Nursing Assignment 1: Palliative Care Strategies for Mrs. Brown's COPD

This essay addresses palliative care strategies for a patient, Mrs. Brown, diagnosed with COPD, emphasizing the importance of improving the quality of life for patients with terminal illnesses. The essay explores the implementation of nursing strategies for managing dyspnea/breathlessness and social isolation, two significant challenges faced by COPD patients. It delves into the assessment of respiratory parameters, pharmacological and non-pharmacological interventions for breathlessness, including oxygen therapy, opioids, and non-invasive ventilation, and the benefits of open communication and supportive care. The essay also highlights the importance of addressing social isolation through counseling, supportive care, and linking patients to self-help groups. The conclusion stresses the need for a holistic approach, integrating both pharmacological and non-pharmacological interventions to provide comprehensive care and improve the overall well-being of the patient. The essay references various sources to support the discussed strategies.

Bachelor Nursing Assignment
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Introduction:
Palliative care approach is usually associated with improvement in the quality of life of
patients and their family members those who encountered with terminal illness and life-
threatening conditions. Palliative approach consists of prevention of symptoms and relief
from the illness (McCabe & Coyle, 2014; PCA, 2018). Attention also need to be given to
holistic approach through physical, psychological and spiritual aspects (Rego & Nunes,
2019). Palliative care provides care to Brown by providing relief from breathlessness and
other symptoms and supports life and ensure Brown dying as normal process. In this essay,
high priority nursing strategies like dyspnoea/breathlessness and social isolation are being
discussed.
Body:
Dyspnoea/breathlessness:
Mrs. Brown is associated with exacerbation COPD; hence, it is necessary to implement
nursing strategy for breathlessness in her. Respiratory rate, ABG levels and breathing pattern
need to be evaluated in Brown because deviation of these parameters from the baseline values
indicate respiratory distress like breathlessness. Moreover, breath sound needs to be
auscultated and nostrils retractions should be observed because breath sounds lessened due to
breathlessness. Brown need to be encouraged for deep breathing which comprises of slow
breathing, end respiration hold and passive exhalation. Deep breathing would be helpful in
improving oxygen saturation and preventing atelectasis. Long-duration expiration is useful to
prevent air trap. Brown should be encouraged to perform diaphragmatic breathing because it
is useful in muscle relaxation and oxygen level improvement. Encourage Brown to clear all
the secretions in the airways through coughing. Nurse should teach Brown about accurate
methods of breathing, coughing and splinting. It would be helpful in complete mobilization
of secretions (Swearingen, 2015; Gulanick and Myers, 2016).
Dyspnoea/breathlessness in the acute setting should be managed through pharmacological
therapy, oxygen therapy, non-invasive ventilation and opioids (Barbera & Jones, 2016).
Intervention need to be provided to Brown both in acute and chronic settings.
Pharmacological treatments for Brown would be helpful in improving dyspnoea, activity
tolerance and reducing rate of exacerbations. Non-invasive ventilation would also be helpful
in case of Brown. Literature reported that non-invasive ventilation would not improve
survival rate in COPD patients; however, it would be helpful in improving dyspnoea and
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quality of life. Non-invasive ventilation would be helpful in the management of dyspnoea
following respiratory failure. Mechanical support like non-invasive ventilation is useful in
cases where pharmacological intervention is ineffective or partially ineffective (Yohannes,
Junkes-Cunha, Smith, & Vestbo, 2017).
In case of Brown also, pharmacological intervention is not completely effective because she
was admitted for three times with COPD exacerbations; however, it was not completely
recovered. Oxygen is usually prescribed in palliative care because of its comfort measure for
patients with breathlessness. However, it has been reported that oxygen therapy has not been
beneficial in dyspnoea. Opioids are the most frequently used drugs for the management of
dyspnoea. It has been reported that opioids are useful in the management of dyspnoea
through both oral and parenteral route in advanced stage of the disease (Yohannes, Junkes-
Cunha, Smith, & Vestbo, 2017; Vanfleteren, Spruit, Wouters, & Franssen, 2016).
It is necessary to establish open communication with Brown to relieve her from
dyspnoea/breathlessness. Supportive and palliative care interventions need to be implemented
in the early course of disease which can effectively manage disease, develop coping strategy
and improve overall quality of life. Implementation of the strategy like pulmonary
rehabilitation and employment of outreach nurses proved beneficial in improving quality of
life of patients with COPD. Physiotherapist and occupational therapist would be helpful in
improving breathlessness and providing assistance to progress independence (O’Toole,
2016). Effective intervention for breathlessness in Brown would be helpful in improving
breathing pattern and improving overall quality of life in Brown.
Social isolation:
Brown was diagnosed with depression. It would lead to social isolation in her life. It has been
proved that people with depressive state are more prone to depression. Hence, nursing
strategy for social isolation need to be provided to Brown. Nurse need to assess factors
responsible for the helplessness of Brown. It would be helpful to verbalize Brown her
feelings. Moreover, it would be helpful in establishing nurse-patient relationship. Nurse
should assess Brown’s perception of social isolation. It would be helpful in the identifying
causative factors for social isolation in Brown. Counselling should be provided to Brwon and
she should be linked to self-help groups. It would be helpful in diminishing feelings of
helplessness, worthlessness, and isolation (Ladwig, Ackley, and Makic, 2016; deWit, and
Kumagai, 2014).
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Supportive care is useful in helping patients and their family members to cure non-curable
disease and its related treatment. Supportive approach comprises of diagnosis and treatment
which lead to either improvement, continuing illness or death. This approach is useful in
management of bereavement. Hence, it is useful in maximising benefits of treatment and
reducing probable unwanted effects of the disease (Gunasekaran et al., 2019). It is also useful
in integrating psychological and spiritual characteristics for providing care to Brown. It is
useful in supporting Brown to live active life till death. It is useful in providing team
approach to address requirements of patient and family members. It is also useful in
augmenting quality of life and positively impacting duration of illness. It also includes
investigations to be carried out for improvement of the distressed clinical complication (Lane
& Philip, 2015).
It is necessary to establish open communication with Brown. This approach is useful in the
encouraging individuality, assisting empowerment and supporting autonomy (McCabe &
Coyle, 2014). Patients with COPD experience poor quality of life; hence, it is necessary to
provide both medical and social care to Brown. It is necessary to establish therapeutic
relationship, to fulfil supportive and palliative care needs of Brown. Therapeutic relationship
would be helpful for Brown to express her feelings about the diseased condition. However,
there might be difficulty for her to express due to breathlessness. Brown mentioned that over
the past few years her condition has been deteriorated and she withdrawn herself from most
of the social activities. Brown realised that her quality of life is poor and she is fearful about
her future. During assessment, it has been observed that she developed coping strategies for
her illness; however, it is difficult to cope up with her illness. Supportive and palliative care
interventions need to be implemented in the early course of disease which can effectively
manage disease, develop coping strategy and improve overall quality of life (Ladwig, Ackley,
and Makic, 2016; deWit, and Kumagai, 2014).
Supportive care proved beneficial in recognising and addressing family issues which result in
improved coping depression with the progression of COPD in Brown. Palliative care is more
useful in case of Brown because along with acute care, palliative care can be effectively
implemented. Social worker would be helpful for Brown to address financial issues in her
care. Effective nursing intervention for social isolation in Brown would be helpful in
improving her quality of life.
Conclusion:
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Mrs Brown was associated with severe exacerbations of COPD. Brown get affected both
physically and non-physically due to COPD. Hence, physical nursing strategy like
breathlessness and non-physical nursing strategy like social isolation was implemented in
Brown. During implementation of nursing strategy for breathless, assessment was done in
Brown and relevant intervention was provided. Supportive care was considered while
providing nursing strategy for social isolation in Brown. Non-pharmacological interventions
hold more significance in case of nursing intervention for social isolation. Hence, for
providing holistic care to Brown, it is necessary to provide both pharmacological and non-
pharmacological intervention.
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References:
Barbera, A.R., and Jones, M.P. (2016). Dyspnea in the Elderly. Emergency Medicine Clinics
of North America, 34(3), 543-58.
deWit, S. C., and Kumagai, C. (2014). Medical-Surgical Nursing - E-Book: Concepts &
Practice. Elsevier Health Sciences. New York. United States.
Gunasekaran, B., Scott, C., Ducharlet, K., Marco, D., Mitchell, I. and Weil, J. (2019).
Recognising and managing dying patients in the acute hospital setting: can we do
better? Internal Medicine Journal, 49(1), https://doi.org/10.1111/imj.14177.
Gulanick, M., and Myers, J.L. (2016). Nursing Care Plans - E-Book: Nursing Diagnosis and
Intervention. Elsevier Health Sciences. New York. United States.
Ladwig, G. B., Ackley, B. J., and Makic, M. B. F. (2016). Swearingen, P. L. (2015). All-In-One
Care Planning Resource - E-Book. Elsevier Health Sciences. New York. United States.
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Lane, H., and Philip, J. (2015). Managing expectations: Providing palliative care in aged care
facilities. Australasian Journal on Ageing, 34(2), 76-81.
McCabe, M.S., and Coyle, N. (2014). Legal and ethical issues in palliative care. Seminars in
Oncology Nursing, 30(4), 287-295.
O’Toole, G. (2016). Communication: Core interpersonal skills for health professionals (3rd
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Palliative Care Australia (PCA) (2018). Palliative Care Service Development Guidelines (pp.
5-14). Canberra. Retrieved from
https://palliativecare.org.au/wp-content/uploads/dlm_uploads/2018/02/PalliativeCare-
Service-Delivery-2018_web2.pdf on 22.03.2019.
Rego, F., & Nunes, R. (2019). The interface between psychology and spirituality in palliative
care. Journal of Health Psychology, 24(3), 279-287.
Swearingen, P. L. (2015). All-In-One Care Planning Resource - E-Book. Elsevier Health
Sciences. New York. United States.
Yohannes, A.M., Junkes-Cunha, M., Smith, J., and Vestbo, J. (2017). Management of
Dyspnea and Anxiety in Chronic Obstructive Pulmonary Disease: A Critical Review.
Journal of the American Medical Directors Association, 18(12), 1096.e1-1096.e17.
Vanfleteren, L.E.G.W., Spruit, M.A., Wouters, E.F.M., and Franssen, F.M.E. (2016).
Management of chronic obstructive pulmonary disease beyond the lungs. Lancet
Respiratory Medicine, 4(11), 911-924.
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