Chronic obstructive pulmonary disease (COPD) is a long-term ailment that makes breathing difficult. COPD is a worldwide public health issue that creates a substantial health burden and mortality (Celli and Wedzicha, 2019). The disease is caused by injury to the air sacs in the lungs, which results in the walls collapsing and the air sacs merging into one big sac. The loss of alveolar adhesion to air passages is caused by damage of the alveoli, which reduces lung elastic recoil (Higham et al., 2019). As a result, the lungs cannot absorb oxygen as well as they should, resulting in lower oxygen levels in the blood. In addition, due to inflammation, the tiny airways and the parenchyma are damaged, limiting airflow (Ohkura et al., 2020). Patients who report manifestations of COPD require close monitoring and quick decision-making that should be made quickly since they are at risk of lung collapse and other organ damage.
Overview of Scenario
Tim, a 70-year-old male who is a heavy smoker, is feeling unwell. He was diagnosed with COPD (Chronic obstructive pulmonary disease) 3 years ago. He did not stop smoking, which is why his COPD got worse. Tim is now on 2litres oxygen therapy at home (with target Oxygen Saturations (SpO2) of 88-92% via a nasal cannula). He has been admitted to the ward with increased difficulty in breathing. He is currently on corticosteroids to reduce airway inflammation, antibiotics, and a prescription of nebulisers (PRN) to open the airway.
The following findings were found on the head-to-toe physical examination, the airway was patent with no flaring, and respiratory rate at 38 breathes per minute. Tim has a SpO2 at 84% breath sounds, wheezing sound, pursed-lip breathing, and uses accessory muscles (pectoralis and neck muscles) when breathing. There are signs of peripheral cyanosis (blueish nail beds and cold extremities on the touch). Tim’s heart rate is at 120 beats per minute, the temperature of 36.6, blood pressure at 100/64 mmHg, and the Glasgow coma scale is 15/15. Tim has no injuries or rashes, but the mucous membrane is dry. Tim is alert, verbally active, has mild pain due to exertion while breathing, and responds well to stimuli.
Based on the clinical manifestations, I ordered a laboratory test, specifically spirometry, which measures how much air the lungs can hold and how first the air can be blown from the lungs. In addition, I ordered other laboratory tests, which will help rule out other lung problems and heart problems. These include chest X-rays, CT scans, and arterial blood gases (ABG). Which will measure how well oxygen is brought into the lungs via inhalation and how well the lungs take out carbon dioxide via exhalation (Siobal, 2016). As blood flows through the lungs, oxygen is absorbed into the blood, and carbon dioxide is exhaled. The ABG also shows kidney function and cases of serious infections (Dai et al., 2020). According to NICE guidelines, it is also crucial to consider alternative investigations, such as the ratio of forced expiratory volume to the forced vital capacity of the lungs, and this ratio should not be above 0.75- 0.85 (Neumeier and Keith, 2020). This investigation is critical, especially for people with extremes of age.
Critical Reflection of the Scenario
Chronic obstructive pulmonary disease is a lung disease that has no cure. Patients who present to the hospital with signs and symptoms of COPD need close monitoring to ease the symptoms and slow the disease since it can easily complicate and cause death (World Health Organization, 2021). Tim is a 70-year-old male who came to the hospital with a history of COPD. Past history of COPD is a predisposing factor of the disease recurring, especially when smoking is not stopped. I used the ABCDE (airway, breathing, circulation, disability, and exposure) structured process on admission. The ABCDE framework is a planned and quick assessment of critically sick patients (Barnes‐Daly et al., 2018). The priority of the approach is to manage life-threatening scenarios, utilising a systematic strategy to keep patients alive and take the first actions toward improvement instead of creating a diagnosis (Smith et al., 2107). I first assessed Tim’s airway to ensure that it was patent. A patient’s airway may be unobstructed, moderately blocked, or entirely clogged, depending on the situation (Smith et al., 2107). I listened and inspected for symptoms of airway obstruction which include wheezing, expiratory grunting and snoring. I administered oxygen via nasal prongs following the airway assessment and repositioned the client in a lateral posture.
After evaluating the airway, I checked his breathing pattern for signs of respiratory distress such as cyanosis and the use of accessory muscles, among others. Next, I counted Tim’s respiratory rate, high at 38 beats per minute. A normal respiratory rate for an adult is 12-20 beats per minute (Hill et al., 2020). A rapid breathing rate is indicative of disease or a cautionary indication that the client’s condition is worsening (Hill et al., 2020). Next, I determined the patient’s peripheral oxygen saturation levels, which revealed an abnormally low value of 84%. A recommended target peripheral oxygen saturation is between 94-98% (van den Boom et al., 2020). Since Tim had compromised breathing, I positioned him laterally while administering oxygen then changed him to the semi-fowler position.
I monitored the circulation short after evaluating the breathing status. The purpose of examining the circulation is to ascertain the cardiac output’s efficacy. Next, I measured the patient’s blood pressure, which was normal at 100/64mmHg. Low blood pressure below 100/60mmHg can be fatal and signify a deteriorating patient (Andreas et al., 2018). I also assessed the patient’s pulse rate, 120 beats per minute. A healthy heart rate ranges between 60 and 100/minutes (Sessa et al., 2018). Next, I delegated an electrocardiogram to determine the rhythm and cardiac electrical activity. Additionally, I checked for other indicators of low cardiac output, including a reduced degree of awareness. This was followed by placing a urinary catheter to see whether there was a decrease in urine production. I inserted an intravenous cannula to facilitate the effective administration of emergency drugs and fluids. I also informed my assistant to continuously monitor the patient’s blood pressure and heart rate to restore them to a normal functioning state.
I then assessed for disability, which entails an evaluation of the person’s neurological state. It should be performed only after the airway, breathing, and circulation has been optimised since these factors might affect a person’s neurological health. Next, I examine the degree of consciousness using the Glasgow Coma Scale (GCS). The patient’s level of consciousness was normal since the GCS was 15/15. Ultimately, I examined the patient’s exposure, which comes last of the elements in the ABCDE approach. Finally, I conducted a comprehensive head to toe assessment of the patient, checking for anomalies and paying particular attention to any rashes, oedema, haemorrhage, or significant drain loss. Tim’s body temperature was normal at 36.6°C; he had no rashes or injuries but had a significantly dry mucous membrane. Dry mucosa indicates dehydration and may result in various health concerns (Bunn et al., 2019). The intravenous line I inserted would help infuse fluids to minimise dehydration.
Following discharge, Tom was sent home with oxygen to run at 2 litres via nasal prongs. I advised on the importance of not changing oxygen flow without seeking assistance from a health care provider. I emphasised that Tim should see a respiratory therapist who would teach him appropriate breathing techniques and effective use of oxygen. We discussed with Tim how to effectively cease smoking habits by joining pulmonary rehabilitation programs.
Identification and Analysis of Decision-Making Issues
In assessing Tim’s general condition, I used the information process model of decision making. The model’s core premise is that the human decision-making mechanism may be divided into two modules: temporary- and permanent memory (Kozlowski et al., 2017). Temporary memory contains the stimulus data necessary to ‘activate’ factual knowledge stored in permanent memory (Kozlowski et al., 2017). A four-stage approach represents the interaction between these two intellectual stores. To begin, the nurse observes patient engagement and collects baseline clinical data of the patient. Additionally, this data might be acquired before patient interaction. For example, I collected Tom’s baseline data on admission, such as the vital signs, including heart rate, respiration rate, temperature, and blood pressure.
The second step involves the nurse in creating early, tentative hypotheses. These hypotheses are related to the short term and long term data collected. The set of hypotheses created is commonly restricted to around four or six (Kozlowski et al., 2017). All the clinical manifestations that presented in Tim’s situation pointed to a possibility of chronic obstructive pulmonary disease. Based on Tim’s age as well as his habit of smoking, I evaluated the possibility of him having a respiratory disorder. Additionally, he had a history of COPD, which predisposes one to a big risk for recurrence. Therefore, before any laboratory investigations, I concluded the likelihood of Tim having a chronic obstructive pulmonary disease.
The third step, interpretation, requires the nurse to identify the signals obtained during the collection phase as either confirming, denying, or not adding to the original hypotheses produced. The laboratory spirometry test is the best option for confirmation of COPD (Neumeier and Keith, 2020). The test for Tim showed a moderate level of COPD. His Forced Vital Capacity (FVC) and Forced Expiratory Volume (FEV) were rated at 78 per cent.
The last step of the processing model requires the nurse to consider the advantages and disadvantages of each choice option and choose the one supported by the majority of evidence. I recommended that Tim begin his therapy sessions to slow down the symptoms and reduce the risk of complications. This was also to improve his ability to lead an active, healthy life. My recommendation is also the cessation of smoking; this could be the most effective way of curbing and treating COPD. According to NICE guidelines, smoking can affect COPD’s phenotypic expression and disease severity (Neumeier and Keith, 2020). I also recommend that Tim begins his medication as soon as possible.
Several medications treat symptoms and complications of chronic obstructive pulmonary disease. According to the NHS guidelines, bronchodilators are used to relax the muscles around the lungs, and they usually come with inhalers (Vallejo-Aparicio et al., 2018). They will help relieve Tim’s coughing and shortness of breath; hence, he will breathe easily. This inhaler can be used before his daytime activities. One effective bronchodilator that Tim was recommended for is Albuterol.
Similarly, Tim’s medication can include inhaled steroids which help open the airway and reduce inflammation in the airways. One example of an effective inhaled steroid is the Ciclesonide drug (Matsuyama et al., 2020). It is also effective when the patient takes a combination of a bronchodilator and an inhaled steroid such as Fluticasone and vilanterol drug inhalers (Vallejo-Aparicio et al., 2018). I recommend that Tim work together with other social workers, such as a chest physiotherapist who would teach breathing exercises. I also suggested that he join various support groups such as rehabilitation centres. I also emphasised the importance of seeing a dietician since certain types of food would worsen inflammation.
I recommend the following home remedies and lifestyle changes to help Tim recover from COPD. With the help of a medical professional, Tim will have to learn various techniques he could use to control his breathing and the different breathing positions to use (Miki et al., 2018). It is vital for Tim to clear his airways often by controlling coughing and drinking plenty of water. Exercising regularly and practising healthy eating habits could also be a remedy (Siboni et al., 2018). Additionally, I will recommend that he avoid engaging in strenuous activities that stimulate faster breathing.
Chronic Obstructive Pulmonary Disease is a condition that causes havoc on patients’ cardiovascular and respiratory systems. Managing COPD usually involves minimising the effects of the symptoms through adequate medication and leading a healthy lifestyle (Miki et al., 2020). Furthermore, the management of COPD involves a multidisciplinary approach, including doctors, nurses, physiotherapists and nutritionists. However, COPD has made patients experience several physical symptoms and some psychological burdens as a life-limiting condition. Therefore, family support is vital to ensure the patient concentrates on recovering rather than anxiety. Ultimately, It is required that the patient also shares their feelings with their doctor, family, or friends.
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