NUR250 Medical Surgical Nursing 1: COPD Exacerbation Case Study

This case study focuses on Mr. Newman, a 44-year-old male admitted with infective exacerbations of COPD. The solution utilizes the clinical reasoning cycle to assess Mr. Newman's condition, including respiratory, cardiovascular, and nutritional aspects, considering his smoking history and lifestyle. Key nursing diagnoses identified are ineffective breathing pattern, ineffective airway clearance, and activity intolerance, with corresponding care plans addressing these issues. Patient teaching strategies emphasize smoking cessation, medication adherence, and breathing techniques. The solution underscores the importance of a multidisciplinary team, involving pharmacists, physical therapists, dieticians, and psychologists, to provide holistic care for Mr. Newman. This document is available on Desklib, where students can find more solved assignments and study resources.

Medical Surgical Nursing
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Consider the patient:
In this essay, case of Newman is being discussed. He is a 44-year man admitted to the
hospital ward due to infective exacerbations of Chronic Obstructive Pulmonary Disease
(COPD). Mr. Newman is associated with risk factors of COPD like smoking and drinking.
He was experiencing activity intolerance due to augmented breathlessness. He lives with his
wife and 2 teenage children. Clinical reasoning cycle need to be used for carrying out holistic
assessment of Newman. With reference to the clinical reasoning cycle, information about the
patient should be gathered (Levett-Jones, 2017). Complete clinical assessment of Newman,
collected information should be processed (Levett-Jones, 2017). Collected and analysed
information indicated that he is associated with respiratory distress.
Patient assessment:
Complete clinical assessment of Newman, collected information should be processed (Levett-
Jones, 2017). Medial assessment for Newman needs to be carried for three conditions like
respiratory assessment, cardiovascular assessment and nutritional assessment. Information
about Newman was gathered from the case study. From the gathered information, it was
evident that he was associated with infective exacerbation of Chronic Obstructive Pulmonary
Disease (COPD). He was heavy smoker which is one of the significant risk factors for
COPD. As a result, he was experiencing breathlessness. Since, Newman was having COPD;
respiratory assessment should be performed in him. Respiratory assessment in Newman
should be performed through recording respiratory rate, measuring ABG levels (measurement
of pH, PaCO2, HCO3 and PaO2), and observing and noting breathing pattern. Moreover,
pulmonary function test should also be carried out in Newman for respiratory assessment
(Baroi, McNamara, McKenzie, Gandevia, and Brodie, 2018). Inflammation in COPD
produces augmented levels of secretions and hyperplasia of bronchial wall which results in
ineffective airway clearance. Impaired gaseous exchange occurs in patients with COPD with
decrease in the blood oxygen level. Since, COPD and cardiovascular disease occur together;
it is necessary to perform cardiovascular assessment in him. COPD and cardiovascular
diseases are linked together through pathophysiological link in the form of lung
hyperinflation, systemic inflammation and COPD exacerbations. Moreover, COPD treatment
proved effective in the improvement of cardiovascular conditions. Cardiovascular assessment
should be performed in Newman through monitoring heart rate, heart beat rhythm, heart
sound, peripheral pulses and blood pressure (George and Green, 2018). Patients with COPD
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might experience cardiovascular conditions like arrhythmia, myocardial infarction, or
congestive heart failure. Due to hypoxemia in the COPD patients, there would be
abnormalities in the right ventricle (RV).COPD patients are usually associated with the
nutrition associated changes like weight loss and malnutrition. Observed deviation from the
normal values in both respiratory and cardiovascular assessment would indicate respiratory
and cardiovascular dysfunction. Malnutrition usually occur in COPD patients mainly due to
resting energy expenditure, decreased food intake, the effects of certain drugs, and, perhaps
most importantly, a high systemic inflammatory response. Nutritional assessment should be
done in Newman through measurement of nutrient intake and measuring corresponding
height, weight, circumference and skinfold (Benoist and Brouquet, 2015). Food consumption
in COPD patients might decrease due to resistance in swallowing and chewing mainly due to
dyspnea, alteration in taste of food due to mouth breathing, excessive mucus production and
constant coughing (Rabe and Watz, 2017; Yang et al., 2017).
Care plan:
Collected and analysed information indicated that he is associated with respiratory distress
(Levett-Jones, 2017). Identified nursing diagnosis in Newman were ineffective breathing
pattern, ineffective airway clearance and activity intolerance. One of the priority nursing
diagnosis in case of Newman is ineffective breathing pattern. Main aim of the nurse is to
maintain normal and effective breathing pattern in Newman. Ineffective breathing pattern
would alter normal breathing rate in Newman. Nurse should be aimed to maintain normal
respiratory rate between 10 – 20 breaths per minute. Hence, nurse need to assess and note
breathing rate in Newman after every 6 hours. Insufficient breathing would lead to alteration
in ABG in Newman which produces lessened oxygen level and altered ventilation pattern.
Hence, nurse need to evaluate ABG levels in Newman on regular basis. Abnormal breathing
pattern indicate respiratory disease and dysfunction in Newman; hence, nurse should observe
and monitor breathing pattern in Newman. Nurse should auscultate breath sound for every 6
hours which would be helpful in noticing lessened breath sounds. Ineffective breathing
pattern would lead to reduced lung compliance which would produce increased work of
breathing. Hence, nurse should assess the use of accessory muscle by Newman. Ineffective
breathing pattern occurs due to respiratory muscle weakness. Hence, it leads to paradoxical
movement of the abdomen. Henceforth, it is necessary to monitor diaphragmatic muscle
weakness in Newman (Yang et al., 2017). Difficulty in breathing would lead to flaring of
nostrils due to heightened respiratory effort; hence, nurse should monitor nostrils retractions
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in Newman (Wang, Tan, Xiao, and Deng, 2017). Nurse should use pulse oximetry in
Newman for monitoring oxygen saturation in Newman because inefficient breathing lead
reduced oxygen saturation in Newman. Newman is associated with infective exacerbations of
COPD; hence, there might be alteration in the sputum quality in him. Hence, quantity, color
and consistency of sputum in Newman need to be evaluated to monitor infection in him.
Management of infection in him would be helpful in reducing COPD exacerbations and
consequently ineffective breathing pattern can be effectively managed. Nurse should ensure
that Newman is practicing deep breathing through augmented slow inhalation, end respiration
hold and passive exhalation because it is helpful in increasing oxygen saturation and
preventing atelectasis. Moreover, air trapping can be effectively controlled through slow
respiration and long-lasting expiration. Nurse should administer respiratory medications and
artificial oxygen according to physician’s order because respiratory medications would be
helpful in airway smooth muscle relaxation and produces bronchodilation for opening air
passage (Baroi, McNamara, McKenzie, Gandevia, and Brodie, 2018).
Another nursing diagnosis for Newman is ineffective airway clearance. Nurse need to assess
airway obstruction in Newman because unobstructed airway is important for normal
functioning of the respiratory system. It is necessary to auscultate lungs to identify normal or
adventitious breath sound because accumulation of fluid and mucus would lead to abnormal
breath sound. It indicates ineffective airway clearance. It is advisable to monitor respiration
for breath rate, pattern, depth, use of accessory muscle and splinting; since, increase in the
respiratory rate and rhythm might occur dur to bronchoconstriction. Nurse should assess
parameters like heart rate, blood pressure and temperature in Newman because increased
work for breathing can lead to tachycardia and hypertension (Wang, Tan, Xiao, and Deng,
2017). Moreover, Newman is associated with infection; hence, there might be increase in the
temperature in Newman. It is necessary to observe efficacy and productivity of cough
because cough is reflux mechanism for clearance of secretions. Moreover, ineffective cough
occurs due to ineffective airway clearance and expulsion of mucus (Baroi, McNamara,
McKenzie, Gandevia, and Brodie, 2018). Sputum sample of Newman need to be submitted
for the co-culture and sensitivity testing because he was suffering through infectious COPD.
Infection might lead to deposition of secretions in the airways. Education need to be provided
for Newman for ideal method of coughing and breathing because proper coughing would be
helpful in removing secretions. Deep breathing would be helpful in improving oxygen
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saturation. It is advisable to carry out nasotracheal suctioning if required because suctioning
is useful to remove thick mucus plugs (Yang et al., 2017).
Third nursing diagnosis for Newman is activity intolerance. Nurse should set aim to ensure
Newman perform all his activities on his own. It is necessary to assess physical activity and
mobility level of Newman because it provides important information for setting goals.
Moreover, it is necessary to assess parameters like resting pulse, blood pressure, heart rate,
heart rhythm and pulse quality in Newman because assessment of these parameters would be
helpful in the discontinuing activity if deviation observed in the parameters. Nutritional status
of Newman needs to be assessed because COPD patients are associated with less intake of
food. However, enough energy is necessary for performing different activities. It is necessary
to monitor duration of sleep in Newman because inadequate sleep would result in inability to
perform activities. Nurse should assess Newman’s baseline cardiopulmonary parameters like
heart rate and orthostatic BP because heart rate should not deviate from the normal range
with routine activities. Assistance need to be provided to Newman in performing daily
activities because it would be helpful in improving tolerance of activity in Newman. Ensure
Newman is increasing activities gradually because gradual increase in the activities would be
helpful in minimising exertion (Ladwig, Ackley, and Makic, 2016).
Patient teaching:
Nurse should inform Newman that smoking is one of the most significant risk factors for the
progression of COPD and its exacerbations. Chemicals present in the cigarette smoke are
mainly responsible for the COPD exaggeration. Newman should be made aware that
chemicals present in the smoke are going to deteriorate lung function gradually over the
period of time. Information need to be given to him that that cigarette smoking obstructs
respiratory tract which lead to disturbance in inspiration and expiration. Newman needs to
stop smoking to manage his problem of breathlessness. Newman should understand
importance of statutory warning mentioned on the cigarette packet. Newman should know
that non-smokers have more chances of recovery from COPD in comparison to the smokers
(Wang, Tan, Xiao, and Deng, 2017).
He should be aware about the importance of medications along with its adverse and side
effects. It would be helpful in the improving adherence of Newman to the medication
consumption. He should be for handling of metered-dose inhaler and nebulizer. It would be
helpful in improving self-care of him. Nurse should educate Newman about different
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breathing techniques like deep breathing and slow breathing (Ng and Smith, 2017).
Exercising different breathing techniques would be helpful in reducing breathlessness in
Newman. He should be instructed that he should keep himself away from smoke, fumes and
dust because all these would exaggerate COPD condition in him. Nurse should educate him
about the importance of health-related quality of life because different factors like eating
behaviour and exercise would exaggerate COPD condition. Newman should be warned about
the probable psychological implications of COPD exacerbations. Hence, Newman should not
take much stress about the psychological implications because stress can exaggerate COPD
exacerbations (Nakken et al., 2017).
Team care:
Professionals from different disciplines like pharmacist, physical therapist, occupational
therapist, dietician and psychologist should be involved in providing care to Newman. All
these professionals need to work as a team to provide holistic care to Newman. Physician and
nurse should perform holistic assessment of Newman considering past clinical history and
current clinical assessment. Based on the assessment, both physician and nurse should plan
effective intervention for Newman. Pharmacist should educate Newman for importance of
medication consumption and also inform Newman about use of medicines and its adverse
effects (Kaptein, Fischer, and Scharloo, 2014). Physical therapist and occupational therapist
should plan suitable physical activity plan and schedule for Newman because optimum
physical activity would be helpful in improving breathlessness in Newman (Carron et al.,
2017).
Dietician should give her appropriate plan because increase in body weight can affect
osteoarthritis and cardiovascular condition. Dietician need to plan suitable diet plan for
Newman which can maintain and improve muscle strength in Newman. Moreover, dietician
also should make sure that diet planned for Newman should tolerate exercise. It has been
observed that COPD patients are associated with severe weight loss and low fat-free mass
(FFM) index. Hence, dietician should prepare diet plan in Newman in such a way that it
would be helpful in maintaining ideal body weight in Newman. Dietician should work along
with pharmacist to avoid food-drug interaction. Psychologist should complete psychological
assessment in Newman because Newman might experience stress and depression due to
breathlessness and subsequent activity intolerance (Van Dijk-de Vries et al., 2016).
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