The aspect to be regarded is the patient, who is a 62-year-old white male with shortness of breath and feeling that getting dressed and climbing a floor is difficult. Additionally, productive coughing ensues with pain in the chest; such a factor severely limited his activities over 3-4 days prior to the day of examination. The patient was admitted to the hospital one year ago with something similar to the symptoms now presented. Previously, he was diagnosed with chronic obstructive pulmonary disease (COPD) – chronic bronchitis. He suffered from the smoking habit of 30 pack-years, which he developed while working in the mining industry for much of his life.
Nevertheless, I was out of this job five years ago. On the other hand, he moves on with his chain-smoking habit. This study might be a source of COPD worsening, with the complication of the patient’s smoking history and former exposure to the workplace. Besides, follow-up assessment is irreplaceable in terms of his current lung function, and reviewing chest X-rays and plan of appropriate COPD treatments as well as the smoking cessation is critical.
As a nurse, the maintenance of an alveolar permeability is an essential step in taking care of my COPD patients. The basics of healthcare are the medical history of a patient who is supposed to take the medication and to confirm the correct treatment. Under these conditions, the top priority will be to start oxygen therapy to boost oxygenation and to also reduce the load on the heart and lungs. Helping illness patients’ self-care is crucial. Explain the effects of their illness and the quality of life that might result from a lifestyle that prevents symptoms and disease progression. Patients can be inspired to fight for their lives by learning about smoking cessation, inhaler strategies, regular functioning, exercise, and healthy eating (Hill Bailey et al., 2013). Working with the healthcare team to create a tailored care plan can improve health and life outcomes.
Pathophysiology
A person experiencing occupational COPD like him has been subjected to hazardous factors twice: the chronic smoking of cigarettes and the dust particles generated from his job, which cause an inflammation of his mucus-producing cells known as goblet cells. Being with bronchial cells, their discharge of mucus in the airways in excess quantity is the factor that plays its role in the disturbance of the mucociliary function of the airways. Hence, too much mucus forms in the small airways, which in turn obstructs the passageways and hinders away-clearing out. The excess mucus suffering from cough and dyspnea that further causes airway obstruction is one of the main symptoms of the patient. A productive cough is a symptom of the body trying to get rid of mucus from the routes that give air to our lungs. However, then the faulty mucus and the mucus ciliary failure make it difficult to clear the mucus completely, thereby leading to further obstruction and worsening of the symptoms (Widysanto & Mathew, 2022). This process shows COPD characteristics; non-stopping irritant exposure causes inflammation, mucus production, and airway obstruction, ending in airflow limitation and symptom manifestation of respiration.
History
The medical history of the patient uncovers, among others, a number of comorbidities and drugs, which are important factors to be considered in improving COPD. His medical past, which includes hypertension in stage 1, where his medication is Hydrochlorothiazide, points to the need for regular monitoring of blood pressure since some of the medications for COPD react with drugs used to treat high pressure (Fu et al., 2020). Furthermore, his past supraventricular tachycardia and the Ivabradine enrollment require controlled monitoring of his heart rate, as there is a possibility that some COPD drugs can affect the working heart.
To top it all, the patient’s obesity, which is presented by a BMI of 41.6, is the major issue in COPD management. Obesity may lead to difficulty breathing and invite worsening conditions and complications. Hence, he will have to focus on dietary changes and physical activity along with weight management in order to improve the general condition and control COPD in the long run. Frequent oversight and collaboration with physicians caring for him are absolute prerequisites to updating the treatment plan every time new issues emerge and to ward off any eventual clashes or complications (Hill Bailey et al., 2013). This teamwork methodology will, in the long term, give them a quality and high-level lifestyle and avoid possible exacerbations and complications due to COPD.
Nursing Physical Assessment
The patient is conscious and oriented in time and place, with a fair condition but obstructed in the respiratory function by shortness of breath described as “eating air.” His physique is endomorphic, as indicated by a BMI of 41.6. The patient has central cyanosis, indicative of insufficient oxygenation to the tissues, which is exactly what the apparatus reveals in the oxygen concentration level, which is affirmed to be 85%. Therefore, on admission, the patient’s blood pressure level was 123/86mmHg, his pulse rate was 128 beats per minute, and his respiratory rate was 25 breaths per minute with respiratory depth diminished. His temperature was 37.1°C. Chest X-ray examination found greater than 200 cm of chest circumference with a 110°-degree angle (180°). Auscultation audios took out evidence of wheezing, decreased whispering pals, and rales. These results show that severe airway obstruction and lung degradation, which reflect the process of pulmonary phlogosis (COPD), are present.
Related Treatments
According to Aclidinium bromide performance characteristics, it is a long-acting muscarinic antagonist (LAMA) that acts as an effective agent in the treatment of chronic obstructive pulmonary disease. The drug works on antagonizing the muscarinic receptors, in particular those of the M3 subtype, which account for most of the physiopathology of COPD. M3 receptors predominantly are in the smooth muscles in the airways and provoke bronchus, constricting mucus secretion and vasodilatation reflex. COPD involves a condition where long-standing exposure to irritants, especially cigarette smoke, triggers inflammation and structural changes in airways (Hill Bailey et al., 2013). The blocking of the airways that leads to the production of increased mucus, further narrowing of the airways, and reduced airflow becomes evident. With M3 receptor inhibition, Aclidinium bromide improves bronchial tone, which helps relieve symptoms, relax airways, and enhance the flow of air.
Aclidinium bromate has seen a huge increase in its demand among COPD patients since it is efficient in treating both shortness of breath and wheezing. Aclidinium bromide is crucial for facilitating proper airflow and easing respiratory difficulties, which, in turn, leads to better health. Successful intrapulmonary deposition of Aclidinium is the very reason for the studied inhaler technique, as it outlines the notions of the right way for drug delivery to the lung area. Patients should get an adequate dose of medication when using the inhaler correctly. Thus, a sufficient supply of the machine is needed, just like any other medical tool. Compliance with the suggested program is another critical factor for aclidinium bromide treatment to ensure the best effect (Fu et al., 2020). The patients need to follow the instructions made by healthcare providers to have bronchodilation of the airway and control the symptoms. Generally, Aclidinium bromide is crucial in convalescing the patient’s health from COPD. In this way, it facilitates air exchange and decreases failures and breathing difficulties, which generally serve to improve the patient’s standard of living.
Nursing Diagnosis & Patient Goal
The essence of nursing is to definitely talk about ineffective airway clearance, which can be evidenced through his symptoms of dyspnea, productive cough, and lower respiratory amplitude. For diseases such as inactivity, the patient has problems conducting daily tasks and insufficient knowledge of the seriousness of the disease and its impact; it is clear that the patient did not stop smoking after getting the disease and should be well cared for. The aim of nursing for me was to increase the case of oxygen passing through the airways so as to bring his blood oxygen level to 88-96 percent (O’Driscoll, 2008). As a way of achieving this, I will make sure the patients are placed in the correct position to help with breathing, encourage the patients to practice effective coughing techniques and use dictated bronchodilators to enhance the combined airway clearance effect.
Recognizing an activity intolerance, identify the patient’s specific physical activity goals and instruct in energy conservation through knowledge education. However, I will additionally advocate for the adaptation and application of assistive tools or activity modifications that help the patients preserve their independence. Above all, dealing with the patient’s inadequate information concerning COPD would be giving an education to the patient about the disease process, as well as the importance of stopping smoking, proper medication usage, and pulmonary rehabilitation benefits (O’Driscoll, 2008). However, through the patient-centered approach that involves the patient in self-management strategies and motivates lifestyle modifications, he will be in control of his health and experience the best quality of life possible.
Nursing Interventions
In order to conquer the ineffective clearance of a patient’s airway, nursing services may include airway suction to remove the accumulation of mucus and, in addition to it, an improvement in oxygen therapy. By rolling the patient and splitting his back while hitting, we will stir up the mucus. Psychological assistance is needed, which enables the patient to exercise coughing, get rid of mucus instead of residuals, and perform posture drainage. Delivering the medications as prescribed, including bronchodilators, expectorators, and antibiotics, also becomes necessary (Fu et al., 2020). What is more, maintaining a good intake of fluid can also clear mucus by providing the body with enough liquid for it to loosen. Investing in the training of nurses with a thorough understanding of the need to quit smoking and reduce exposure to harmful agents should be stressed. Being in a team and with the health doctors, it is important to monitor the patient’s progress continuously and also make a change in the health care plan when needed. This is a prerequisite for effective management of COPD and airway clearance, targeting maximum recovery.
By and large, self-control is an indispensable need in the management of COPD, and a fair outcome could be achieved if the recommendations given were implemented after hospital discharge. (Benzo & McEvoy, 2019) It will also shed light on the patient’s level of knowledge of his disease; hence, they are able to give relevant and targeted education and help. As the patient must continue smoking, he should be informed of the programs and resources that are helpful in quitting this bad habit. Smoking cessation should be an essential step in the patient slowing down his COPD progression. Sending the patient home with the wrong procedure could trigger an asthma attack, so as a nurse, educating the patient on the correct inhalation techniques for their prescribed medications is vital. Educating and instructing the patient appropriately and offering written copies or videos of the instruction materials for practice in between visits can help ensure that the patient effectively manages his condition after leaving the clinic (Bourbeau et al., 2004). Regular follow-up and monitoring of the patients’ achievements are key points as they could deal with the challenges such as concerns and, as a result, support the self-management effort.
Evaluation
Having done the nursing interventions that reduced exposure to smoke and made sure the patient had no exposure to smoke when he/she was still in the hospital, I saw the patient’s condition improving. The blood oxygen level was 89%, and he was breathing easily, obviously meaning successful oxygenation. According to the patient, the outcomes had been the best that could be wished for. He was able to reduce the symptoms significantly and go about his daily life, such as moving about the house, going to the bathroom, and dressing without much difficulty as opposed to before.
Hence, his coughing and chest pain declined while the latter abated because of chronic coughing. This assigns a success to the care methods that aimed to aid airway draining. In addition, the patient was finally using his inhaler correctly, which necessarily means that he had properly been taught and exercised the correct inhalation technique (Benzo & McEvoy, 2019). Consequently, the positive outcomes indicate the great success of the nurses’ interventions in the management of his airway, oxygenation, and the control of COPD symptoms. Continuous support, as well as further education, should be provided after discharge for the patient to improve and effectively manage the condition.
Recommendations
Two main objectives need to be achieved if it is possible to keep avoiding COPD relapse after hospitalization, and the prescribed medication is a way to do that. The patient needs to prevent exposure to smoke. This means a total abandonment of smoking and staying away from passive smoking. Participating in the smoking cessation programs advocated by health care professionals has the potential of literally turning around the patient’s respiratory health; hence the effect is felt up to its progression. Regular medication when it has been recommended is vital as well. The patient takes his meds in a way the doctor prescribes and follows the instructions correctly, meaning the right amount of time. Attending the regular health provider meeting is essential to dose the efficiency of the medication and, if necessary, to make any changes.
The patient’s regimen can be improved further if he exercises regularly. Exercise can help improve breathability, enlarge respiratory muscles, and boost general strength, which will contribute to attacking symptoms and improving the quality of life for COPD patients. Proper feeding is also equally emphasized as it can aid the patient in keeping the desired weight and deliver vital nutrients for total innate health. Also, having your weight in check plays a huge role in the health of your COPD. A weight loss plan should be provided for a patient with a predisposition for this type of disease and a BMI exceeding limits. A nutritious diet and a well-balanced one can help his BMI level as well as enhance his health condition and overall well-being. This guidance and support for an individual’s adherence, education at every step, and continuous encouragement are the ones that can largely contribute to the quality of life and overall well-being in a long-term perspective. Alongside other healthcare professionals, such as dietitians and respiratory therapists, can be crucial in furnishing patients with a comprehensive COPD cart. (Bourbeau et al. 2004).
References
Benzo, R., & McEvoy, C. (2019). Effect of health coaching delivered by a respiratory therapist or nurse on self-management abilities in severe COPD: analysis of a large randomized study. Respiratory care, 64(9), 1065-1072. https://doi.org/10.4187/respcare.05927
Bourbeau, J., Nault, D., & Dang-Tan, T. (2004). Self-management and behavior modification in COPD. Patient Education and Counseling, 52(3), 271–277. https://doi.org/10.1016/s0738-3991(03)00102-2
Fu, Z., Lin, Y., Liu, Z., Yu, Y., Tang, Q., Yang, Z., & Li, L. (2020). The effect of airway suction nursing care for COPD patients with airway mucus hypersecretion. Int J Clin Exp Med, 13(11), 8627–8635. https://e-century.us/files/ijcem/13/11/ijcem0117388.pdf
Hill Bailey, P., McMillan Boyles, C., Duff Cloutier, J., Bartlett, A., Goodridge, D., Manji, M., & Dusek, B. (2013). Best practice in nursing care of dyspnea: The 6th vital sign in individuals with COPD. Journal of Nursing Education and Practice, 3(1). https://doi.org/10.5430/jnep.v3n1p108
O’Driscoll, R. (2008). Overdose on Oxygen? Psnet.ahrq.gov. https://psnet.ahrq.gov/web-mm/overdose-oxygen#:~:text=For%20most%20COPD%20patients%2C%20a
Pisano, M., & Mazzola, N. (2013). Aclidinium Bromide Inhalation Powder (Tudorza). Pharmacy and Therapeutics, 38(7), 393–396. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3776488/
Widysanto, A., & Mathew, G. (2022, November 28). Chronic Bronchitis. PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK482437/#:~:text=Chronic%20bronchitis%20is%20a%20type
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