Exacerbation Of COPD: Pathophysiology, Management, And Nursing Strategies Essay.

Appropriate evidence based literature sources must be used and APA or Harvard referencing used throughout. You must follow Academic Standards and policy in writing, with the report to be written in third person.

Students are encouraged to write up this report prior to undertaking their CCC presentations. The CCC Report must be uploaded with the CCC Declaration cover sheet otherwise the report will not be marked until a copy is received by the tutor allocated to mark the report.

Please refer to the marking guide below for the specific requirements of the assignment, you may use the marking guide headings throughout your paper however please note the section on Evaluation of nursing and medical management should not be a heading but should be integrated throughout your entire paper supporting your knowledge and understanding of the patient case.

Discussion:

• Demonstrates understanding of patient’s medical condition(s), including relevant anatomy and physiology and in

- depth pathophysiology discussion.

• Nursing management Included

Clinical assessment using (IS)BAR – based approach (systems approach discussion for assessment discussion), explanation of how nursing management relates to medical management with clear clinical rationales provided, role of interdisciplinary team involvement explained and primary health care strategies described.

• Medical management and Treatments described including all relevant pharmacological, non – pharmacological treatments,pain management explained and clear clinical rationales provided.
• Relevant Laboratory results / Diagnostic tests included and discussed.
• Evidence of ability to make clinical inferences based upon the data available.
• Psychosocial / Environmental / Economic aspects discussed
• Ethical and legal aspects included
• Education needs of patient / family addressed
• Discharge Planning addressed

Patient’s brief account

Patient’s brief account

The patient is a 71-years old woman called Mrs. Sue Thompson. The physician has diagnosed her with Exacerbation of COPD. She is of an Australian origin and hails from the south.

Physiological, social, and economic background

Mrs. Thompson is married and lives together with her husband and their children. She has two biological sons and one foster son. She is a former office worker and a bank cleaner. Furthermore, she likes sewing and her husband have been unwell recently. The patient has been doing most of the housework although the sons and daughter-in-law have been helping her. All her family members are supportive. She does not take alcohol but is an ex-smoker.  

Presenting complaints and reasons for admission

Sue reported to the health facility with numerous complaints. She was suffering from hypertension, Type 2 diabetes, and COPD. Furthermore, the patient had depression and mini-stroke (TIA). She is also allergic to latex, amoxicillin, and erythromycin. The doctor admitted her after diagnosing Exacerbation of COPD.

Past Medical History

She has had an ectopic pregnancy and reflex sympathetic dystrophy. Furthermore, the patient has a history of recurrent depression and rotator cuff pathology. Mrs. Thompson has a past surgical history of reduction mammoplasty in 2001. In 2002, she passed through incisional Hernia repair. She also underwent nonalcoholic steatohepatitis and CARB in 2003 and 2007 respectively. Additionally, she had cataract removal and IOL implant on the right in 2016.

Family History

The patient’s mother had breast cancer. The other relations had IHD and muscular degradation. There is also a history of diabetes.

Patient’s Observation

The patient has been frequently comes out of bed; thereby, having miserable nights. She also pants and has sarcotic lung disease. Furthermore, she has additional breathing problems.

Current Medication: ATROVENT UDV Neb solution and AZAPIN tablet.

Current Diagnosis: Exacerbation of COPD.

Anatomy/pathophysiology of Exacerbation of COPD

Epidemiology

Fourteen percent of Australians above the age of forty have COPD (Kelly et al., 2018). The figures elevate in individuals above the age of seventy. Thirty percent of those people have the disease, and Mrs. Thompson happens to be one of them. Seven percent of the affected individuals above the age of forty have chronic COPD with signs and symptoms. However, a quarter of the affected individuals are unaware of the infection. Recent research has ranked the disease as the second cause admissions in Australian hospitals (Meszaros et al., 2015). Furthermore, the disease ranks third in the mortality list after cancer, heart disease, and stroke. Australian lung foundation states that over seven hundred thousand individuals have the disease.

Physiological, social, and economic background

Anatomy and physiology

Exacerbation of COPD affects the circulatory and respiratory systems. The disease affects the lung thereby limiting its ability to carry out gaseous exchange (Qing et al., 2018). The human body contains a trachea and a pair of lungs.  The trachea is responsible for oxygen inhalation and carbon dioxide expulsion. During inhalation, atmospheric air passes through the nose where it gets filtered of harmful materials. The mucous in the nasal cavity aids in air filtration. The clean air moves to the lungs from the nose via the trachea.

The epiglottis prevents the entry of unwanted materials in the windpipe. The air then moves to the bronchi from the trachea and eventually reaches the lungs. Afterward, the filtered air runs into the bronchioles and finally into the air sacks. The alveoli enable oxygen to diffuse into the capillaries. Moreover, the air sacs can uptake carbon dioxide and exhale the gas at a later stage. The diaphragm lies below the lungs on the right side, and it separates the lungs from other body organs.

Additionally, the organ aids in inhalation and expiration. Intercostal muscles also help the diaphragm in the breathing process (Broussard, Hall, and Levitzky, 2014). Exacerbation of COPD interferes with the normal breathing and blood circulation.

Pathogenesis

COPD limits the flow of expiratory generation during inspiration and expiration. The disease occurs due to the limitation of the time that the lung needs to empty its contents. Severe inflammation of the airwaves prevents the patients from having a flawless breath. Furthermore, the elevation of the lymphocytes and macrophages in the walls of the airwaves decrease the lumen of passage. Air pollution is the primary cause of severe airwave inflammation.

Furthermore, bacterial and viral infections also inflame the air channels. The inflammation alters the cellular pattern during exacerbations. The condition worsens due to an elevation in the number of neutrophils and eosinophils.

Inflammatory mediators are also responsible for the narrowing of the air channels. The mediators include RANTES, chemokines, and cytokines (Kato, and Hanaoka, 2017). An increase in the level of inflammation interferes with the functions of the lungs. Furthermore, the health of the patient depreciates during the infections. The increase in the resistance of the airwaves also leads to COPD. The inflammations restrict the smooth flow of air from the lungs to the alveoli and vice versa.

Furthermore, the inflammation interferes with the mucous glands. Therefore, the amount of mucus is insufficient to clean the incoming air (Boucherat et al., 2016). The harmful contents of the air block the air channels hence leading to the progression of the infection.

Presenting complaints and reasons for admission

Signs and Symptoms

The infection affects the breathing patterns of the affected individuals. The patients breathe in a shallow and a fast manner after an intensive exercise. A majority of the clients also experience frequent coughing spells. The patients also experience breath shortness after a minimal activity or when resting (Marron et al., 2017). The affected individuals also feel confused or sleepy in a majority of occasions. Their levels of oxygen are lower than the usual amounts. The patients also secrete more mucus than usual. The slime can be green, yellow, or tan. Furthermore, certain patients exude blood-tinged mucus. Frequent wheezing is a common phenomenon among the patients.

Some symptoms require urgent medical attention. The lung has the responsibility of carrying out the gaseous exchange. COPD infection inhibits the ability of the lungs to get rid of carbon dioxide and take in oxygen gas (Ansari, Keaney, and Alotaibi, 2017). Therefore, the level of carbon dioxide increases leading to health-threatening symptoms that call for urgent treatment. The symptoms include a severe headache and confusion.

Furthermore, the patients find difficulty in movement and experience difficulty during the breathing process. The patients also find difficulty in sleeping and experience headache in the morning. The clients have swollen legs and alteration in nail or skin color. Fever is also common among the affected individuals.

Causes

The disease results from cigarette smoking. Individuals living in homes with poor ventilation are also at risk of contracting the disease (Hasegawa et al., 2014). The process of cooking burns fuels hence producing fumes that cause the infection. Bacterial and viral infections lead to the disease by causing inflammation of the airways (Kawamatawong, Apiwattanaporn, and Siricharoonwong, 2017). Air pollution also causes COPD. Changes in weather conditions and excessive activity lead to exacerbations. Little amounts of sleep and stress also lead to the infection.

Risk Factors

The first risk factors are increased smoking rates and decreased the quality of outdoor and indoor quality of air (Müllerova et al., 2015).

Identity (I)

Name: Mrs. Sue Thompson

Gender: Female

Age: 70 years six months

Nativity: Australian

Situation (S)

Sue has been diagnosed with Exacerbation of COPD after URTI after surgery indicated that the patient had a running nose. She had to sit outside the bed for most of the night and was wheezing in the morning. Mrs. Thompson was also coughing with no phlegm coming up from her.

Background (B)

Mrs. Sue Thompson had type 2 diabetes and pulmonary hypertension. Furthermore, she had multiple P.Es on rivaroxaban and systematic scleroderma. The patient had also suffered from Sarcoids, depression, and anxiety. Heart failure is another condition affecting Mrs. Thompson. The wheezing and lack of sleep are among the observations that made the doctor conclude that she had COPD.  

Past Medical History

Assessment (A)

Vital Signs

Wheezing

Coughing

Sitting on the bed at night

Oxygen levels of between 92-96%

Sarcoid Lung Disease

Respiratory rate is 20

Blood Pressure is 128/61

Heart Rate is 113

Medication

The patient continued to use drugs such as ATROVENT UDV Neb solution and AZAPIN tablet. The physician carried out diagnostic imaging in the form of x-rays of the chest.

Cardiac Monitoring

The process involves intermittent or continuous checking of heart activities by the physicians and the nurses. The doctors apply electrocardiography to check on the cardiac rhythm of the patient (Host-Madsen, 2017). The client wears a Holter monitor which assists to check the heart rate. The doctors also recommend the taking of medication according to the prescription. The drugs are ATROVENT and AZAPIN tablet. The patient should even ambulate as tolerated and stretch the webs.

Holding Bay Checklist

KEHM-Australia requires nurses on duty to identify patients in line with the health care policies. The nurse should first register the name, Date of Birth and the type of medication and surgical procedure towards the client. Furthermore, the care providers should indicate the reason and site of the surgical procedure (Lowndes, Egan, and McEvoy, 2018). The physicians should seek consent from the kin or the patient. However, the doctors must explain the risks and procedures of surgical methods. The nurse should take down the medical history of the patient. Furthermore, the history of the family members is essential before diagnosis.

The nurse should also check for the vital signs and symptoms of the disease. The laboratory report should contain information on respiratory rate, blood pressure, and the rate of oxygen. The wheezing, coughing and interrupted sleep confirm the diagnosis of COPD (Siu et al., 2016). The nurse should ensure that every preparatory step is complete before beginning the process of treatment. The nurse should be keen on coughing, wheezing, type 2 diabetes, and depression.

Surgical Treatment

COPD involves chronic bronchitis and emphysema as separate problems of the lungs. Mrs. Sue has severe signs and symptoms such as wheezing and coughing. Furthermore, she has difficulties breathing. The symptoms are frequent and severe hence require surgical procedures to accompany the prescribed medications. Lung surgery is a remedy that enhances the breathing process as it clears the inflammations from the air channel. Surgical procedures eliminate emphysema better than drugs (Ichinose et al., 2015).  However, an assessment is necessary before the beginning of surgical procedures. Individuals who are week due to the disease should not undergo the surgical operation. Mrs. Sue Thompson is a seventy-year-old who is weak and should take her medications.

Family History

The victim must undergo the rehabilitation of the pulmonary system before surgery. Furthermore, the patient should be a cigarette smoker at the time of the operation. However, Mrs. Sue Thompson is a former smoker hence is not fit for surgical procedures. Possible surgical operations involving the lungs include bullectomy and LVRS. Bullectomy consists of the removal of blebs or large bullae from the lungs (Marchetti, and Criner, 2015). Bullae refer to air sacs formed from destroyed alveoli. The large air sacs interfere with the functions of the lungs.

Furthermore, the structures jeopardize the process of gaseous exchange.  LVRS improves the quality of the patient’s life and the capacity to carry out the exercises. The objective of operations is to decrease the lung size by clearing almost thirty percent of damaged tissues of the lungs.

Diagnosis

There has been a severe issue of misdiagnosis in the case of Exacerbations of COPD. Individual nurses have informed former smokers that they have the disease which is not always right. The previous smokers may be having other lung diseases apart from COPD.

Furthermore, most diagnosis is negative until the advanced stages of infection. The doctor should first look at the symptoms of COPD. The physician should then assess the patient’s medical history (Lange et al., 2016). Additionally, the care providers should seek information on the history of the family members. The caregiver should then inquire of a possible encounter with lung irritants such as the cigarette. Numerous tests help to diagnose Exacerbation of COPD including CT-scan and X-rays. The physicians carried out x-rays on Mrs. Sue Thompson.

Pulmonary Tests

The test gauges the quantity of air that the patient can exhale and inhale. Furthermore, the tests ascertain whether the lungs are supplying sufficient oxygen gas to the bloodstream or otherwise. Physicians prefer spirometry as an ideal test for the proper functioning of the lungs. The doctor asks the patient to breathe out into a particular tube (Hyatt, Scanlon, and Nakamura, 2014). A spirometer connects to the tube hence measuring the level of expiration. The machine gauges the amount of air that the lung can contain at any given time.

Furthermore, the test checks for the rate of expiration during the breathing process. Spirometry can detect COPD before the emergence of the symptoms. The test also monitors the disease progression and the effectiveness of treatment. The primary role of the test is to gauge the impacts of administering a bronchodilator. Other tests measure the pulse oximetry, diffusion capacity, and lung volumes.

Patient’s Observation

CT scan

The physicians scan the lungs to check for possible emphysema infection. The scan also gauges whether the patient is eligible for surgical procedures (Cheng et al., 2016). Lung cancer is another infection that physicians can detect by using the scan.

X-Rays

 The physicians conducted x-rays on Mrs. Thompson. X-rays detect the presence of emphysema just like CT scan. The condition is a principal causative agent of COPD. Furthermore, the x-ray can distinguish COPD from other infections of the lungs (Inoue, Watanabe, and Okazaki, 2016).

Gas Analysis of the Arterial Blood

 The test gauges whether the lung is functioning correctly or otherwise. The examination gauges the capacity of the lung to take up oxygen and get rid of carbon dioxide (Fotheringham et al., 2015).

Laboratory Tests

 Physicians do not apply the tests in the diagnosis of COPD. However, the criteria are essential in investigating the origin of the symptoms of the disease. Furthermore, laboratory tests enable physicians to eliminate other conditions apart from COPD. Clinicians have applied the tests to check for the deficiency of AAT which is a genetic disorder (Fotheringham et al., 2015).  AAt is an indirect cause of COPD; hence, the laboratory tests are indirect measures of the disease. The tests are appropriate for patients with a record of COPD in their family history. Furthermore, laboratory tests help in identification of the disease at ages below forty-five years.  

Cessation of Smoking

 Cigarette smoking is the primary cause of COPD. The patient is a former smoker; hence, her termination enables her condition to tone down. Smoking reduces the ability of an individual to breathe. The doctor should recommend replacement products for nicotine for the smokers and former smokers. Furthermore, some medications assist one to quit the smoking habit.  

Medications

Bronchodilators are medications in the form of an inhaler. The drugs enhance muscle relaxation around the airways. Furthermore, bronchodilators reduce breathe-shortness and coughing sensations (Cascio et al., 2017). The result is that the inhalers ease the breathing process.  The bronchodilators differ regarding the stage of infection. Some bronchodilators are useful in the short-run while others assist in the long-run treatment. The short-term bronchodilators are Ipratropium, levalbuterol, albuterol, and Ventolin. The long-term remedies include aclidinium, tiotropium, formoterol, and indacaterol.

Inhaled Steroids help to reduce the inflammation of the air channels. Furthermore, the inhalation of the steroids prevents COPD exacerbations. The side effects of the steroids are hoarseness, bruising and oral infections (Kew, and Seniukovich, 2014). The drugs are essential for individuals with recurrent COPD exacerbations. Inhaled steroids include budesonide and fluticasone.

Anatomy/pathophysiology of Exacerbation of COPD

 Individuals who are allergic to the inhalers can use oral steroids on their path to recovery. The patients should take the medications on a short-term basis to prevent the progression of COPD. However, long-term intake of steroids poses further health risks to the patient. The side effects of the steroids include cataracts, osteoporosis, and weight gain (Kew, and Seniukovich, 2014). Acute effects include diabetes and increased exacerbations.

Antibiotics are other medications that tone down the effects of COPD. The drugs treat the causes of COPD symptoms such as influenza, pneumonia, and acute bronchitis (Crisafulli et al., 2016). Theophylline prevents exacerbation and improves breathing. The side effects of the drug include tremor, headache, and nausea.

 Lung therapies such as oxygen therapy and pulmonary rehabilitation assist individuals with severe exacerbations such as Mrs. Sue Thompson. Oxygen therapy supplies oxygen to the lungs of an individual with the deficiency. The treatment elevates the quality of a patient's life and eases the process of breathing (Ha, et al., 2018). Rehabilitation involves training in exercise, training, and advice on nutrition. Pulmonary rehabilitations shorten the duration of hospitalization. Moreover, the rehabilitation exercise improves the ability of an individual to engage in daily activities.

The principal aim of treatment is to restore the regular activity of the patient's life. The physicians encourage the patient and monitor the process of recovery. Mrs. Thompson should maintain contact with the physicians to report any emergency or urgent development. Telephone communication is an essential segment of postoperative care after the patient's discharge. The nurses should give the orders and instructions to the patients.

Furthermore, the care providers should issue the patients with telephone numbers that are operational on a 24-hour basis (Chenoweth, Kable, and Pond, 2015). The physicians further advice the patient to take the medications and observe a balanced diet. The doctor should carry out an evaluation process after two weeks to check on the progress of the patient and her response to medication. The check-ups aim to monitor the levels of exacerbations.

Treatment for Depression

Mrs. Thompson has developed stress and anxiety due to her exacerbation of COPD. Pressure is a common phenomenon among the patients of COPD. Surgical procedures to eliminate the inflammation of the air channels reduce depression (Chukhraev et al., 2017). The family members should motivate her and monitor to ensure that she takes her drugs and observe a balanced diet. Furthermore, her sons and daughter-in-law should help her to run the house chores. The remedies help to reduce the depression that results from COPD infection.

Epidemiology

Conclusion

Exacerbation of COPD results from the interference of the breathing system by inflammation of the air channels. Cigarette smoking is the leading cause of the disease. The indications from the diagnosis of Mrs. Sue Thompson show that she has COPD. The symptoms of the disease include coughing, wheezing, fever, and sleepless nights. The risk factors are inflammation of the air channels and smoking. Treatment is through the administration of medication and surgery. The medicines include oral steroids, inhaled steroids, and antibiotics. Surgery to remove lung inflammation is also a remedy for COPD. Treatment of depression also decreases the effects of the disease. A proper discharge procedure should follow the medical attention.

References

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