COPD Essay: George Williamson's Nursing Problems and Interventions

This essay presents a case study of George Williamson, a 72-year-old male diagnosed with COPD, who continues to smoke and exhibits nonadherence to his medication. The essay identifies two primary nursing problems: smoking and unfavorable behavior, including a sedentary lifestyle and medication noncompliance. It discusses the pathophysiology of COPD, linking it to assessment data such as SpO2, FEV1, and blood pressure. The essay explores both pharmacological and non-pharmacological interventions. Pharmacological interventions include Bupropion SR and Varenicline for smoking cessation, while Cognitive Behavioral Therapy (CBT) is proposed to address the smoking issue. For the unfavorable behavior, the essay suggests physiotherapy and patient education, emphasizing the importance of exercise, medication adherence, and developing a therapeutic relationship with the patient. The essay emphasizes the role of nurses in implementing and evaluating these interventions to improve George Williamson's health outcomes.

Running Head: COPD 0
COPD
Essay
APRIL 2, 2020
[Company name]
[Company address]

COPD 1
Chronic obstructive pulmonary disease
Chronic obstructive pulmonary disease (COPD) is described as a lung ailment
categorized by the chronic hindrance of lung airflow that inhibits the normal respiration and
is not completely revocable. symptoms comprise breathing trouble, production of cough and
mucus (sputum), and wheezing. These particular health issues are not limited to a specific
city or nation; it is affecting people from all around the world (Barnes, 2016, 16-27). George
Williamson is 72 years male diagnosed with COPD. He is a lifelong smoker ever after the
diagnosis. He was prescribed with salbutamol. However, he forgets to take the inhaler. He
developed stubborn and sedentary behavior, and have reduced exercise tolerance. The clinical
examinations identified he has Spo2 of 93% FEV1 of 36 per cent, BP of 125/60 with the
pulse rate of 84. Two nursing problems in his case are his smoking issue and unfavorable
behavior. This particular essay will discuss the relation of nursing problems with assessment
data, the pathophysiology of signs and symptoms, and interventions.
Chronic obstructive pulmonary disease (COPD) is a dangerous condition that disturbs
the patient's lungs and their capability to respire. Pathophysiology is the development of
opposing functional changes linked with an illness. For individuals with COPD, this initiates
with impairment to the air route and small air sacs in the patient's lungs. Symptoms develop
from a cough with the mucus to trouble breathing. The impairment done by COPD cannot be
undone. Though, there are some precautionary measures patients can take to reduce your risk
of emerging COPD (Martinez, 2016, 871-878). COPD is a complete term for numerous
chronic lung ailments. The two key COPD conditions are long-lasting bronchitis and
emphysema. These illnesses affect dissimilar parts of the patient’s lungs, nonetheless both
results in difficulty breathing (Barrett, Hart & Camporota, 2019, 418-428). There are main
nursing problems are identified in the case of Mr. George smoking issues and unfavorable
behavior. In the case of Mr. George smoking is the major problem that can hinder his

COPD 2
recovery process and may develop another health issue. Cigarette smoking is the foremost
cause of COPD in different Western nations. Cigarette- linked noxious agents hurt the airway
epithelium and initiative the important courses that lead to comprehensive airway swelling
and structural alterations. Once these mediators are detached, repair processes must, ideally,
carry the air route back to their usual structure and purpose (Wheaton et al., 2019, 533). In
general, an insufficient repair procedure is supposed to play an important role in the growth
of long-lasting airflow obstacles in some, nonetheless not all, smokers. Certainly, in
numerous subjects, most of the inflammatory alternation continues notwithstanding smoking
cessation. This failure of bronchial swelling to resolve might subsidize to systemic variations
and continuing degradation of bronchial and lung matrix (Agustí & Faner, 2018, 324-326).
As Mr. George continued smoking ever after the diagnosis of COPD, this may cause other
health issues such as cardiovascular problems. For individuals older above 70 years, the
acceptable oxygen saturation level is 95 per cent. Mr. George ha a slower oxygen saturation
level which might be the effects of smoking. His spirometry results showed FEV1 of 36 % (it
was 42 % 6months ago) which is the severe or advanced stage of COPD. The normal blood
pressure level is 120/80. Mr. George was having a blood pressure of 125/60 which identified
as elevated. These elevated levels might be associated with lifelong smoking.
There two different interventions that can be beneficial for Mr. George to address
identified nursing problems: pharmacological intervention and psychotherapy. There are
some medicines that are generally provided to the COPD patients along with the behavioral
therapy. Medication can increase the chances of quitting smoking. Two to this medication
that can be used in Mr. George’s case are Bupropion SR and Varenicline. Bupropion SR is a
drug that comprises no nicotine. The physician can prescribe this drug to a COPD patient. It
might support withdrawal and decrease the need to smoke. Some individuals have negative
effects when taking this medicine (Gentry & Gentry, 2017, 433-441). Varenicline is a

COPD 3
medication that is also nicotine-free. A nurse can provide this drug with Bupropion according
to the prescription. Varenicline (Chantix) supports the desire for nicotine and the removal of
symptoms. It acts in the brain to decrease the bodily effects of nicotine. This indicates that
even if the patient starts smoking once more after quitting, he will not get as much pleasure
from it when he is taking this drug. A nurse must assess the patient and identify if he has any
allergies to the drugs that will be used for smoking cessation (Cedillo et al., 2017, 7-18).
Cognitive Behavioral Therapy (CBT) can also be used for Mr. George. CBT for
smoking cessation is the evidence-based intervention that is clinically established by many
scientific studies and is the intervention of choice for leaving smoking. Cognitive-behavioral
therapy for leaving smoking emphasizes on changing people’s responses to their needs to
smoke. This happens by altering thoughts and behaviors. Altering thoughts happens by
examining uncooperative thought patterns that result in smoking, and formerly learning
additional effective patterns (Spears et al., 2017, 1029). Learning alternative behaviors
includes recognizing the functions that smoking assists, and substituting the smoking with
other different behaviors that assist the same function. CBT for smoking cassation may
include cognitive restructuring, mindfulness training, stimulus control, self-monitoring,
functional analysis, and impulse tolerance training. Studies have shown that pharmacotherapy
combined with CBT achieves high and stable abstinence rates (Heslop-Marshall, 2019, 16-
22). A nurse can apply the treatment for Mr. George with the guidance of the physician.
However, using this therapy alone may not have effective outcomes, thus providing it with
pharmacological treatment in the case of Mr. George's favorable outcomes can be observed in
few months and he will be able to avoid smoking.
Another major problem identified in the case of Mr. George is his difficult behavior
which might be associated with his deterioration. It has been reported by his granddaughter
that he often forgets to take his drugs and not using his SAB correctly. He is too stubborn to

COPD 4
listen to anyone and developed exercise tolerance issues. He has also developed a sedentary
behavior and stay alone most of the time. These issues might have occurred as a result of
stress. It has been reported that older individuals with chronic health issues often develop
psychological issues such as stress and depression (Wshah, 2020, 1-9). Stress and anxiety can
make the diseased person feel short of breath and cause his or her COPD symptoms to turn
out to be worse. Having COPD or any other chronic illness can be emotionally stressful,
rousing up fears about the long-standing future and that of the family. It is common to sense
depressed, upset and stunned at times (Bastos, Vieira & Lima, 2019, 192-192). This might be
the reason Mr. George has developed a wheezing sound problem. Wheezing is the sound that
can be heard by other individuals with or without using a stethoscope. It happens When the
patient exhales and the air is forced through the narrow or congested air passages in the
lungs, the patient and other individuals may hear a whistling or a musical sound. In
individuals with COPD, it's most frequently caused by extra mucus hindering the airways
(Huang et al., 2015, 2121). Nonadherence is not taking pharmacologic or nonpharmacologic
interventions according to approved references from a health care professional. It is common
in individuals diagnosed with chronic obstructive pulmonary disease. Nonadherence in taking
medications on time, smoking cessation, upholding regular bodily activity and exercise,
initiating and staying in pulmonary restoration and enduring on with the post reintegration
exercise/activity medicine, and successfully ensuing self-management instructions results in
opposing outcomes across manifold areas. These comprise a faster weakening in airway
function, increase symptom burden, weakened health status, and augmented health care usage
and death risk (Plaza et al., 2016, 547-554). Physical activity is recognized as a beneficial
approach to managing the symptoms of COPD (Cavalheri et al., 2016, 419-426). In the case
of Mr. George physical activity is negligible and he mostly stayed on his chair. physical
activity considerably decreases across all severity phases of COPD, and this weakening is

COPD 5
paralleled by a deteriorating of lung function and well-being status. Continued physical
inactivity is linked with the development of exercise intolerance and depletion of muscle
(Cavalheri et al., 2016, 419-426).
To address this problem two different interventions can be used in the case of Mr.
George are physiotherapy and education. Keeping active upholds general capability and
wellbeing in the case of COPD patients. Breathlessness is very upsetting, and the natural
response is to stop the physical activity causing the breathlessness (Patel & Sorani, 2020,
103-108). As Mr. George stopped doing exercises and mostly spends his time on a chair, he
should be encouraged to perform daily exercise. This Can be done by a nurse and
physiotherapist who can guide him to adhere to the medication and perform physical
activities. Patients required to be relieved that, though it is distressing, breathing difficulty is
not dangerous, and he must carry on with physical activities and interests. With proper
assistance and guidance, the patient will be capable to continue to perform daily activities and
workout and should be motivated to do so (de Alvarenga et al., 2016, 12). The patient might
need instruction on pacing their daily activities. As Mr. George is an isolated patient, he
needs to be encouraged to uphold superior and lower limb strength by simple workout
programs so that simple but significant tasks for example going to the toilet are controllable.
Another approach is education which can be provided to Mr. George. The patient is not more
adhere to the drugs, intolerant to exercise, and like to be isolated. Nurses equipped with
essential skills needed to develop a therapeutic relationship with the patients such as active
listening, verbal and nonverbal communication, having knowledge of different cultures,
being empathetic, and respect the client (Ng & Smith, 2017, 2129). Develop a therapeutic
relationship with Mr. George is very essential as he does not listen to anybody. A nurse must
start their conversation with the patient when he is calm and ready to talk. They must listen to
him what he is trying to say. This develops a feeling that the nurse cares for the patient. As

COPD 6
the patient is old and diagnosed with chronic disease, he must be dealt with respect and
empathy. This will allow him to develop a sense of empowerment in his treatment. The nurse
can educate the patient about the importance of adhering to the medication and performing
exercises daily. The nurse must also include his granddaughter in the treatment process which
will allow her to feel safe for her grandfather. Including her in the decision-making will also
help the patient to feel safe. The nurse must also educate the patient about self-management
strategies to cope with stress and sedentary behavior issues (Kyngäs et al., 2016, 32-39). with
these interventions, the patient will be able to manage the symptoms of COPD in a few
months.
In conclusion, the chronic obstructive pulmonary disease is the ailment of the lung in
which there is a hindrance to airflow is identified. Mr. George is 72 years old male diagnosed
with COPD ten years ago and recently visited the hospital with his granddaughter. His
daughter reported that he developed sedentary behavior and even after the diagnosis he
continues smoking. She also reported that she doe not take his medicine accurately. Two
different nursing problem in his case is smoking, and unfavorable behavior. It has been
identified that smoking might be the reason of his deterioration. Thus, using medication and
Cognitive behavioral therapy are two intervention can be beneficial for him. two medicines
that can be provided to him are Bupropion SR and Varenicline. The unfavorable behaviors
might occur as a result of stress and not adherence to the medication. this problem can
address by using physiotherapy and education. With physiotherapy, he will be motivated to
perform the exercise, and with nursing education, he will be encouraged to adhere to
medication and stress management strategies.

COPD 7
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