COPD CASE STUDY
Category : Nursing Case Studies
COPD CASE STUDY
William is a 55 year old retired policeman who was constantly having cough during the last 2 weeks before he was brought to the hospital by his youngest daughter. Lately, he has been experiencing troubles in breathing. He described it as a difficulty in expiration during breathing. For this reason, he asked his youngest daughter who is living just two blocks away from him to take him to the hospital.
William admits to be a chronic smoker, consuming two packs per day and drinks alcoholic beverages regularly with his friends. After undergoing a thorough examination, his physician ordered a series of sputum tests and other lung tests. Chronic infection was detected in the lungs most probably due to smoking which irritates the bronchi and bronchioles. There was also obstruction of the airways which is responsible for William’s difficulty in expiration. He was diagnosed to have chronic obstructive pulmonary disease (COPD).
The chronic infection as is seen in William’s case is caused by his excessive smoking or other substances which irritate the bronchi and the bronchioles. The principal reason for the chronic infection is that the irritant seriously deranges the normal protective mechanisms of the airways, including partial paralysis of the cilia of the respiratory epithelium by the effects of nicotine; as a result, mucus cannot be moved easily out of the passageways ( 2000).
Nursing diagnosis reveals ineffective airway clearance which is related to excessive and tenacious secretions. The assessment criteria include William’s ability to maintain an upright position, cough and sputum. Diagnosis further reveals activity intolerance related to fatigue and inadequate oxygenation for activities. Assessment criteria include tolerance to activities of daily living and aggravating factors. Another nursing diagnosis is anxiety related to breathlessness and fear of suffocation. Assessment criteria include anxiety level of William and his knowledge of breathing techniques.
Other possible nursing diagnosis for William includes (1) powerlessness related to feeling of loss of control and restrictions that this condition places on his lifestyle, (2) sleep pattern disturbance related to cough, inability to assume recumbent position and environmental stimuli, and (3) high risk for altered nutrition: which is less than body requirements related to anorexia and secondary to dyspnea, halitosis, and fatigue.
Interventions for ineffective airway clearance includes teaching (1) William the proper controlled coughing methods, (2) teaching William methods to reduce the viscosity of the cough secretions and (3) auscultation of the lungs prior to and after having William perform coughing exercise. Uncontrolled coughing is ineffective and would further make William feel frustrated therefore it is important to teach him controlled coughing methods. Thick secretions, which are difficult to expectorate, can cause mucus plugs which can lead to atelectasis therefore the need for the patient to be taught with methods in reducing the viscosity of secretions. Auscultation can help evaluate the effectiveness of coughing exercises.
Nursing interventions for activity intolerance related to fatigue and inadequate oxygenation for activities includes (1) explaining to William what factors increase oxygen demand which in turn can cause an increased cardiac workload and oxygen requirements; (2) teaching William the methods of conserving energy which can then help prevent excessive energy expenditure; (3) increase William’s activity as tolerated since moderate breathlessness improves accessory muscle strength; (4) maintaining supplemental oxygen therapy for William which can increase circulating oxygen levels and improve tolerance; and (5) after William’s activity, there is an assessment for abnormal responses to activity increase and the patient should be monitored for decreased pulse, decreased or unchanged systolic blood pressure, and excessively increased or decreased respirations.
Nursing interventions for William’s anxiety related to breathlessness and fear of suffocation includes (1) providing a calm quiet environment when the patient is experiencing episodes of breathlessness which can promote relaxation, (2) William should not be left alone or unattended when he is experiencing episodes of breathlessness, and (3) the nurse should help the patient with all his tasks during acute episodes since during this time, the patient will be unable to perform activities that they usually do.
Individuals with a family history of lung disease and those with an early onset of emphysema should be tested for α1-antitrypsin deficiency to determine the serum levels. Phenotyping should be done if the level is low. The normal phenotype is constituted by the MM genetic pattern. The most common abnormal phenotype associated with α1-antitrypsin deficiency is the ZZ pattern. Persons with the MZ phenotype are carriers of the disease, but do not appear to have an increased risk of developing COPD (2004).
William has to undergo COPD therapy. He also has to quit smoking and drinking for it will be futile to undergo therapy and still continue with his health damaging habits. He should be constantly monitored by the nurses and by his daughter as well so that his therapy will be effective.
William’s case is not a hopeless one. Chronic obstructive pulmonary diseases are experiences by many individuals worldwide. There are already many drugs that can help patients who have COPD. But of course, these drugs alone cannot cure the ailment.
William in his case has to stop his smoking and drinking habits as this may only worsen his condition. Smoking continually will eventually destroy his lungs even if he will be taking drugs that are used in COPD therapy.