HLT51612
Implement and monitor Nursing Care for Clients with Chronic health problems
Introduction
Chronic obstructive pulmonary disease (COPD) is a serious, progressive and disabling condition that limits airflow in the lungs. People with COPD are prone to severe episodes of shortness of breath, with fits of coughing. In contrast to asthma where medication can reverse symptoms or they can reverse naturally, shortness of breath related to COPD may not be fully reversible even with treatment. (Salvi & Barnes 2009)
COPD is therefore used as an umbrella term to describe a number of lung diseases that interfere with a persons breathing. Emphysema, chronic bronchitis and asthma are the 3 most common causes.
In this assignment I will discuss
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the clinical manifestations of COPD related to a case study. Other topics that will be covered are the types of medications used to treat COPD, Holistic Nursing Care Plan and a Discharge Plan that will include information and education on the management of COPD in a home environment. Pathophysiology COPD refers to group of diseases that affects the lungs. The most common cause is from long term exposure to tobacco smoke. Other risk factors include exposure to gases or irritants such as chemical fumes and dust, exposure to heavy amounts of second hand smoke and/or pollution. (Salvi & Barnes, 2009) COPD primarily affects two different structures in the lungs, the bronchi and the alveoli, when this occurs, symptoms may vary from person to person but long term out look is effectively the same as the body struggles to get oxygen and airflow slowly declines When COPD affects the bronchi tubes -which are responsible for the transportation of air in and out of the lungs- the tissues in the bronchi become chronically inflamed (bronchitis) and excessive mucus is produced narrowing the airways. It is accompanied by a productive hacking cough and sputum production that usually last more than 3 months. Emphysema results from air becoming trapped in the spaces of damaged lung tissue. It is primarily characterised by damaged to the air sacs (alveoli) where they increase beyond the normal size of the airspaces, interfering with gas exchange (Snider. G.L 1995) The result is enlargement of the lungs leading to strenuous breathing. Clinical Manifestasions Unfortunately most people who are diagnosed with CPOD seek medical attention late into the development of their disease as most symptoms start gradually and progress slowly over time.
When patients finally seek help, they will usually present with a combination of symptoms such as worsening dyspnea, chronic coughing with sputum production which may or may not include acute chest pain and wheezing (Zab. M. 2014)
Mrs Walker presented to emergency with classic clinical manifestations of COPD. Her history of being a 40 pack year smoker likely contributed to the damage in her lungs as she presented with an audible wheeze and a productive cough on assessment. As we know inflammation in the lungs causes the excessive production of mucus which interrupts airflow and will result in laboured breathing (dyspnea) and coughing as the lungs try to clear and get more oxygen. Mrs Walker high respiratory rate and low oxygen saturation
ations such as less oxygen circulating the body. Because the body is unable to receive enough oxygen, it compensates by making the heart work harder (tachycadia). Another factor that points to COPD in Mrs Walkers case is the presentation of oedema in both her legs which is indicative of Pulmonary hypertension, a common complication of having COPD (Robert Naeije,
2005) Medications There are many different types of medications that can be used to treat and manage COPD. The most common types are: Short-Acting Bronchodialators: Given usually in emergency situations to provide quick relief. It comes in an inhaler or as a liquid. Mrs Walker was prescribed Salbutamol 5mg 4hourly and Ipratropium bromide 500mcg QID, both medications are examples of short-acting bronchodilators often prescribed to treat and manage COPD. Salbutamol works by relaxing the muscles in the airways of the lungs making it more smooth and breathing more easy, while Long-Acting Bronchodialtors: Helps to manage COPD over a longer period of time, but is ineffective for emergency situations. Corticosteroids: help by reducing the inflammation in the lungs (and in the body), it is often used in conjunction with bronchodialators to make breathing more effective. Oxygen therapy: Helps to manage hypoxia associated with COPD. It also helps by preventing or slowing down right side heart failure. Mrs Walker was prescribed Oxygen 2L per nasal prongs, Salbutamol 5mg 4hourly, Ipratropium bromide 500mcg QID and Frusemide 40mg BD as medical management for CPOD. Oxygen can help lessen the strain on the heart, for a person living with COPD. It helps to combat hypoxia and receives
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The risk factors that Jessica presented with are a history that is positive for smoking, bronchitis and living in a large urban area with decreased air quality. The symptoms that suggest a pulmonary disorder include a productive cough with discolored sputum, elevated respiratory rate, use of the accessory respiratory muscles during quite breathing, exertional dyspnea, tachycardia and pedal edema. The discolored sputum is indicative of a respiratory infection. The changes in respiratory rate, use of respiratory muscles and exertional dyspnea indicate a pulmonary disorder since there is an increased amount of work required for normal breathing. Tachycardia may arise due to the lack of oxygenated blood available to the tissue stimulating an increase in heart rate. The pedal edema most probably results from decreased systemic blood flow.
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)
Chronic obstructive pulmonary disease in this assignment will be referred to as COPD; it is a term for collective chronic lung conditions
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).
Chronic obstructive pulmonary disease, better known as COPD, is a disease that affects a person’s ability to breathe normal. COPD is a combination of two major lung diseases: emphysema and chronic bronchitis. Bronchitis affects the bronchioles and emphysema affects the alveoli.
Chronic obstructive pulmonary disease or COPD is a group of progressive lung diseases that block airflow and make it hard to breathe. Emphysema and chronic bronchitis are the most common types of COPD (Ignatavicius & Workman, 2016, p 557). Primary symptoms include coughing, mucus, chest pain, shortness of breath, and wheezing (Ignatavicius & Workman, 2016, p.557). COPD develops slowly and worsens over time if not treated during early stages. The disease has no cure, but medication and disease management can slow its progress and make one feel better (NIH, 2013)
Carone M, D. C. ( 2007). Clinical Challenges In COPD[e-book]. (Oxford: Clinical Pub) Retrieved March 24, 2014, from (EBSCOhost).
The main symptom of the disease is shortness of breath, which gets worse as the disease progresses. In severe cases, the patient may develop cor pulmonale, which is an enlargement and strain on the right side of the heart caused by chronic lung disease. Eventually, this may cause right-sided heart failure. Some patients develop emphysema as a complication of black lung disease. Others develop a severe type of black lung disease in which damage continues to the upper part of the lungs even after exposure to the dust has ended called progressive massive fibrosis.
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).
First, a problem with your lungs or airways may disturb the patient’s breathing system. Sudden breathlessness could be an asthma attack. This shows that your airways have narrowed and you will produce more phlegm (sticky mucus), which will cause you to cough and wheeze. You will feel breathless because it will be hard to move air in and out of your airways. Patients are recommended to use a spacer device with your asthma inhaler. This will bring more medicine to your lungs, helping to relieve your breathlessness. (NHS, 2013)
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...
Chronic bronchitis results from prolonged irritation of the bronchial membrane, causing cough and the excessive secretion of mucus for extended periods. By far the most common cause of chronic bronchitis is cigarette SMOKING, but air pollution and industrial fume and dust inhalation are also important irritants. Patients with chronic bronchitis are subject to recurrent infections with H. influenzae and pneumococci. Pulmonary EMPHYSEMA often coexists, and over a long period of time the patient may suffer from
Chronic obstructive pulmonary disease, also known as COPD, is a lung disease that block airflow and makes breathing difficult. There are two common condition, emphysema and chronic bronchitis that help make up COPD. There are also about four gold stages; mild, moderate, severe, and very severe. COPD is the fourth leading cause of death in the U.S, the disease typically occurs after age 35.
Cardiovascular System: He does not experience any chest pain or palpitation. He does not have dyspnea or leg swelling.