Chronic Obstructive Pulmonary Disease Argumentative
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Chronic Obstructive Pulmonary Disease (COPD) is an irreversible debilitating disease of the airway that is currently the fourth leading cause of death in the United States and is rising. Chronic obstructive pulmonary disease is treatable but currently there is no known cure and it is a major cause of morbidity and mortality. COPD causes reduction in airflow during the ventilation cycle due to the loss of air way elasticity, narrowing of the airways, chronic airways inflammation and over active mucous production (Frace, 2008). Known risk factors for development of COPD include tobacco use (including second hand smoke), air pollution, dust and exposure to chemicals used in the production of coal, cotton and grain. There are many complications of COPD, the most common are pneumonia, pneumothorax, cor pulmonale, atelectasis, and in severe cases there maybe respiratory insufficiency and failure (Bare, Cheever, Hinkle, & Smeltzer, 2010).
Nursing management for a patient with chronic obstructive pulmonary disease begins with assessment; gathering information from the patient including detailed medical history, present symptoms and evaluate findings of diagnostic tests. Symptoms vary with each patient, but may include chronic cough, clubbing of the fingers, chest tightness, weight loss, cyanosis, difficulty breathing with a higher rate of respirations and difficulty sleeping (Weber, 2008). It is common for patients suffering from difficulty breathing to use their accessory muscles to promote more efficient breathing which in turn causes weakness and fatigue. Patients further along in the disease process often are barrel-chested with kyphosis due to over inflation of the lungs caused by the inability to fully exhale (Bare, Cheever, Hinkle, & Smeltzer, 2010).
In diagnosing a patient with chronic obstructive pulmonary disease many different test are available, including pulmonary function tests, arterial blood gas measurements, chest x-ray, high-resolution computed tomography (CT) chest scan and screening for alpha1-antitrypsin deficiency (Frace, 2008). Spirometry is an example of a pulmonary function test and is used to help confirm the diagnosis of chronic obstructive pulmonary disease, determine the severity of the disease and to monitor the progression of the disease. Arterial blood gas measurements are used to monitor oxygenation levels in the lungs and gas exchange because hypoxia may result from pulmonary secretions and respiratory fatigue. Chest x-rays are typically used to rule out any other conditions that may mimic similar symptoms of chronic obstructive pulmonary disease, particularly asthma which was previously classified as a form of COPD.
Alpha1-antitrypsin protects the lungs from neutrophil elastase enzymes which can disrupt the connective tissue in the lungs, any deficiency in Alpha1-antitrypsin is a known cause of COPD (Bare, Cheever, Hinkle, & Smeltzer, 2010). Common nursing diagnosis for a COPD patient include ineffective airway clearance due to thick mucus secretions, decreased ciliary function, lack of energy, bronchospasms, damage to the alveolar wall and impaired exhalation evidenced by unrelenting cough, wheezing, difficulty breathing with activity and abnormal vital signs. Impaired gas exchange due to increased upper and lower airway resistance, over production of secretions, bronchoconstrictions, increased residual volume and loss of elasticity in lung tissue evidenced by difficulty breathing, abnormal arterial blood gas values, restlessness and confusion.
Risk for infection related to decreased ciliary function, poor nutrition, over active secretions and a impaired pulmonary defense system evidenced by elevated white blood cell count, fever, chills, increased cough and changes in sputum color and odor. Imbalanced nutrition: less than body requirements possibly related to the poor appetite, side effects of medication, fatigue from over use of accessory muscles and difficulty breathing evidenced by loss of weight, decreased muscle tone, distorted taste senses and patient reports disinterest in eating (Doenges, Moorhouse, & Murr, 2007). Planning begins with establishing measurable realistic goals, setting priorities, identifying patient’s wants and needs and select accurate nursing interventions (LeMone, Lillis, Lynn, & Taylor, 2008).
The major goals for COPD patients include achieving airway clearance, improve breathing patterns, increase nutritional intake, improves tolerance during activities, remains free of infection and discomfort and preparing patient for discharge and self-care instructions. The ability to achieve these goals rely not only on the nurse but also heavily on the patients input on their plan of care and willingness to incorporate the needed changes into their life style (Gulanick,&Myers, 2007). Implementing begins when the plan of care developed by the nurse and patient is put into action with goals in sight (LeMone, Lillis, Lynn, & Taylor, 2008). In achieving effective airway clearance the nurse auscultates lungs monitoring for decreased or absent lung sounds, crackles or wheezing as these signs may indicate presences of airway obstruction and resistance.
Assess for any changes in respiratory rate and depth as this could be an early sign of respiratory troubles. Assess the characteristics of secretions as changes in color, consistency and/or odor maybe a sign of infection. Assist in mobilizing secretions, by teaching the patient correct coughing techniques and keeping the patient hydrated so secretions are diluted making them easier to expel. Assessing the patients’ level of consciousness and mood frequently as restlessness is an early sign of hypoxia and if not corrected lethargy and coma may result. Encourage the patient to reduce all irritants especially tobacco smoke which affects the respiratory tracts ciliary cleansing mechanism allowing bacteria and foreign matter to obstruct the air passage way. Interventions for improving breathing patterns include teaching the patient to sit upright which is the optimal breathing position to provide room for better lung expansion and pursed-lip breathing to promote a more controlled, complete and effective exhalation.
Administer prescribed oxygen therapy, monitor oxygen saturation and ABG levels because an increase in PaCO2 and a decrease in PaO2 are early signs of respiratory failure (Gulanick, & Myers, 2007). Interventions to improve nutritional intake include assessing the cause of poor appetite, assessing the patient’s ability to eat and assessing the oral cavity. Often the patient has used all their energy trying to breath which leaves them fatigued and unwilling to eat. Encouraging the patient to eat smaller more frequent nutritionally balanced meals containing soft moistened food will require less energy and lessen the feeling of fullness and discomfort. Interventions to prevent infection include assessing for fever, changes in sputum, increased white blood cell count, chills, nausea, changes in breath sounds, vomiting and shortness of breath as these are all indications of possible infection. Teaching the patient ways to prevent infection include proper hand washing techniques, proper handling and cleaning of breathing equipment, avoiding large crowds, getting sufficient rest and appropriate fluid intake and nutrition (Doenges, Moorhouse, & Murr, 2007).
During evaluation of the outcomes of the selected nursing interventions the patient would be free of excess secretions, have clear lungs sounds, demonstrate effective coughing techniques and express strategies to improve unhealthy life-style actions. The patient will maintain adequate gas exchange, normal arterial blood gas levels, remain alert and orientated, responsive and have no reduction in mental status or level of consciousness. Patients’ nutritional status is maintained with adequate caloric intake, normal serum albumin levels and maintains a stable body weight. Patient will remain free from infection, demonstrates accurate techniques to prevent infection and will seek medical attention early if any changes in health status relating to signs and symptoms of infection occur (Doenges, Moorhouse, & Murr, 2007).
Bare, B., Cheever, K., Hinkle, J., & Smeltzer, S. (2010). Textbook of medical-surgical nursing (12th ed.). Philadelphia, PA: Lippincott Williams & Wilkins. Doenges, M., Moorhouse, M., & Murr, A. (2007). Nurse’s pocket guide: Diagnoses, prioritized interventions, rationales (11th ed.) Philadelphia, PA: F.A. Davis Company Frace, M. (2008, July). Understanding Chronic Obstructive Pulmonary Disease. Med – Surg Matters, 17(4), 8-10. Retrieved April 2, 2010, from ProQuest Nursing & Allied Health Source. (Document ID: 1629171571). http://proquest.umi.com/pqdweb?did=1629171571&sid=10&Fmt=3&clientId=83181&RQT=309&VName=PQD Gulanick, M., & Myers, J. (2007). Nursing care plans: Nursing diagnosis and intervention (6th ed.). St. Louis, MO: Mosby & Elsevier LeMone, P., Lillis, C., Lynn, P., & Taylor, C. (2008). Fundamentals of nursing: The art and science of nursing care (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins Weber, J. (2008) Nurses’ handbook of health assessment (6th ed.). Philadelphia, PA: Lippincott Williams & Wilkins