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Chronic obstructive pulmonary disease (COPD)

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Introduction

Chronic obstructive pulmonary disease (COPD) is a significant health problem ranked 12th for worldwide burden of disease and projected to be 5th by the year 2020 (British thoracic society (BTS),1997). The aim of this assignment is to explore the nature of COPD, the lived experience of those with the condition and their special needs. In particular it looks at the measures used to help the patient manage the symptoms of COPD and minimise the damage associated with pulmonary changes to improve a patient's quality of life "nursing is the use of clinical judgement and the provision of care to enable people to promote, improve, maintain, or recover health and when death is inevitable, to die peacefully" (RCN 2002, p.1). The author will explore the principles of chronicity and relate how COPD fits into these criteria as a chronic illness. A case study will highlight the key clinical manifestations of an acute exacerbation in a COPD patient, provide the framework for diagnosis and will discuss the strategies for acute care management. An exacerbation in a COPD patient is a significant clinical event requiring prompt diagnosis and management (GOLD, 2001). A critical review of principles of chronicity, definitions of the disease, risk factors and nursing interventions for COPD will also be discussed. Chronic illnesses have profound consequences for the individual and psychological well being (Alexander, Fawcett and Runciman, 2000). The patient's experience and the effects of their condition on family and carers will be looked at in detail. Focus of this assignment is on experiences of living with COPD from the patient and their significant others' perspectives and as such the pathogenesis of the respiratory disorder will not be explored in detail. The activities of the multidisciplinary team (MDT) in the diagnosis and management of COPD will be identified. In the United Kingdom, COPD is ranked as the fourth leading cause of death (behind heart disease, cancer and cerebrovascular disease) ...read more.

Middle

The SHO ordered 24% oxygen by face mask to improve the patient's oxygen saturation, pulmonary function tests, chest X-ray and ECG. He ordered for arterial blood gases (ABGs), to determine a more accurate oxygenation status of the patient. The nurses' immediate goal was to restore adequate oxygenation. The respiratory therapist administered a beta2 agonist, albuterol therapy by nebuliser to reverse bronchospasm. There was no improvement in George's oxygen status and an anti-cholinergic bronchodilator (ipratropium bromide) was nebulised. In accordance with the BTS, 1997 guidelines, this acts by blocking the vagal stimulus to the bronchi, thus reducing muscle constriction and mucus production. As noted by Combivent (cited in Brewin, 1997), this practice of combining the stimulating effect of the beta2 stimulant with the blocking effect of anti-cholinergic drugs, has been found to be very effective in COPD As oxygen therapy was being administered we continuously monitored the pulse oximeter to achieve an arterial saturation level of greater than 90%. (Chojnowski, 2003). An arterial blood gas was being constantly checked every 30 minutes of the oxygen therapy to assess for carbon dioxide retention. Antibiotics were prescribed and given to George as a prophylactic measure .Expectorants were also prescribed for mucous clearance. Referrals were done to other healthcare professionals for George's pulmonary rehabilitation comprising a combination of exercise and education. The physiotherapist was required to teach breathing exercises and optimise breathing, thereby arresting the downward spiral of breathlessness. The progressive course of COPD is often associated frequency of acute exacerbations. Prior to his admission George was having the services of a home help. George was persuaded to go and live with his daughter but he refused moving out his house to any alternative accommodation. Adjustment and social behaviour are important dimensions of social health and key indicators of life quality. Leidy (1996) asserts that successful adjustment is defined by a sense of intrapersonal well-being in concert with a harmonious relationship with the environment, a balance between personal needs and environment demands. ...read more.

Conclusion

Nursing Standard. 12(4). P. 49 - 55 5. British Thoracic Society. (1997). Guidelines on the management of COPD. Available at: http://www.brit-thoracic.org.uk 6. Carpenito, L. (2000). Nursing diagnosis: application to clinical practice. Lippincott 7. Chojnowski, D. (2003). "GOLD standards for exacerbation in COPD". The nurse practitioner. 28(5). P. 26-35 8. Dluhy, N. (1995). "Mapping knowledge in chronic illness". Journal of Advanced Nursing. 21(6). P.1051-1058 9. Elkin,M.K., Perry,A.G & Potter, P.A (2000). Nursing interventions & clinical skills. (2nd ed). Philadelphia. Mosby. 10. Fehrenbach,C. (2002). "Chronic obstructive pulmonary disease". Nursing Standard. 17(10). P. 45 - 53 11. Global Obstructive Lung Disease Initiative (GOLD) (2001). The phase III GOLD Initiative. Available at: http://www.goldcopd.com 12. Gullickson, C. (1999). "My death nearing its future: a Hendeggarian hermeneutical analysis of lived experiences of persons with chronic illness". Journal of Advanced Nursing. 18. P.1386-1392 13. Hodges, H. & Grier, E. (2001). "Masterworks of art and chronic illness experiences in the elderly". Journal of advanced nursing. 36 (3). P. 389- 398 14. Levin, M.E. (2002). "Management of diabetic foot: prevent amputation". South Medical Journal. 95(1). 15. Mackay, L. (1996) "Health Education and COPD: a study". Nursing Standard. 10(40).p. 34-39 16. Margereson, C., Heslop, A., Esmond, G.& Dunn, E. (1997). "Chronic respiratory illness - a challenge four nurses". Nursing Standard. 11(26).p. 45-47. 17. Monaghan, L. (2001). "Managing COPD: establishing an effective link". Nursing Management. 8(7). p. 16 19 18. Mosby's medical, nursing & allied health dictionary (2002). Mosby 19. Petty, T.L. (1999). "The rising epidemic of chronic obstructive pulmonary disease in women". Women's health in primary care. 2(12). P.942 - 953 20. Royal College of Nursing (2002). RCN Bulletin. Issue No.63. p.1. London. RCN 21. Somerson, S., Husted, C & Somerson, S. (1996). "Mastering emergency airway management: the skills you need to help your patient service". American Journal of Nursing. 9(5). 22. Trudea, M. (1999). Evaluating the quality of COPD care". American Journal of Nursing. 99(3). P 47-50 23. Woo, K. (2000). "A pilot study to examine the relationship of dyspnoea physical activity and fatigue in patients with COPD". Journal of clinical nursing. 9(4). P. 526 - 533 ...read more.

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