NUR20006: Case Study on Acute Exacerbation of COPD

This case study focuses on a 65-year-old female, Mrs. Lucienne Oporto, admitted to the hospital with an acute exacerbation of COPD. The assignment details the stepwise method of assessment, including mental status, cardiovascular, and respiratory assessments, considering her medical history of hypertension, diabetes, and smoking habits. The study explores anticipated assessment findings, such as shortness of breath, coughing, and fatigue, and delves into the pathophysiology of COPD, including expiratory flow limitation and dynamic hyperinflation. Furthermore, it discusses relevant nursing interventions, such as patient education, smoking cessation, oxygen therapy, and discharge planning, including medication management and patient education for self-management of COPD symptoms, emphasizing the importance of a COPD plan and pharmacist involvement for a safe discharge. The case study highlights the importance of comprehensive care for patients with COPD, addressing both physical and psychological aspects.

Running Head: COPD
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COPD
Essay
Student name
10/9/2019

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Acute exacerbation of COPD
Mrs Lucienne Oporto is a 65 years old female who was admitted to hospital two days ago
with the symptoms of acute exacerbation of COPD. Two weeks ago, she was treated with
antibiotics due to the susceptibility of chest infection and when symptoms improved, she stopped
taking the antibiotics. Acute exacerbations of COPD are considered by a falling of the enduring
breathing indications like dyspnea, sputum or cough, day to day differences and requirement of
alterations to the patient’s medicinal treatment (Fletcher, 2013). Depending on the severity of
COPD, it can be managed in primary care or hospitalization is required in some severe
conditions. Below mentioned is the stepwise method with four mechanisms procedures the
analytical impost for the acute exacerbation of COPD. An applicable medicinal past that
categorizes one or more of the three fundamental indications: “increased shortness of breath
increased sputum volume, and increased sputum purulence”. These indications have to be
understood in the background of other medical circumstances such as “disease severity,
frequency of previous acute episodes, the presence of comorbidities (cardiovascular, diabetes,
skeletal muscle)”, and the socioeconomic atmosphere.
In the case of Mrs Lucienne Oporto, there are three different assessments will be done by
body systems: assessment of mental status, cardiovascular assessment, and respiratory
assessment.
As discussed by Mrs Lucienne Oporto her husband died a few months and her son lives
in another city and her daughter with 3 children visit her daily. Now she has the responsibility of
the farm and has to manage things on her own. Therefore there is a possibility that she has
developed some mental issue like depression, stress etc as she also stooped taking medication.

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This will be done by assessing her attitude, mood, motor response etc. to assess the mental status
and problem like stress perceived stress scale can be used which include some questions to
examine the problem. This particular assessment will help in providing the complete support to
the patient including emotional support (Plana et al., 2017).
Another essential assessment will be done for Mrs Lucienne Oporto is a cardiovascular
assessment, which includes assessing the heart-related problem of the patient. Mrs Lucienne
Oporto has a history of hypertension; therefore assessing the circulatory condition is necessary.
The assessment will include assessing the heart sounds, the peripheral vascular system etc.
regular assessment of blood pressure is necessary. This can be done by auscultation and
assessing the radial and pedal pulses. Sphygmomanometer will be used to check his blood
pressure (Boeck et al., 2016).
Regular Respiratory assessment is also necessary as the patient experiencing symptoms
like shortness of breathing, tiredness, and low oxygen saturation. She also smokes 1 pack of
cigarettes which might deteriorate her health condition. As the patient has respiratory complaints,
palpitation of the chest areas for bulges, and abnormal movement will be assessed. The
respiratory assessment will be begun with physical assessment by analyzing ad observing the
rate of respiration, effort and function (Lundblad, Piitulainen & Wollmer, 2017).
Further, based on Mrs Oporto three anticipated assessment findings, assessment of
pulmonary conditions and respiratory functions will be assessed, as the patient complained about
increased shortness of breath and has a history of Type 2 diabetes and hypertension. Three
anticipated assessment findings for Mrs Oporto are shortness of breathing, coughing, and
tiredness. Individuals with COPD often have damaged lungs that make it difficult to breathe, and

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they experience shortness of breathing as it takes more efforts to inhale and exhale the air.
COPD results in frequent coughing and increased mucus formation. COPD can cause the
patient's lungs to generate excess mucus (Park, 2017). In COPD the airway and lungs if the
patients are inflamed, this results in chronic cough with phlegm and breathing issues. As
discussed by the patient she smokes 1 packet of cigarette daily which can worsen her respiratory
conditions. The patient has also reported to experience tiredness (Plana et al., 2017). COPD
makes breathing hard, which impact the energy level of the patient and cause fatigue as without
oxygen supply the whole body feel exhausted. In early diagnosis the symptoms are mild but with
the time it often becomes worse. Additionally, Mrs Oporto shows clinical symptoms of flu as
well, therefore, will assess pulmonary conditions like pneumonia and lung cancer as Mrs Oporto
smokes a packet of cigarette weekly. For advanced treatment, we will assess the forced
spirometry to manage the exacerbation throughout the repossession or to plan the treatment of
COPD or to observe the recovery process. The shape and symmetry of her chest will be
observed. The thorax of an adult is wider than its deep. The patient might have developed the
barrel chest because of the COPD caused by bone degeneration which often reduces the
expansion of the chest. The shortness of breathing will be assessed regularly with or without
exertion and orthopnea which is frequently observed in COPD patient (Oliveira et al., 2018).
Exacerbation of COPD is described as the event in the common course of the disorder
that is categorized by an alteration in the diseased person’s baseline dyspnea, coughing, or
sputum outside everyday variability and adequate to warrant an alteration in management
(Mitchell, 2015). Recent readings have specified that the status of health of individuals with
COPD is affected by the presence and occurrence of acute exacerbations and that the occurrence
of the COPD exacerbations is recognized as one of the most significant factors of health-related

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life quality. Expiratory flow limitation is the pathophysiological symbol of COPD. People with
COPD experience flow limitation when the expiratory flow throughout the respiration shows the
maximal probable flows that are generated by them at that volume. Time taken for lung
emptying in flow-limiting patients during the spontaneous breathing is frequently insufficient to
permit EELV (expiratory lung volume to decline to its normal relaxation volume resulting in the
lung over inflations (Radovanovic et al., 2018). Dynamic hyperinflation takes place when the
inspired tidal volume upsurges and expiratory time reduces. During the exacerbations airways,
resistance in COPD is abruptly increased and this deteriorates the EFL. Smoker with the stable
COPD have the chronic inflammation of the overall tracheobronchial tree recognized by the
increased number of cells called macrophages and CD8 lymphocytes in the patient’s airways
wall and of the neutrophils in his airway lumen, COPD exacerbations are considered to show
worsening of airway inflammation, caused mostly by the viral and bacterial contamination and
air pollution. Past medical history of Mrs Oporto includes emphysema, type 2 diabetes,
hypercholesterolemia, hypertension, COPD, depression, and osteoporosis. These clinical issues
might be the reason for the worsening of her health (Kim, 2017). Emphysema causes air sacs to
damage in the patient’s lungs. The walls present between numerous air sacs are impaired,
triggering them to change their shape. These results in the stretchiness loss of sacs and trap the
air instead. With time it becomes progressively difficult to drive the air completely out of the
patient’s lungs and they no longer unfilled efficiently. This result in more air than usual to exist.
This particular phenomenon is named air trapping and result in the lungs hyperinflation.
Additional air in the patient’s lungs and the extra effort desired to respire adds to the shortness of
breath (Anzueto & Miravitlles, 2017).

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It has been identified that diabetes is the common comorbidity of COPD, and it is
associated with impaired functioning of lungs. It is associated with the reduced adjusted mean
residual forced expiratory volume in a second and the forced vital capacity. Exacerbations of
diabetes might occur due to the different biochemical alterations in the structure of patient's lung
tissues and airways that include a number of mechanism like because of systemic inflammation,
oxidative stress, hypoxemia or finally to the direct damage triggered by chronic hyperglycemia
(Page, O’Shaughnessy & Barnes, 2016). Mrs Oporto also has a history of hypercholesterolemia.
The number of studies conducted on COPD identified that increased levels of cholesterol in the
body is associated with the increased rate of decline in forced vital capacity and emphysema.
Increased cholesterol levels in the body result in heart diseases such as hypertension, and
coronary microvascular disease. This is caused by the buildup in the blood vessels. This reduced
the flow of blood which make the patient feel tired and short of breath, this might add to
Exacerbation of COPD. The impact of osteoporosis- and osteoporosis-induced fractures in
COPD patients is enormous. One of the most usual fractures induced by osteoporosis is the VCF
(vertebral compression fracture) which is linked to the Kyphosis and back pain. Kyphosis can
result in loss of height and impaired lung function (Okazaki, 2016). An impact of impaired lung
function among COPD patients is more pronounced as they already have impaired lungs
(Anzueto & Miravitlles, 2017).
Patient education will be the first intervention in the case of Mrs Oporto as she has
stopped taking drugs, not performing exercises, and also developed smoking and drinking habits.
The instructive appointments will be based on motivational discussion, based on age, sickness,
and rational capability and lifestyle, following the below mentioned main mechanisms:
Explanation of the composition and composition of the airways and the belongings of COPD to

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the patient (Stoilkova-Hartmann et al., 2018). The patient will be encouraged to reduce smoking
as it is the most common factor of her health condition. Education will be provided in a
favourable way to manage with inhaling difficulties, particularly throughout the application. She
will also be educated and motivated to perform recommended exercises to enhance her lung
functioning. Additionally, a one-day interference exercise package can also be presented for the
team founded organization of COPD (Sari & Osman, 2015). Smouldering cessation, counting the
custom of lung age as a motivational instrument, indication founded COPD organization,
valuation, and teaching in bronchodilator methods, the role of pulmonic reintegration,
organization of exacerbation, the usage and value of nursing maintenance preparation and
teaching around secondary comportment alteration (Howcroft et al., 2016).
Another nursing intervention will be provided in the case of Mrs Oporto is oxygen
therapy. Oxygen therapy is a type of treatment used by some people with chronic obstructive
pulmonary disease (COPD). It is occasionally called supplemental oxygen. Exacerbation of
COPD results in lung damage that might keep the patient’s lungs from being capable to absorb
sufficient oxygen (Corrado, Renda & Bertini, 2016). If the patient's body does not have sufficient
oxygen, it becomes difficult to function properly. Oxygen therapy brings an additional supply of
O2 into the patient’s body that can benefit from improving COPD symptoms. Not ever with the
person, COPD requires oxygen therapy; however, it is a portion of the management plan for
numerous patients. Providing oxygen therapy to the patient can help her in reducing the
breathing issues, fatigue problem improves mental alertness and mood, and improve sleep
quality (Pavlov et al., 2018).

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For the discharge planning of Mrs Oporto, I will include the pharmacist to discuss the
safe discharge from the hospital. In the discharge plan, Mrs Oporto will be provided with a
COPD plan for the improvement of health results. The COPD plan includes the patient
instruction to start the antibiotic and steroid therapy if the patient experiences any indications of
increased cough, increased production of mucus and, phlegm, thus, reaching the high-yellow
area (Jennings, 2015). The pharmacist in the planning prescribed the steroid and antibiotic
therapy for COPD planning within the PACT model and consulted the PCP for the insurance of
effective inter-professional conclusion making. Additionally, the registered nurses will educate
the patient on the plan with specific emphasis on the plan procedure and steps for the self-
management of COPD symptoms. Mrs Oporto will be instructed to contact the hospital before
starting a medication plan so that a thorough valuation of indication could be achieved for safety.
If the patient observes decompensated COPD or with deteriorating indications were triaged to
crucial medicinal upkeep or crucial arrangements with the PCP (Wang, 2014). The enduring
recommendation also is a serious constituent for the COPD maintenance facility. Druggists will
be inserting recommendations for tobacco management facilities, lung reintegration, a COPD
collection teaching session, and recommendation to subject care if required. Pharmacologist will
appraisal the nebulizer method and alterations and imparts back approaches used to safeguard
enduring accepting. The patient will be fortified to bring home devices into the hospital for
performance valuation. Demonstration of devices also was obtainable and used by druggist and
nurses for nebulizer education as required. The druggist will designate chart documentation
about the correct steps to use the inhaler. Medicine settlement will also be achieved for gasped
devices to protect enduring is by means of medicine as approved (Lainscak, 2013).

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