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Severe copd case study
Severe copd case study
Exacerbation of copd case study
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Introduction
Chronic Obstructive pulmonary disease (COPD) is a severe public health problem that affects health related quality of life (HRQoL). In COPD patients, limitation of the airway function is generally persistent and patients usually suffer from considerable physical and psychological symptoms, and impairments of functional ability and HRQoL (Vestbo et al., 2013). Common symptoms of COPD include chronic cough, sputum production and exertional dyspnea (Ng & Smith, 2017). These symptoms affect HRQoL, but can they can be managed. The ultimate goals of COPD management are to maintain or improve patients’ functional quality and ability, facilitate patients to better live with the chronic condition with less acute respiratory exacerbations
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All databases were searched from September 2017 to October 2017. Main topics and key terms were identified and used throughout search to limit the results. The key phrase “Self- management education programs” was used to initiate the search among the different databases. However, the use of key terms: “Chronic obstructive pulmonary disease” and “Quality of Life” were then incorporated within the search criteria to further limit the search results. In addition, articles were selected by an inclusion and exclusion criteria. The inclusion criteria of this review were as follows: (1) original articles, (2) patients with confirmed diagnosis of COPD, (3) self- management education as a major intervention and (4) HRQoL outcomes. Articles were excluded if they were (1) systematic review articles, (2) greater than 6 years old and (3) published in a language other than English. Upon application of the mentioned inclusion and exclusion search criteria 7 articles were examined, and 3 were chosen for interpretation and analysis. Articles were then critiqued and analyzed with the use of evidence-based table formats (Appendix A). The use of guidelines, such as key terms, inclusion and exclusion criteria, aided in the identification of strengths and weakness of individual
The presented case is of a patient named R.S. who has a smoking history of many years, which can be directly tied to his development of chronic bronchitis, a chronic obstructive pulmonary disease (COPD) specified as Type B. It is estimated that in 90% of chronic bronchitis or “blue bloaters”, cigarette smoking is the major cause. Chronic bronchitis involves persistent and irreversible airway obstruction, due to the constant inflammation of the bronchial mucosa, leading to hypertrophy and hyperplasia of bronchial glands. The latter exposes the individual to higher risks of bacterial infections; often colonization of organisms such as Streptococcus or Staphyloccocus pneumoniae can be exhibited. This is due to the lost or impaired function of mucociliary clearance action which results from the replacement of certain sections of ciliated columnar epithelium by squamous cells in the bronchi. (Copstead &Banasik, 546-547)
Mrs. Jones has a history of COPD. She was already taking albuterol for her illness and it was ineffective when she took it that day. Mrs. Jones had been a smoker but had quit several years ago. According to Chojnowski (2003), smoking is a major causative factor in the development of COPD. Mrs. Jones's primary provider stated that she had a mixed type of COPD. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) was established to address the growing problem of COPD. The GOLD standards identify three conditions that contribute to the structural changes found in COPD: Chronic bronchiolitis, emphysema, and chronic bronchitis. A mixed diagnosis means that the patient has a combination of these conditions (D., Chojnowski, 2003). Mrs. Jones chronically displayed the characteristic symptoms of COPD. "The characteristic symptoms are cough, sputum production, dyspnea on exertion, and decreased exercise tolerance." (D., Chojnowski, 2003, p. 27).
Sawicki, GS, Sellers, DE, Robinson, WM. 2009. High treatment burden in adults with cystic fibrosis: challenges to disease self-management. The Journal of Cystic Fibrosis 8(2), pp. 91-96.
Previous research used noninvasive ventilation to help those with COPD improve their altered level of consciousness by allowing the alveoli to be ventilated and move the trapped carbon dioxide out of the lungs. When too much carbon dioxide is in the blood, the gas moves through the blood-brain barrier and causes an acidosis within the body, because not enough carbon dioxide is being blown off through ventilation. The BiPAP machine allows positive pressure to enter the lungs, expand all the way to the alveoli, and create the movement of air and blood. Within the study, two different machines were used; a regular BiPAP ventilator and a bilevel positive airway pressure – spontaneous/timed with average volume assured pressure support, or AVAPS. The latter machine uses a setting for a set tidal volume and adjusts based on inspiratory pressure.
To better understand how COPD affects an individual you should first know how the lungs function. When you breathe in air it first goes through your trachea then into your bronchioles. Once in the bronchioles the air goes to the air sacs called alveoli. In the alveoli, the gas exchange occurs with the capillaries. Gas exchange is when the oxygen enters the bloodstream and carbon dioxide enters the alveoli. During the breathing process, alveoli will inflate when inhaling and deflate while exhaling.
This systematic review conducted by Takeda A, Taylor SJC, Taylor RS, Khan F, Krum H, Underwood M, (2012) sourced twenty-five trials, and the overall number of people of the collective trials included was 5,942. Interventions were classified and assessed using the following headings.-
The purpose of this essay is to explore nursing care priorities for a patient with a common health condition. A common health condition is a disease or condition which occurs most often within a population. The author has chosen scenario 3 for this essay and will describe the nursing assessment and care planning provided to a patient with Chronic Obstructive Pulmonary Disease (COPD). The WHO definition of COPD is a lung disease which has a chronic obstruction of the airways that impedes normal breathing and is not fully reversible (). According to), there are estimated to be over 3 million people in the UK with COPD. It is common in later life and there are approximately 25,000 deaths each year, with 15% of COPD being work related (The identity of the patient will remain anonymous in adherence with the Nursing and Midwifery Council, Code of Conduct on patient confidentiality (). However, the patient will be referred to as Mr B in this essay. The author has chosen the priority of eating and drinking for Mr B. Patients with COPD are at increased risk of malnutrition and nurses must make certain they screen patients and offer advice or refer as necessary (). If this priority is managed well it will have a positive effect on the other priorities (, 2012). In accordance with NICE Guideline 101 (), the treatment and care provided should consider each persons’ individual requirements and preference. Care and treatment should take into account people’s individual needs and choices. To allow people to reach informed decisions there must be good communication, supported by evidence-based practice (). This essay will provide an evidence based discussion on how care will be implemented in relation to Mr B and his eating and drin...
Carone M, D. C. ( 2007). Clinical Challenges In COPD[e-book]. (Oxford: Clinical Pub) Retrieved March 24, 2014, from (EBSCOhost).
Whilst looking at the impact that breathlessness can have on patient the author will look at the physical, psychological and social health implications and how this can affect the overall (holistic) quality of life for these patients. Often these three areas overlap and the physical implications of breathlessness can have a direct effect on the patient’s social health, financial ability to provide for themselves and others, which in turn affects the person physiological well-being or vice versa.
Chronic obstructive pulmonary disease (COPD) is preventable disease that has a detrimental effects on both the airway and lung parenchyma (Nazir & Erbland, 2009). COPD categorises emphysema and chronic bronchitis, both of which are characterised by a reduced maximum expiratory flow and slow but forced emptying of the lungs (Jeffery 1998). The disease has the one of the highest number of fatalities in the developed world due to the ever increasing amount of tobacco smokers and is associated with significant morbidity and mortality (Marx, Hockberger & Walls, 2014). Signs and symptoms that indicate the presence of the disease include a productive cough, wheezing, dyspnoea and predisposing risk factors (Edelman et al., 1992). The diagnosis of COPD is predominantly based on the results of a lung function assessment (Larsson, 2007). Chronic bronchitis is differentiated from emphysema by it's presentation of a productive cough present for a minimum of three months in two consecutive years that cannot be attributed to other pulmonary or cardiac causes (Marx, Hockberger & Walls, 2014) (Viegi et al., 2007). Whereas emphysema is defined pathologically as as the irreversible destruction without obvious fibrosis of the lung alveoli (Marx, Hockberger & Walls, 2014) (Veigi et al., 2007).It is common for emphysema and chronic bronchitis to be diagnosed concurrently owing to the similarities between the diseases (Marx, Hockberger & Walls, 2014).
World Health Organisation. 2009. Self-care in the Context of Primary Health Care. Report of the
The clinical manifestation one may see in patients with chronic bronchitis are chronic cough, weight loss, excessive sputum, and dyspnea. Chronic cough is from the body trying to expel the excessive mucus build up to return breathing back to normal. Dyspnea is from the thickening of the bronchial walls causing constriction, thereby altering the breathing pattern. This causes the body to use other surrounding muscles to help with breathing which can be exhausting. These patients ca...
According to the Healthy People Database, in 2010 the aging population was estimated at 40 million, this number is expected rise to nearly 70 million by the year 2030 (National Center for Health Statistics, 2000). At the forefront of health concerns for this aging population will be the intervention, management and treatment of chronic diseases. This increase in both this specific population as well as the required medical care will place a significant amount of stress on an already distressed healthcare system, which in turn will affect the availability of recourses and costs. Including patients in their self care with strategic health promotion such as encouragement and education geared towards specific socioeconomic groups will be more cost effective and beneficial in the management of chronic disease. Studies indicate that patients involved in self management of disease processes often have better patient outcomes.
Norris SL, Lua, J, Smith SJ, Schmid CH & Engelgau, MM 2002, ‘Self- Management Education for Adults With Type ‘Diabetes’, Diabetes Care, Vol. 25 no.7, July, pp.1159-1171.
Miller, C. (2011). An integrated approach to worker self-management and health outcomes: chronic conditions, evidence-based practice, and health coaching. AAOHN Journal: Official Journal Of The American Association Of Occupational Health Nurses,59(11), 491-501. doi:10.3928/08910162-20111025-02