Transformative Clinical Practices

Part 1: Collecting the Clues

Introduction

Clinical deterioration is defined as the worsening of the normal clinical condition of a patient which may lead to severe complications like protraction at the hospital health care unit, organ failure, or death. It can be prevented in several conditions with early detection of the symptoms. Several systems have been designed to early assess the clinical deterioration of the patient and preventing them from severe consequences of it. Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a condition that arises when the symptoms of COPD starts to become worse. It includes cough, shortness of breath, wheezing, and excess mucus production (Mannino, Clerisme-Beaty, Franceschina, Ting & Leidy, 2018). The condition of the AECOPD could be accelerated due to smoking or living in an air polluted area (Morantes-Caballero & Fajardo Rodriguez, 2019).

Consider the Patient:

The patient is a 62-year-old male suffering from AECOPD has been admitted to the medical ward of the hospital. He was experiencing shortness of breath and had an infection in his lungs. He has also reported that he feels mild fatigue sometimes. The symptoms started 24 hours ago and aggravated gradually worsening the condition of the patient. The patient was producing wheezing sound. His respiration rate (RR) is 40 breaths per minute, oxygen saturation (SPO2) level is at 85%, pulse rate (PR) at 140 beats per minute and blood pressure is 140/100 mmHg. The body temperature of the patient is 39.8 ˚C. He nebulizes small doses of Methylprednisolone thrice a day. His country of origin is Africa. He has been married for the past 30 years and has two children. He lives with his wife and she takes care of him. He used to be a heavy smoker and tried to quit smoking due to medical complications. He used to work for a private transportation firm and is now retired due to deteriorating health conditions.

Collect Clues:

Upon admission to the hospital, initial assessment form was filled for the patient and vital parameters were analyzed. He has experienced similar symptoms about one month ago also. He has a history of heavy smoking and is diagnosed with AECOPD. The CBC test of the patient was carried out to diagnose the presence of infection. He has a family history of COPD showing that his father had it. He was experiencing disorientation and anxiety. He was producing an excess amount of mucus which was green in color. He is kept at supplemental oxygen therapy as per the guidelines directed by The Thoracic Society of Australia and New Zealand. The medication is administered as prescribed by the doctor. His respiration rate started to stabilize after keeping him at supplemental oxygen therapy for 15 hours. The condition of the patient at the time of hand over is:

Pulse Rate (PR): 105 beats per minute

Respiration Rate (RR): 25 breaths per minute

Oxygen Saturation (SPO2) level: 92%

Blood Pressure: 130/95 mmHg

Body Temperature: 38.1 ˚C.

Process the Information:

The patient was disoriented and anxious due to breathlessness. He has mucus secretion in the lungs which is due to infection. This is confirmed by the CBC test of the patient’s blood samples. The number of white blood cells is higher than the normal level. There was mucus secretion in his lungs due to infection. He was experiencing shortness of breath due to excess mucus blocking the airways. His body temperature was very high from normal. The patient had a very high pulse rate (PR) of 140 beats per minute and blood pressure of 140/100 mmHg at the time of admission. So, Troponin I level was tested in blood serum to diagnose any signs of myocardial infarction. The patient was producing a mild wheezing sound while breathing. The airways obstructed are preventing movement of air. The patient was feeling weak and unable to move. The health conditions of the patient are analyzed and the observations are:

Pulse Rate (PR): 100 beats per minute

Respiration Rate (RR): 23 breaths per minute

Oxygen Saturation (SPO2) level: 92%

Blood Pressure: 130/90 mmHg

Body Temperature: 37.9 ˚C.

Understand the Patient’s Problem:

The patient had a major issue of AECOPD in the past. The patient is sensitive to air pollution which is one of the reasons for the aggravation of conditions of AECOPD (Berend, 2016). Acute exacerbation of COPD becomes worse when there is an additional infection in the lungs. He has got an infection in the lungs which has further intensified the symptoms by obstructing the flow of air through the airways. The patient feels fatigued due to weakness and requires someone to assist him around the clock. The functioning of the lungs of the patient has deteriorated due to the past record of smoking and increased the prognosis of AECOPD (Dransfield et al., 2017). The patient does not undertake proper and timely medication. All these factors have led to the combined effect on the clinical deterioration of the patient’s condition (Ritchie & Wedzicha, 2020).

Part 2: Planning Care and Evaluating Outcomes

Plan and Implement Interventions:

A patient-centered care model is best suited to be applied for the treatment. This model will also accelerate the recovery of the patient. The nurse administered long-acting muscarinic antagonist in combination with long-acting ß-agonist to the patient as they are more efficient than the short-acting bronchodilators and it will relieve acute exacerbations (D’Urzo et al., 2019). It will also avoid future acute exacerbations as the patient is already weak and acute exacerbations slow down the recovery of the lungs (Pavord, Jones, Burgel & Rabe, 2016). The systematic corticosteroids were administered to the patient to increase the recovery speed. Methylprednisolone was administered orally. Doses of antibiotics were given to the patient as prescribed by the doctor. The nurse guided the patient about the long-lasting side-effects of smoking on the lungs and their role worsening the situation of AECOPD (Lung Foundation Australia, 2020). The patient was weak and unable to move without support so a nurse was specifically assigned to the patient to help him (Nursing and Midwifery Board, 2020). All the vital parameters of the patient were continuously monitored in order to keep a track record of the progress of recovery. The response of the patient’s body to agonist and antagonist administered through an inhaler was also kept under check. Informed knowledge was provided to the patient in order to help him better decisions for his health. The importance of proper medication was also provided. The diet of the patient was designed in such a manner so that it facilitates the efficiency of the treatment.

The medicines administered to the patient are Aclidinium (Rx) which is 340 µg per day along with Formoterol 12 µg per day through an inhaler to ease breathlessness. In addition to Aclidinium (Rx), Methylprednisolone is given to the patient to reduce inflammation in the lungs. 40 mg per day dose of Methylprednisolone is given to the patient orally. Doxycycline (Gen Rx) is used in 100 mg per day dose for a lung infection.

A systematic information record is maintained about the progress and medication of the patient. It was handed over to the nurse in the next shift and updated by her. The information record helps in obtaining all the information relating to the progress of the patient and the changes that have been incorporated in the treatment.

Evaluate Outcomes:

The patient-centered care method of treatment decreased the recovery time of the patient. It provided interventions specifically designed for the patient and offered a highly systematic diagnosis to each physical change. The patient is able to breathe properly and no discomfort is felt. The patient is experiencing mild weakness but able to sit and have a conversation with the doctors and nurses. There was no more uneasiness in his lungs. The patient looked calm and stable at the time of handover. Correct evaluation and action in accordance with the situation by the nurse made the treatment much more efficient. The patient was satisfied with the treatment undertaken.

Reflect and Learn from the Process:

The process of patient-centered care is a new learning experience for me. This experience provided me with a better understanding to evaluate critical situations. I learned the importance of decision making in critical situations. It was very informative to work with so many people as a team. The patient-centered care method is much efficient as all the interventions designed in this method are with respect to the individual. This experience provided me in-depth learning about patient care due to time to time modifications in methods used according to the situation. I got the opportunity to lead and experience different aspects of leadership in health care. I learned some technical information regarding the systematic progress maintenance of patients. My skills were better utilized and provided me a platform to improve myself and better serve in the health care of patient. The interaction between nurse and patient is an important part of the process. So, I interacted with the patient to exchange information while keeping the conversation informal in order to keep him comfortable.

Part 3: Quality of Written Expression and Conclusion

Conclusion

It is concluded from this study that clinical deterioration associated with acute exacerbation of COPD can be life-threatening if not treated early. The patient-centered care method is efficient in reducing the time required for the recovery of the patient. Correct decision making in critical situations plays a vital role in health care. Analyzing the situation helps in taking well-informed decision. Collaborative teamwork increases the efficiency of treatment by providing better diagnostics and interventions.

References for Transformative Clinical Practices

Berend, N. (2016). Contribution of air pollution to COPD and small airway dysfunction. Respirology, 21(2), 237-244.

D’Urzo, A., Chapman, K. R., Donohue, J. F., Kardos, P., Maleki-Yazdi, M. R. & Price, D. (2019). Inhaler Devices for Delivery of LABA/LAMA Fixed-Dose Combinations in Patients with COPD. Pulmonary Therapy, 5(1), 23-41. doi: 10.1007/s41030-019-0090-1

Dransfield, M. T., Kunisaki, K. M., Strand, M. J., Anzueto, A., Bhatt, S. P., Bowler, R. P., Criner, G. J., Curtis, J. L., Hanania, N. A. & Nath, H. (2017). Acute exacerbations and lung function loss in smokers with and without chronic obstructive pulmonary disease. American Journal of Respiratory and Critical Care Medicine, 195(3), 324-330.

Lung Foundation Australia. (2020). COPD-X Australian and New Zealand Guidelines for the Diagnosis and Management of Chronic Obstructive Pulmonary Disease: 2017 Update. Retrieved on 08 September, 2020, Retrieved from https://copdx.org.au/wp-content/uploads/2017/11/2017-MJA-COPD-X-plus-Appendix.pdf

Mannino, D. M., Clerisme-Beaty, E. M., Franceschina, J., Ting, N., & Leidy, N. K. (2018). Exacerbation recovery patterns in newly diagnosed or maintenance treatment-naïve patients with COPD: secondary analyses of TICARI 1 trial data. International Journal of Chronic Obstructive Pulmonary Disease, 13, 1515-1525. doi: 10.2147/COPD.S149669

Morantes-Caballero, J. A., & Fajardo Rodriguez, H. A. (2019). Effects of air pollution on acute exacerbation of chronic obstructive pulmonary disease: a descriptive retrospective study (pol-AECOPD). International Journal of Chronic Obstructive Pulmonary Disease, 14, 1549-1557. doi: 10.2147/COPD.S192047

Nursing and Midwifery Board. (2020, 2017). Registered Nurse Standards for Practice. Retrieved 08 September, 2020, Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Pavord, I. D., Jones, P. W., Burgel, P.-R., & Rabe, K. F. (2016). Exacerbations of COPD. International Journal of Chronic Obstructive Pulmonary Disease, 11 Spec Iss(Spec Iss), 21-30. doi: 10.2147/COPD.S85978

Ritchie, A. I., & Wedzicha, J. A. (2020). Definition, Causes, Pathogenesis, and Consequences of Chronic Obstructive Pulmonary Disease Exacerbations. Clinics in Chest Medicine, 41(3), 421-438. doi: 10.1016/j.ccm.2020.06.007

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