Comprehensive Nursing Assessment: Case of COPD Patient

Patients often have complex care needs, and often present with multiple co-morbidities or problems. The process of conducting a comprehensive nursing assessment, and the coordination of care based on these findings is central to the role of the Registered Nurse (NMBA 2006). Evidence-based interventions must then be planned and implemented in a patient-centred approach in order to achieve agreed treatment goals and optimise health (Brown & Edwards 2012).

Part I: Identification of Health Issues and Preliminary Prioritisation

Mr Cooper has presented to the emergency department following the development of a productive cough and increased shortness of breath on a background of chronic obstructive pulmonary disease (COPD). His vital signs are

attended, a social history obtained and various investigations initiated to diagnose him with likely community-acquired pneumonia. This diagnosis, combined with his existing COPD causes decreased airway and lung compliance, metabolic changes with infection, and various additional chronic and acute nursing problems (Brown & Edwards 2012).
The patient has self-reported a productive cough, which when combined with his use of accessory muscles for respiration, scattered wheeze on auscultation and increased respiratory rate are defining characteristics for Ineffective Airway Clearance (Ackley & Ladwig 2014). This diagnosis is also related to underlying pathophysiology of his COPD, mucous production associated with pneumonia, and subsequent retained secretions due to decreased lung compliance causing increased expiratory effort (Crisp et al 2013), leading to his FEV1 being 50% of predicted value.
Mr Cooper also presents with hypoxemia and hypercapnia, with an SpO2 of 88% on room air, PaO2 of 70mmHg and PaCO2 of 55mmHg – all of which are outside normal limits (Brown & Edwards 2012). Mr Cooper has left lower lobe consolidation on chest imaging, with acidosis on ABG (pH 7.32), alongside observed dyspnoea and anxiety – indicating a diagnosis of Impaired Gas Exchange (NANDA 2014). This diagnosis may also be the cause of his tachycardia or modest hypertension. These factors in association with a ventilation-perfusion mismatch at the alveolar site, are further qualifiers for this diagnosis.