Nursing Practice: Developing Integrated Care

Pathophysiology of COPD

Chronic obstructive pulmonary condition is a category of chronic lung disorders, generally known as COPD. Emphysema, and recurrent bronchitis are the most severe. Most COPD patients have any of these disorders. Emphysema gradually kills air sacs in the bloodstream, messing with the passage of oxygen externally (Terzikhan et al., 2016). Typically, severe COPD signs don't show until the illness is more advanced. Since COPD affects the lungs, patients after mild physical exertion can find themselves out of breath. If during a normal exercise such as ascending stairs the patient feels himself breathing heavier than usual he / she will see a doctor. Tests that rely on the degree of res-piratory safety of patients will show disorders such as recurrent bronchitis and cirrhosis. One expla-nation why breathing is more difficult is that the lungs create more mucus and as a result, the bron-chioles become inflamed and narrower (Rao et al., 2019). With more mucus, less blood is inhaled through the patient's airways. This means that less blood enters the capillaries of patient's lungs through exchange of air. Less carbon dioxide is exhaled, too. Coughing to seek to to clear the mu-cus from the lungs is a popular COPD symptom.

When there is note from the patient that they gen-erate more mucus and breathe harder to remove it, he / she will see a doctor. Many other health problems can follow as COPD progresses (Reijnders et al., 2018). Beyond coughing, as patient breathes, he/she can experience wheezing . Chest tightness can also be induced by the accumulation of mucus and the widening of bronchioles and alveoli. These are not common aging signs. He / she will consult doctor if the patient encounters them. Less oxygen flowing in the body of the patient will leave him / her feeling either fatigued or lightheaded. Power scarcity may be a sign to multiple problems and communicating with the doctor is an vital fact. This can assist in assessing the seri-ousness of the condition of a patient. Weight reduction may also arise in patients with serious COPD, because the patient's body requires more and more calories to breathe. Chronic obstructive pulmonary disease is a category of chronic lung disorders, generally known as COPD. Emphysema, and recurrent bronchitis are the most severe (Rodrigues et al., 2017). Most COPD patients have any of these disorders.

Emphysema gradually kills air sacs in the bloodstream, messing with the passage of oxygen outward. Chronic bronchitis diagnosis involves an inflammatory mononuclear cell inva-sion of the airway pillar, and an accumulation of neutrophils into the lumen of the airway. It is be-ginning to elucidate the molecular events which cause the inflammation and its pathogenetic func-tion in causing mucus hypersecretion. Emphysema is a medical condition characterized by chronic expansion of distal airspaces to the bronchioles of the terminals (Occhipinti et al., 2018). This re-sults in a drastic reduction in the region of the alveolar surface usable for gas trade. Three of em-physema's main signs are shortness of breath, and persistent cough. Such turn up in the early stages. An individual with shortness of breath, or tachycardia, seems unable to catch a breath. It can only occur during physical exertion, but it can also continue to happen at rest as the disease progresses. Smoking is leading cause of persistent pulmonary obstructive disorder (COPD).

Subjective and Objective Data on COPD

Subjective data

Nancy has difficulty swallowing, emphysema is worsening. She has rested at home in a chair as she is having difficulty lying down breathing. She feels drained, and very sleepy. She's translucent, her eyes tinged in violet. She has chest pressure and a wheeze which is noticeable. She has low appetite and lacks sleep.

Objective data

Superimposed infection has been noted in Nancy. Skin is moist and cool. COPD for many years. Nancy has been progressively getting worse over the last few weeks and now has a productive cough, poor appetite and sleeplessness. Sputum is thick and rust coloured with bright blood specks. High fever is noted with Pulse- 120, Blood pressure- 170/90, Respiratory rate >27, SpO2 < 90%, high SOB and high hypersonate

Smoking and COPD

Smoking causes COPD flare-ups, too. Smoking harms the air sacs, airways and insulation. Injured lungs have difficulty breathing in and out adequate oxygen and it becomes impossible to breathe. Smoking is major cause of persistent pulmonary obstructive disorder (COPD) (Mularski et al., 2018). Smoking harms the air sacs, airways and insulation. Injured lungs have difficulty breathing in and out adequate oxygen and it becomes impossible to breathe. People of level 3 or 4 COPD have an 8.4 year life span, or 5.6 years greater. Current smokers risk 0.6 years for smoking, 1.5 more years for stage 2 COPD and additional years for stage 3 or 4 COPD relative to completely identical individuals who have no lung disorder (Weycker et al., 2017).

Pathophysiological Changes Associated with COPD

Evolution of detrimental physiological changes correlated with an disease indicates that the signs of COPD are similar (Voelkel et al., 2017). The signs Nancy encounters suggest she has a mild COPD. This starts with disruption to the airways in the lungs and tiny air sacs. Symptoms vary from a mu-cus cough to trouble breathing. Also, COPD cannot reverse the damage. Exacerbations are caused by events that render it hard for patients to breathe and Nancy was reported with smocking. The in-dicators of an exacerbation of COPD go beyond the effects of normal COPDs.

Wheezing- Airflow into a short or cramped section of a wide airway is unstable, causing airway walls to vibrate; this noise causes the wheezing sensation. By comparison, chaotic air movement through a small section of the wide, extrathoracic airways creates an inspiratory whistling (stridor) noise.

Dyspnea- The sensation of breathing energy, activation of chemoreceptors, mechanical sensations in receptors of the lung and chest wall, and neuroventilatory dissociation may all lead to dyspnea feeling. An disparity within the body between the respiratory gasses. Tachypnea can be caused by a reduced blood oxygen content (hypoxemia) or an elevated blood carbon dioxide content (hypercap-nia). An surplus of acid-base within the body.

Chest tightness- The inflammation, coupled with the excess mucus, is causing the airways too short. That can trigger a sense of tightness in the throat (Liang et al., 2018). Emphysema may also induce a feeling of chest tightness. The disruption to the air sacs will allow air to become stuck in the lungs of a COPD patient, causing it more difficult to breathe out oxygen.

Pharmacological Management of Prescribed Drugs

The aim of chronic obstructive pulmonary disease (COPD) pharmacological therapy is to eliminate and manage symptoms, decrease the incidence and extent of exacerbations, and increase overall health status and appetite for exercise (Wedzicha et al., 2017). The method to treating persistent ob-structive pulmonary disease (COPD) has experienced major improvements during the past decade (Kaul et al., 2018). The World Health Organization recommends four aspects of a treatment strat-egy for COPD including condition identification and monitoring, reducerisk factors, effective COPD control; and exacerbation prevention. This is important to enable patients to reduce their ac-cess to danger, whether it be smoking cessation or the elimination of biomass access (Herath et al., 2018). The primary aim of therapy is to relieve chronic effects, enhance quality of life and dramati-cally decrease the likelihood of potential exacerbations. COPD is a type of obstructive pulmonary disorders like cystic fibrosis, bronchiectasis and asthma as well (Shah et al., 2018). COPD is identi-fied by lung and supportive tissue degeneration and degradation, conditions that occur in emphy-sema, recurrent bronchitis or both. Emphysema begins with small airway disorder and progresses to alveolar collapse, with broad airway widening and mucous gland hyperplasia predominating.

Ventolin- This is used for managing and reducing signs (wheezing and shortness of breath) trig-gered by recurrent lung disorder (chronic obstructive pulmonary disorder-COPD that involves bron-chitis and emphysema).

In people with reversible obstructive airway disease, ventolin HFA is used to manage or avoid bronchospasm, and to manage or avoid bronchospasm in people with reversible obstructive airway disease. Ventolin HFA is often used to combat the bronchospasm induced by exercise.

Spirivia- The inhaler drug Spiriva (tiotropium bromide), if given in the early stages of the disorder, allows delay development of COPD. Adding Spiriva to various types of respiratory drugs enhances lung capacity, enhances quality of life, and decreases the amount of exacerbations of disease (three or more days of coughing, purulent sputum, wheezing, and/or shortness of breath required. Spiriva is an anticholinergic drug which is inhaled (Bekele et al., 2020). Anticholinergic medications inhibit locking up of the muscles around the broad airways. Spiriva is the only long-acting component of this family of medications licensed in the United States. Atrovent contains the short-acting anticho-linergic medications.

Amoxylin- Amoxicillin is an antibiotic and is commonly used in COPD. The most dangerous bac-teria, including Streptococcus pneumoniae, influenzae and Moraxella catarrhalis, are aimed at anti-biotic therapy (Bhakta et al., 2019). In particular, mild to moderate COPD exacerbations are han-dled with older broad-spectrum antibiotics such as amoxicillin-clavulanate potassium. Preventing severe exacerbations helps rising problems in the long run.

References for Pharmacological Management of Nancy's COPD Condition 

Bhakta, P., O'Brien, B., Karim, H. M. R., & Esquinas, A. (2019). Trial of Noninvasive Ventilation with Pressure or Adaptive Support in Acute Exacerbation of COPD by Sehgal IS et al: Further Con-siderations. COPD, 16(3-4), 303-304.

Bekele, A., Getachew, M., Sherman, C. B., & Schluger, N. W. (2020). Prevalence of Chronic Ob-structive Pulmonary Disease (COPD) Among Patients Successfully Treated for Pulmonary Tuber-culosis in Ethiopia. Ethiopian Medical Journal, 58(02).

Herath, S. C., Normansell, R., Maisey, S., & Poole, P. (2018). Prophylactic antibiotic therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database of Systematic Reviews, (10).

Kaul, V., Farokhi, M. R., Megally, M., Peters, J. B., Boer, L. M., Molema, J., ... & Criner, G. J. (2018). Physical activity is the strongest predictor of all-cause mortality in patients with COPD: a prospective cohort study. American Journal of Respiratory and Critical Care Medicine, 197(4), 517-519.

Liang, Z., Long, F., Wang, F., Yang, Y., Deng, K., Gu, W., ... & Chen, X. (2018). Identification of copd phenotypes with different factors related to exacerbation risk using sputum and serum autoan-tibody profiles. In D101. MECHANISTIC AND TRANSLATIONAL STUDIES IN COPD (pp. A7444-A7444). American Thoracic Society.

Mularski, R. A., Clark, B., Pasquale, C., Gillespie, S. E., Crawford, P., Malanga, E., ... & Davis, K. J. (2018). Validation of a Scalable Efficient Interoperable Linkage Process for Patient-Level EMR Data to Patient-Reported Registration Data Within the COPD Foundation Patient Powered Research Network: Building on Common PCORnet Data Networks Toward a Comprehensive COPD Re-search Data Resource. In A102. DETERMINANTS OF OUTCOMES AND HIGH-VALUE CARE IN COPD (pp. A2514-A2514). American Thoracic Society.

Occhipinti, M., Paoletti, M., Bigazzi, F., Sieren, J., Palazzi, M., Camiciottoli, G., & Pistolesi, M. (2018). Lung Function and BMI Predictive Models to Assess CT Emphysema Extent in COPD. In A75. COPD: TARGETS, MODELS, AND CLINICAL STUDIES (pp. A2382-A2382). American Thoracic Society.

Rao, D. M., Phan, D. T., Choo, M. J., Weaver, M. R., Oberley-Deegan, R. E., Bowler, R. P., & Gally, F. (2019). Impact of fatty acid binding protein 5-deficiency on COPD exacerbations and cig-arette smoke-induced inflammatory response to bacterial infection. Clinical and translational medi-cine, 8(1), 1-11.

Reijnders, T., Troosters, T., Janssens, W., Gosselink, R., Langer, D., Davenport, P., & Von Leupoldt, A. (2018). The impact of dyspnea catastrophizing on the neural processing of respiratory sensations in patients with COPD.

Rodrigues, F., Loeckx, M., Demeyer, H., Hornikx, M., van Remoortel, H., Janssens, W., & Troost-ers, T. (2017). Six years health status and physiological function evolution in subjects with preclini-cal COPD.

Shah, A., Van Eeden, S. F., Ayas, N., & Jen, R. (2018). Pro-Atherogenic Cytokine Profile of Pa-tients with COPD and OSA Overlap Syndrome: A Pilot Study. In C34. COPD POTPOURRI (pp. A4788-A4788). American Thoracic Society.

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