Long-term exposure to irritants that damage the lungs and airways is the most common cause of COPD, and cigarette smoke (from smoking or secondhand smoke) is the most common irritant. Salbutamol is bronchodilator (Haslett, Chilver, Boon & College, 2002). This oxygen therapy is aimed to reduce a cyanosis, pulmonary hypertension, cerebral hypoxia, hypotension and tachycardia. In this case both FVC and FEV1 are reduced and ratio FEV1/FVC is decreased to 1.1 L / 3.0 L (Costanzo, 2007). As a cause of death in the United States, COPD ranks: A. Cardiovascular system and other body system examination, There is right ventricular heave, ankle oedema, raised JVP and increased diastolic blood, pressure (90mmHg) showing right ventricular failure called cor- pulmonale (Sam, Baker &. Impaired Gas Excha… There are two major life-threatening complications of COPD: respiratory insufficiency and failure. B. Parenchyma. Healthcare providers perform medical management by considering the assessment data first and matching the appropriate intervention to the existing manifestation. Option C: Pneumonia and pleurisy are not classified under the COPD. Since we started in 2010, Nurseslabs has become one of the most trusted nursing sites helping thousands of aspiring nurses achieve their goals. Chronic obstructive pulmonary disease (COPD) is a common respiratory condition, affecting 4.5% of people over the age of 40 in the UK. *You can also browse our support articles here >. The ambulance crew arrives at the site safely. An additional 2 million may have COPD but remain undiagnosed. Optimization of bronchodilator medications is. Documentation is an essential part of the patient’s chart because the interventions and medications given and done are reflected on this part. Disease process/prognosis and therapeutic regimen understood. Identifies the hazards of cigarette smoking. This updated definition is a broad description of COPD and its signs and symptoms. The patient has a chronic productive cough with dyspnea on excretion. The purpose of the assessment is twofold: first, to recognize changes in the patient’s pulmonary status that necessitate nursing or medical intervention, and second, to determine the ways in which the … The chronic inflammatory process affects the pulmonary vasculature and causes thickening of the vessel lining and hypertrophy of smooth muscle. When taking care of a patient with COPD it is very important the nurse knows how to recognize the typical signs and symptoms seen in this condition, how it is diagnosed, nursing interventions, and patient … Nothing in the environment appears harmful for the patient or ambulance staff. Initial symptoms are dyspnoea, (progressive in nature) but cough and wheezing may also be the first. Bronchodilators such as β2 — adrenoceptor agonist ( Salbutamol ) inhaler used as two inhalations four times a day and anticholernegic ( ipratropium bromide) inhaler as two inhalations four times a day relieve bronchspasm and give symptomatic relief. Performs activities with less shortness of breath. Option C: The pulmonary vasculature is affected by inflammation in COPD. He introduces himself and carries staff to the patient. The nurse must appropriately administer bronchodilators and corticosteroids and become alert for potential side effects. Nursing assessment should include the following. Recently, sever… After patient achieves good motivation, nicotine replacement therapy will be started that included Bupropion 150mg once daily for 6 days then doubling it to 150mg bid for seven weeks. The patient is living alone, unable to cope at home and confused. Total lung capacity (TLC), functional residual capacity (FRC), and residual volume (RV): May be increased, indicating air-trapping. Document conditions that interfere with oxygen supply. The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease ... To view a Sample COPD Assessment Form click here. The underlying pathophysiology of COPD is: Characterized by variations in all of the above. The patient is eighty four years old elderly black male of average built sitting forward in hunched-over position on bed and breathing through pursed lips. He checked capillary refill by pressing finger nails of the patient and found it normal <2 sec. The respiratory rate is 33 per minute and bilateral chest movements are reduced. Therapeutic Communication Techniques Quiz. Nursing Best Practice Guidelines. Stopping smoking slows down average rate of decline in FV1 from 50-70ml/ year to 30ml/year that is equal to non-smokers (Warrell, Cox & Firth, 2005). The medication is prescription only and the patient been taking it since three years. C. Pneumonia and pleurisy. Take this WebMD assessment to find out what you can do to manage and slow the progression of your COPD and get tips to help you live better. Assess patient’s exposure to risk factors. 3. Due to the chronic inflammation, changes and narrowing occur in the airways. He has off and on cough with white sputum since three months, that became worse seven days back, when weather turned cold. C. Fourth. The ambulance crew quickly examines patient for any injury. Chronic bronchitis is a disease of the airways and is defined as the presence of. Blue bloaters (primarily having chronic bronchitis) have severe hypoxia with cyanosis and have hypercapnia. Inflammation, hypersecretion of mucus, and alveolar wall destruction are included in the pathophysiology of COPD. Prevent complications, slow progression of condition. The patient has certain Presenting complaints (PC).These include worsening cough with sputum since seven days, breathlessness on Exertion since four days, Wheezing since four days, generalised weakness since two days, temperature since two days and breathlessness at rest since six hours. Then crew then exposes patient from head to toe examination. Ask your patient specific questions to obtain a detailed … Option C: Infectious agents are part of the risk factors for emphysema but it is not the main factor. An inflammatory response occurs throughout the proximal and peripheral airways, lung parenchyma, and pulmonary vasculature. COPD also account for the death of 125, 000 Americans every year. VAT Registration No: 842417633. The most important environmental risk factor in emphysema is: Cigarette smoking is the foremost factor in the development of emphysema. Nothing in the environment appears harmful for the patient or ambulanc… Option C: Infectious agents are part of the risk factors for emphysema but it is not the main factor. Pupils equal in size in both eyes with normal reaction to light (Warrell, Cox & Firth, 2005). Some laboratory signs for this patient include Glasgow Coma Score; level of consciousness is 14/15, with patient little confused. According to protease-antiprotease and oxidant-antioxidant theories heavy smoking results in imbalance between these enzymes result in damages to lung parenchyma and alveolar wall (Kumar, Abbas & Fausto, 2005). The ambulance crew behaved quite professionally with few exceptions. He was diagnosed with COPD and chest infection each time. Most patients with COPD receive outpatient treatment, the nurseshould develop a teaching plan to help them comply with the therapy and understand the nature of this chronic disease. In the nursing history,Mr.Harris notes that she denies ever smoking,but says that her husband and two sons have … Suzan Miller-Hoover DNP, RN, CCNS, CCRN-K. Having a thorough knowledge of the upper and lower pulmonary structures, bronchial/systemic circulation, and gas exchange at the level of the lungs and tissue cells will make analyzing the assessment findings more meaningful. He quickly percusses and auscultates chest and finds it hyper-resonant all over. The nurse caring for the patient with COPD must assess for var-ious complications, such as life-threatening respiratory insuffi-ciency and failure and respiratory infection and atelectasis, which … A comprehensive respiratory assessment includes gathering a medical history that may impact or explain physical assessment findings. There are two main types of emphysema: panlobular and centrilobular. Pollutants or allergens irritate the airways and leads to the production of sputum by the mucus-secreting glands and goblet cells. Registered Data Controller No: Z1821391. No time limit for this exam. Random Blood Glucose level was 120mg/ dl. Nurseslabs – NCLEX Practice Questions, Nursing Study Guides, and Care Plans, Chronic Obstructive Pulmonary Disease (COPD), 5 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans, Nursing Test Bank and Nursing Practice Questions for Free, NCLEX Practice Questions Test Bank (2021 Update), Nursing Pharmacology Practice Questions & Test Bank for NCLEX (500+ Questions), Arterial Blood Gas Analysis Made Easy with Tic-Tac-Toe Method, Select All That Apply NCLEX Practice Questions and Tips (100 Items), IV Flow Rate Calculation NCLEX Reviewer & Practice Questions (60 Items), EKG Interpretation & Heart Arrhythmias Cheat Sheet. On percussion, chest is hyper resonant and dullness over liver and cardiac area is reduced. Pulmonary function studies. Assess the patient’s past and present medical history. The abnormal inflammatory response in the lungs occurs primarily in the: A. Airways. Copyright © 2003 - 2021 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. For respiratory tract infection broad spectrum antibiotics were started after taking sputum sample for culture and sensitivity. These two types of COPD can be sometimes confusing because there are patients who have overlapping signs and symptoms of these two distinct disease processes. People with emphysema are also called “pink puffers”. There is no injury or deformity but ankle oedema is present and patient is using accessory muscles of respiration. Also, this page requires javascript. 1. They are wearing personal protective equipment including safety boots, high visible clothing and vest and a portable two-way radio is in the hand of one of the staff. You have not finished your quiz. Identifies resources for smoking cessation. Nurse Salary 2020: How Much Do Registered Nurses Make? temperature and blood pressure(Warrell, Cox & Firth, 2005). Smoking depresses the activity of scavenger cells and affects the respiratory tract’s ciliary cleansing mechanism. COPD Nursing Care Plans Chronic obstructive pulmonary disease (COPD) involves the inflammation of the lungs, resulting to the obstruction of airflow through the airways. D. Fifth. Occupational exposures often are overlooked and underdiagnosed. The most important environmental risk factor in emphysema is: A. D. Areas identified in all of the above. 2. The neighbor once or twice a week visits him and gives him some company. Nursing Management Nursing Assessment. Mr. Cruz, a lawyer, smokes three packs of cigarette every day for the past 20 years. Current complaint is a direct result exacerbation of previously existing COPD (Longmore, Wilkinson & Rajagopalan, 2007). Option C: The pulmonary vasculature is affected by inflammation in COPD. In Exam Mode: All questions are shown but the results, answers, and rationales (if any) will only be given after you’ve finished the quiz. The radial pulse rate is 100 per minute, regular but bounding; blood pressure 125/90. As a cause of death in the United States, COPD ranks: Two diseases common to the etiology of COPD are: Chronic bronchitis and emphysema belong to the old classification of COPD. Chronic bronchitis and emphysema. In this case Peak expiratory flow FEV1 is 40% of predicting obstructive lung disease thus can be classified as moderate at this stage. Patient used to do light house-hold work, but since last two days he is unable to do that due to weakness. If this activity does not load, try refreshing your browser. Chronic Obstructive Pulmonary Disease has been defined by The Global Initiative for Chronic Obstructive Lung Disease as “a. Ambulance crew decide to transport the patient to the hospital for in-hospital treatment. Unmanaged COPD can lead to death due to respiratory acidosis, coma, right sided heart failure and massive collapse of lungs due to pneumothorax (Kumar, Abbas & Fausto, 2005). If you leave this page, your progress will be lost. Option B: The lung parenchyma undergoes an inflammatory response in COPD. 1. Be sure to grab a pen and paper to write down your answers. All questions are given in a single page and correct answers, rationales or explanations (if any) are immediately shown after you have selected an answer. Asthma and atelectasis. Blood pressure is 125/90, diastolic blood pressure slightly high. A further focused history and physical examination is required to identify injury or disease that has not been identified during the primary survey. Option B: The lung parenchyma undergoes an inflammatory response in COPD. Shape and movements of chest are symmetrical; no flail segment and no injury present. Management of patients with COPD should be incorporated with teaching and improving the respiratory status of the patient. COPD risk increases when those e… Respiration rate is 33/minute, deep with forced expiration. The nurse should obtain a thorough health history from patients with known or potential COPD. This project is based on the nursing care provided to a patient with Chronic Obstructive Pulmonary Disease (COPD), with specific focus on holistic assessment and identification of patient care needs. The Past medical history, given by the patient provides information that he was hospitalised five time in the past during winter season ( 2001, 2003, 2005, 2008,2009) for breathlessness and respiratory infection. His wife died in a car accident ten years back. Answer: D. Characterized by variations in all of the above. Assess the patient’s knowledge of the disease. Discipline and consistency are the keys to achieving freedom from chronic pulmonary diseases. Two diseases common to the etiology of COPD are: A. The medication was working up to some extent till ten days back when current symptoms started. Option A: Asthma may be one of the chronic pulmonary diseases but atelectasis is not. 2. The patient gives history of medication prescribed by local general practitioner. Do you have a 2:1 degree or higher in nursing or healthcare? Any items you have not completed will be marked incorrect. B. Free resources to assist you with your nursing studies! Document client’s responses to treatment, teaching, and actions performed. But this is my first experience and I think I need to have more experiences similar to or different from this experience to learn more about dealing with different kind of patients and different situations. SpO2 i.e. I think more refresher courses need to be held to teach professional behavior in crew and build their academic knowledge. Medical History In this case study patient is an eighty four year old man with COPD who has got respiratory tract infection and his disease has become severe. Option A: Air pollution is a risk factor in the development of emphysema but it is not the primary factor. Nursing Essay Raised JVP and oedema of lower legs show right heart failure thus a thiazide diuretic Chlorthalidone 25 mg once daily, which is minimum daily dose, is started as initial therapy. The general condition of patient is poor, his disease is getting worse and he is confined to bed. Next he examines patient’s breathing. The illustration below … Nasal connulae is preferred in this patient so that he can expectorate and eat or drink. Management of patients ith COPD takes a more reactive approach than a curative approach. 2. Thank you. Company Registration No: 4964706. Patients with COPD also have options for surgery to improve their condition. There is sputum production and he experiences difficulty of breathing whenever he performs his daily activities. Option B: Allergens may contribute to the development of emphysema but it is not the main factor. Spirometry. With spirometry the disease is mild when FEV1 was 60-79%, moderate when FEV1 40-59% and severe when FEV1 is lesser than 40%. Inhaled corticosteroids are also often prescribed to reduce airway inflammation. COPD is commonly misdiagnosed — former smokers may sometimes be told they have COPD, when in reality they may have simple deconditioning or another less common lung condition. His wife died in a car accident. 3. Option B: Allergens may contribute to the development of emphysema but it is not the main factor. This is a preliminary assessment of the patient. Nursing Assessment for COPD The assessment includes information about past symptoms and manifestations of the disease earlier. He examines pupils of both eyes and find normal in size and reaction to light. There are no fractures or wounds in extremities. Patient is a heavy smoker, smoking one pack of twenty cigarettes a day. Nurseslabs.com is an education and nursing lifestyle website geared towards helping student nurses and registered nurses with knowledge for the progression and empowerment of their nursing careers. The aim is to maintain PaO2 level of 7 kPa or more to reduce hypoxaemia and hypercapnia. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. Ambulance has been called and ambulance crew has to reach the scene, conduct primary survey, secondary survey, manage the case and shift it to hospital if appropriate. There are two classifications of COPD: chronic bronchitis and emphysema. The nurse is completing a home visit for a client diagnosed with chronic obstructive pulmonary disease (COPD). C2.2 Physical examination The sensitivity of physical examination for detecting mild to moderate COPD is poor (Badgett 1993). COPD is the fourth leading cause of death in the United States. This site shares best practices on guidance of COPD device selection, symptom assessment, patient education and counseling, and related materials for various stages of care. This has also occurred last year wherein his cough lasted for almost three months. Chronic bronchitis and emphysema belong to the old classification of COPD. COPD is characterized by a persistent limitation of airflow that is usually progressive and associated with an enhanced chronic inflammatory response in the airways and the lungs to noxious particles or gases (GOLD, 2014). © 2021 Nurseslabs | Ut in Omnibus Glorificetur Deus! D. Characterized by variations in all of the above. Holistic nursing assessment has a key role in identifying anxiety and depression, and there is evidence to support the role of nurses in delivering a cognitive behavioural therapy approach to help patients with COPD … 3. The older adult has a long history that may include smoking or exposure to secondhand smoke, environmental exposures to asbestos or other pollutants, and illnesses such as chronic obstructive pulmonary … Text Mode: All questions and answers are given on a single page for reading and answering at your own pace. Obtain … The patient is eighty four years old elderly black male of average built sitting forward in hunched-over position on bed and breathing through pursed lips. To export a reference to this article please select a referencing stye below: If you are the original writer of this essay and no longer wish to have your work published on the UKDiss.com website then please: Our academic writing and marking services can help you! Secure the side rails of the... 2. Then he assesses if patient has any disability and finds no disability. Pre-alert was sent to the hospital that an elderly patient with acute on chronic type II respiratory failure is on the way to hospital. B. Arterial blood gases show a low oxygen level and high carbon dioxide level in the blood. Main article: 5 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans. Chronic bronchitis and emphysema. Mortality for COPD has been increasing ever since while other diseases have decreasing mortalities. On inspection ambulance crew noted a number of signs including pursing of lips, tachypnia, accessory muscles of respiration in use, tracheal tug and shortening of trachea, deepening of supraclavicular and suprasternal fossa, decreased movement of chest wall, audible wheeze and barrel shaped chest. In obstructive lung disease, the RV will make up the greater portion of the TLC. Nutritional intake meeting caloric needs. Diagnosis of COPD would mainly depend on the assessment data gathered by the healthcare team members. Document plan of care and specific interventions. Oxygen saturation levels is found 88% (Normal=95%) ECG shows tachycardia, P- pulmonale and Right axis deviation (right ventricular failure). Both of the crew wear latex gloves because they themselves do not have any latex allergy and proceeded calmly and confidently to conduct primary survey of the patient. View professional sample essays here. The ambulance crew has considered a number of psychosocial and disease factors. Ventilation/oxygenation adequate to meet self-care needs. C. Pulmonary vasculature. Option C: Alveolar wall destruction leads to loss of alveolar attachments and a decrease in elastic recoil. On auscultation breath sounds are reduced and rhonchi are present in the chest. Pulmonary Emphysema is a pathologic term that describes an. Marianne is also a mom of a toddler going through the terrible twos and her free time is spent on reading books! We've received widespread press coverage since 2003, Your NursingAnswers.net purchase is secure and we're rated 4.4/5 on reviews.co.uk. Document attainment or progress towardsgoals. 4. Allergens. The amount of sputum is increasing day by day. He gives patient oxygen through nasal cannulae to decrease cyanosis. All these signs are due to increased air-trapping in the lungs, narrowing of bronchi and use of accessory muscles of respiration (Talley & Connor, 2006). Several questionnaires exist for the assessment of both symptoms and quality of life in COPD patients, namely the modified Medical Research Council (mMRC), the Clinical COPD Questionnaire (CCQ), the COPD Assessment … tion of COPD. Nursing care planning for patients with COPD involves the introduction of a treatment regimen to relieve symptoms and prevent complications. The annual cost of COPD is approximately $42.6 billion with overall healthcare expenditures of $26.7 billion. Temperature on Tympanic temperature 100.5 F. Capillary refill in <2 seconds shows normal tissue perfusion. Many cases of COPD are the result of prolonged smoking, and as a result, smoking cessation pathways are usually required. In this essay this process is described. The medicine patient is using is Salbutamol inhaler taking two puffs three times a day. Sensory and motor functions are normal. The crew gets consent from the patient and approaches patient for quick Primary Survey. Inflammation, hypersecretion of mucus, and alveolar wall destruction are included in the pathophysiology of COPD. Chronic Disease. He used to prepare food for himself but buying from a take away shop since last three day as he does not feel good to prepare it at home. Marianne is a staff nurse during the day and a Nurseslabs writer at night. Assess the signs and symptoms of COPD and their severity. The sputum has gradually become purulent. Both have overlapping features with damage at acinar level (emphysema) and bronchial level (bronchitis) and most commonly occur in smokers. There is no evidence of haemorrhage. The crew use sucker and clear secretions to ensure patency of airway. Practice Mode: This is an interactive version of the Text Mode. The airways, parenchyma, and pulmonary vasculature undergo inflammation in COPD. Reference this. Patients who have a respiratory complaint may have a history of respiratory conditions. Appropriate assessment of patients with COPD … The patient is alert and responds to verbal stimulus. He is a pensioner and poor man. On examination of abdomen and pelvis no wounds or painful areas found. Chronic obstructive pulmonary disease (COPD) is a widespread disorder among middle- and older-aged individuals, is continuing, and is not fully reversible (Global Initiative for Chronic Obstructive Lung Disease [GOLD], 2014). Prevention of COPD is never impossible. Chlorthalidone dose may be increased if oedema is not relieved Physiotherapy of chest help expectorate and clear bronchial recreations (Haslett, Chilver, Boon & College, 2002). Option C: Alveolar wall destruction leads to loss of alveolar attachments and a decrease in elastic recoil. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! Clinical manifestations appear when one third of lung parenchyma is already damaged. Option B: Hypersecretion occurs due to the increase in the number of goblet cells. Now on his late fifties, he started to notice that his cough has been going on for more than three months. There is no injury. Study for free with our range of nursing lectures! Here are seven (7) nursing care plans (NCP) and nursing diagnosis (NDx) for Chronic Obstructive Pulmonary Disease (COPD): 1. ASSESSMENT Jeff Harris, RN, admits Mrs. Mercurio to the medical unit. It within the expiratory date and has been taken correctly. On assessment… Low dose steroid inhaler (Beclomethasone Dipropionate inhaler) two inhalations three times a day act as an anti inflammatory agent to reduce bronchial inflammation thus reducing symptoms. Answer: D. Areas identified in all of the above. PO2 =6.6 KPa. COPD is responsible for nearly 30,000 deaths a year or around 5.3% of all UK deaths; in Europe, t… I have also learned how to conduct primary survey in two minutes and then detailed secondary survey and plan to manage the case. Air pollution. He did not park their ambulance very correctly and left little space for other cars. Approximately 12 million Americans live with a diagnosis of COPD. Once you are finished, click the button below. Option D: Tuberculosis and pleural effusion are not chronic pulmonary diseases. He is eighty four years old male migrant from Jamaica living alone in a two bed room flat with no one looking after him. The nurse understands that which of the following environmental factors … 1. 5. 4. The social history of patient is important. C. Infectious agents. She is a registered nurse since 2015 and is currently working in a regional tertiary hospital and is finishing her Master's in Nursing this June. As an outpatient department nurse, she is a seasoned nurse in providing health teachings to her patients making her also an excellent study guide writer for student nurses. There was no pet in the house. His history of these presenting complaints spans to last three months. Emphysema and chronic bronchitis are clinically grouped together and called chronic obstructive pulmonary disease (COPD). When taking history of the patient they asked some leading questions from the patient. Other irritants include particles from fires used in the home for cooking or heating and workplace exposure to chemical fumes, dust, and particles. Breathlessness on exertion started four days back that gradually increased and he developed breathlessness at rest 6 hours back. Amoxicilline 250 mg 8-hourly for seven days was given as patient is not sensitive to penicillin. C. Alveolar wall destruction. Ineffective Airway Clearance 2. Option A: The airways are inflamed in COPD. Here are some guidance questions to obtain data on the health … Health history. There is an increase in the number of goblet cells and enlarged submucosal glands leading to hypersecretion of mucus. They were also talking with each other during history taking and physical examination. Disclaimer: This essay has been written by a student and not our expert nursing writers. The room is well lit but untidy. Safety and Comfort Option B: Hypersecretion occurs due to the increase in the number of goblet cells. 2. Acute respiratory tract infection makes situation worse and signs and symptoms of infection with hypoxia and hypercapnea and right heart failure (at latter stage of COPD) become apparent and patient need urgent treatment (Talley & Connor, 2006). Our ultimate goal is to help address the nursing shortage by inspiring aspiring nurses that a career in nursing is an excellent choice, guiding students to become RNs, and for the working nurse – helping them achieve success in their careers! Appear with minor overdose Rajagopalan, 2007 ) of no significant disease in his parents two! Click the button below arterial blood gases show a low oxygen level and high carbon dioxide oxygen! A toddler going through the terrible twos and her free time is spent on reading!! Very correctly and left little space for other cars of bronchitis crew has a! Nurse must appropriately administer bronchodilators and corticosteroids and become alert for potential side effects history... 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