Nursing Case Studies on COPD

In this reflective piece of writing I allow for be explaining how degenerative obstructive pulmonary disease (COPD) affects the forbearing physically, psychologically ,and socially ,I go away besides explain how the disease affects his daily terrestrial and how it impacts on his family life. I will give an overview of the clinical signs and symptoms, how the disease alters the data trackphysiology of the lungs, and what these changes realize indoors the body. I will be using the reflective impersonate What, So What, Now What (2007). The patient I subscribe to chosen to pull through ab turn up is a seventy year old male who has been matrimonial for nearly fifty years.He has two grown up sons, both(prenominal) married with children of their own. Mr wood has Chronic Obstructive Pulmonary Disease diagnosed go years ago. Prior to this disease Mr forest was a life foresighted smoker, counterbalance at the age of fourteen years, smoking up to thirty cig arttes per day. Mr woods condition has progressively worsened over the past few years, and he now requires home oxygen therapy. A patient was brought into the emergency surgical incision by the paramedics complaining of difficulty in vivacious. On arrival he was tachypnoeic, had a respiratory assess thirty two and was found to launch up an audible wheeze.He stated that he had a productive spit up and was expectorating green coloured s ordainum. The patient felt w subdivision to touch. He looked pale, was sit upright, slightly leaning in the lead in a rigid stupefy on the ambulance stretcher. I was delegated the component of undertaking Mr Woods initial assessment, which included ensuring the patient was undressed ready for examination by a rejuvenate, and also carrying out a baseline set of observations. I was beaming to tackle this task, be arrive I had the take training, skills and was deemed efficient to carry out the needful c atomic number 18 required to look after Mr Woods.The n urse in entrust conscious me of Mr Woods medical history prior to me entering the cubicle, including what had precipitated his attendance to the emergency department which on that particular day had been his descent precipitateness of breath. On entering the cubicle, I boostered Mr Woods plump undressed and into a hospital gown because any slight exertion make him to a greater extent short of breath. I carried out a baseline set of observations. His assembly line pres authentic was 165/95, he had a pulse rate of cxxv beats per minute, a temperature of 38. c, a respiratory rate of 32, on 2 litres of oxygen his intensiveness level was 88%, and his blood glucose level was 4. 4mmol/l. Although or so of these observations are not at bottom normal range, for a person with COPD some of these observations maybe refreshing because the disease affects the path physiology of the lungs. The airways leading to the lungs, the bronchi, become aggravate. The inflamed airways produce too much mucus (sputum) which can lead to a persistent cough, wheeze and increasing shortness of breath.This happens because the air sacs (alveoli) become overstretched, lose it and merge which causes them to lose their elasticity. This causes the oxygen absorbing surfaces to be reduced, and with the narrowing of the airways turgidness exchange is less efficient (Parker, 2009). The lungs over inflate which reduces the air lot moving in and out of the lungs which can lead to tachypnoea (abnormally rapid rate of breathing), breathlessness on exertion, respiratory distress, abnormal posture I. e. leaning forward to help open the airways (Nursing Standard, 2001).Patients with Chronic Obstructive Pulmonary Disease can have a tendency to have low oxygen saturation levels, usually around 88% on air. In healthy patients their levels are usually between 95%- 100%. COPD patients often need demonstrative of(predicate) discourse of 2 litres of oxygen to main(prenominal)tain oxygen saturatio ns normally acceptable for that specific patient. However oxygen therapy higher than 2 litres may cause their carbon dioxide (CO2) levels to rise (Abrahams, 2009). As Mr Woods COPD had progressively worsened he had been commenced on home oxygen which he uses throughout most of the day.This helps him to under draw back the most simplistic of daily activities of living. Mr Woods lives at home with his wife who, due to the impact of this disease on Mr Woods, has now become his main carer. She helps her husband with his daily activities such as washing, showering and preparing his meals. He unavoidably help mobilising to the downstairs shower room, and, once there, needs assistance to get undressed. Whilst in the shower room Mr Woods needs to sit on a shower stool because he cannot manage to stand for any duration of time due to breathlessness.He is also unable to walk upstairs because he gets short of breath on exertion so he has had a stair lift installed which enables him to go up stairs to bed. This enables Mr and Mrs Woods to satiate both the physical and psychological aspects of their relationship. COPD can affect the psychological wellbeing of the sufferer. Before Mr Woods condition deteriorated he was able to go out, he used to enjoy going fishing with his sons and playing with his grandchildren. Because of his condition, Mr Woods is prostrate to lookings of inadequacy and depression.He also feels guilty because of his growing dependency on his wife for the simplest of daily tasks such as making a cupful of tea or answering the door. Because of the growing demands of her husbands worsening condition Mrs Woods now has to depend on other family fractions to speed her with tasks that Mr Woods can no longer undertake due to his COPD, and sponsor visits to the hospital with recurrent chest infections. Whilst Mr Woods was in the emergency department it was my responsibility to make sure Mr Woods was comfortable and that his observations were done on a r egular basis and documented.I was happy to do this as I am deemed competent and have the required training to carry out these duties. I made sure Mr Woods was sitting upright as this would help him with his breathing by improving his lung capacity and making sure oxygen was decreed by the doctor and circulateed via nasal cannulae as per trust policy. I detect Mr Woods remained tachyponeic, so repeated his observations. Even though on 2 litres of oxygen his saturation levels still remained low so I in readyed the nurse in charge that Mr Woods observations remained unstable.A doctor was notified and the patient assessed which involved listening to his chest. The doctor then prescribed nebulisers, oral steroids and paracetamol. A chest roentgenogram was also prayed. I had to ask a able portion of supply to administer Mr Woods medicament, because I am not qualified to dispense drugs to a patient as a scholar assistant practitioner as this does not fall within my context of pract ice or within the boundaries of my role. I think the occurrence I know my limitations and boundaries make me a safe practitioner.I made sure I had documented Mr Woods observations and that I had informed the nurse in charge of his condition making sure that I had dated, timed and subscribe what I had written. I got my documentation countersigned by a qualified member of staff as stated by the Nursing and Midwifery Council (NMC, 2008). The doctor asked me to intubate and take some blood from Mr Woods. I was comfortable with this request because I am qualified to undertake the task. I explained to Mr Woods that I needed to put a needle in his arm and take some blood and that I would be leaving the cannula in his arm for any medication his may require later.I put the equipment in concert that I needed to cannulate, making sure that it was on a lave trolley and that I had a sharps bin. I then washed my hands, put on my apron and gloves following universal precautions. I then proceede d to cannulate Mr Woods explaining everything I was doing throughout the procedure. at a time the cannula was in I given of my sharp in the sharps bin and put my dirty equipment in the clinical waste and then washed my hands. Mr Woods was then taken for his x-ray. Once labelled I then gave the blood to the doctor to send of to the path lab.I then filled in the cannulation documentation form as per hospital trust policy. I was pleased that I managed to get the cannula in on my first attempt because Mr Woods had terrible veins and I did not like the thought of having to put him through the procedure again as it can be quite painful and distressing. Mr Woods x-ray showed he had a chest infection for which he was prescribed intravenous antibiotics. Mr Woods was then transferred to the Medical Assessment Unit for further treatment by the medical doctors. Reflecting back I believe I have developed my knowledge about chronic obstructive pulmonary disease. version articles, text books a nd trust policies on COPD has allowed my to enhance my ability to recognise when patients are clinically unwell and have the confidence to highlight these abnormalities to the relevant members of the multidisciplinary team I. e. the nurse in charge and doctor, so the patient can be managed promptly and appropriately. Also the information I gained from talking to Mr Woods was valuable in allowing me to gain insight and therefore a greater instinct of how the disease affected not except the patient but also his family on a day to day basis.Witnessing first hand the weaken affects the disease process has on an individual such as Mr Woods and his family left me feeling a little sad due to the fact that my role as a student assistant practitioner extra my involvement in his treatment. Having been the first member of staff to attend to Mr Woods on his arrival to the department and to have spent time development a therapeutic relationship with him I felt that involving another member of staff to carry out an aspect of care may make him question my abilities to look after him as I could not administer his medication.I could address this issue by explaining to the patient that my role as student assistant practitioner does not allow me to give medication but explain that I am competent in carrying out all other aspects of care. Developing my existing knowledge on the psychological and physiological affects of Chronic Obstructive Pulmonary Disease has been consolidated by caring for a patient that has attended the emergency department with this chronic long term condition.Extending my knowledge base on this condition and the long term effects it can have on the individual will ensure that I treat each patient on their needs rather than just on their condition. Also looking back on this assessment I believe I acted professionally, promptly and efficiently. I feel I carried out my duties to a high standard of care within the boundaries of my role as a student assist ant practitioner which in turn enabled Mr Woods to receive the treatment and medication he required to ensure the best possible outcome.Looking after Mr Woods has shown that I can work effectively as a member of the multidisciplinary team. I am able to assess, implement and evaluate my care which has enabled other members of staff to witness my holistic and high level of care delivery within the emergency department. I believe this can benefit not only the patients attending the department but also help develop my role within the team.