• Internal Code :
  • Subject Code : NUR2101
  • University : University of Southern Queensland
  • Subject Name : Nursing

Case Study Analysis: Gladys

Chronic diseases are generally the conditions that persist in an individual for a longer duration. A chronic condition can be defined in terms of duration of the presence of being observed in an individual for a consistent period of here months or more than that (Burton, 2016). These conditions tend to mark as an obstacle in the patient’s daily routine activities. These conditions not only deteriorate the health status of a person but also adds to the financial constraints to the people suffering from the same. The people who contact these conditions tend to heal at a slower pace as well, in comparison to their healthy counterparts and there is usually a prolonged length of stay observed in these individuals.

They also hamper the status of independence in an individual and in worst-case scenarios, people suffering from the same have been left with some physical as well as mental disabilities too. By inculcating healthy habit sin daily routine and with the help of assigned healthcare professionals these conditions can still be managed effectively. This paper will undertake a case analysis for a patient who suffers from Chronic obstructive pulmonary disease (COPD) and a right sided heart failure.

COPD is a slowly progressing respiratory disorder, which is marked by subjective respiratory insufficiency in an individual (Anzueto, 2017). Multiple underlying factors can lead to the development of this condition in an individual. Some of the factors can be observed on a personal level while others are environment-related factors. Personal factors can be inclusive of habits like smoking, genetic related factors and so on, whereas, environmental factors can be in terms of smoke, pollutants, allergens and so on. Right-sided heart failure, on the other hand, is a common type of heart failure observed in individuals. This is also known as cor pulmonale or pulmonary heart disease (Dessap, 2016). To help the patient in preventing the adversities related to these chronic conditions, it is crucial to note for the early signs and symptoms to draft a treatment plan, most apt for these individuals.

There is a close underlying relation between COPD and heart failure. Although the relation cannot be directly established it is observed in the COPD patients, that respiratory complications can be seen to be tagged along with cardiovascular compromises in the patient as well. This can also be observed in a patient in a slow gradual manner. Most of the COPD patients are observed to have low-level of systemic inflammation. This inflammation can be directly associated with the risk of developing cardiovascular issues in an individual. COPD patients also tend to have a moderate to severe restriction in respiratory flow. This brings a rise in the level of C-reactive protein in these individuals (Branco, 2017).

This protein is also a unique presentation of the presence of inflammation in the body. The same protein levels are usually found to be observed high in patients having cardiovascular compromise. It is also a test done to examine the presence of heart failure in the patients. As a result of systemic inflammation, there is a marked peripheral insufficiency and thus, an underlying cardiac risk. This also brings about a reduced blood flow in the body which can be marked by reduced blood return to the heart. Thus, there is a grave chance of reduced ejection fraction, which can directly lead to heart failure.

A reduced level of ejection fraction is also observed in COPD, due to respiratory insufficiency, which is brought by reduced oxygen amounts transported to various parts of the body, through the medium of blood circulation. This increases the demand and push in the body and thus, puts a constant strain on the right ventricle to pump more blood in the body (Richardson, 2016). The body eventually tends to tire out and it leads to right-sided heart failure due to overwork of cardiac as well as respiratory muscles.

Many diagnostic tests and steps can be followed to evaluate the damage caused by these chronic conditions in the patient. One of these is blood gas analysis. This will help in evaluating the acidity or basicity of the blood. It will also help in determining the level of mixed oxygen in the blood, which will be beneficial for providing supplemental oxygen to the patient (Magnet, 2017). Also, blood test can be ensured for the patient. The most important test, will be monitoring for the value of C-reactive protein in the body. It will help in analyzing the impact of inflammation on the body of the individual.

Normal blood workup can also help identify the underlying infections and the blood cells count in ten body. Furthermore, Chest X-ray can be done which will help determine the cardiomegaly in the patient. It will also help in evaluating the chest secretions and any blockage in the lower passages, hampering the proper ventilation in the body. It will also help in examining for any chest deformity developed due to respiratory insufficiency in the patient (Yamada, 2017).

Vitals can also be monitored as it is important to note for various vitals, such as heart rate, blood pressure, saturation and so on. This is vital from noting for any dip in the normal reading of the individual and providing him relief for the same. Moreover, EKG can help in identifying for abnormal rate and rhythm of an individual. Where, as ECHO can be useful in evaluating the ejection fraction as well as the conduction in various blood vessels as well. It will also help in defining the condition based on insufficiency, into the category of mild, moderate or severe, so that appropriate therapy and treatment intervention is provided to the patient, following the same (Harshvardhan, 2018).

There are two main areas of concerns that are to be pondered upon in this case while managing care for the patient. These points are the patient experiencing breathlessness and having swelling in his lower extremities. The concern of breathless can be related as a respiratory complication whereas, the swelling in the legs can be included as a cardiac complication. These issues can hamper with the activities of daily living in an individual, such as toileting, bathing, having lunch or dinner and so on. The patient is in dire need of acute interventions to reduce the complications and prevent the patient from developing any acute infection.

Nurses play a vital role in the management of chronic conditions and the following interventions can be helpful for the patient to provide him with the holistic care required. One of the interventions can be maintaining bronchial hygiene. It is important from preventing the development of any infection in the lungs. The patient can be helped with the technique of postural drainage to help in evacuating out the cough. Steam inhalation can be given before this so that not much effort of the patient is required to cough out the thick sputum. The patient can also be taught the techniques of deep breathing as well as pursed-lip breathing which will help promote a sense of calmness in the patient as well (Gordon, 2019).

The second intervention can be maintaining a physical regimen. It is important from maintaining a normal lung expansion so that maximum inspiratory, as well as expiratory volume, is maintained. The exercise regimen can be set in an incremental pattern and can thus, help attain target vital gradually, without putting additional constrain on the patient (Ding, 2018). The last intervention can be education. Many of the patients do not have complete information about their current medical status. It is important to educate the patient as well as their family about the implications of their conditions and as to how most effectively these conditions can be managed.

The help of the multi-disciplinary approach can also be taken in the given scenario. A nutritionist can be provided to the patient to guide on healthy food items as well on imparting education about boosting immunity. Nurses can also work in close collaboration with the other healthcare professionals to keep close monitoring of regular follow-up and medication reconciliation in these individuals as well (Collinsworth, 2018).

In conclusion, although there is a lack of evidence observed in terms of establishing a direct correlation between COPD and heart failure, certain underlying factors can be a direct indicator explaining a linear correlation between the two clinical conditions. Multiple intervention strategies can be used in the given case scenario and can be used to identify the conditions in the early stages. The role of nurses along with a multi-disciplinary approach can be used to provide the patient with the required holistic care approach as needed by them. Patient education is another vital part that should be an integral part of the intervention plan. Working collaboratively, with an equal collaboration with the patient as well as healthcare staff, can help attain positive outcomes from the patient.

References

Anzueto, A., & Miravitlles, M. (2017). Pathophysiology of dyspnea in COPD. Postgraduate Medicine, 129(3), 366-374.

Branco, R. G., & Garcia, P. C. R. (2017). Ferritin and C-reactive protein as markers of systemic inflammation in sepsis. Pediatric Critical Care Medicine, 18(2), 194-196.

Burton, G. J., Fowden, A. L., & Thornburg, K. L. (2016). Placental origins of chronic disease. Physiological Reviews, 96(4), 1509-1565.

Collinsworth, A. W., Brown, R. M., James, C. S., Stanford, R. H., Alemayehu, D., & Priest, E. L. (2018). The impact of patient education and shared decision making on hospital readmissions for COPD. International Journal of Chronic Obstructive Pulmonary Disease, 13, 13-25.

Dessap, A. M., Boissier, F., Charron, C., Bégot, E., Repessé, X., Legras, A., ... & Vieillard-Baron, A. (2016). Acute cor pulmonale during protective ventilation for acute respiratory distress syndrome: prevalence, predictors, and clinical impact. Intensive Care Medicine, 42(5), 862-870.

Ding, B., Judge, D., Small, M., Bent-Ennakhil, N., & Siddiqui, S. (2018). Functional performance in patients with COPD: Association with treatment regimen, GOLD group, lung function, and symptom burden in a cross-sectional study. International Journal of Chronic Obstructive Pulmonary Disease, 13, 27-85.

Gordon, C. S., Waller, J. W., Cook, R. M., Cavalera, S. L., Lim, W. T., & Osadnik, C. R. (2019). Effect of pulmonary rehabilitation on symptoms of anxiety and depression in COPD: a systematic review and meta-analysis. Chest, 156(1), 80-91.

Harshvardhan, L., Chand, T., Mehta, S., Singh, A., & Maheshwari, D. (2018). Comparative study of CA-125 and 2D echo for detection of right ventricular failure in COPD patients. International Journal of Advances in Medicine, 5(4), 10-53.

Magnet, F. S., Majorski, D. S., Callegari, J., Schwarz, S. B., Schmoor, C., Windisch, W., & Storre, J. H. (2017). Capillary PO2 does not adequately reflect arterial PO2 in hypoxemic COPD patients. International Journal of Chronic Obstructive Pulmonary Disease, 12, 26-47.

Richardson, A., Tolley, E., Hartmann, J., Reedus, J., Bowlin, B., Finch, C., ... & Self, T. (2016). Evaluation of chronic obstructive pulmonary disease (COPD) and reduced ejection fraction heart failure (HFrEF) discharge medication prescribing: is drug therapy concordant with national guidelines associated with a reduction in 30-day readmissions?. Respiratory Medicine, 119, 135-140.

Yamada, Y., Ueyama, M., Abe, T., Araki, T., Abe, T., Nishino, M., ... & Kudoh, S. (2017). Difference in diaphragmatic motion during tidal breathing in a standing position between COPD patients and normal subjects: Time-resolved quantitative evaluation using dynamic chest radiography with flat panel detector system (“dynamic X-ray phrenicography”). European Journal Of Radiology, 87, 76-82.

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