Integrated Nursing Practice 2

Table of Contents



Nursing Intervention 1.

Nursing Intervention 2.



Introduction to Nursing Interventions

Nursing is an important part of the medical practice in a health care centre. Intervention of a nurse in a health care centreis directly related with the total treatment procedure. As per medical dictionary, nursing intervention is the sum total of the acts and responsibilities which are kept by a nurse. In other words, nursing intervention refers to the daily clinical routine what a nurse has to maintain in a health care centre. With the physicians and other members of the clinical team in a health care centre nurses work together to determine the proper intervention according to the patient's need. There are different types of nursing interventions. For example, dependent, independent or collaborating, interdependent nursing intervention. In the given case history, George Williamson had been diagnosed with COPD along with the problem of anxiety. In this case both independent nursing intervention and collaborating nursing intervention are needed.

Body of Nursing Interventions

Nursing Intervention 1

COPD or Chronic obstructive pulmonary disease is a common disease of older person. This disease is characterised by mortality, utilization of health care, unsatisfied needs of patients as well as their caregivers. Treatment of the older COPD patients is very much difficult and challenging. Because COPD causes a number of other unwanted difficulties and diseases including anxiety, pulmonary embolism, heart failure and others. It is also characterised with the risk of cognitive and functional decline (Bhakta et al., 2019).

Anxiety is characterised with uneasy and vague feeling of uneasiness. The source of this feeling is not specific. This feeling is characterised with the anticipation of threat and danger. Most often older people with serious physical problem or long term course of physical illness end up with anxiety. So, a nurse as a part of health care provider need to handle this case of anxiety carefully. In the given case history of George Williamson, anxiety has been detected while he is suffering from COPD (Sehgal et al., 2019).

In the case study of George Williamson, it can b seen that, George Williamson is 72 year old person. He was diagnosed 10 years back with COPD. Yet he never quite his habit of smoking. He was prescribed to inhale steroid. He was advised to take this steroid 2 times in a day. His grand daughter, who was taking care of George Williamson's at home, said that he was not using his steroid inhaler due to his forgetfulness. She also infirmed that, he was not doing his regular exercise and had started to spend almost all of his time laying on easy chair in his room. According to her, George Williamson became too stubborn to hear any advice from any of his family members. She expressed her worry if his lifestyle, which was mainly sedentary, may cause more difficulty for his health.

To handle this case of George Williamson is too much challenging for an independent nursing intervention. Here are some independent nursing intervention given which will be helpful to treat George Williamson with his problem of COPD and anxiety as well(Voelkel, Mizuno & Cool, 2017).

  1. First of all a nurse is supposed to listen to the patient actively. This intervention is a crucial part both in the course of behavioural and mental health. It is essential for a good nurse to be an active listener. Because it helps to build rapport between the health care personnel and the patient. George Williamson is an aged person and he feels anxious about his health condition. The nurse need to listen carefully and actively what he want to say about his onset condition (Rabelo, 2017).
  2. Next the nurse need to do is control the patient's pain. Mr. George Williamson is suffering from COPD which is too much painful for him in his 72 years of age. Difficulty with breathing makes the situation more difficult. The physicians have prescribed him proper medication according to his physical condition. Those medication are capable to ease his pain but it is not so easy for an old man who is 72. Along with spending time in a healthcare environment and laying on an unfamiliar bed where other patients are present is more painful for an older man. So the nurse need to take well care about his medication timing as well as his present condition in the hospital room, to ease his pain (Blomberg et al., 2016).
  3. Risk for mortality in older patients with COPD is extremely high. Thus the nurse need to do advanced care planning while taking care of them. They need to treat them in this way that, even after having proper information about their present condition, they will be hopeful to sustain their life span. So, while taking proper care of Mr. George Williamson, the nurse should prepare him for the worst result though make them feel hopeful for the best. All of these will go through the conversation with the patient carefully. In this aspect the nurse need to make an advanced planning which includes giving the patient time to time update information about his preferences, values and goals.
  4. While giving George Williamson update information about his health condition, the nurse should be conscious about his mental state of anxiety. It will be better to plan perfect care of George Williamson with full supporting and enthusiastic way. Otherwise the situation may go to the worst condition.

Nursing Intervention 2

Chronic obstructive pulmonary disease is a lung disease that occurs due to the poor rate of airflow in the lungs (Voelkel, Mizuno & Cool, 2017, p. 199). The reason for this disease to develop in the human body can be because the tissues in the lungs of the person break down and allow the flow of air to get reduced.Another reason for this medical condition to thrive is because there is some obstruction to the rate of airflow due to the due to the path of the airflow.However, certain nursing interventions can reduce the effect of the disease (Zwakman, Weldam, Vervoort, Lammers & Schuurmans, 2019, p. 78). One of those interventions is to improve the breathing pattern of the patient. Improvement in the breathing pattern of the patient can be done by these following methods

  • Inspiratory muscle training - Inspiratory muscle training is a training therapy that consists of several breathing processes. The nurses have to make the patients conduct inspiratory muscle training. To improve their breathing condition. It ultimately goes on to make a difference in the breathing pattern of the patients. This initiates a change in the activity of the muscles in the lungs which are responsible for the breathing process. It has been shown that more the patients partake in the breathing process, the more they will be able to get used to the pattern of this therapy. It will be very helpful for patients in increasing their breathing capacity. It has been shown that inspiratory muscle training increases the person's endurance levels This can also mean that it plays a catalyst role in improving the lung capacities of individuals. COPD is a disease that has serious chances of damaging the lungs, especially the muscles in the lungs. Inspiratory muscle training is a process that improves the capacity of the lungs. It has been seen that when a person indulgence in inspiratory muscle training, the lung capacity of the person increases (Vilaça,de Souza Pedrosa, Amaral, do Amparo Andrade, de Castro & de França, 2019, p. 22(6)). Inspiratory muscle training makes the patient perform the activity of deeper breathing. Deeper breathing is a process that provides more oxygen to the lungs as well as the inspiratory muscles of the lungs. This ultimately improves the oxygen capacity of the inspiratory muscles. Ultimately this results in more oxygen being available to other muscles in the body for other important purposes. So, this training process is something that helps the body in multiple ways (Schultz et al, 2018, p. 51(1)). If a patient is diagnosed with COPD, then it means the breathing pattern of the patient or the level of breathing intake of the patient is low. This does not meet the oxygen requirement of the lungs for the patient. That is why it is necessary to improve the functioning levels of the respiratory muscles. It will allow the lungs to take in more oxygen through the breathing process.
  • Diaphragmatic Breathing –The diaphragm is a large and critically important muscle located at the base of the lungs. This is one of the most important muscles in the body. It is the most important muscle which assists in the process of breathing. For a person who is suffering from COPD,it is possible for the airto not reach the diaphragm in the correct amount (Mendes et al, 2019, p. 140). In such a situation many of the other muscles of the body, namely the chest muscles or the neck muscles have to bear the workload of the breathing process. Diaphragmatic breathing is a technique that allows air or oxygen to reach the diaphragm in a reasonable volume.To perform diaphragmatic breathing exercises, the patient must lay still in a comfortable position. The important objective of the process is to allow the oxygen to reach the base of the lungs (Gu, Liang, Zhu & Chen, 2018, p. 11(9)). Otherwise, the patient can't receive the benefits of this exercise.
  • Pursed Lip Breathing–Pursed lip breathing is a therapy process that makes the patients slow down their breathing. This ultimately allows more oxygen to intake into the patient's lungs. It is necessary for the lungs of a COPD patient to work at a reasonable level. This is because the level of functioning in the lungs can in a matter of moments become reduced. This can cause a high level of damage in COPD patients (Parisien-La Salle et al, 2019, p. 115).Therefore,it becomes a priority for the nurses to stabilize the lungs. It becomes a critical necessity to make it effective in intaking air or oxygen.Since this is a technique that is used to improve the breathing patterns of people (Potdar, 2018, p. 59). It is not only used on patients but also on other people to improve their levels or their capacities in day-to-day activities. However, in COPD patients the idea is to increase the efficiency of the lungs (Damle, Shetye & Mehta, 2016, p. 2). Through the technique of pursed-lip breathing, the patients can introduce a higher volume of oxygen to the diaphragm This Results, in a higher level of efficiency of the lungs.

Conclusion on Nursing Interventions

Nursing is a noble profession. It is directly related with the well being of the patients. When a patient comes in the health care centre, they are generally not prepared. They may have serious disease which may end life, or may be not so serious will return home after some time. Total intervention of a nurse will be focused on the health care planning which include physical as well as mental issues. Most of the times it is very difficult and challenging to manage older patients especially when they are in serious condition. An ideal nurse are expected to follow the nursing interventions to make the patient comfortable in their unfamiliar environment inside the health care centre. Nursing Intervention is a crucial part of the over all clinical set up in a health care centre which is directly related with the welfare of the human being. A good nurse should follow this purpose.

References for Nursing Interventions

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 Considerations. COPD16(3-4), 303-304.

Blomberg, K., Griffiths, P., Wengström, Y., May, C., & Bridges, J. (2016). Interventions for compassionate nursing care: A systematic review. International journal of nursing studies62, 137-155.

Damle, S. J., Shetye, J. V., & Mehta, A. A. (2016). Immediate effect of pursed-lip breathing while walking during six minute walk test on six minute walk distance in young individuals. Indian J Physiother Occup Therapy10(1), 56-61.

Gu, W. L., Liang, Z. Y., Zhu, C. B., & Chen, R. C. (2018). Clinical outcome of a novel breathing training maneuver in stable COPD patients. Int J Clin Exper Med11(9), 9802-9810.

Mendes, L. P., Moraes, K. S., Hoffman, M., Vieira, D. S., Ribeiro-Samora, G. A., Lage, S. M., ... & Parreira, V. F. (2019). Effects of diaphragmatic breathing with and without pursed-lips breathing in subjects with COPD. Respiratory care64(2), 136-144.

Parisien-La Salle, S., Rivest, E. A., Boucher, V. G., Lalande-Gauthier, M., Morisset, J., Manganas, H., ... & Dubé, B. P. (2019). Effects of pursed lip breathing on exercise capacity and dyspnea in patients with interstitial lung disease: a randomized, crossover study. Journal of cardiopulmonary rehabilitation and prevention39(2), 112-117.

Potdar, S. (2018). A Comparative Study between the Effect of Breathing Control and Pursed Lip-Breathing Exercises in COPD Patients on Expiratory Flow Rate. Journal of Physiotherapy Research2(4), 1-3.

Rabelo‐Silva, E. R., DantasCavalcanti, A. C., Ramos Goulart Caldas, M. C., Lucena, A. D. F., Almeida, M. D. A., Linch, G. F. D. C., ... & Müller‐Staub, M. (2017). Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA‐International (NANDA‐I) and Nursing Interventions Classification (NIC). Journal of clinical nursing26(3-4), 379-387.

Schultz, K., Jelusic, D., Wittmann, M., Krämer, B., Huber, V., Fuchs, S., ... & Alma, H. J. (2018). Inspiratory muscle training does not improve clinical outcomes in 3-week COPD rehabilitation: results from a randomised controlled trial. European Respiratory Journal51(1), 1702000.

Sehgal, I. S., Agarwal, R., Dhooria, S., Prasad, K. T., Kalpakam, H., & Aggarwal, A. N. (2019). Adaptive Support Ventilation During Non-Invasive Ventilation in Acute Exacerbation of COPD: In StatuNascendi. COPD16(3-4), 305-305.

Vilaça, A. F., de Souza Pedrosa, B. C., Amaral, T. C. N., do Amparo Andrade, M., de Castro, C. M. M. B., & de França, E. E. T. (2019). The effect of inspiratory muscle training on the quality of life, immune response, inspiratory and lower limb muscle strength of older adults: a randomized controlled trial. Rev. Bras. Geriatr. Gerontol22(6), e190157.

Voelkel, N. F., Mizuno, S., & Cool, C. D. (2017). The Spectrum of Pulmonary Disease in COPD. In COPD (pp. 195-207). Springer, Berlin, Heidelberg.

Voelkel, N. F., Mizuno, S., & Cool, C. D. (2017). The Spectrum of Pulmonary Disease in COPD. In COPD (pp. 195-207). Springer, Berlin, Heidelberg.

Zwakman, M., Weldam, S. W., Vervoort, S. C., Lammers, J. W. J., & Schuurmans, M. J. (2019). Patients’ perspectives on the COPD-GRIP intervention, a new nursing care intervention for COPD. BMC family practice20(1), 78.

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