Acute Exacerbation of COPD Patients Free Sample for Students

Question: Discuss about the Chronic Obstructive Pulmonary Disease. Answer: Introduction COPD is a chronic condition that leads to the impairment of the respiratory system due to the destruction of the alveoli and inflammation of the airway. While it can be stable in its chronic state among patients, COPD exacerbations are life-threatening and therefore need stringent measures to manage. This study will focus on highlighting the pathophysiology of COPD and its exacerbation especially among long-term smokers. The discussion will also highlight the medical and nursing plans, patient education and the discharge plan of one case-Bill McDonald suffering from COPD exacerbations. Pathophysiology of COPD as Seen in the Patient Cigarette smokers who have a stable COPD usually experience a chronic inflammation in their entire tracheobronchial tree. This inflammation brings about an increase in macrophage and CD8 T lymphocyte numbers within the walls of the airway, including neutrophils in the lumen of the airway (Sallis, 2016). Prolonged smoking which causes COPD brings about the destruction of a patients lung parenchyma cells which line the alveoli. The alveoli walls thus lose elasticity and get damaged. While a healthy airway and/or air sacs are made of elastic contracting and relaxing muscles to enable breathing, inflamed and further obstructed airways for the case of COPD patients, leads to a lower respiratory rate and tidal volume (Turan et al, 2013). This impact on the patients ventilation-perfusion ratio resulting to impaired ventilation. The air which is trapped within the large spaces in the altered alveoli walls inhibits lung deflation leading to an impaired gaseous exchange across the alveoli. On the other hand, ineffective airway clearance which results from airway inflammation and poor lung deflation forms part of the chronic symptoms of the disease. Obstruction bronchitis is one of the major sub-conditions in COPD. It is characterized by bronchi and bronchiole inflammation (Nguyen et al, 2015). The inflammation in the airway also leads to mucus gland hyperplasia and increase in phlegm and mucus produced by the goblet cells. Excessive phlegm and mucus damages the cilia in the airway and even further blocking the patients respiratory linings. In acute cases also described as exacerbation of COPD, the patients experiencing worsened chronic inflammation of their airways as a result of air pollutants and viral and/or bacterial infections (World Health Organization, 2013). During these exacerbations, patients inflammatory cellular pattern undergoes changes including an increase in eosinophils and neutrophil numbers. Other inflammatory mediators also increase in numbers; cytokines particularly the tumor necrosis factor-, chemokines like CXCL8; different chemokine receptors like CCR3 and/or CXCR2; E-selectin and/or ICAM-1adhesion molecules; oxidative stress markers among others(Sallis, 2016). The worsening state of airway inflammation is thus responsible for the extensive deterioration of the functioning of the lungs of patients and their poorer clinical status in times of exacerbations. Therefore, exacerbation of COPD which is the acute status of the disease is an event within its natural course which presents with changes in a patients normal chronic cough, sputum and/or dyspnea (Turan et al, 2013). This change in the disease pattern brings about the need for change in its management. Management Plans for Acute COPD Exacerbation Nursing Plan The nursing plan for acute COPD exacerbation concentrates on the management of the following causative factors of the worsening disease pattern; primary defenses that are inadequate due to decreased ciliary action and malnutrition; imbalance in oxygen supply in the tissues and the demanded amount leading to immobility and; clogged airways(Hillegass et al, 2017). In regard to managing primary defenses that are inadequate due to decreased ciliary action and malnutrition, a nurse needs to understand the risk factors, the intervention to reduce the risks and illustrate the necessary changes in the lifestyle of the patient (Vestbo et al, 2013). The nurse will monitor the patient temperature to ensure that it remains within the right range as the infection can lead to serious fever. The nurse should advice on nutrition and let the patient be provided with a proper diet (Nguyen et al, 2015) since exacerbations result to increased metabolic rate. The nurse should also advice the patient to r educe the smoking rate and prolonged smoking which flares up COPD. In regard to managing the imbalance particularly between oxygen supply within the tissues and its demanded amount which leads immobility a nurse should aim at improving patient mobility and their tolerance to exercises (Bradley Curry, 2013). The patient should then be put on pulmonary rehabilitation while being encouraged to change to a healthy lifestyle involving diet monitoring behavior. These interventions should thus result in nutritional balance and normal levels of both arterial CO2 and O2. Medical Management There is need for to medically manage the clogging of the airways among patients with acute exacerbation of COPD as a result of excessive mucus production. The medication plan here includes relieving the symptoms of the acute exacerbation of COPD and preventing further complications. The nursing intervention thus includes administering oral prednisone, ipratropium and also salbutamol medicine using nebulizers in order to improve the breathing rate and ease of the patients (Sallis, 2016). While the oral prednisone medicine acts as an anti-inflammatory agent, both ipratropium and salbutamol form a good combination of bronchodilators which improve the mucous clearance rate. They also improve the smooth muscle dilation and thus facilitating an improved breathing among patients. The medications above if administered among acute exacerbation COPD patients lead to an improved ability to exercise and also contribute to a better quality of life. In particular, oral prednisone blocks eosinophilic inflammatory markers at the airway, including the serum C-reactive protein leading to a decrease in the inflammation of the airway so as to reduce dyspnea. Oral prednisone should be administered to the patient in amounts ranging between 40mg and 100mg in each 6 hour period (Vestbo et al, 2013). It is an important oral corticosteroid that decreases inflammation of the airways while speeding up the recovery rate. On the other hand Ipratropium Bromide and/or salbutamol nebulizers have an inhalation solution which comprise of ipratropium bromide and Salbutamol combination. The 65 year Bill McDonald should be given an adult dose of 3Ml vial through nebulization four times each day including an allowance of 2 additional doses of 3Ml of the vial each day (Bolton et al, 2013). The patient should however be monitored for side effects including general body aches, congestion of the ears, and even chills due to hypersensitivity. Oral amoxicilli n can be given to the patient as a first-line antibiotic (500mg tablet) given 3 times a day (Vestbo et al, 2013). All the oral antibiotics need to be administered to the patient in between 5 and 10 days. More importantly, bacterial infection signs such as flu and/or pneumonia must be monitored for management. Home Care Considerations for Acute Exacerbation of COPD Patients There are different factors that need to be considered particularly in regard to home care for patients that need to be discharged from hospitalized care for acute exacerbation of COPD. One of the factors includes the availability of necessary equipment to enhance further management of the disease, including a seamless transfer of care from hospital to the home (Sallis, 2016). As explained, this particular equipment has been already availed for Bill McDonalds use. However, the hospital nurse should consider and asses its appropriateness. Secondly, there is need to consider the ability of homecare agents, community and family to recognize exacerbation early signs in the patient, the ease and plan to call for a doctor in case of unmanageable patient situation(Bradley Curry, 2013). It is also important to understand whether the disease management coordinator has educated the family and the patient sufficiently on self-monitoring and self-management approaches before discharge. Another important consideration before discharging the patient includes the possibility or convenience for home visits by medical doctors to follow up on the patient treatment. Studies indicate that there is need to consider the possibility and capability of a patient engaging in active lifestyle which can support both their physical and mental health, airway clearance, and even enables an early detection of exacerbation of COPD for rapid response (Bolton et al, 2013). Further, there is need to consider the patients capability to adhere to medication, proper diet and smoking cessation plan while under homecare before discharging them. Usually adherence to medication is influenced by a patients perception of the effectiveness of the medication, and their individual depression moods, apart from demographic factors and the severity of the disease (Sallis, 2016). Appropriate dietary needs must be available for patients in homecare facilities so as to fasten healing and stabilization of COPD patients though physical exercises. Support Resources in the Community Learning Needs on Disease Process and Discharge Plan Among the support resources available to Bill McDonald in the community include the oxygen equipment and the community homecare nurse who can facilitate the availability of other resources. These can include indoor and outdoor platforms for physical exercises such as flat walking, body stretching, aerobics, and resistance exercises. According the British Thoracic Society there is need, to have resources for moderate intensity aerobic trainings in homes for COPD patients (Sallis, 2016). They should strive to achieve a 60% of the peak work rate within a 30-60 minute session. They also need to have resistance trainings to enhance the functioning of the major muscles at least each in every 48 hour interval. Proper diet and education materials on smoking cessation and self-management of COPD also form the most imperative tools for COPD patients (Nguyen et al, 2015). The community nurse as a resource can aid in educating the patient to monitor their own treatment process, assess and monito r their oxygen needs for both home and activity sessions while by extension addressing their psychosocial concerns and co-morbidity. In regard to learning needs a COPD patient like Bill McDonald requires education on; medication adherence, mobility, home oxygen titration, the use of pursed-lip breathing approach, airway clearance, smoking cessation approaches, avoidance means of exposure to any perfumes, dust, chemicals which trigger the exacerbation of Chronic Obstructive Pulmonary Disease among patients(Sallis, 2016). These learning needs are appropriate in regard to management and are important during patient discharge from hospitalized care. Knowing well that patients forget up to a whole 80% of the content they are taught after a hospital visit, a target of at least 50% retention of the teachings can be important for Bill. There is need to use the Teach Back approach which includes 5 major steps (Khdour et al, 2012); 1. Sharing the information on the above learning needs; 2 asking the patient to repeat the teachings; 3 listening to the information they have retained from the teachings; 4 sharing again the cru cial teachings on the identified learning needs and further; 5 asking again what the patient has picked from the teachings for clarifications. In particular the patient should first be taught on how to use both the metered dose inhaler (MDI) and/or the spacer in the administration of bronchodilators. Secondly the patient needs to be taught to stop smoking and that it is major cause of their chronic obstructive pulmonary disease status. The patient needs to be taught the pathophysiology of the disease and ways of preventing airway and alveoli wall inflammations (Turan et al, 2013). Thirdly, the patient needs to have an explicit understanding of the early indicators of COPD deterioration which may need a medical review. The patient should be informed on monitoring indicators to ensure that any rapid changes in the disease pattern are reported to the home care nurse and/or doctor (Nguyen et al, 2015). Further, the patient needs education and training on the promotion of adequate nutritional intake so as to meet the bodys metabolic needs. Conclusion In conclusion therefore, while COPD is a chronic condition that can be stabilized, exacerbations are life-threatening and therefore need stringent measures to be prevented. The above discussion brings out the definition of COPD and its description as a chronic condition that however can be extremely acute when exacerbation occurs especially among long-term smokers. The discussion focuses on highlighting the medical and nursing plans, patient education and the discharge plan of one case-Bill McDonald suffering from COPD exacerbations. 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