation if it stands life threatning. The method helps in diagnosing if the patient is having
acute or major asthma, tension in pneumo thorax or pulmonary oedema. This process helps in
understanding the respiratory rate, specific oxygen percentage and accurate imaging of chest
to understand the location of trachea (Resus.org.uk, 2019).

8CASE STUDY
Unless proven considering hypovolaemia as the prime cause of shock, in almost any
medical and urgical emergency. When cardiac indications are not evident any individual with
cool peripheries and rapid heart rate can be given an intravenous fluid. Haemorrhage is
removed quickly in surgical patients (Resus.org.uk, 2019).
Remarkable hypoxia, hypercapnia, stroke, or the recent use of sedatives or analgesic
drugs are common causes of unconsciousness. Initial patient's conciousness level assessment
with AVPU system (Alert, Voice, Pain, Unresponsive): alert, responds to auditory stimuli,
reacts to external stimuli or response to all stimuli was done Use of Glasgow Coma Scale
score was done based on the above conditions. Super-orbital pressure can be used to give a
painful stimulus (Romanelli and Farrell. 2019).
Full body exposure may be essential to analyze the patient correctly. Patient dignity
must be respected and heat loss minimized. The process is followed by proper reviewing of
patient’s vital signs, keeping full clinical history of the patient into consideration,
understanding the care need to be acted upon for patient’s positive health enhancement and a
by studying the response of the patient to the therapies (Resus.org.uk, 2019).
In the last decade, patient safety was the focus for many campaigns, but much of the
emphasis was on hospital care where the risk of drug mistakes, drops, acute respiratory
infections, wrong site surgery and thus patient damage is high. In addition, ambulatory
treatment environments are where patients receive most of their health care—
perhaps those with a serious illness like cancer or COPD. Thus, the requirement of interaction
and making of interpersonal relation with the patient is required to provide a speedy recovery.
The development of a patient safety culture does not take the form of a checklist, although it
is necessary to test the office processes against risk. People understand that the fundamental
device defects are the main source of mistakes in the culture of protection of patients and not

9CASE STUDY
patients. To order for good systems to be built for secure patient care, a team strategy requires
no fault. Accordingly, the philosophy of patient care is based on trust and cooperation. It
takes time to form a public health and safety culture and leaders who promote risk
management efforts. Doctors and healthcare professionals have a leading role and are capable
of improving patient safety by cultivating a team culture and developing strategies for risk
reduction (Gesme and Wiseman. 2012).
Nursing Interventions for COPD patient in this Case
Nursing interventions were adapted in this case, was a trial with motivation towards
smoking cessation. Smoking cessation is considered as one of the most significant methods
which reduce the risk of COPD. The smoke of tobacco contributes a lot to the development
of COPD (Sciencedirect.com, 2019). Thus, motivational reduction in smoking can be one
best intervention towards reducing the impacts of COPD in the patient. The reliability of the
concise guidance alone or in conjunction with specific patient care or group support provided
by nurses was tested in a randomised controlled trial (RRT). The biochemistry of smoking
status has been validated and nicotine dependency and dyspnoea, 2, 3, 6 and 9 and 12 months
were registered. The survey included 91 COPD cigarette smokers (mean age 61, 47 females).
There were no significant differences between the groups after 12 months of cessation, but
nicotine addiction had significantly reduced in all groups. Throughout 12 months, there were
no changes in subject confidence or dyspnea (Wilson et al., 2008).
Another possible intervention in such can be providing support by nurses through
telemedicine. The user of electronic information technology to deliver health care support to
the patients who require them (Wootton., 2008). In new treatment models, nurses often play a
crucial role due to different kinds of support in telehealth. Consultations with nurses and
programs in disease control are important measures that enable nurses to provide,
complement or improve the resources provided to their physicians. Consultations undertaken

10CASE STUDY
by experienced nurses often include duties generally applicable to medical practitioners, such
as patient clinical assessments, analysis, and distribution of medical products in countries
such as the United Kingdom. The treatment strategies performed by nurses was designed to
help people adapt and improve their quality of life. These provide medical care, controlled
self-management, reduction of smoking, and lung recovery (Fletcher and Dahl., 2013).
In addition, another nursing intervention that can be provided to elderly patients like
TONY is to provide a quality life. A survey was made run among individuals above 60 years,
and it was found that most of them are either depressed ou anxiety striken and are not being
able to enjoy a quality life. Minimal Physical Intervention (MPI) was linked to the normal
treatment of COPD patients in a randomised controlled trial. Of primary care is treated
COPD patients aged 60 years or older and suffering from mild to severe major depression (n=
187). The therapy was based on cognitive and self-management therapeutic strategies (CBT).
The findings were normal and at one and three and nine months following treatment
measured symptoms of depression, anxiety symptoms and disease-specific quality of life.
Results indicated that the manifestations of depression (median BDI Differences 2.92,
p=0.04) and distress (mean symptoms symptomatic checkliste (SCL) Difference 3.69,
p=0.003) were significantly reduced in patients receiving MPI at nine months compared with
those of those who obtain regular treatment (Lamers et al., 2010)
Therefore, it can be concluded that the case reflects a patient with Chronic obstructive
pulmonary disease (COPD) which has taken to a wrong turn due to patient’s intensive
smoking habit. Measures with a holistic evaluation of the patient had also been enacted so
that patient can be treated properly by keeping a holistic view of physiological, sociological,
developmental, moral and cultural concerns.

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Moreover, the article holds a keen knowledge of healthcare management by keeping a
view of cultural and social beliefs of the individual in consideration while treating them.
Moreover, it concludes, what were the type of assistance individuals with COPD were
given, who could not stop smoking. Long term damage decrease may be a more appropriate
target than a complete cessation in this area for intractable smokers and thus, nurses need to
increase their concern in resolving this field. In older COPD patients with nurse-led MPI
lowered depressive symptoms and anxiety and enhanced disease-related quality of life. The
MPI seems a great complement to current COPD patient disease control systems. Healthcare
professionals are an appropriate solution to provide care and support throughout the entire
lifetime of the condition for individuals with COPD.
While more research is needed to determine the efficacy of nursing-led operations and
evaluations, there is growing evidence that such interventions benefit, particularly in
connection with the hospital at home and early discharge, quitting smoking and lung
rehabilitation programs as well as measures to improve life-management. Research also has
shown that healthcare professionals can provide as impacting treatment as doctors.
Nonetheless, there are clear areas to improve that is demonstrated by a lack of
standardised skills and specific training criteria, combined with a lack of medical oversight,
adequate finance and workplace stresses among COPD nurses. Nurses need to increase their
presence in planning and delivering additional tactics to enhance COPD patients ' quality of
life and to lessen the future strain of COPD patients. However, this will discourage nurses
from accepting expanded isolation duties. In order to provide health care professionals with
high quality, safe and efficient healthcare, better co-ordination and support from
employees, together with official recognition of their new roles, is necessary, and in this way,
comparable health care facilities can be optimised throughout the world.