COPD or Chronic Obstructive Pulmonary Disease is a common respiratory illness. It impacts the quality of life of people.  There is a significant population that suffers from this disease. 

This case study highlights important issues of COPD.  We will analyse the care, treatment, and assessment of COPD in this blog. 

COPD is a serious issue in Australian healthcare. It leads to serious consequences and even death. The treatment could be costly as the patient is admitted in the long term. 

Nursing students play a critical role in looking after COPD patients. They are responsible for managing them. They make their care plans and provide the right treatment. 

Students receive thorough instruction and training to make the right diagnosis and treatment.  They are educated to meet the complex requirements of COPD. 

This case study offers Australian nursing students a useful and perceptive look at COPD. It emphasises a patient-centred approach to nursing care and assessment.

Patient Profile

Mrs Ross is a 68-year-old woman suffering from worsening dyspnea. She arrives at the ER with a persistent cough. She has been experiencing more phlegm than usual during the previous seven days. She also has a 40-year smoking history. Upon her check-up, she was diagnosed with severe COPD. 

Respiratory Assessment

• Decreased breath: The nurses checked the state of her lungs. The result showed her breath sounds to be of low volume. This shows that COPD has affected her lungs causing airflow impairment.

• Wheezing: Wheezing noises could be heard on expiration. It also shows the damage to the airway. It hints towards bronchospasm and airway blockage. These are the symptoms of COPD.

• Crackles: There may be fine or coarse crackles. These also point towards airway inflammation. These crackles indicate the harm caused to the linings of the lungs. 

Hence the symptoms found upon examining the lungs indicate COPD. 

Respiratory rate and effort: 

• Elevated respiratory rate:Mrs Ross's heartbeat shows to be higher than normal. This shows her body has been making up for insufficient gas exchange. There is a distress leading to her respiratory rate.

• Increased effort for breathing: Medical professionals look for symptoms of increased effort to breathe. In Mrs Ross's case, they found symptoms such as the use of auxiliary muscles, tight lips, and bent posture.

Oxygen Saturation:

Below normal range: Mrs Ross's oxygen saturation is lower than normal. It points to hypoxemia. This is a result of respiratory issues. Her oxygen levels are compromised as a result of compromised gas exchange. 

An evaluation of oxygen saturation gives important details. It is an indication of respiratory health. It also helps to decide if the patient requires oxygen therapy.

Medical History

COPD History

After a regular check-up, it is important for a background check. Nurses should check the medical history This helps with better analyses and decision making. Upon a background check, it was learned Mrs Ross has experienced acute attacks of COPD before. 

• Chronic symptoms: She has ongoing respiratory symptoms. They are suggestive of the advancement of COPD. She has been diagnosed with dyspnea, a persistent cough, and increasing phlegm. These clearly match her medical history. 

• Concurrent illnesses:Hypertension: Mrs. Ross has a history of hypertension. It calls for continuous care. Ignoring it can lead to cardiovascular problems. Hypertension is a prevalent condition faced by COPD patients.

• Type 2 Diabetes Mellitus: She also has type 2 diabetes mellitus. This calls for an approach where all conditions get required care. Hence health care professionals need to follow up with all conditions. 

Psychosocial Evaluation: 

a. Emotional Condition:

Fear and anxiety: Mrs. Ross discusses her fears and anxieties. She feels troubled about her respiratory symptoms getting worse. She also feels worried about how they would affect her quality of life.

Psychological assistance: an evaluation of her emotional well-being is necessary. It helps to address her concerns and offer psychosocial support. Emotional support is necessary throughout the COPD management journey. 

b. State of Function:

Daily Activities: Mrs. Ross's respiratory problems are making it difficult for her to complete everyday tasks. This suggests a decline in her functional status. In case the condition worsens it can lead to possible damage to her independence.

Self-care abilities: She expresses worries about her capacity to take care of herself at home. She emphasised the need for a thorough nursing examination. She also asks for help to maximise her capacity for self-management.

These check-ups are required to carry on proper treatment. They help with creating a customised plan catering to all the needs of patients. It helps healthcare professionals to create a plan to treat COPD and other illnesses. 

Management:

1.    Oxygen Treatment:

The nurses need to keep the oxygen level within the desired range. The normal range is 88–92% for COPD patients. As Mrs. Ross has less oxygen than the normal level, nurses need to administer more oxygen.

They should also monitor oxygen saturation and flow rate. It helps to achieve optimal oxygenation without affecting respiratory drive. 

2.    Medical Administration:

Bronchodilators: To enhance airflow, nurses should give both short- and long-acting bronchodilators. They help to ease bronchospasm too. Nurses can use beta-agonists and anticholinergics. 

Corticosteroids: To lessen airway inflammation nurses should provide the necessary therapy. There are many systemic corticosteroid therapies available. 

Antibiotics:  Mrs Ross also suffers from excess phlegm. It reflects the chances of infection. Nurses should run necessary antibiotics for cures. 

3.    Assistance in Quitting Smoking:

Nurses should also offer guidance and assistance in quitting smoking. They stress the significance of quitting and how it can lead to faster recovery and better results.  
You can suggest working with community services and programs. They act as a positive influence in quitting smoking.

4.    Patient Education:

Inform Mrs. Ross about the symptoms, course, and self-care techniques of COPD.

Nurses should teach breathing exercises. They should also educate about the details like how to cough effectively, and how to utilise oxygen devices and inhalers correctly. This will help her to look after her health. 

Talk about changing lifestyle. You can talk about being more physically active and having a healthier diet.

Nursing Care Plan:

1.    Monitor Respiratory Status:

The first step of any care plan is the right diagnosis. use suitable evaluation tools. For COPD you can use a pulse oximeter, to check oxygen saturation.To diagnose respiratory conditions you should focus on change in rate and effort. You should observe the change and prescribe medicines accordingly. 

You can use capnography to know end-tidal carbon dioxide levels. It is important for patients with severe COPD or those who are at risk of hypercapnia.

2.    Provide Emotional Support:

You should focus on active listening strategies. Nurses should show empathy for the patient's feelings.  Carefully hear out what they are feeling and help them to control their emotions. 

Provide the necessary assurance to uplift her energy. Show them support and use words of affirmation.  This will help her to build confidence to fight the illness. 

Also, discuss coping mechanisms to improve emotional health. Nurses should focus on coping abilities, such as mindfulness exercises, relaxation techniques, and fun activities.

3.    Collaborate with Multidisciplinary Team:

Nurses work together with the interdisciplinary team to create personalised care plans. They are suitable to meet patient's requirements and preferences. 

Review regular progress and address any issues. Nurses should adjust the treatment plan as necessary. The goal is to maximise results during interdisciplinary rounds.

In order to help Mrs. Ross transition from the hospital to her home, locate community resources, support services, and educational materials. This will help with discharge planning activities.

All these factors will help you to come up with a plan that will help Mrs.Ross with her treatment. 

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