Assessment and Critique of Care for a Patient with COPD Exacerbation

Identify one of the presenting symptoms or problems for Mr Murphy and discuss the care plan or that identified problem.

Service User:  
Thomas is 63 years old with a long-standing history of emphysema, known COPD

Present situation: 
Thomas has just been admitted to a respiratory ward following a 2-week history of chest infection. He was treated with oral antibiotics at home however made little improvement. When he was visited by a community nurse, he was tachypnoeic with low O2 saturations. He was using accessory muscles and appeared to have peripheral cyanosis. As a result, he was admitted to hospital for treatment of acute exacerbation of COPD. 

Personal and social history:  
Thomas lives alone in a 2-storey house with his cat Snowy. His wife Jeanne died 2 years ago.  He is normally independent with his ADLs, although he admits to the nurse that recently he has been struggling with the stairs. He has 2 children and 1 grandchild who visit at the weekends, supporting him with shopping if needed. Thomas is very keen to maintain as much independence as possible. Mr Murphy struggled to give up smoking and occasionally still smokes. 

Assessment: 

Thomas is sat up in bed and is currently quite low in mood and anxious. He is very keen to return home and does not fully understand why he must be in hospital.  He is now receiving 2L (24%) O2 via a Venturi Mask.

Making 
Identify one need experienced by the patient/service user and explore the impact this will have using the Biopsychosocial Model. You will need to include a critique of the care given related to this need using evidence to support your views. This needs to focus on the decisions made by the care team, including any reasoning for interventions and treatment. From the evidence used, you need to offer recommendations for how this care could be enhanced or improved to ensure patient centred care.     

Module Learning Outcomes:
Learning Outcome 5. 
Critique the care, intervention and treatment plan of a given patient across the lifespan with appropriate explanation. Assignment Guidelines: Case study structure 

1.Introduction (150 words). 
Start with a brief introduction of your chosen patient using approximately 30 - 50 words. You will need to provide more information of the patient in the appendix. Present your introduction and ensure it answers these 3 questions:
a. What? The introduction needs to clearly explain what this case study is about. This section needs to explain in your own words what is required in the assignment brief given above.
b. How? The second part of the introduction need to outline how this case study is structured. You need to summarise the details given in the body.
c. Why? An introduction needs to articulate why critiquing and evaluation of care is of significance to care delivery. 

2.Body (1200 words)
a.Briefly explain the Engel (1977) Biopsychosocial Model which you will use for your assessment.

b.Identify a patient’s need (health problem) and assess it holistically from the biological, psychological and social aspects. Critique the care for that need based on whether it meets all the biopsychosocial needs which arise from that need, whether it is supported by evidence or not and then, recommend a better care plan. (For example, how would the stoma affect the patient’s physical/psychological status/quality of life or how would patient with schizophrenia cope with one of their symptoms). You will need to support your critique and reasoning with evidence-based practice. 

c.From your critique, identify the recommendations that would be appropriate to introduce to the patient’s care plan, based on the latest evidence-based research / practice.

3.Conclusion (150 words)
Summary: Put a short concluding statement of approximately 50 words then summarise the key learning points that have emerged from your critique. 

5.Appendices
In a table, you will give more information on your patient/service user with the following information:
Presenting complaint /symptoms Past medical history Medication Intervention/Treatment The implemented care plan for the patient for the identified problem.