Case Study: Aboriginal Elder with COPD and Healthcare

This case study examines the healthcare journey of John, a 74-year-old Aboriginal elder diagnosed with COPD. The case details John's background, including his medical history of cardiac issues, smoking habits, and family history of related illnesses. It outlines his presentation at a healthcare center with symptoms of shortness of breath, fever, and cardiac pain, leading to immediate admission and treatment with oxygen therapy. The case study further describes diagnostic tests, including X-rays and ABG tests, revealing respiratory acidosis and low oxygen saturation. The subsequent treatment plan includes medication, nursing interventions, and community support, such as smoking cessation programs, dietary changes, and physical therapy. The case highlights the collaborative efforts of nurses, doctors, and other healthcare professionals, emphasizing patient-centered care, cultural sensitivity, and the importance of community resources in managing chronic conditions. The study concludes with a reflection on the nursing responsibilities and the impact of holistic care on improving the patient's quality of life.

Running Head: Case Study
Case Study of a COPD patient
Name of the Student
Name of the University
Authors Note

1Case Study of a COPD patient
Introduction
COPD (Chronic Obstructive Pulmonary Disease) is the disease which restricts the
airflow in the respiratory tract of a human, and this condition is not fully reversible.
Restricted airflow can cause inflammation in the airways and pulmonary vasculature (Barnes,
2016). The pulmonary peripheral airways are narrowed down, and the alveoli are destroyed.
The parenchymal destruction causes shortness of breath. Smoking cigarettes, air pollution,
exposures to the pollutants due to occupational and environmental factors are the major
causes of this disease. Seven million Australians are affected by chronic respiratory distress
(Australian Institute of Health and Welfare, 2018). COPD is the fifth leading disease for
death among the Australians (Australian Institute of Health and Welfare, 2018). COPD
causes the highest percentage of the total burden of all respiratory conditions in Australia
(Australian Institute of Health and Welfare, 2018).
Background
I am John, an aboriginal elder person affected by the COPD. I am74 years old and live
in Queensland. I went to a reputed healthcare centre with my wife. My wife Sarah told the
doctor that I had been suffered from shortness of breath and the fever. I was also
suffered from cardiac pain so that we decided to visit the clinic. Sarah went to the clinic with
premedical history. I had to face cardiac failure, which reflected in my premedical history.
The heart failure was followed by myocardial infarction at the age of 68 years. I was
suffering from hypertension and had undergone through surgery for appendectomy 8 months
ago. My mother was died after having myocardial infraction when she was 45. She was a
smoker and a patient of diabetes and hypertension. She was a single mother. I have a sister
who is three years younger than me. My sister lives in New South Wales and is a patient of
arthritis. I do not know about my father’s medical history. However, I can only remember

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that my father was an alcoholic. Therefore, my mother might be a sufferer of domestic
violence. Our father left us when I was just a five-year-old kid. I am married for 30 years. I
have three children who do not live with us. They live separately with their families.
I retired from an automobile company where I was posted as a Factory Supervisor. I
smoke 5 packs of cigarettes monthly. Before I had cardiac arrest, I used to smoke 20 packs
monthly. I drink alcohol on weekends or occasionally. My medication chart consists
furosemide 4mg daily, Metoprolol 50 mg B.D., Spironolactone 25 mg daily, Lisinopril 20 mg
B.D., Salmeterol/fluticasone 50/500 dry powder inhaler one puff B.D., Tiotropium DPI,
Albuterol/ipratropium MDI p.r.n. There are so many medicines so that my wife and I are so
confused which medication should I intake and when. I do not know if I have allergies in
some substances.
After I went to the clinic, I was checked, and my vital signs were noted down. My documents
consist the following information;
Blood pressure: 130/84
Pulse rate: 80
Respiratory rate: 35
Temperature: 40.5 C
Height: 6 ft
Weight: 85 kg
BGL: 9.2 mmol/L
I was unable to speak properly, and wheezing can be heard by the doctors while they
were assessing me. My nails were clubbed and stained. When Sarah was asked whether I had

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been given any pneumonia vaccine within the past three months, she was unable to answer
the question. I could not remember it also as my previous doctor did not tell me much about
treatments. As I could not able to talk much, my wife told me that I was producing unknown
coloured mucous. On questioning her, she told us that I had faced exacerbation of COPD for
three times in the last six months. I was suggested to admit in the emergency of the healthcare
organisation immediately by the doctors and nurses.
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After admitting I was treated with oxygen therapy, and then I was taken to the X-ray
room. They observed the accumulation of fluid in my thorax from my X-ray report. The pulse
oxymetry result showed that the oxygen saturation rate is 90 %. As the early intervention, I
was administered oxygen to the patient by placing myself in half lying head elevated
position. They continued my anti-hypertensive medications and medications for heart failure
with the suggestions of the physicians. ABG test was conducted along with the Blood pH,
pCO2, pO2, HCO3, B.E. and SaO2 were checked (Mehany, Elaal and Kamel, 2016.). The
result shows that I might have respiratory acidosis and the oxygen saturation rate was low.
The nurses told my wife that my condition shows the presence of medical co-morbidity of
high blood sugar, hypertension and pneumonia. They informed Sarah and me that they would
keep me under observation for at least 7 days. After a week, they discharged me after doing
further check-up and investigation. After 7 days, I started improving and they shifted me to
the elderly ward and I was in the general ward till discharge day. My oxygen mask was
removed then. I was taking albuterol/ipratropium with the help of nebuliser 4 times a day
(Agrawal et al., 2019). Nurses were helping me to use nebuliser. The doctor suggested
antibiotics for 7 days and then the dose was reduced. The oral corticosteroids were continued

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(Walters et al.,2018). Sarah asked the healthcare workers to refer a nurse to look after me as
she is getting older and she was afraid whether she could able to take care of mine. She also
told them that we were newly relocated to the place and did not know anybody. After 15
days, I was discharged from the hospital. All the blood tests were done and after that I was
given the pneumococcal vaccine before discharge (Walters et al., 2017). A white girl was
appointed as the allocated R.N. for me, and the hospital referred us to the community nurse.
The community nurse was an elderly nurse and her name was Dorothy, She lived nearby our
locality.
After my discharge, the young R.N. gave education to Sarah and me with the
community nurse about the medication and the diet plan.She recommend both Sarah and me
to visit the clinic after 15 days and asked the community nurse to inform them whenever
needed. As the scarcity of the health care workers is prominent in the remote areas of
Queensland the R.N. had to return to the health centre. After two days, she came our place to
check my condition. She used to come to our house daily for next 10 days. She was a very
sober person and reminded me of my daughter who lived in Sydney. She used to take a
series of healthcare sessions. She used to show the methods of breathing exercises,
inspiration muscle training, activity pacing, self-care training (checking the B.P. and glucose
level), Physical conditioning, oxygen therapy, nutrition therapy and coping mechanisms
(Lenferink et al., 2017). Jack , the physiotherapist was recruited and he used to come every
day and took a session for 2 hours every day.
In the second month when my vital signs were improved, they involved the
community resources in the treatment procedures . They encouraged me and Sarah both to
join local community smoking cessation program (Gershon et al., 2019). As both of us were
smoker due to our cultural rituals and ethnicities. Dorothy recommended me to use
respiratory mask whenever I would go out (Barrett et al., 2019). Susie, the R.N., reviewed the

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Metered Dose Inhaler techniques in every home visits as she taught me in the hospital and the
technique was beneficial to manage my condition (Griffith et al., 2019). I told both Dorothy
and Susie that we do not want to leave our ethnicity regarding tobacco use. They told us that
the program would help us to get rid of addiction only. They did not have any intention to
harm our religious views. Susie told us to maintain a journal every day. The chest
physiotherapy was recommended by the doctor to relieve the bronchospasm and continuing
the oxygen flow (Solomen, 2019). They told me that breathing patterns were improved due to
regular inspiratory muscle training. Diaphragmatic breathing exercises were introduced to my
care plan (Morrow et al., 2016). Dorothy suggested the physiotherapist to teach me some
activity to reduce the tensions and degree of dyspnea.
In the third month, Susie changed my diet plan and encouraged me to eat frequently.
She told me and Sarah to maintain the frequent meal technique, which was taught by Tony,
the Nutritionist. Tony told us this diet plan was focused on increasing the anti-oxidants in the
body. It was quite a bit hard for us as we did not like the foods much. The taste of the foods
was very numb and boring. We were perplexed at first, but Dorothy encouraged and
supported us to continue. Susie told us to join the cooking workshop, which was conducted
by the local government for obese patients. Additionally, she enrolled both of us in the
pulmonary rehabilitation centre so that both of us could enjoy each other’s company. Susie
and Dorothy discussed with the physiotherapist to teach me energy conservation measures
while performing the daily activity. The energy conservation exercises were very helpful and
saved a lot of energy, and I felt less fatigued after doing tasks. Whenever we faced a problem,
we used to call in the health centre or inform us about the situation in Susie’s weekly visits.
In the fourth month, Jack taught me some alternative technique of relaxation. He gave
them relaxation tape and taught me some exercises with it. My wife and I made a good bond
with some of our neighbours. Sarah and I used to go for an evening walk every day. Susie

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came to know that from Dorothy and suggested us to take her with us. I opposed that, but
Susie convinced Sarah that it was just for security and emergency help. Sarah agreed with
her, and I had to agree with them. I used to check the vital signs every day in proper interval.
Susie used to check my health journal also in every visit and used to encourage me to write.
Susie asked us to visit the clinic twice in a month.
Conclusion
As a nurse, I came to know many aspects of treatment which will help me in the
future practice. During the treatment procedure, Nurse Susie used to collaborate with the
physiotherapist, doctors and Nutritionist for making the care plan of the patient. Moreover,
she used to collaborate with the community nurse, Dorothy. Both the nurses helped them to
socialise with the neighbourhood and the community. The above discussed incidences reflect
the negotiation and the better decision making capacity of Susie. The patient-centred care was
improved nurse’s skills to administer the medication on time and suggest the best
intervention for the patient. She reviewed the journal and encouraged John to maintain
it. During this activity, she could empathise with the patient and provide him with a
culturally competent treatment. The regular interventions were improvised as per the
patient’s need and health condition. Susie made a good rapport with them and with the
community nurse also. Both Susie and Dorothy helped John and Sarah to improve their daily
lifestyles. The community nurse informed the R.N. that the couple usually went every day for
the walk, which shows the sincerity of a nurse towards the safety of the patient. Every week
the patient was improving and now his vital signs are normal. R.N. suggested them to visit
the clinic twice in a month which was an excellent decision to make them active and maintain
the follow-ups. After reading the blog of a COPD patient, I learned many nursing
responsibilities and how balancing the medication administration rate and assisting the

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patient with emotional and mental support could help to manage care plan of a culturally
diverse person.

8Case Study of a COPD patient
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