The assessment task for this module requires you to write about a client/patient in whose care you have participated during a period in hospital.

Authors Avatar

Assessment Task 2

Appendix I 14

Appendix II 15

References 16

Bibliography 16

Assessment Task

The assessment task for this module requires you to write about a client/patient in whose care you have participated during a period in hospital. It must focus on the client/patient's lived experience of the altered health status that preceded their admission to hospital as well as discussing the role of the registered nurse in meeting some or all of their health needs in an acute care setting.

Submission Date - 28th February 2005

The Ward and Trust will not be mentioned by name in accordance with the NMC Code of Professional Conduct (2002).

The client that will be named in this assignment has been given a pseudonym Paula Money, to protect her identity in accordance with the section 5 of the NMC Code of Professional Conduct (2002).

This assignment will focus on a chronic illness and the patient/clients lived experience of this. The Roper, Logan and Tierney's model will be used to discuss the health needs of the client as it identifies and groups nursing activities in relation to the process of living (Roper et al 2001).

The patient observed for this study had chronic obstructive pulmonary disease (COPD). It is the term used to describe conditions such as emphysema, chronic bronchitis, chronic airway obstruction, and irreversible asthma. (Unison Healthcare, 2003) The causes of this disease can be exposure to industrial pollutants or inherited genes, but is most common in those that smoke or have a past history of smoking. The disease results in debilitating breathlessness, decreased exercise tolerance, poor nutritional intake and often-social isolation. It is characterised by exacerbation's that can be triggered by viruses, atmospheric pollutants, and air temperature. The most important help, which patients with COPD who smoke can receive from nurses, is how to give up smoking. (NICE 2004)

The patient, Paula Money, is a 63-year-old lady who had been diagnosed with Chronic Obstructive Pulmonary Disease (COPD) 10 years ago. She has had several hospitalisations and has been admitted this time with exacerbation and end stage COPD and will remain in hospital until this acute attack passes, for approximately 10 to 14 days. She has been diagnosed as terminal and it has now been agreed with her and her family that she will not be resuscitated if she were to have a cardiac or respiratory arrest during her stay in hospital.

Paula worked all her working life in the public house trade. She had become a smoker at the age of 16 and had continued to smoke around 10 to 15 cigarettes a day. These are measured in pack years as 27. Bourke (1998) states that the total dose of tobacco inhaled is important to establish pack years.

Her exercise tolerance had reduced gradually over time, and now she was only able to walk 15 metres before becoming breathless and was just able to get dressed in the morning.

Paula had always been fairly fit and healthy and never suffered with any major health problems until a period of illness led to her being diagnosed with COPD caused by her long term smoking. Smoking is the single greatest cause of preventable illness and premature death in the UK and is responsible for 23 per cent of all male deaths and 12 per cent of all female deaths. (Health Development Agency (HDA) 2004).

Paula is divorced with 3 grown up children, and her health has now deteriorated to the point where she is housebound and unable to work. Her children have now become her full time carers.

Eleven years ago Paula had been suffering with recurrent colds and coughs and initially put it down to 'over-doing' it. The cough got progressively more productive and chronic and she consulted her GP who prescribed antibiotics. As these did not clear the cough up a further course of antibiotics was prescribed. Again, these did not work but at that stage she decided that the cough would eventually go on its own and proceeded to carry on with her daily living. Her exercise tolerance at this stage was reduced to around 50 metres before she was breathless and requiring a rest.

There was no marked change in her condition for about 8 or 9 months until she woke one morning feeling very lethargic, breathless, and unable to get out of bed. Her breathing had become very shallow and she felt that she was unable to 'catch her breath'. She called her GP who arranged an ambulance to take her into hospital.

Paula was admitted and put on oxygen. This worried her as, up until that point, she had thought she had just had a flu type virus, which she could not get rid of.

She was asked whether she smoked, which she confirmed, and was then told, before any investigation, that it was thought to be COPD - or Emphysema as it was called then.
Join now!

She remained in hospital for 10 days while the hospital undertook a series of tests, which included: Serial domiciliary peakflow measurements - to exclude asthma; CT scan of the thorax- to investigate symptoms that seem disproportionate to the spirometric impairment; Echocardiogram (ECG) - To assess cardiac status if features of cor pulmonale; Pulse oximetry - To assess need for oxygen therapy; Sputum culture - To identify organisms if sputum is persistently present and purulent.

The diagnosis was confirmed as COPD. Paula was prescribed a short course of high strength corticosteroids and was also prescribed bronchodilator inhalers, which ...

This is a preview of the whole essay