Pathophysiology, Pharmacokinetics, And Patient Education For COPD Essay.

Outline the pathophysiology of COPD

1. Outline the pathophysiology of COPD

COPD is one of the most life-threatening diseases which affects the lungs and cause trouble while breathing. COPD occurs when the lungs get exposed to several harmful minor particles and gases that cause abnormal inflammation of the lungs. This type of chronic inflammation plays a vital role in COPD pathophysiology (Zhao et al., 2020). Smoking and some other irritants of the airways triggers the accumulation of neutrophils, T-lymphocytes and several other inflammatory cells in the airways. As soon as these cells are activated, they cause triggering of the inflammatory response in the body against the condition. The influx of the molecules that are also termed the inflammatory mediators travels to the site of infection for destroying and removing the inhaled irritants from the airways. During the development of COPD in an individual, the disease's chronic condition produces excessive mucus in the airways, leading to irritating and obstructing airflow passage into the lungs (Zhao et al., 2020). The lining inside the airways gets irritated and swollen, which causes impairment of the cilia function present in it. This causes difficulty while breathing and obstruct the process of air exchange in the body. In some cases, the airways lose their elasticity due to the damage to airways and alveoli walls (Zhao et al., 2020). 

2. Give a written explanation of the pathophysiological basis for the subjective and objective data.

In the given case study, Mr Hodges is feeling anxious about his condition; anxiety, along with COPD, produces a cycle of breathlessness that might provoke panic in a patient. This makes a patient more anxious about their health condition. The same situation might have triggered anxiousness in Mr Hodges. Dyspnoea is a condition in which a patient suffers from dyspnoea. COPD is often associated with shortness of breath due to obstruction in the airways (Zhao et al., 2020).

In most cases of COPD, it has been observed that often both hot and cold temperatures are associated with the increased respiratory morbidity among patients suffering from COPD. The association of elevated heart rates with COPD is one of the most common clinical symptoms recorded to date. In COPD, the blockage of airways is associated with limited airflow, which effects the circulatory system and causes an elevation of the blood pressure in the patient (Zhao et al., 2020). Due to reduced airflow through airways, oxygen saturation is low in this patient (Zhao et al., 2020).       

3. Give a detailed explanation of the pharmacokinetics and pharmacodynamics of each of the prescribed medications. 

1. Salbutamol sulfate – drug class - beta agonist

PD – the pharmacodynamics of the salbutamol or albuterol is a moderately selective beta (2)-receptor agonist is used as the bronchodilator for managing asthma as well as other chronic obstructive diseases. It binds with the beta 2 receptors that are usually found in bronchioles of respiratory system. It activates Gs protein which is associated with the receptor along with exchange of GDP to GTP (Arafa & Ayoub, 2018).

PK - it has been observed that after inhalation of the salbutamol inhaler, the extreme plasma concentration of this drug is observed after approximately three hours. Complete excretion of the drug usually occurs within 72 hours of the dosage. It is usually excreted through urine and faeces. 

Give a written explanation of the pathophysiological basis for the subjective and objective data

Common adverse effects: major common adverse side effects of salbutamol are feeling shakiness, elevated heart rate, headaches, cramps, muscle weakness, nausea, dizziness, arrhythmia, chest pain and mouth dryness. However, the symptoms vary from person to person based on several factors.

2. Ipratropium bromide – drug class – anticholinergic

PD – it is short acting drug which inhibits parasympathetic nervous system, based on level of airways that produces bronchodilatation. It acts as the antagonist of muscarinic acetylcholine receptor. It relaxes bronchial airways that reverses narrowing which accounted for the wheezing breathing, cough, abnormalities in exchanging of gases and chest tightness.

PK - it has been observed that after inhalation of the Ipratropium bromide inhaler, effect of the drug initiates after around 1 to 2 hours and is recorded to last for about 4 to 6 hours.

Common adverse effects: includes acidity, burning eyes, diarrhea, heart burn, indigestion and joint pain (Samlaska & Rackham, 2019).

3. Prednisolone – drug class – corticosteroid

PD – it is usually used for the treatment of autoimmune disease and inflammation. It usually binds to glucocorticoid receptor, inhibits pro inflammatory signals and promotes the anti-inflammatory signals. It has wide therapeutic window since various dose are required in different cases (Sweeney et al., 2021).

PK – the drug has short duration of action with half life of 2.1 to 3.5 hours.

Common adverse effects- includes fluid retention in body, elevated blood pressure, mood swings, change in glucose tolerance, weight gain and increased appetite.

4. Mr Hodges is prescribed 2 litres of oxygen via nasal prongs continuously. What are the important nursing considerations when administering oxygen to patients with COPD?

 The important nursing consideration when administering oxygen to patients with COPD are as follows:

1. Prevention of CO₂ narcosis – often patient with COPD tends to develop CO₂ narcosis that causes hypercapnia, a condition in which PaCO₂ is raised. Therefore, before administering oxygen the initial condition of the patient is to be monitored properly to avoid such situation (Allibone, Soares & Wilson, 2018).
2. Pulmonary oxygen toxicity – before administering oxygen, the nurse must measure the approximate amount of oxygen that is to be administered so that development of pulmonary oxygen toxicity can be prevented (Allibone, Soares & Wilson, 2018).

• Monitoring the SpO₂ – close monitoring of the oxygen saturation level is to be done, so that worsening of hypoxaemia can be prevented in the patient (Allibone, Soares & Wilson, 2018).

5. Mr Hodges is preparing for discharge and is prescribed a Salmeterol (serevent) accuhaler 50 microgram/blister to take home. Apply your pharmacotherapeutic knowledge to the patient education you would provide to Mr Hodge's prior to discharge.

Salmeterol accuhaler is a type of long-lasting agonist drug of the beta 2 adrenergic receptor which is presently prescribed for treating CPOD and asthma. Its duration of action is longer than any other agonist of beta 2 adrenergic receptor. It binds to active site of the receptor as well as to the exo sites of it. This Salmeterol helps in relaxation of the bronchial smooth muscles, bronchodilation and increased in the airflow (Cates et al., 2018).

50µg dose of the inhaled salmeterol reaches the C_max of 47.897pg/mL, T_max of 0.240h, and AUC of 156.041pg/mL/h⁵. 57.4% of the drug is eliminated through faeces and around 23% through urine (Cates et al., 2018). It should be administered as the directed dosage. With overdosing of the drug, the patient may experience metabolic acidosis, anxiety, palpitation, chest pain, sinus tachycardia, hypokalaemia and many more. In case of over dosing, the patient is to be brought to the hospital for providing symptomatic and supportive treatment (Cates et al., 2018).  

1. Application of the ACSQHC Medication Safety Standards and Quality Use of Medicines principles to inform safe medication practice in this case?

 The ACSQHC Medication Safety Standards and Quality Use of Medicines principles is used for ensuring informed and safe practice of medication in different sectors of health care services. The quality use of medicines indicates the selection of management options correctly based on the consideration of the place of the medicines in the treatment of the illness along with maintaining health. It also guides about choosing the suitable medicines for an individual based on the clinical conditions and the benefits of using it for the health condition. It also describes about the guidelines for considering the risk factors associated with the dosage and medication (Disalvo, 2019). The principles describe about the dosage of the medicine and the length of the treatment process with the same. The principle also provides the guidelines for monitoring the considerations and the cost for individual, health system and community as the whole system. It also guides foe safe and effective use of medicines in every part of the health care system. In ensures proper monitoring of the outcomes, minimal misuse of the medicine, over dosing and under dosing of the same. In this case, the patient was administered with four medicines each having a different role to play for the treatment of COPD (Disalvo, 2019). Before administering the medicines, the patient's health condition was kept in consideration and so the dosage was designed in well planned manner. Before, discharge he was thoroughly explained about the use of the medicines, the risk factors associated with the over use of it and the dosage that is to be administered (Disalvo, 2019).

Give a detailed explanation of the pharmacokinetics and pharmacodynamics of each of the prescribed medications

1. Application of nursing professional codes and standards to decision-making and safe medication practice in this case?

The application of nursing professional codes and standards to decision-making and safe medication practice is important in order to guide the nurses and other health professionals o make correct decisions in emergency situation. The decision making is an important part of the care plan which would help to effectively deal with the situation for overcoming the emergency situation (Schmidt & McArthur, 2018). The codes of the nursing professional and standards to decision making contains several provisions that deals various area of the patient care and guidelines to deal with the decision-making process. the nurses and other health care professionals must adhere to the guidelines for effective treatment procedure and communication with the patient. the safe medication practice helps to ensure that the medicines are used under proper guideline so that the misuse or overdose of the same can be avoided. Different medicines have different guideline and dosage amount for effective treatment (Schmidt & McArthur, 2018). If a patient does not adhere to the instructions, the medicine might cast adverse impact on the health of the patient which sometimes are considered to be fatal. In order to reduce such situations, the patient must be educated as per the guideline with exact and appropriate information about the medicine and the reason for choosing it over others. In this case, before administering oxygen therapy, certain nursing considerations were mentioned for ensuring the patient safety. Again, while discharging, he was explained about the drug's use and mode of action and some other information that would help to properly understand every aspect of the medicine (Schmidt & McArthur, 2018). 

References

Allibone, E., Soares, T., & Wilson, A. (2018). Safe and effective use of supplemental oxygen therapy. Nursing Standard, 33(5). EBSCOhost | 131246644 | Safe and effective use of supplemental oxygen therapy.

Arafa, M. G., & Ayoub, B. M. (2018). Bioavailability study of niosomal salbutamol sulfate in metered dose inhaler: controlled pulmonary drug delivery. Journal of aerosol medicine and pulmonary drug delivery, 31(2), 114-115.

https://doi.org/10.1089/jamp.2017.1448

Cates, C. J., Schmidt, S., Ferrer, M., Sayer, B., & Waterson, S. (2018). Inhaled steroids with and without regular salmeterol for asthma: serious adverse events. Cochrane Database of Systematic Reviews, (12). https://doi.org/10.1002/14651858.CD006922.pub4

Disalvo, D. M. (2019). Improving Quality Use of Medicines for People with Advanced Dementia in Long-term Care (Doctoral dissertation). OPUS at UTS: Improving Quality Use of Medicines for People with Advanced Dementia in Long-term Care - Open Publications of UTS Scholars

Samlaska, C., & Rackham, A. (2019). Bromangiomas-ipratropium bromide–associated angiomas. JAAD Case Reports, 5(9), 776. https://dx.doi.org/10.1016%2Fj.jdcr.2019.06.021

Schmidt, B. J., & McArthur, E. C. (2018, January). Professional nursing values: A concept analysis. In Nursing forum (Vol. 53, No. 1, pp. 69-75). Professional nursing values: A concept analysis - Schmidt - 2018 - Nursing Forum - Wiley Online Library

Sweeney, C., Bracarda, S., Sternberg, C. N., Chi, K. N., Olmos, D., Sandhu, S., ... & de Bono, J. S. (2021). Ipatasertib plus abiraterone and prednisolone in metastatic castration-resistant prostate cancer (IPATential150): A multicentre, randomised, double-blind, phase 3 trial. The Lancet, 398(10295), 131-142. https://doi.org/10.1016/S0140-6736(21)00580-8

Zhao, Q., Meng, M., Kumar, R., Wu, Y., Huang, J., Lian, N., ... & Lin, S. (2020). The impact of COPD and smoking history on the severity of COVID?19: A systemic review and meta?analysis. Journal of medical virology, 92(10), 1915-1921.

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