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1.Ineffective airway clearance
Neville has established chronic obstructive pulmonary disease which mainly includes lung diseases like emphysema and bronchitis. Chronic bronchitis causes inflammation and narrowing of bronchioles, increased production of secretions/mucus in lungs and coughing is compromised making it difficult to clear secretions from respiratory tract. Further, hyperplasia of bronchial walls and fatigue affects clearance(Waschki, et al. 2011).
2.Impaired gas exchange
COPD comprises of emphysema and bronchitis where emphysema causes destruction of lung tissue around smaller airways and enlargement of air spaces. Thus, the airways especially alveoli get overinflated and collapsed and lose their ability to efficiently exchange gases. Airways get partially blocked or damaged, lose their elasticity and get mucous clogged, making breathing difficult.
3.Risk of impaired ventilation
As Neville has still not stopped smoking completely and takes around 10 cigarettes per day, the toxins/irritant would continue to be present for inflammatory response in lungs. This inflammation would progress to worsen the present narrowing of airways and lung tissue breakdown and would increase the chances of impaired ventilation. Basically, airways are mucous clogged, inflamed or damaged and thus, the ability of lungs to take up oxygen and remove carbon dioxide is lost(Almagro, et al. 2012).
4.Imbalanced nutrition: less than body requirements
Patient suffering from COPD suffers from decreased nutritional intake due to various following reasons:
1.Dyspnea makes it difficult to swallow or chew food
2.Taste of mouth is altered and dryness occurs due to chronic mouth breathing
3.Chronic mucous production affects swallowing
6.Side effects of medicines like anorexia, nausea or vomiting
7.Risk for infection
COPD patient is at high risk of infection due to:
1.Primary natural defence mechanisms are affected like ciliary action to propel irritants has reduced
2.Damage and destruction of lung tissue has affected acquired immunity of body
3.Continuous exposure to smoking and irritants
4.Medications like corticosteroids weakens immunity
6.Chronic disease process
Related nursing problem: COPD patient is highly communicable as they have transferable diseases
Reason: disease gets transferred to others via breathing, touch and other means.
Goal of care: to ensure that patients didn’t suffered from additional diseases
Specific bedside nursing interventions: they cover their faces with masks and also wear gloves while serving patients (LeMone, et al. 2015).
Wash their hands after giving treatment to the others
Rationales for nursing interventions: to prevent communicable diseases by covering their faces and hands.
Spray of pesticides to kill germs
Indicators that plan is working: fall in the communicable diseases within the premises
COPD Patients didn’t get suffered from the additional diseases
Related nursing problem: Loss of energy
Reason: due to COPD symptoms like cough, sputum, dyspnoea, it becomes difficult to eat food. Further, the side effects of drug or fatigue lead to improper health
Goal of care: to ensure that patient’s diet should be proper so that they adequate energy to deal with situation
Specific bedside interventions: there is need to give regular small feedings to remove the loss of energy
Increase the usage of liquid material such as Glucose, juices, etc.
Increase the usage of the fruits and other substitute substances,
Rationales for nursing actions: to prevent the situation of fatigue and vomiting
To identify individual needs and requirements
To enhance the overall calorie intake (Han, et al. 2010).
Indicators:Maintenance of patient’s recommended weight
Patient should consume liquid diet as much as they can
3.Clean and Dressed:
Related nursing problem: premises need to remain clean and other staff should be well dressed
Reason: the absence of cleanliness may lead to increase in the bacteria and other harmful substances that affect the health of COPD patients.
Goal of care: to ensure cleanliness within the COPD premises to protect the patients get affected.
Specific bedside interventions: regular cleaning should be processed with the supervising activity
Cleaning chart should be maintained and examined properly
Staff members should be well dressed
Rationale for nursing action: to maintain adequate cleanliness within the premises
To prevent dust and other substances that might create problems for others.
Indicators: premises remain cleaned
Related nursing problem: COPD symptoms get worsened with exertion
Reason: in COPD, adequate rest is necessary as body gets weak and fatigued with chronic disease process. Further, exertion increases the oxygen demand of body that remains unfilled by damaged lung tissues and inflamed airways worsening the symptoms of dyspnoea, wheezing, cough, etc.
Goal of care: to keep the patient adequately rested and comfortable
Specific bedside nursing interventions: provide quite and comfortable environment to the patient
External Temperature must be controlled
Bed must be clean, hygienic and comfortable
Adequate nutrition must be provided
Maintain record of sleep and sleep patterns (Stoller, et al. 2010).
Rationale: a warm and cosy environment and comfortable bed ensure good sleep and rest
Adequate diet is associated with sound sleep
Records help in assessing patient’s sleep duration
Indicators: a good and comfortable sleep of 6 to 8 hours indicates that patient is rested well.
5.Warm and comfortable:
Related nursing problem: COPD symptoms of shortness of breath and wheezing may get worsened
Reason: cold environment makes it more difficult for COPD patients to breath
Goal of care: to provide warm and comfortable environment to the patient
Specific bedside interventions: surrounding temperature would be controlled and maintained at comfortable range
Clean and comfortable bed would be availed
Clean and cosy sheets would be provided to the patient to cover himself
Rationale: warm and comfortable environment keeps COPD symptoms under control Indicators: patient sleeps and rest comfortably and the symptoms are under control(Agustí, et al. 2012).
Prednisone is a steroid which is given orally in COPD to decrease the inflammation in the airways. This drug reduces the swelling in the bronchioles and alveoli, controls mucus production and thus makes breathing easier. Oral prednisone is found to be very effective in COPD exacerbation conditions where symptoms are getting worse with time(Tiziani, 2010).
However, there are various side effects of long term use of oral corticosteroids like weight gain, high BP, bone loss, loss of muscle mass, increased chances of infection and stomach ulcers. Thus, nurses are required to keep monitoring patient’s overall condition, must give drugs as per prescribed doses and must educate patient to avoid sudden withdrawal.
Ipratropium bromide via nebuliser
Ipratropium bromide belongs to bronchodilators which are given to expand air passages in the lungs. COPD symptoms like wheezing and shortness of breath are controlled by this drug as they open up and relax the muscles around airways making breathing easier. When given through nebuliser, the drug provides quick relief(Vogelmeier, et al. 2011).
Nurses are required to take special precautions while giving this drug through nebuliser. The drug must not go into patient’s eyes or it would cause eye irritation, blurred vision or vision changes and the nebuliser’s mouth piece must be cleaned after every use to prevent cross infection. Some general side effects are also associated with the drug like back pain, dryness of mouth or altered taste that must be taken care of by the nurses.
Amoxicillin falls under the category of broad spectrum antibiotics and is given to prevent the risk of airway infections or other infections that may deteriorate the condition of patient suffering from COPD. The chronic COPD disease process impairs the defence system of affected person making the antibiotic administration necessary.
The drug must be administered exactly as the prescribed dose, for the full length of time and should be taken with food. Various side effects are associated with amoxicillin and diarrhoea is one of the commonest side effects. In case the patient experiences diarrhoea, doctor must be immediately consulted. Additionally, there are other side effects of the drug like flu like symptoms, rashes, urticaria, and easy bruising, headache or stomach pain. In fact, the drug may also affect functions of kidney and liver.
Neville needs to be informed and educated to stop smoking. He needs to be informed that tobacco smoking is the most common cause of COPD and a long term exposure of irritants like tobacco in the lungs initiates inflammatory action. This inflammation leads to damage and breakdown of lung tissues, narrowing of small airways and increased production of mucus making it difficult for patient to breathe. It needs to be explained to him that although, the damage has been already done to his lungs but smoking cessation would slow down the process of his disease progression.
Neville is having established COPD and is experiencing severe symptoms like dyspnoea and shortness of breath. He stills smoke nearly 10 cigarettes a day and thus needs to be explained and assisted to completely quit smoking and help him recover(Hoogendoorn, et al. 2010)..
It will be ensured that Neville knows and understand the importance of quitting smoking by effectively communicating with him. He would be explained about the adverse effects of smoking and its role in his disease progression in simple and unambiguous manner. All his doubts and confusions would be made clear and he would be assisted and supported for this action. He needs to gradually cut down his cigarettes. He would be suggested useful ways to quit smoking and may even be advised to take nicotine gums that may help him to succeed (Torres, et al. 2015). Seeing his present disease condition and symptoms, it is important for him to completely stop smoking.
I think salbutamol overdose has occurred.
Immediately, the nebuliser mask would be removed
1.Doctor would be called urgently
2.Stomach irrigation would be done using activated charcoal or laxatives
3.Drugs would be given to treat cardiac symptoms like tachycardia
These immediate nursing actions are taken since salbutamol overdose have various adverse effects. Along with the restlessness, dyspnoea and tachycardia, even tremors, hypokalemia and hyperglycemia may also occur. Thus, first of all, the nebuliser mask would be removed and the doctor would be called to take immediate action. By the time, to prevent undesired absorption of salbutamol in the patient’s body, activated charcoal or laxatives would be given(Manara, et al. 2012). Activated charcoal can absorb excessive drug and laxatives can help in eliminating it out of the body. Further, symptomatic relief of cardiac symptoms would be provided in consultation with doctor.
The patient Neville is 62 yrs old having moderate established chronic obstructive pulmonary disease. The patient came with the complaint of worsened dyspnoea, cough, purulent sputum and excessive breathlessness on little exertion. The symptoms of cold and upper respiratory tract infection improved in two days of admission but his dyspnoea and shortness of breath are were worsening with time initially but now Neville’s condition is stable. The patient is mild hypertensive and usually has tachycardia. He is chronic smoker and still smokes nearly 10 cigarettes per day(Thompson, et al. 2011).
Patient was given high protein, high carbohydrate diet, was kept safe, warm, comfortable, fed, hydrated and rested. He was informed and educated to quit smoking and is trying to do the same.
Patient’s current medications are:
1.Ipratropium bromide via nebuliser
2.Salbutamol via nebuliser
Patient’s current condition is stable and his COPD symptoms of dyspnoea and shortness of breath are under control. The patient is now being transferred to high dependency unit for further recovery where he would be closely monitored and appropriately treated.
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