Chronic disease is the one which a person suffers from a long time which changes the way a person is living and affects the major organs and organ systems of the body (Naviaux, 2019). It changes the life of the person suffering from such disease and it can also be life-limiting diseases as it might decrease the life span of a person. In the selected case study it is seen that the patient Ms Gladys suffers from chronic obstructive pulmonary disease along with right-sided heart failure. The aim of the present essay is to discuss the pathophysiology of chronic obstructive pulmonary disease and heart failure with a brief outline of the relevant diagnostic tests. The essay also outlines the complications of chronic obstructive pulmonary disease with cultural, developmental and health literacy considerations and three nursing priorities and their management.
Chronic obstructive pulmonary disease is a chronic condition which affects the airflow to the lungs due to abnormal inflammatory reaction in the respiratory system mainly lungs (Kim, 2017). The main reason for the response is chronic smoking which causes the exaggerated response in the mucosa of the lungs and causes changes like hypersecretion, emphysema and constriction of blood vessels. These changes cause characteristics of chronic obstructive pulmonary disease like increase in airflow resistance in small airways with increased compliance of the lungs, entrapment of the air and more obstruction of air. The inflammatory response in the lungs is a normal response to smoking but the toxins present in the lungs cause the tissue destruction and impaired defence mechanisms and impaired healing (Watson, 2018).
This is a progressive condition and does not subside even after smoking cessation as there is an imbalance between oxidants and oxidative stress in the lungs. There is an increase in the inflammatory cells and inflammatory mediators like neutrophils, macrophages and T lymphocytes and mediators like interleukin 1 beta and 6. The pathogenesis causes hypersecretion of mucus, dysfunction of cilia, airflow obstruction and hyperinflation of the lungs causing abnormalities of gaseous exchange, and pulmonary hypertension (Kim, 2017).
Right ventricle as compared to the left ventricle is distinct anatomy and has a specific function (Faletra et al., 2020). It has specific functioning in the systemic venous return and pulmonary function due to which it has thinner walls and fewer muscle fibres. It plays a vital role in maintaining the cardiac output which is the interplay between the preload, contractility, afterload, ventricular interdependence and heart rate (Jan & Tajik, 2019). Right-sided heart failure can be because of either cardiac or respiratory disease and in the case of Ms Gladys, it is due to chronic obstructive pulmonary disease.
There is the presence of pulmonary hypertension and it is called cor pulmonale as it causes an increase in afterload causing the heart to overwork causing heart failure (Miike et al., 2018). Chronic obstructive pulmonary disease increases the afterload by rarefaction of the vascular bed, hypercapnia and acidosis and hyperinflation, airway resistance, endothelial dysfunction and hypoxia. The symptoms of chronic obstructive pulmonary disease and heart failure are that the patient might not be able to perform activities of daily living, breathlessness, pain and fatigue (Miike et al., 2018).
Ms Gladys is suffering from the chronic obstructive pulmonary disease which does not have much of diagnostic tests until the disease is advanced. The tests may include a lung function test which is done by the use of spirometry where the volume of air that can be held by the lungs can be estimated (Lange et al., 2016). Chest radiograph can show the presence of emphysema which can be confirmed by computed tomography. Arterial blood gas analysis is helpful to understand the functioning of the lungs to effectively remove carbon dioxide (Lange et al., 2016).
The presenting condition is right heart failure which can be diagnosed by the use of ECG where there is a deviation on the right axis, there is RV strain, deflection is S and Q with inversion of T (Conrad et al., 2019). The morphology of right ventricle can be seen by echocardiography and the heart failure can be deduced.
The first complication that can be seen in a patient with chronic obstructive pulmonary disease is that the patient may be more prone to infections in the respiratory system (Kubota et al., 2016). It is due to the impaired inflammatory response and impaired healing of the mucosa of the lungs. As it is a chronic condition there is exaggerated mucosal response and impaired ciliary response. The noxious substance when enters the respiratory system is tackled by the mechanical mucosal response and the microorganisms surpasses the first line of defence and reaches the second line of defence. The inflammatory cells take care of the microorganisms but due to the impairment there is exaggerated response and the infection makes the breathing more troublesome (Kubota et al., 2016).
The second complication that can be seen is the development of heart failure which has already occurred in Ms Gladys and it is due to multiple systems that can be seen in a patient with chronic obstructive pulmonary disease. The disease causes hyperinflation of the lungs and further pulmonary hypertension (Kubota et al., 2016). This causes an increase in the afterload of the cardiac system making the heart to work more to fulfil the perfusion of the tissues, organs and periphery of the body. This overworking can cause the heart to go into failure (Kubota et al., 2016).
From the case of the patient, it can be seen that cultural history is not mentioned. The patient is an old patient and there are age changes in the respiratory system and the cardiac system needs to be considered. With the increase in age, the functional capacity of the organs is reduced and in this case, the lung capacity and cardiac function are affected. She lives alone with nobody to take care of her and help her with the activities of daily living. Her general practitioner has told her about her heart failure but due to her lack of awareness, she is not able to understand what the implications are and how does the affect her quality of life. While caring for the patient it is required that all these factors are to be considered and addressed for providing better care and improve the quality of life of the patient.
The first nursing priority that is identified and needs to be addressed is to manage the ineffective airway clearance. There should be assessment and monitoring of respirations and breath sounds. This is required because it can be helpful in knowing the degree of involvement and obstruction that is present. Being not able to breath can be described as dyspnea and air hunger which is the classic sign of chronic obstructive pulmonary disease (Lin et al., 2020). The patient is asked to keep away from dust and any other allergen which can cause the risk of breathless and difficulty in breathing. The patient can be taught proper positioning of ease of breathing and provide comfort to the patient in breathing (Lin et al., 2020).
The second nursing priority is to reduce the risk of infection as due to the condition the patient might be more prone to infections which might exaggerate the dyspnea (Kubota et al., 2016). As a nurse, there should be continuous monitoring of the patient's vital signs. It includes heart rate, blood pressure, respiratory rate, and temperature of the patient. The change in vital signs is suggestive of underlying infections and blood culture might be required for the deduction of the microorganism involved. Sputum culture is taken for that while at the same time the colour, consistency, odour and character can be suggestive of the infection. Prophylactic antibiotics might be administered to the patient as a part of reducing the infection (Altenburg, 2019).
The third nursing priority is to increase knowledge and awareness of the patient as she does not understand the disease process of heart failure. Patient education and counselling can be given to the patient to increase the knowledge about the pathophysiology of the underlying disease process. Increasing the knowledge helps the patient to put the perspective of the disease in the life and understand what measure that she might need to take in order to improve her quality of life (Jarab et al., 2018). Suffering from a chronic condition can cause emotional upheaval and the patient might need counselling to get her with the psychological situation.
Ms Gladys is suffering from chronic obstructive pulmonary disease and the present diagnosis is heart failure. The structure and functioning of the respiratory system are affected by the disease like there is tissue destruction and exaggerated inflammatory response. It causes difficulty in breathing and has a productive cough. The heart failure is a reflection of the respiratory condition causing cor pulmonale causing pain and reducing the quality of life. The patient has the risk of infection as complication other than heart failure. She lives alone and does not have an awareness of her condition. the nursing priorities considered are ineffective airway clearance, risk of infection and increasing the knowledge and awareness of the patient.
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