• Internal Code :
  • Subject Code : QCD310
  • University : Queensland University of Technology
  • Subject Name : Nursing

Case Study: Chronic Obstructive Pulmonary Disease (COPD)

Introduction

The patient is the given case study has been recently diagnosed with Chronic Obstructive Pulmonary Disease (COPD). The patient is a chronic smoker with comparatively lesser number of cigarettes consumed per day basis. The patient is also having a hectic work schedule and is unable to make time for physical activity. The patient is well-aware of his current situation and although his current clinical status is okay, he is still at a higher risk of developing complexities from his COPD. The patient knowingly, is reluctant to take any treatment intervention to manage his diseased condition. The health care professional is able to sense the reluctance and has challenged staged in front of him, to provide the patient with the required care as per his comfort and ease.

Types of COPD

There are three major types of COPD as following:

1. Chronic bronchitis- This is caused by prolonged inflammation of the lung passages such as bronchi that leads to increased mucus production in the lung passages. In chronic conditions, there is a severe restriction of airflow in the lung capacity due to these changes. These changes in the patients tend to result in recurrent chest infections as well as productive cough production (Kesimer, 2017).

2. Pulmonary emphysema- This condition is mainly marked by injury to the alveoli, which are the air sacs in the lungs. These are the main structures responsible for gaseous exchange. The alveoli tend to either destroy completely or get collapsed. In few of the cases, the alveoli gets narrowed or inflamed as well. This narrows the passages for gaseous exchange resulting in severe breathlessness and in some cases irreversible changes in the patient (Nakashima, 2019).

3. Refractory asthma- It is chronic lung condition which is marked due to hyper responsiveness of the lung passages. The lining of the lung passages tend to get inflamed and thus there is a major restriction observed in gaseous exchange. It is also marked by the inflammation of the respiratory structures responsible for gaseous exchange and also brings about an increased mucus production which is irreversible in nature (Carpaij, 2019).

Pathophysiology of COPD

COPD is developed due to a combination of peripheral inflammation and slow progressive narrowing of the air passages. This is also brought by the airflow limitation to the lower lung passages involving the alveoli and terminal bronchioles, which are the main structures involved in smooth conduction of airflow throughout the lung passages (Kesimer, 2017). This causes an abnormality in the alveolar structures in a slow progressive manner and also destructs the pulmonary vascular bed. The surrounding structure near to the vascular bed also inflames over the due course of time, leading to the extent of airflow limitation from lower passages to the higher lung passages.

There is a reduced influx as well as efflux of the air from the lung airways (Radovanovic, 2018). This eventually leads to reduced inspirational capacity and might also bring about severe breathlessness in the patient. Whereas, the reduced exhalation process increases the air trapping in the lungs which eventually again lead to reduced inspiratory capacity. Due to this abnormality in the gaseous exchange, there are low levels of saturated oxygen measured in the patients in the form of hypoxemia (Radovanovic, 2018). This impaired gaseous exchange then worsens the patient status leading into slow progressive development of COPD.

Step Taken for Self-Care Management by The Patient

James can take up the following steps on his own in order to self-efficiently manage his own condition

1. Quit smoking- This can be done by James with the help of medications, counselling, and nicotine replacement therapy and so on. Smoking is an underlying risk factor for COPD that promotes lung degeneration in the patient (Hayes, 2017).

2. Proper diet and exercise- James can take up for a balanced diet. This will help in promoting his health and undermine the complications associated with COPD condition. Exercise can be helpful for the patient to help him develop his functional capacity and can also be helpful in improving his overall muscle strength. Exercises regimen like aerobics as well swimming can be opted out, which will be good for enhancing cardiovascular training for the patient (Pierobon, 2017).

3. Adequate rest- The patient in the case study has a busy work schedule and therefore, he is unable to make time for other activities. Taking proper rest will help in providing his body the required relaxation and will also be helpful in promoting a good sleeping pattern in the patient.

4. Breathing pattern- Patient can make use of various breathing techniques such as deep breathing, diaphragmatic breathing and purses lip breathing, which will be helpful for the patient in promoting a healthy ventilator patter in times of breathlessness.

5. Bronchial hygiene- James can make use of steam inhalation in the morning. This will be helpful in removing the additional secretions and maintaining a clear chest cavity. This will also be helpful in reducing the chances of chest infections (Jolly, 2016).

Importance of Communication

Communication is mainly helpful in channelizing the thoughts from one person to another. The patient in the case study is although aware of his present clinical status but is reluctant to take any treatment. His behavioral display might be due to some of the myths and preconceived notions attained by the patient. The patients are generally unaware of their present medical condition and they can get all confused with the medical terminology (Reinke, 2017). The patient might also be reluctant for treatment due to his unspoken fears and perceptions regarding the condition of COPD. The healthcare professionals can be very helpful in the given scenario, by helping the individual with clearing his myths and doubts regarding the condition.

They can also provide educational information on how to manage their conditions in their own personal surroundings. Any effective communication can be both verbal as well as non-verbal in nature. As a healthcare professional, one should be able to judge for the nature of the patient and should be able to act in accordance with the same. It is imperative that the healthcare professionals treating the patient do not formulate for any pre-fixed ideas about the patient (Houben, 2019).The personal values and beliefs of the patient should also be given due importance and should be considered as an integral part while planning for treatment intervention for the patient. The body language of the counselor should be of empathy and that of a welcoming nature. Effective communication channels between the patient and the care giver as crucial from the point of view of managing for medical care and coordination of the patient and also ensuring the smooth facilitation of these services for the patient as well (Stokes, 2019).

Strategies of Intervention

  • Patient education- The patient in the case study is quite agitated by his condition and for further management of the same. The healthcare professional can work in close coordination with the patient and his family to provide him with detailed information regarding his present clinical condition (Collinsworth, 2018). This will be helpful in not only providing the patient with the useful information, but will also be helpful in providing the patient with a sense of re-assurance and confidence to manage his condition.

  • Empathy- The care and coordination can be provided to the patient with a close consideration for empathy for the patient. This will be helpful in gaining confidence of the patient and providing him with a sense of authorization over his own personal life. This will also help in impeding the process by the means of promotion of effective communication between the care coordinator and the patient (Jany, 2019).Having an empathy for the patient will also be helpful in for the healthcare professional to get an insight of the beliefs and values of the patient and thus, will help in improving the care plan and attaining improved healthcare outcomes from the patient.

Conclusion

COPD is a commonly occurring respiratory condition which can hamper the daily routine of the patient, leading up to them developing disability in severe cases. However, with the right help this condition can be very well detected in early stages and can also be effectively managed conservatively. The healthcare professionals play a major role in not only clearing the myths of the patient regarding their condition, but can also help in providing them with a treatment intervention. They can also work in coordination with the patient to provide them the required care as per their individual needs, which will be helpful in obtained improved status of quality of life for the patient.

References

Carpaij, O. A., Burgess, J. K., Kerstjens, H. A., Nawijn, M. C., & van den Berge, M. (2019). A review on the pathophysiology of asthma remission. Pharmacology & Therapeutics, 201, 8-24.

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, 1325.

Hayes-Watson, C., Nuss, H., Tseng, T. S., Parada, N., Yu, Q., Celestin, M., ... & Moody-Thomas, S. (2017). Self-management practices of smokers with asthma and/or chronic obstructive pulmonary disease: A cross-sectional survey. COPD Research and Practice, 3(1), 3.

Houben, C. H., Spruit, M. A., Luyten, H., Pennings, H. J., Van Den Boogaart, V. E., Creemers, J. P., ... & Janssen, D. J. (2019). Cluster-randomised trial of a nurse-led advance care planning session in patients with COPD and their loved ones. Thorax, 74(4), 328-336.

Jany, B. H., Bals, R., Buhr-Schinner, H., Dreher, M., Koczulla, A. R., Jany, L., ... & Randerath, W. (2019). COPD: Rethinking patient management–how to approach a challenging patient group successfully. Respiration, 97(4), 363-368.

Jolly, K., Majothi, S., Sitch, A. J., Heneghan, N. R., Riley, R. D., Moore, D. J., ... & Singh, S. J. (2016). Self-management of health care behaviors for COPD: A systematic review and meta-analysis. International Journal of Chronic Obstructive Pulmonary Disease, 11, 305.

Kesimer, M., Ford, A. A., Ceppe, A., Radicioni, G., Cao, R., Davis, C. W., ... & Barr, R. G. (2017). Airway mucin concentration as a marker of chronic bronchitis. New England Journal of Medicine, 377(10), 911-922.

Nakashima, R., Kamei, S., Nohara, H., Fujikawa, H., Maruta, K., Kawakami, T., ... & Nakagata, N. (2019). Auto-measure emphysematous parameters and pathophysiological gene expression profiles in experimental mouse models of acute and chronic obstructive pulmonary diseases. Journal of Pharmacological Sciences, 140(2), 113-119.

Pierobon, A., Bottelli, E. S., Ranzini, L., Bruschi, C., Maestri, R., Bertolotti, G., ... & Giardini, A. (2017). COPD patients’ self-reported adherence, psychosocial factors and mild cognitive impairment in pulmonary rehabilitation. International Journal of Chronic Obstructive Pulmonary Disease, 12, 2059.

Radovanovic, D., Pecchiari, M., Pirracchio, F., Zilianti, C., D’Angelo, E., & Santus, P. (2018). Plethysmographic loops: A window on the lung pathophysiology of COPD patients. Frontiers in Physiology, 9, 484.

Reinke, L. F., Feemster, L. C., McDowell, J., Gunnink, E., Tartaglione, E. V., Udris, E., ... & Au, D. H. (2017). The long term impact of an end-of-life communication intervention among veterans with COPD. Heart & Lung, 46(1), 30-34.

Stokes, T., Tumilty, E., Latu, A. T. F. A., Doolan-Noble, F., Baxter, J., McAuley, K., ... & Dummer, J. (2019). Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: Qualitative study of the views of health professional stakeholders and patients. BMJ Open, 9(11).

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