Adult with Chronic Obstructive Pulmonary Disease (COPD)
Dear writer, Please use Please use Australian current journals, books, etc One page list of problems and interventions (referenced) included Rest of the inform for this essay is on the upload inform. Thank you.
Assessment Details
Assessment 2: Case study Essay
For this assessment you can select either Essay Case 1 (the paediatric case) or Essay Case 2 (the adult case).
Essay Case Option 1: Infant following repair of a Patent Ductus Arteriosis
It is 10am and Annabelle is a 4 month old infant who has returned to the Paediatric Cardiac Care Unit after a surgical repair of her Patent Ductus Arteriosis (PDA). Her PDA was first identified at her six week post delivery check-up. Annabelle’s mother noticed that she was not gaining weight prior to the first paediatrician visit. She states “Belle doesn’t seem interested in feeding, and seems to go to sleep or pull off the breast mid way through a feed.” Annabelle’s mother also states that Annabelle seems to sleep a lot and doesn’t seem to have the same energy levels as her eldest child did when he was a baby. Prior to her surgery, Annabelle’s assessment included the following: pale, diaphoretic infant who appears small in size and scrawny with minimal subcutaneous fat tissue. Bare weight is 5.125 kgs (approximately 10th percentile). She has rapid breathing with RR 50 breaths / minute and congested sounds which is typical finding in infants with PDA. Her medical record stated she was born at term and her birth weight 3.5 kgs (75th percentile). Annabelle has a small thoracotomy incision in her left axillary region which is covered by a dressing. Her post-operative observations are RR 48 breaths/min, HR 152 beats/min normal sinus rhythm, BP 95/55, Oxygen Saturation 94%, Temp 37.2C. Annabelle is crying but no tears are present, her eyes are shut tightly, her brows are drawn together in a frown and she has an open and square shaped mouth. As you try to inspect her dressing she pulls her arm away. Annabelle has intravenous therapy of 0.9% Normal Saline (NaCl) infusing at 22mls per hour. Annabelle was fasting for hours prior to her surgery. She was last breastfed at 3am during the night. Her mother states her nappy was wet about 6am prior to surgery and her current nappy is dry. Annabelle is ordered a nurse controlled analgesia (NCA) infusion of Morphine to commence at 0.01mg//kg/hour which equates to 0.05mg/hour of Morphine Sulphate IV continuously to run as a side line to her fluid infusion. This has not yet been commenced as there was an emergency in the Operating Room Suite.
Essay Case Option 2: Adult with Chronic Obstructive Pulmonary Disease (COPD)
David is a 72 year old male admitted to the medical ward this morning with an infective exacerbation of his Chronic Obstructive Pulmonary Disease (COPD). David has a history of smoking since he was a teenager but finally managed to quit 3 years ago when he was diagnosed with COPD. David had noticed he had been coughing more throughout the night and his sputum had turned a thick green colour. He has also reported that he had not eaten or drank much in the two days before his admission as he was feeling so unwell. As you examine his mouth you note his tongue is white and his lips are cracked and dry. The urine bottle on the side of his bed contains a small amount of dark amber urine. David’s weight on admission was 55kgs and he is 176cms tall.
He is currently receiving 3rd hourly nebulised ventolin and is on 2L/min of oxygen via the nasal prongs. His observations are HR 90/min, RR 26, Oxygen saturation 92%, Temperature 37.8 oC. He has an IV cannula insitu and is his medical chart shows that he is prescribed 6 hourly IV hydrocortisone and IV antibiotics. When you enter the room to ask David how he is feeling you notice that he is sitting up on the side of his bed leaning over his bedside table and coughing. He is pale and seems to be using his shoulders and upper chest as he breathes. As you listen to his chest with the stethoscope you can hear coarse crackles and there seems to be decreased air entry in both lower lobes. He also has a prolonged expiratory phase. He responds that “I can’t seem to get my breath, and my mouth is so dry and I can’t seem to cough this stuff up.”
For this essay, select either Essay Case Option 1 (the paediatric case) or Essay Case Option 2 (the adult case).
Every patient you care for is likely to have a number of actual and potential health related problems. There are at least three (3) priority problems that the patient is experiencing currently. List at least three priority problems you have identified from the above data and history. For each problem identified, list as many nursing interventions as you have discovered in your research of the literature. Include a one to two line rationale for each intervention. Submit this one page list with your essay.
Please be aware that the main focus should be the essay itself and not this one page list which is essentially a map or plan of your thinking about the case. We have asked for this page as sometimes students choose incorrect priority problems so this page will allow us to see if it was a problem with identification or prioritisation. As with any academic writing it should be referenced and you can include these references in your main essay reference list. Your main focus should be the essay.
For your essay, you must prioritise the problems you identified and select the two highest priority problems from your list.
The 2000- word essay should cover the points below:
· Introduction (150 words): State an overview of the patient’s condition and identify the TWO priority nursing problems. Give a brief plan for the essay topics.
· For the first problem (850 words): Briefly explain how it relates to the patient’s assessment data. You will need to draw on your understanding of pathophysiology to explain the link between the problem and the patient’s signs and symptoms. Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature. Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
· For the second problem (850 words): Briefly explain how it relates to the patient’s assessment data. You will need to draw on your understanding of pathophysiology to explain the link between the problem and the patient’s signs and symptoms Identify TWO priority nursing interventions to address the problem. Discuss briefly the nursing interventions you will implement (explain what is involved in implementing the intervention, why it is suitable, any relevant positive or negative aspects/considerations) and support/justify the use of these interventions with reference to current evidence-based literature. Outline the evaluation criteria/data that would indicate that each intervention is improving or resolving the identified problem.
· Conclusion (150 words): Briefly restate the patient’s condition and problems and how the nursing interventions can benefit the patient’s health.
You need to discuss at least one independent nursing intervention in your essay. For any collaborative nursing interventions you use you must discuss the nursing responsibilities and actions in relation to this collaborative intervention. Medications cannot be both of your chosen collaborative interventions for a problem. If a medication is one of your collaborative interventions you must identify an appropriate drug that is likely to be/or has been prescribed by the doctor (in the case options some medications have already been prescribed). You must also consider and discuss the nursing responsibilities associated with the medication (action, dose, side effects, prevention and management of same, administration requirements, evaluation).
WRITING TIPS:
Refer to current academic peer-reviewed journal articles to justify your ideas.
Format of Assessment 2
-All questions should be attempted and written in essay format
-Margins: 2cm on 4 sides; & line spacing: at least 1.5; Font size: 12
-Adherence to the stated word limit is required
-QUT APA referencing style
-A full reference list is required at the end of the assignment.
Student:
Professor:
Course title:
Date:
List of problems and interventions for Essay Case Option 2 – the adult case
Problem 1: Ineffective Airway Clearance
Nursing Interventions
Auscultate breath sounds. The nurse should note adventitious breath sounds such as crackles, wheezes and rhonchi. Rationale for this intervention: some level of bronchospasm is present with obstructions within the airway and might or might not be manifested with adventitious sounds (Avsar, 2011).
Evaluate or monitor the respiratory rate. The nurse should note the inspiratory/expiratory ratio. Rationale for this intervention: Tachypnia is commonly present to some extent and might be pronounced on admission or during stress or concurrent acute infectious process.
Reduce environmental pollution, for instance by minimizing smoke and dust. Rationale. Dust and smoke are precipitators of allergic type respiratory reactions that could aggravate or set off onset of acute episode (Vijayan, 2013).
Problem 2: Impaired Gas Exchange
Nursing Interventions
Evaluate respiratory depth and rate. The nurse should note the use of accessory muscles, inability to converse or speak, and pursed-lip breathing. Rationale: this intervention is important in assessing the extent of respiratory distress and/or chronicity of the illness process (Stone et al., 2014).
Elevate head of the bed, and the nurse should help the patient to assume a position that makes breathing easy. Rationale: delivery of oxygen might be improved through upright position, and breathing exercises to decrease the collapse of the airway, the work of breathing, and dyspnea (Johnston et al., 2011).
Problem 3: Imbalanced Nutrition
Nursing Interventions
The patient should be encouraged by the nurse to rest for a duration of 1 hour before and after meals. Give frequent small feedings. Rationale: this will help to reduce fatigue during mealtime. It also offers opportunity for increasing total intake of calories.
Avoid foods which are very cold or very hot. In essence, extremes in temperature could worsen or precipitate coughing spasms (Mapel & Roberts, 2012).
Case study Option 2: Adult with Chronic Obstructive Pulmonary Disease (COPD)
Introduction
In this case, a 72 year old patient presents with an infective exacerbation of his Chronic Obstructive Pulmonary Disease (COPD). The patient has been persistently coughing and his sputum had turned to a thick green color. His tongue is white, and his lips are dry and cracked. His urine is dark amber, and at 176 centimeters in height, he weighs just 55 kilograms. The patient is pale and appears to be using his upper chest and shoulders as he breathes. Listening to his chest using the stethoscope reveals that there are course crackles. In addition, there is decreased air entry in both the patient’s lower lobes. A prolonged expiratory phase is also noticed in the patient. The two priority nursing problems are: (i) to maintain airway patency; and (ii) enhance nutritional intake. This essay provides a detailed discussion of the nursing problems experienced by the adult patient in case study 2, along with the interventions to be implemented.
First nursing problem: maintain airway patency since the patient has ineffective airway clearance
The patient has ineffective airway clearance. This is evidenced from the signs and symptoms that the patient has shown to have including the following: first, the patient has persistent cough with sputum. Secondly, inside his room, the patient sat up on the side of his head leaning over his bedside table and coughing. This implies that the patient is in severe distress and seeks the position that will most ease breathing (Weldam et al., 2013). The patient appears to be using his upper chest and shoulders as he breathes. Thirdly, there are crackles which are abnormal breath sounds; by listening to his chest with a stethoscope, one can hear coarse crackles and there seems to be decreased air entry in both lower lobes. Moreover, the patient’s expiratory phase is long. There is a statement of difficulty breathing; the patient said that he cannot seem to get his breath. The patient has ineffective airway clearance and this relates to the assessment data in that he is on 2L/min of oxygen through the nasal prongs, and one of his observations is oxygen saturation.
For this patient, the desired outcomes are: (i) to maintain patent airway with breathing sounds clear; (ii) to display behaviors to improve clearance of airway, for instance expectorate secretions and coughing effectively; (iii) to demonstrate effective pattern of breathing (Vijayan, 2013). Other expected outcomes are: (iv) to exhale with exertion; (v) to exhibit respiratory rate that is within limits which are near-normal, and to make use of forward-leaning postures, abdominal muscle breathing/diaphragmatic breathing; as well as controlled techniques of breathing/pursed-lip breathing (Hareendran et al., 2013).
The first intervention is that the nurse should encourage the individual to utilize controlled breathing methods such as abdominal breathing, forward-leaning position and pursed-lip breathing. The objective is basically a decreased respiratory rate as well as improved expiratory tidal volume, hence reducing air trapping. In essence, pursed-lip breathing will decrease dypnea whenever it is utilized with activities which produce tachypnea, which results in progressive air trapping (Stone et al., 2014). It is notable that pursed-lip breathing will decrease the respiratory rate, decrease PaCO2, increase tidal volume and increase SaO2, and PaO2. To instruct it, the nurse should ask the patient to do the following: (a) inhale via the nose for some seconds while keeping the mouth closed; and (b) breathe out slowly, taking twice as long as breathing in, through pursed lips that are held in a narrow slit (Wedzicha et al., 2013). The nurse can teach the patient to use this method by making use of a child’s soap bubble wand and then blowing a single big bubble. It is of note that this approach offers instant patient feedback, it merges a pleasant activity with an assessable way of visualizing a pursed-lip exhalation, and it promotes decreased use of accessory breathing and relaxation of the upper body of the patient (Weldam et al., 2013). The evaluation criteria that would indicate that this intervention is resolving or improving the identified problem is: the patient is able to use controlled breathing methods such as abdominal breathing, forward-leaning position and pursed-lip breathing. Secondly, patent airway is maintained with clear breathing sounds clear.
The second priority nursing intervention is to note the degree or presence of dyspnea, such as reports of anxiety, restlessness, air hunger and use of accessory muscles. To rate breathing difficulty, the 0 – 10 scale would be used. Precipitating facto...