Case Study: Hadden

Introduction

Hadden is a 63 years old male who has been suffering from COPD. He is a very heavy smoker with an average of 20 cigarettes per day. He has been diagnosed with a viral infection that has led to acute exacerbations of COPD. He has a medical history of hypertension and OSA (obstructive sleep apnea) which demand the use of CPAP. He feels breathlessness while doing basic domestic tasks and this has made it difficult to maintain a normal living. This assignment will focus on providing nursing interventions, and self-management techniques to Hadden as his priority for maintaining COPD. The assignment will strive to use components of the clinical reasoning cycle to develop effective decision making and nursing strategies for Hadden.

Identification and Explanation of Self-Management Priorities

According to Buus, Hoeck and Hamilton (2017), the nurse needs to collect relevant patient information from handovers, reports and focused assessments. Hadden has been suffering from increased dyspnea with minimal exertion. He was flushed in appearance and he experienced significant fatigue during the day. His respiratory rate was 34 bpm which made him suffer from breathlessness, HR was 90 bpm, BP was 132/88 and SpO2 was 92% on 2Lpm of O2. The normal heart rate of a healthy person lies near 70bpm however an HR of 90 bpm indicated severe breathlessness and heart concern for the patient (Malchaire, ALFANO & Palella, 2017).

It has been stated that patients who are suffering from COPD experience symptoms such as breathlessness, increased sputum production during cough, recurring chest infections, and dyspnea (Bhakta et al., 2019). This is mainly because of the excess of mucus production in the lungs of the patients due to inflammation. This inflammation is bought up by exposure to risk factors such as active or passive smoking, recurrent lung infections to exposure to allergens such as dust (Bhakta et al., 2019). Hadden is involved in significant smoking and is prescribed with several medications which must be managed.

“According to the standard 6 of registered nurse standards for practice NMBA (2017), the registered needs to provide safe, comprehensive and quality care to the patients by developing strategies as per the goals and priorities”. The primary priority of the nurse in terms of self-management for the patient will be to educate him about his medication chart. Since the patient has been prescribed with several medications and he is concerned about the process of taking those medicines which are making him anxious so he requires basic assistance with those medicines. Understanding the rationales and medications prescribed to the patient can certainly help him engage in the treatment which can thus give fruitful results to the patient (Dowell, Williams & Snadden, 2018).

Increase in dyspnea and sleep apnea requires the patient to undergo home oxygen-based therapy. So the next strategy will be based upon educating the patient about the importance of using home oxygen, followed by the importance of smoking cessation and attendance at pulmonary rehabilitation. Self-management of the respiratory symptoms can include strategies such as keeping a distance to the allergens such as dust and smoke which will thus require patient education and awareness about the disease and the risk factors (Morrison et al., 2017).

Nursing Interventions to Support Hadden

The pain problems that are identified for Hadden are lack of awareness about the medication chart, increased anxiety due to worsening of symptoms, lack of knowledge about the use of home oxygen and harmful impacts of smoking. The nursing goals for the patient will thus be to educate the patient about the pharmacological and non-pharmacological self-management measures in context relieve symptoms of the disease. Next goal for the patient will be to reduce anxiety by educating him about his condition and promoting home oxygen as the patient is suffering from obstructive sleep apnea and finally, the goal will be to achieve smoking cessation in the patient.

Nursing interventions are steps or measures that are followed to help a patient recover from his condition (Morrison et al., 2017). Primary self-management priority for Hadden was to help him gain information about his medication chart. Rationales to the medication can help him gain confidence and this can ultimately involve him in his care. “His current medications include trilogy elliptic. Salbutamol, augmentin duo forte, prednisolone, Nicorette patches and home oxygen therapy”. Informing the patient about his medication such as salbutamol is used as a bronchodilator and it can relieve breathlessness can help the patient more concerned for the medicine (Peacock, 2020). Moreover, self-management strategies such as the use of electronic time-based medication dispenser can help him manage the medicines on time which can prevent anxiety in the patient (Campling et al., 2017).

The interventions will involve the patient to use the bronchodilators such as salbutamol to prevent airflow obstruction and corticosteroids such as Trelegy and augmentin is an antibiotic for the management of COPD exacerbations (Peacock, 2020). The patient will be educated to follow breathing exercises such as pursed-lip breathing to maintain positive pressure and support with the individualized exercise regime. The next intervention will be based upon helping the patient keep a distance from allergens such as cigarettes by enhancing smoking cessation. Smoking cessation will be provided through the use of medications such as nicotine patches (nicotine replacement therapy). Nicorette patches are often used as nicotine replacement therapy and they are equal to 15 cigarettes per day (Jang et al., 2017).

Strategies Used to Evaluate Outcomes

Evaluating the outcomes for prescribed interventions is one of the most important steps of the clinical reasoning cycle (Van der leeden et al., 2018). It allows a nurse to analyze the effectiveness of the interventions and it checks the critical thinking and decision-making skills of a nurse. “According to standard 7 of the registered nurse standards for practise (2017), it is important for the registered nurse to monitor and evaluate the progress of the nursing interventions toward the outcomes”. The evaluation of the interventions will be based upon the improvement in the vital signs and signs and symptoms of the patient. Since the patient is facing significant breathlessness so the first evaluation criteria would be to investigate the breathing abilities of the patient.

The lung function which includes spirometry will be followed to evaluate the pulmonary function of the patient (Peters, Kaminsky & Maksym, 2018). An increase in the understanding of the medication in addition to the use of the electronic medication dispenser can be effective for the patient hence an evaluation of the medication awareness will be made by a series of the questionnaire. The questionnaire will involve questions based upon the use of the medication, and effectiveness of the medication as per the use. Finally, the evaluation for exercise efficiency and smoking cessation will be made by comparing the present condition with the previous condition.

Conclusion

In conclusion, it can be stated that patients with COPD experience several health concerns. These patients require proper self-management strategies to overcome their health inefficiencies. A nurse plays an active role in bringing back the normal lifestyle of the patient by providing proper support, guidance and education. The nursing management is based upon the development of priorities, interventions based upon those priorities and finally goal-based strategies to overcome those issues. Patients with COPD have symptoms such as breathlessness, OSA, cough and chest tightness but strategies such as proper use of pharmacological and non-pharmacological interventions followed by exercises and smoking cessation can certainly be effective for the patients. Moreover, awareness regarding the treatment can help the patients gain confidence and it can give better health results.

Reference

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. COPD, 16(3-4), 303-304.

Buus, N., Hoeck, B., & Hamilton, B. E. (2017). Nurses’ shift reports: a systematic literature search and critical review of qualitative field studies. Journal of Clinical Nursing, 26(19-20), 2891-2906.

Campling, N., Richardson, A., Mulvey, M., Bennett, M., Johnston, B., & Latter, S. (2017). Self-management support at the end of life: patients’, carers’ and professionals’ perspectives on managing medicines. International Journal of Nursing Studies, 76, 45-54.

Dowell, J., Williams, B., & Snadden, D. (2018). Patient-centered prescribing: seeking concordance in practice. USA: CRC Press

Jang, S., Park, S., Jang, B. H., Park, Y. L., Lee, J. A., Cho, C. S., ... & Ko, S. G. (2017). Study protocol of a pragmatic, randomised controlled pilot trial: clinical effectiveness on smoking cessation of traditional and complementary medicine interventions, including acupuncture and aromatherapy, in combination with nicotine replacement therapy. BMJ Open, 7(5), e014574.

Malchaire, J., ALFANO, F. R. D. A., & Palella, B. I. (2017). Evaluation of the metabolic rate based on the recording of the heart rate. Industrial Health, 55(3), 219-232.

Morrison, D., Mair, F. S., Yardley, L., Kirby, S., & Thomas, M. (2017). Living with asthma and chronic obstructive airways disease: Using technology to support self-management–An overview. Chronic Respiratory Disease, 14(4), 407-419.

NMBA. (2017). Registered nurse standards for practice. Retrieved from https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx

Peacock, S. (2020). Medications Used for the Respiratory System. In Understanding Pharmacology in Nursing Practice (pp. 283-317). Springer, Cham.

Peters, U., Kaminsky, D. A., & Maksym, G. N. (2018). Standardized Pulmonary Function Testing. Lung Function Testing in the 21st Century: Methodologies and Tools Bridging Engineering to Clinical Practice, 5.

Van der Leeden, M., Stuiver, M. M., Huijsmans, R., Geleijn, E., de Rooij, M., & Dekker, J. (2018). Structured clinical reasoning for exercise prescription in patients with comorbidity. Disability and Rehabilitation, 1-6.

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