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Holistic Nursing Practice. J Am Geriatr Soc. Profiles of older Medicare decedents. Costing Report. COPD has often been misdiagnosed as asthma due to similar symptoms, presentation, lack of knowledge, training and understanding around the disease its symptoms and causes study shows those who are undiagnosed or misdiagnosed often causes a delay in treatment at the earliest stage of disease trajectory. So, they will typically present at the Emergency Clinic complaining of shortness of breath, coughing and feeling anxious. This is a preliminary assessment of the patient. COPD (2017). Studies have elucidated that nurses play a vital role in screening and managing anxiety. Saturations of 95 per cent or above are normal. Int J Gen Med. Patient developed mild fever two days back, before that he gives no history of fever. Assessment and management of an exacerbation of COPD Written by: Beverley Bostock-Cox | Published: 15 April 2013 Matthew is a 72-year-old retired policeman with a complex medical history, including type 2 diabetes, a myocardial infarction eight years ago and moderate/severe COPD … Other tool, less known is the Mini Assessment Tool, known as MNA, common in assessment in older adults (Nestle Nutrition Institute, 2009). Churchill Livingstone Elsevier, Edinburg. In more advanced disease, physical features com­monly found are hyperinflation of the chest, reduced chest expansion, hyperresonance to percussion, soft breath […] 29,1,101-106. What is COPD? The respiratory rate is 33 per minute and bilateral chest movements are reduced. He quickly percusses and auscultates chest and finds it hyper-resonant all over. The MUST (BAPEN, 2011) identifies unintentional weight loss as an indicator of risk; however, not all the issues that affecting or can affect a patient’s, person’s ability to maintain their nutritional health will be identified using a screening tool. This difficulty with prognosis may be compounded by a tendency for primary care professionals to overestimate survival. If you need assistance with writing your essay, our professional essay writing service is here to help! Emphysema and chronic bronchitis are clinically grouped together and called chronic obstructive pulmonary disease (COPD). General Practice of Nursing Vol 1, pp1-3. Do you have a 2:1 degree or higher? Nothing in the environment appears harmful for the patient or ambulance staff. In this essay this process is described. When taking history of the patient they asked some leading questions from the patient. Twelve activities of daily living are used to measure a patient’s ability, they are: “maintaining a safe environment, communicating, breathing, eating and drinking, eliminating, personal cleansing and dressing, controlling body temperature, mobilising, working and playing, expressing sexuality, sleeping and dying”. We've received widespread press coverage since 2003, Your NursingAnswers.net purchase is secure and we're rated 4.4/5 on reviews.co.uk. Long-term exposure to irritants that damage the lungs and airways is the most common cause of COPD, and cigarette smoke (from smoking or secondhand smoke) is the most common irritant. The neighbor once or twice a week visits him and gives him some company. It helps to identify areas of risk, as well as highlight person own individual health, needs to support a patient’s journey. Holistic nursing assessment has a key role in identifying anxiety and depression, and there is evidence to support the role of nurses in delivering a cognitive behavioural therapy approach to help patients with COPD manage the two conditions (Heslop-Marshall et al, 2018). Available at: https://www.mna-elderly.com/forms/mini/mna_english.pdf Downloaded 22st May, 2019. If this is not possible, calculate the patient’s mid-upper arm circumference by measuring the ulna length an upper arm circumference with a tape measure, as described in the MUST (BAPEN,2011). The PBC group COPD lead developed a nursing protocol for management of acute COPD exacerbations and a review protocol consistent with NICE guidance. Nutrition. The patient is eighty four years old elderly black male of average built sitting forward in hunched-over position on bed and breathing through pursed lips. COPD is a disease of increasing public health importance around the world.COPD has emerged as the third leading cause of chronic morbidity and mortality worldwide. Nurse care and patient education is vital to prevent episodes of panic in COPD patients (Willgoss et.al, 2011). Protein energy undernutrition develops when nutritional intake is not enough to meet demand; for example, when patients has a difficulty to access food. Assessment and management of an exacerbation of COPD Written by: Beverley Bostock-Cox | Published: 15 April 2013 Matthew is a 72-year-old retired policeman with a complex medical history, including type 2 diabetes, a myocardial infarction eight years ago and moderate/severe COPD … they are at risk of hypercapnic respiratory failure - often referred to as type 2 respiratory failure). Nestle Nutrition Institute (2009). A variety of procedures, tests, and questionnaires can be used to evaluate patients with chronic obstructive pulmonary disease (COPD) for clinical and research purposes. Respiration rate is 33/minute, deep with forced expiration. In a subgroup of patients with COPD, high concentrations of oxygen may depress breathing (i.e. COPD has a wide spread effect on the body effecting weight loss, exercise intolerance and peripheral oedema, It is estimated around three million people in the United Kingdom (UK) are living with COPD, but the National Institute for health and care excellence reports only 900,000 of those have officially been diagnosed (NICE, 2010). Some laboratory signs for this patient include Glasgow Coma Score; level of consciousness is 14/15, with patient little confused. Supporting patient’s nutritional requirements is a fundamental aspect of nursing care. In this case both FVC and FEV1 are reduced and ratio FEV1/FVC is decreased to 1.1 L / 3.0 L (Costanzo, 2007). He was diagnosed with COPD and chest infection each time. It is commonly caused by distinct disease processes such as Emphysema and Chronic Bronchitis. He checked capillary refill by pressing finger nails of the patient and found it normal <2 sec. Expected outcomes. 2011. Copyright © 2003 - 2021 - UKEssays is a trading name of All Answers Ltd, a company registered in England and Wales. Progressively worsening breathlessness for the patient with COPD limits everyday activity, reduces quality of life and increases the risk of premature death. Exacerbations are a common problem amoungst patient with COPD. Unintentional weight loss in older adults. Co… Symptoms include cough and breathlessness. In addition, nurses must take an interactive and team approach to the care and management of patients with COPD who have acute respiratory failure. Respirology 18(4): 616-29. There is no injury. VAT Registration No: 842417633. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. Many patients with COPD have acute exacerbations that lead to acute respiratory failure and require hospitalization. Introduction. On auscultation breath sounds are reduced and rhonchi are present in the chest. Current complaint is a direct result exacerbation of previously existing COPD (Longmore, Wilkinson & Rajagopalan, 2007). Lee SD. COPD is diagnosed through a combination of patient history, physical assessment, and spirometry. Some patients might find it difficult sharing their personal information to health care professionals in front of loved ones about their condition, due to sensitive information that might be exposed or harbouring guilt from either a history of smoking or not seeking treatment earlier (Fromer, 2011). References: A study by Lunney et al (2002) introduce End of Life as its own phase, divided int four distinct trajectories varying in length and rate of decline in functionality. 1. Lung Institute (2017). According to protease-antiprotease and oxidant-antioxidant theories heavy smoking results in imbalance between these enzymes result in damages to lung parenchyma and alveolar wall (Kumar, Abbas & Fausto, 2005). Acute respiratory tract infection makes situation worse and signs and symptoms of infection with hypoxia and hypercapnea and right heart failure (at latter stage of COPD) become apparent and patient need urgent treatment (Talley & Connor, 2006). The Roper-Logan-Tierney model for nursing: based on the activities of living. American Family Physician. Pulmonary function studies are used to help confirm the diagnosis of COPD, determine disease severity, and monitor disease progression. COPD Mr. Whaley is a 65-year-old man with a history of COPD who presents to his primary care provider’s (PCP) office complaining of a productive cough off and on for 2 years and shortness of breath for the last 3 days. It within the expiratory date and has been taken correctly. Nursing Essay Germany. Wills. Assessment of patients with chronic obstructive pulmonary disease (COPD) is important to establish an accurate diagnosis, assist in making therapeutic decisions, measuring outcomes for clinical and research purposes, and determining prognosis. Other irritants include particles from fires used in the home for cooking or heating and workplace exposure to chemical fumes, dust, and particles. Nursing. He used to prepare food for himself but buying from a take away shop since last three day as he does not feel good to prepare it at home. A careful family history in reference to close relatives with COPD is important because COPD runs in families. Mild wheezing was present since one month but it became more prominent four days back. Cough. Malnutrition Screening tools: comparison against two validated methods in older medical inpatient. So, they will typically present at the Emergency Clinic complaining of shortness of breath, coughing and feeling anxious. Blood pressure is 125/90, diastolic blood pressure slightly high. In addition, looking at the effects of nutrition it’s also important to consider the effects of involving patients’ friends, family and care givers when assessing and planning future care. Patient gives Family history of no significant disease in his parents and two children. The crew use sucker and clear secretions to ensure patency of airway. In addition, looking at nutrition it also important to select an appropriate nutritional screening tool   to be used during the assessment, for example the Malnutrition Universal Screening Tool, known as MUST (BAPEN, 2011). 3. In COPD there is chronic inflammation of airways, lung parenchyma and pulmonary vasculature. 2002;50(6):1108–12. 3rd Edition. Nurse care and patient education is vital to prevent episodes of panic in COPD patients (Willgoss et.al, 2011). Desired Outcome. London: Nursing and Midwifery Council. Chronic Obstructive Pulmonary Disease (COPD) exacerbations play a central role in the natural history of the disease, affecting its overall severity, decreasing pulmonary function, worsening underlying co-morbidities, impairing quality of life (QoL) and leading to severe morbidity and mortality. Steve Hunter, BSc, RGN,is critical care outreach nurse at Princess Royal Hospital, Haywards Heath, West Sussex. Low oxygen therapy (24-28% of O2) was given to the patient by using nasal cannulae to deliver 1-2 litres of oxygen per minute. Promoting Home- and Community-Based Care Teaching Patients Self-Care Provide instructions about self-management; assess the knowledge of patients and family members about self-care and the therapeutic regimen. Ensuring individuals’ holistic needs with COPD are met requires, as Holland (2008) describes, a nursing process that utilises problem solving strategies to identify patients’ problems and needs. The term ‘health trajectory’ describes changes in health over period of time, defending the stage a patient is at in their health trajectory allows for effective intervention and care planning ( Seamark et al, 2007).The patient group for purpose of that assignment are within the   severe stage of their illness with long term limitation of function and well-being with intermittent serious episodes of COPD progression .Disease trajectory during the third stage of COPD patients experience exacerbation which can have a big impact on life quality (limitation) and often requiring hospital admission (Curie,2017). Both have overlapping features with damage at acinar level (emphysema) and bronchial level (bronchitis) and most commonly occur in smokers. Price, D.M (2008). The poor prognostic sight in COPD is the fact, that many patients with COPD are underweight. Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD): 1. The ambulance crew behaved quite professionally with few exceptions. It is important to support adult patients with their nutritional requirements; it can be in hospital or community. Shape and movements of chest are symmetrical; no flail segment and no injury present. Existing reviews identify important aspects of managing life with COPD with which patients may need support”. 2. Chronic obstructive pulmonary disease (COPD) is a long-term lung disease characterised by breathlessness, cough and sputum production. Digital Edition: COPD – nursing care and implications for nursing 10 September, 2002 Some nurses will be actively involved in helping diagnose COPD by carrying out spirometry and reversibility testing, while others, particularly in secondary care, will be less involved in this diagnostic process. Global Strategy for the diagnosis, management and prevention of chronic obstructive pulmonary disease. Chronic obstructive pulmonary disease is a progressive lung disease characterised by airflow destruction and destruction of the lung parenchyma (GOLD, 2019). COPD risk increases when those e… Disclaimer: This essay has been written by a student and not our expert nursing writers. But this is my first experience and I think I need to have more experiences similar to or different from this experience to learn more about dealing with different kind of patients and different situations. He did not park their ambulance very correctly and left little space for other cars. The COPD care plan for activity intolerance may include a nursing diagnosis of … Gaddey, H.L Holder. It also shows the nurse asking questions about the patient’s life quality, and closely explaining every step of the assessment so that the patient knows what’s happening. This essay should not be treated as an authoritative source of information when forming medical opinions as information may be inaccurate or out-of-date. His wife died in a car accident ten years back. COPD is a long-term medical condition, but it is both preventable and treatable. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. Teach patients and family members early signs and symptoms of infection and other complications so that they seek appropriate health care promptly. Global Initiative for Chronic Obstructive Lung Disease (GOLD). Understanding a patient’s perception of their illness is an important first step to providing comprehensive, multifaceted care for patients with long term conditions. Published by Springer Nature. The general condition of patient is poor, his disease is getting worse and he is confined to bed. Blue bloaters (primarily having chronic bronchitis) have severe hypoxia with cyanosis and have hypercapnia. Although COPD is a bracket name given to multiple lung conditions such as emphysema and chronic bronchitis the two conditions are very similar and often present with similar symptoms. Stopping smoking slows down average rate of decline in FV1 from 50-70ml/ year to 30ml/year that is equal to non-smokers (Warrell, Cox & Firth, 2005). The nurse may need to ask whether the patient can remember the initial symptoms of angina, which will help him to predict the potential coming of angina. Chronic Disease. The patient has certain Presenting complaints (PC).These include worsening cough with sputum since seven days, breathlessness on Exertion since four days, Wheezing since four days, generalised weakness since two days, temperature since two days and breathlessness at rest since six hours. Nursing Interventions. Nursing Older People. The people which are at high risk of developing malnutrition extends beyond those with chronic, progressive conditions in this case its COPD. It will prioritise this health need with a specific focus on a holistic approach to nursing assessment, when assessing patients with Chronic Obstructive Pulmonary Disease, known as COPD. COPD patients often need supportive treatment of 2 litres of oxygen to maintain oxygen saturations normally acceptable for that specific patient. Edinburgh: Churchill Livingstone. Because smoking has such a detrimental effect on the lungs, the nurse must … The diagnosing and assessing copd path for the chronic obstructive pulmonary disease pathway. Nursing and Midwifery Council (NMC), 2018. Available at:   https://lunginstitute.com/blog/stage-3-copd-severe-copd. The aim of management is to treat infection, reduce cyanosis, increase oxygen saturation in blood, decrease carbon dioxide saturation in blood and provide symptomatic relief to patient. Patient and service user care. Some common questions often asked by doctors or nurses to help evaluate the patient are listed in Tables 1 and 2. It causes 115,000 admissions to hospital every year. However, accurate predictions of life expectancy for individual patients with COPD remains extremely difficult. Expanding nursing practice in COPD: is it key to providing high-quality, effective, and safe patient care? Disclaimer: This is an example of a student written essay.Click here for sample essays written by our professional writers. Low dose steroid inhaler (Beclomethasone Dipropionate inhaler) two inhalations three times a day act as an anti inflammatory agent to reduce bronchial inflammation thus reducing symptoms. 2007 May; 100225–233. Evidence-based information on nursing of copd patients from hundreds of trustworthy sources for health and social care. Chronic Obstructive Pulmonary Disease (COPD) – also known as Chronic Obstructive Lung Disease (COLD) – is a chronic inflammation of the lungs that causes obstruction of airflow 1 and ineffective airway clearance. Seamark, D.A, Seamark, C.J, Halpin, D.M.G (2007). On examination of abdomen and pelvis no wounds or painful areas found. Any lung irritant can cause COPD and also exacerbate it. Booker, C. Nicol, M. and Alexander M.F (2011). Conclusion. The crew gets consent from the patient and approaches patient for quick Primary Survey. Nursing Diagnosis (list 3 … SL (2016). There was no pet in the house. Prompt treatment of respiratory tract infection is necessary because it leads to worsening of breathlessness and cause type II respiratory failure in COPD patient. It is very important to inform the patient about the reason for that procedure as well as obtain consent and using appropriate communication methods. This documentation was used to deliver a consistent standard of care for patients … Does the … The medicine patient is using is Salbutamol inhaler taking two puffs three times a day. He examines pupils of both eyes and find normal in size and reaction to light. Guidelines and recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the American Thoracic Society/European Respiratory Society (ATS/ERS) endorse spirometry for diagnosis. The radial pulse rate is 100 per minute, regular but bounding; blood pressure 125/90. He reports that he has had several chest colds in the last few years, but this time it won’t go away. Nurse needs to assess how the patient usually deals with his COPD, HTN, GERD, and DMT2. The EKG also is not useful in evaluating patients with COPD. Then he assesses if patient has any disability and finds no disability. The risk of developing malnutrition can be quantified with the MUST tool (BAPEN 2011), which can indicate the necessity for referral to other part of multidisciplinary team, for example to dietitian, and address the implementation of an individualised needs and help create care plan. National Institute for Health and Care Excellence (2016). I. COPD Assessment Test (CAT). The patient is eighty four years old elderly black male of average built sitting forward in hunched-over position on bed and breathing through pursed lips. Diagnosis and assessment of COPD must be done carefully since the three main symptoms are common among chronic pulmonary disorders. Clinically appropriate, evidence-based rehabilitation programs for home c … Zero you don’t cough at all. It will prioritise this health need with a specific focus on a holistic approach to nursing assessment, when assessing patients with Chronic Obstructive Pulmonary Disease, known as COPD. 11th Feb 2020 Breathlessness on exertion started four days back that gradually increased and he developed breathlessness at rest 6 hours back. It will locate the point of the trajectory of the disease, as well as the care environment the assessment takes place with, and why these are important in relation to the relevance of the chosen assessment. Accessed 16th May 2019. National Institute for Health and Clinical Excellence (NICE, 2011). Health Improvement Scotland (2014). Breathing problems tend to get gradually worse over time, but there are many different medicines and therapies that can help people keep these under control for longer” (NICE, 2016). He is eighty four years old male migrant from Jamaica living alone in a two bed room flat with no one looking after him. Introduction About half of patients discharged after a hospital admission for COPD will die within two years. The patient is able to identify stressors, and threats to his role. Stratton RJ, Green CJ, Elia M (2003) Disease related malnutrition and evidence-based approach to treatment. Nothing in the environment appears harmful for the patient or ambulanc… British Lung Foundation (2019). COPD is one of the respiratory diseases which requires palliation of symptoms, is known to have four stages within its disease trajectory beginning with mild, moderate and progressing to moderately severe (Currie, 2017). Heterogeneity and Personalized Treatment. Each long term condition comes with a set of challenges. Then ambulance crew examines patient’s airway, and find lips and tongue blue due to cyanosis and secretions in the throat. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD… National Institute of Clinical Excellence (NICE, 2011) highlight “COPD is the fourth highest mortality rate being one of the costliest conditions treated within the NHS, with a total annual cost of over 800 million in direct healthcare costs. British Association for Parental and Enteral Nutrition (2011). Occupational exposures often are overlooked and underdiagnosed. At this first contact with the patient it is essential that appropriate history taking is performed to clarify presenting symptoms, past history and the patient's expectations to focus and plan person centred nursing care … He is a smoker since last sixty years but did not consume any alcohol or habit forming drug. Search results. Nursing care planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. The social history of patient is important. Impaired Gas Excha… The aim is to maintain PaO2 level of 7 kPa or more to reduce hypoxaemia and hypercapnia. Most people find out they have COPD in their fifties or older, and it’s much more common in people who smoke. He has off and on cough with white sputum since three months, that became worse seven days back, when weather turned cold. The content within this essay is generalised across a patient group and does not relate to any specific patient, staff member or trust (NMC, 2018). The amount of sputum is increasing day by day. C2.2 Physical examination The sensitivity of physical examination for detecting mild to moderate COPD is poor (Badgett 1993). Kidneys of elderly patients have reduced drug clearance so toxic effects of drugs appear with minor overdose. (Fromer,2011). Symptoms include increased breathless, especially when people are active, a persistent cough with phlegm, frequent chest infections and wheezing. Patient used to do light house-hold work, but since last two days he is unable to do that due to weakness. Looking for a flexible role? goldcopd.org. This article will explain how to conduct a nursing head-to-toe health assessment. Temperature on Tympanic temperature 100.5 F. Capillary refill in <2 seconds shows normal tissue perfusion. Pulse rate is 100/min, regular and bounding. (Hodson and Blimires, 2015) Implies if a COPD patient had recently lost any weight or unintentionally gained, holistically assessing patients for muscle fatigue, oedema, hypersecretion and bronchoconstriction, Respiratory muscle fatigue can lead to hypoxaemia, hypercapnia and respiratory acidosis, Hypoxia and acidosis can lead to peripheral oedema. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. Global Initiative for Chronic Obstructive Lung Disease (2011). Although this assessment tool is commonly used for those with COPD, it doesn’t identify if a person had lost or gained weight and become malnourished. And finds it hyper-resonant all over, Chilver, Boon & College, 2002.. % on air within the expiratory date and has peripheral oedema indicating chances of like. Meeting patients ’ nutritional needs early signs and symptoms of infection and other complications so he! ( Longmore, Wilkinson & Rajagopalan, 2007 ) on assessment, getting background on! Please refer to an authoritative source of information in assessment increasing patient ’ s important to support patients. Himself and carries staff to the patient is using accessory muscles of.! Activity, reduces quality of life and increases the risk of developing malnutrition extends beyond those chronic! Also learned how to conduct primary survey hospital or community, C. Nicol, M. and M.F! Of metabolic demand ( Price,2008 ) a spectrum of lung pathologies associated with patient! States that COPD is a direct result exacerbation of previously existing COPD ( Longmore, Wilkinson Rajagopalan. 4639 words ( 19 pages ) essay Published: 8th nursing assessment for copd patient 2020 in nursing should be aware that nutritional. Conduct a nursing protocol for management of acute COPD exacerbations and a history of fever evaluate the patient has in... 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