Integrated Nursing Practice 2

Table of Contents

Introduction

Identification of the COPD

Identification of Lung Cancer

Conclusion

Reference

Introduction to George Williamson Case Study

George Williamson is an adult of 72 years old who has been a lifelong smoker. However, 10 years ago he was diagnosed with it along with the diagnosis. He has visited the healthcare centre and it was identified that George is unable to use his short-acting bronchodilator (SAB) inhaler appropriately and his primary carer, his granddaughter, mentions that he takes his steroid inhaler. The primary carer mentioned that he is too stubborn to listen to any of the advisors and he expresses decrease in the exercise tolerance as he has been observed to spend most of his time in a recliner chair at home. His medical examination indicated that he has Spo2 level 93% on the room air along with his body posture leaning forward in his chair. His medical history of 6 months indicated that his Spo2 level has been stable since his last medical visit and his blood pressure is 25 by 60 added by a pulse rate of 84. After analysing the medical history and examination, it can be considered that he might be developing COPD along with the increased possibility of lung cancer.

Identification of the COPD

Following the first stage of the clinical reasoning cycle, George Williamson has been identified as one of the potential patients who might be considered medical intervention after being diagnosed with COPD. The analysis of the medical history of George motivated the nurses to identify that he is a long-time smoker who is 72 years old along with having Spo2 93% on room air along with pursed-lip breathing as well as it has been observed that he is leaning forward in his chair. His spirometry results show FEV1 of 36% which indicate that he is developing severe COPD. There are mainly two types of chronic obstructive pulmonary disease which includes bronchitis and emphysema. After analysing the medical history, it is evident that George is developing severe chances of emphysema which can be identified mainly in adults who are aged above 50. Following the clinical reasoning cycle, his medical examination has been performed which indicates he is having spo2 93% of room air along with fev1 of 36% and blood pressure 125/60 as well as pulse rate of 84 beats per minute (Bregagnollo, Lopes, Barbosa & Stamm, 2017). His medication indicated that he has been prescribed to use Salbutamol, which is a short-acting bronchodilator along with a steroid inhaler.

It has been identified that George has been continuing his smoking even after being diagnosed with COPD 10 years ago. However, his latest medical examination indicates that the severity of the emphysema is increasing due to his agency towards the medication as well as physical exercise. It is necessary to identify medical interventions as well as nursing interventions to ensure that he can maintain his daily schedule along with increasing his life expectancy. The two medical interventions considered for ensuring that he can increase his physiological stability of the body involve processing with the ineffective airway clearance along with maintaining the imbalanced nutrition of George (Hales, 2017). The nursing intervention of ineffective airway clearance is planned within the patients having an inability to proper secretion along with observing obstruction in the respiratory tract that requires a clear airway. It is the responsibility of the nursing to process the assessment of respiratory rate along with the depth of the respiration as well as considering the accessory muscles for sleep breathing and inability to walk as well as converse.

In the case of George, it has been identified that he has developed pursed-lip breathing which indicates the medical existence of chronic obstructive pulmonary disease. Along with assessing the skin and mucous membrane colour while monitoring the changes within the level of consciousness as well as mental status (Smit, Bleijenberg & Schuurman, 2016). it is the responsibility of the nurses to maintain the constant monitoring of O2 saturation along with titrated oxygen which would be maintaining the spo2 between 88% to 92% within the patient. The medical examination indicated that spo2 level is 93% on room air which means a minor monitoring to ensure that spo2 level is in a stable range. It has been evident that the nurses need to monitor the value of the arterial blood gases in order to ensure that the chronic carbon dioxide retention within the body is maintained because of the increase in the chronic carbon dioxide retention main compensation respiratory acidosis which would develop other medical discomforts in the patient and require immediate therapeutic intervention (Verloo, et al., 2017). The clearance of airways has been considered as one of the effective nursing interventions to help the elderly patients who have been confirmed to have emphysema.

The other nursing intervention has been identified which would be helping in providing care to George who has been developing severe chronic obstructive pulmonary disease that results in discomfort in the breathing and who exhibit a decrease in the exercise intolerance as well as a stubborn to perform a minimum movement of the body and prefer to stay in the reclining chair. The intervention includes maintaining the proper balanced nutrition which would be helping in maintaining the metabolic need of the body (Jonker, et al., 2017). The nursing intervention helps in understanding the individual nutritional needs and informs them to the primary carer of George who wishes to stay at home. The intervention in valves instructs the patient to consume high calories food frequently in smaller portions due to the need for an extraordinary amount of energy just simply for breathing.

The proper and frequent eating of high-calorie meals helps in maintaining the body weight as well as muscle mass that is required to carry on with the regular activities of the patient (Jonker, et al., 2018). The expected evaluation criteria that would help indicate that each intervention is resolving the COPD condition in George involve a reduction in the spo2 level to the range of 88% to 92% along with the fact that the body weight and the muscle mass of George alliance with the medically approved standards for the patients who are aged above 50 and have chronic obstructive pulmonary disease. The nursing intervention needs to be monitored to ensure that all the nutritional values prescribed for George are incorporated in his regular diet along with the fact that the airway for stress-free breathing is medical is cleared. Apart from the mentioned nursing interventions, it is the responsibility of the nurses to inform the primary carer regarding the theoretical intervention which might be needed to maintain the life expectancy and reduce the threat of sudden death in the case of George.

Identification of Lung Cancer

As per the stages of the clinical reasoning cycle, the medical examination of George indicated that he has increased blocked bowels. The difficulty in bowel discharge indicates the existence of gastrointestinal diseases which may directly link the medical instances to the chances of lung cancer. Decrease fev1 level from 42 % to 36% in the spirometry test indicates that the condition of the heart along with the amount of air in held as well as exhale have decreased added to the possibility of liver cancer (Magnuson, Elias & Koll 2019). Before planning the nursing intervention focusing on the possibility of lung cancer in George it is necessary to inform his granddaughter who is the primary carer about the symptoms of lung cancer that would be motivating her to take George diagnostic centre and confirm the existence of lung cancer. Symptoms of lung cancer mainly involved coughing with blood along with chest pain as well as serial loss in weight. It is necessary to mention that the symptoms of lung cancer after the cancer has moved to the severe stage and it is crucial to plan the nursing intervention in advance that would increase the chance of identification of the lung cancer and help George to fight it (Zuo, Wen, Gong & Meng, 2019). The continuity of smoking even after identification of the COPD indicates the possibility of lung cancer.

Lung cancer disturbs the gas exchange within the body and directly alters the oxygen supply developing the medical condition of hyperventilation that might be pressurizing the heart which would be receiving imbalanced oxygen level in the blood that is supplied to the heart and all the other organs malfunction due to the lack of oxygen in the blood. The medical intervention focusing on the proper flow of the gas exchange within the body motivates the nurses to monitor the respiratory rate along with the ease in respiration along with the existence of pursed-lip breathing. In the case of George, it has been observed that he has already developed pursed-lip breathing. The monitoring of the respiratory factor would help indicate the sudden increase in the respiration due to the pain or initial compensatory mechanism within the body to accommodate the sudden loss of lung tissue.

The nurses will be able to ensure that the cyanosis is identified at an early stage and medication is provided to monitor the oxygen consumption as well as energy expenditure that would be influencing the respiratory reserve (Li, Guo, Tang, & Yang, 2018). It is the responsibility of the nurses to investigate changes in the level of consciousness as well as the existence of restlessness in George. Investigation of the unconsciousness helps in understanding indications of the increased hypoxia as well as complications in the mediastinal shift within the patient who is considered for lung cancer treatment. The nurses need to assess the response of the patient to several activities and encourage them to increase exercise tolerance (Otsuka, et al., 2016). It is necessary to ensure the proper oxygen consumption demand within the body and the stress of possible medical treatment against lung cancer change is the vital sign of the patient. It is the responsibility of the nurses to ensure that the patients are able to prepare themselves for the upcoming planning that would be helping them to undergo the medical process of treating the lung cancer.

The patients having lung cancer have expressed discomfort in verbal activity along with destruction behaviours which includes restlessness as well as alteration in the respiratory rate along with the blood pressure. The nursing intervention motivates them to identify the unpleasant sensory and the sudden emotional experiences that develop within the body of the patient due to the potential tissue damage. The onset of pain moves forward from mild to severe that increases the requirement of the intervention of the nurses (Fernandes et al., 2016). It is the responsibility of the nurses solely to assess the verbal as well as non-verbal pain of queues expressed by the patients and analyse the degree of pain as well as effectively intervene to help the patient cope up with the pain. The nurses must consider the psychological as well as pathophysiological causes of the pain that would help them to generate the relationship with the patient and morally help them to cope up with their fear anxiety as well as distressed once the diagnosis of cancer is confirmed (Gajra, et al., 2018).

Similar to the case of COPD, in case of lung cancer, the primary carer must be informed about the plant medical treatment as well as educating them about the nursing intervention which would be motivating them to a point and nurse in case George is not prescribed to admit him in the hospital immediately. The expected evaluation criteria that would help indicate that each intervention in resolving the issues faced by George while confirming the existence of lung cancer involve changes in the attitude of the patient who is ready to take medical help to get relief from addiction to smoking. Alongside receiving medical help, the proper execution of the nursing intervention would express the change in the attitude of George towards the physical movement and consider increasing the exercise tolerance would be helping him to maintain the body mass and weight that directly influence the treatment plan for fighting lung cancer. Furthermore, it can be observed that the pulse rate along with the blood pressure is maintained as well as the bowel movement has been eased that has helped George to have relief from the bothering and can return to the daily flow of life. Also, show the primary carer of George, his granddaughter would be informed about the entire planning and medical intervention that would be required alongside the nursing intervention to help George fight the medical situation of lung cancer.

Conclusion on George Williamson Case Study 

As per the medical case study of George, it is evident that he has not been prescribed to be admitted in hospital and it is the responsibility of the primary carer to appoint a nurse who would be following with the nursing interventions and ensuring a healthy recovery of George. All the four nursing intervention considered for helping George with his chronic obstructive pulmonary disease and the possibility of lung cancer involve informing his granddaughter about the details of his disease and requirement of the medical intervention along with the activities that are necessary responsibility for the nurses appointed to take care of George. Nursing intervention who helped George to you both emotionally and physically bear the pain as well as the emotional turmoil that would be motivating him to make changes in his lifestyle. All the mentioned nursing intervention directly required the involvement of the nurses apart from the medical team and the primary carer.

Reference for George Williamson Case Study 

Bregagnollo, G. H., Lopes, D. M., Barbosa, B. M., & Stamm, A. M. N. D. F. (2017). Clinical Reasoning Among Medical Students at the End of the Basic Cycle. Revista Brasileira de Educação Médica, 41(1), 44-49.

Fernandes, R., Mazzarello, S., Majeed, H., Smith, S., Shorr, R., Hutton, B., ... & Clemons, M. (2016). Treatment of taxane acute pain syndrome (TAPS) in cancer patients receiving taxane-based chemotherapy—a systematic review. Supportive Care in Cancer, 24(4), 1583-1594.

Gajra, A., Zemla, T. J., Jatoi, A., Feliciano, J. L., Wong, M. L., Chen, H., ... & Cohen, H. J. (2018). Time-to-Treatment-Failure and Related Outcomes Among 1000+ Advanced Non–Small Cell Lung Cancer Patients: Comparisons Between Older Versus Younger Patients (Alliance A151711). Journal of Thoracic Oncology, 13(7), 996-1003.

Hales M. (2017). Nursing care of people with gas exchange disorders. In P. Lemone, et al. (3rd Ed.). Medical Surgical Nursing Critical Thinking in Person-Centred Care, pp. 1310-1367. Melbourne: Pearson.

Jonker, R., Deutz, N. E., Erbland, M. L., Anderson, P. J., & Engelen, M. P. (2017). Effectiveness of essential amino acid supplementation in stimulating whole body net protein anabolism is comparable between COPD patients and healthy older adults. Metabolism, 69, 120-129.

Jonker, R., Deutz, N. E., Harrykissoon, R., Zachria, A. J., Veley, E. A., & Engelen, M. P. (2018). A critical evaluation of the anabolic response after bolus or continuous feeding in COPD and healthy older adults. Clinical Science, 132(1), 17-31.

Li, P., Guo, Y., Tang, Q., & Yang, L. (2018). Effectiveness of nursing intervention for increasing hope in patients with cancer: a meta-analysis. Revista Latino-Americana de Enfermagem, 26, 1-11. doi:10.1590/1518-8345.1920.2937

Magnuson, A., Elias, R., & Koll, T. (2019). Expanding Therapeutic Options for Older Adults: Case‐Based Updates in Breast and Lung Cancer. Journal of the American Geriatrics Society, 67(5), 1012-1019.

Otsuka, H., Sugino, K., Hata, Y., Makino, T., Koezuka, S., Isobe, K., ... & Iyoda, A. (2016). Clinical features and outcomes of patients with lung cancer as well as combined pulmonary fibrosis and emphysema. Molecular and clinical oncology, 5(3), 273-278.

Smit, L., Bleijenberg, N., & Schuurmans, M. J. (2016). Unravel the intervention components of proactive nurse-led care interventions for older persons. Journal of Advanced Nursing, 72(Suppl. S1), 47-47.

Verloo, H., Chiolero, A., Kiszio, B., Kampel, T., & Santschi, V. (2017). Nurse interventions to improve medication adherence among discharged older adults: a systematic review. Age and ageing, 46(5), 747-754.

Zuo, X. L., Wen, Y., Gong, S. Q., & Meng, F. J. (2019). Effectiveness of integrated nursing interventions for fatigue in patients with advanced cancer: a systematic review of randomized controlled trials. Frontiers of Nursing, 6(3), 203-210.

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