Chronic obstructive pulmonary disease (COPD) is a lung infection-related disease. The illness obstructs air flow into the lungs, interfering with the natural breathing function. In the United States and the Middle East, common contributing variables to COPD include an individual's age, smoking status, race/ethnicity, gender, and work. Of 1,454 research participants over the age of 30 who were active smokers, 25.6% were diagnosed with COPD (Liu Yong et al. 2015). Adult smokers over the age of 45 are also at increased risk of developing lung problems. The 65-year-old male of Middle East descent has a history of abdominal aortic aneurism and systolic heart failure which is secondary to a prolonged history of smoking and also due to the age factor. There are severe ischemic cardiomyopathy and the dysfunction of the left ventricles which shows an ejection fracture of up to 15%. The patient has a history of smoking at least one pack of cigarette a day for the past 50 years upon which he developed a heart condition known as a chronic obstructive pulmonary disease (COPD). However, the patient has since quit smoking for the past three years. The patient has also had a history of hypertension, hypercholesterolemia, hypothyroidism and a chronic renal failure. Surgically, the patient has an assistive device placed in the left ventricle of the heart to temporarily serve as a bridge; he is due for a heart transplant.
The patient’s admitting diagnosis is evidenced by the extent of the ischemic condition he is experiencing. The patient is also due for surgery to insert a left ventricle assistive device, he has further developed a three-vessel coronary artery disease. Consequently, it is also important to note that the patient has developed an infection in the urinary tract which was acquired at the hospital thus prolonging his stay in the facility. The vital signs are stable with an average pressure of 80, 18 respirations per minute, an oxygen saturation of 98% and a temperature of 97-degree farads. A Doppler machine is also recommended for use in the measurement of blood pressure which evaluates blood circulation in the major arteries using an ultrasound technique since the patient does not have a palpable pulse related to the present illness.
Laboratory and Diagnostic Tests
The patient reported blood in stool, and a confirmatory test of the stool sample was taken for testing thus showing an extended-spectrum beta-lactamase-positive. The tests can also be done using urine samples and the strains tests positive. This test is used to ascertain the infections that happen beyond the lungs. This bacterial infection can result from decreased immunity, wound sepsis and also as an opportunistic infection secondary to another disease. Further, the fecal occult blood test was taken to check for blood in the stool which turned positive; this showed that there was an abnormal bleeding in the lower digestive tract and can be a sign of anemia.
Hemoglobin is a molecule of a protein in the erythrocytes which is responsible for transportation of oxygen molecules from the lungs to the tissues and also carries carbon (IV) oxide from the tissues to the lungs. Low levels of proteins can be caused by trauma, an underlying disease et cetera. In this case, it could be caused by the incision on the right side of the patient’s abdomen, the urinary tract infection or due to the edema which shows that there was a poor venous return to the heart and subsequently to the lungs. The hematocrit level was also low (23.4) with the normal usually at 37-47, this is also the due cause of anemia to the patient. The platelet and Mean corpuscular volume (MCV) levels were in the normal range showing the clotting capabilities, and the levels of the blood of the patient respectively were normal.
The patient had very high Blood Urea Nitrogen (BUN) of 38 contrary to the normal of between 4 and 24. This test is usually done to check on how well the kidneys are working. The patient’s kidneys are not working correctly due to the high levels of BUN showing inability to remove urea from blood; this is due to heart failure and dehydration. The blood sample also shows high creatinine (CREAT) levels of 2.2 when the normal should be between 0.5-1.5. This also shows impairment in the kidney or an underlying disease of the kidney due to poor clearance of creatinine from the kidneys.
Medications
Generic name
Medication classification
Therapeutic use
Adverse effects.
Route and Dosage
Nursing implications
Amiodarone
(pacerone)
nexterone
Therapeutic: antiarrhythmic, class III
Prolongs action potential and refractory period. Inhibits adrenergic stimulation and decreases peripheral vascular resistance (vasodilation.
Dizziness, fatigue, malaise,
CHF,
worsening of arrhythmias, abdominal pain, low libido
p.o-800-1600mg/day for1-3 weeks.
I.V- 150mg over 10 minutes followed by 360mg over the next 6 hrs.Then 540mgs over the next 18hrs.
Assess pacing and defibrillationthreshold in apatient with pacemakers and implanted defibrillators.
Assess for fatigue, dyspnea, cough, or tachypnea.
Carvedilol (coreg)
Coreg CR
Therapeutic: antihypertensive.
Pharmacologic: beta blockers
Blocks stimulation of beta 1 (myocardial) and beta 2 (pulmonary & vascular) adrenergic receptor sites.
Also has alpha 1 blocking activity which may result in orthostatic hypotension.(Davis Drug guide 4.1.0 app.)
Decreased H.R and cardiac output.
Dizziness, fatigue, diarrhea, nausea, constipation, bronchospasms.
Wheezing
Hypoglycemia
Back pain.
p.o-6.25mg twice daily 7-14 days.
For left ventricular dysfunction- 6.25 mg twice daily.
Monitor B.P and pulse rate.
Assess for orthostatic hypotension when assisting patient up from asupine position.
May increase blood glucose level.
Daxazosin
(cardura)
Cardura XL
Therapeutic: antihypertensive
Dilates both arteries and veins by blocking postsynaptic alpha one adrenergic receptors.
Lowers B.P
Increases urine flow
Depression, drowsiness.
Arrhythmias, chest pain,edemas, and palpitations.
P.O- 1 mg once daily
Monitor B.P and pulse rate 2-6hrs after thefirst dose
Monitor intake and output ratios.
Observe patient closely.
Furosemide (lasix)
Lasix special
Therapeutic: diuretics.
Pharmacological: loop diuretics
Inhibits reabsorption of sodium and chloride from the descending loop of Henle and distal convoluted tubule.
Increases potassium and calcium levels.
Diuresis
Edema
Decreases B.P
DEHYDRATION
Hyperglycemia
Hypocalcemia
hypovolemia
P.O- 20-80mg/day as a single dose STAT. youmay repeat in 6-8 hrs.
I.V- 20-40 mg may repeat in 1-2 hrs.And increase by 20mg every 1-2 hrs.Until the required responseis obtained(Davis drug index 4.1.0).
Assess fluid status
Monitor B.P and pulse to check for any hypersensitivity after administration.
Assess patient for anorexia, nausea, and vomiting if receiving digoxin.
Lisinopril
(prinivil)
Prinzide
zestoretic
Therapeutic: antihypertensive.
Pharmacologic: ACE inhibitors
Angiotensin-converting enzyme (ACE) inhibitors block conversion of angiotensin I to vasoconstrictor angiotensin II
Prevent degradation of bradykinin and other vasodilator prostaglandins(Davis drug index 4.1.0).
Lowers B.P
Abdominal pain
Diarrhea
Chest pain
Hypotension
Impaired renal function
P.O- 10mg once daily.
Initiate therapy at 5 mg daily for renal impairment.
Monitor hypertension.
Monitor for fluid output through urine.
Assess patient for signs of facial edema.
Aspirin
(acuprin)
Apo-ASA
Therapeutic:
Antipiretics, Analgesics.
Pharmacologic: salicylates.
Produce analgesic effect and lowers inflammation and fever by inhibiting production of prostaglandins.
Also, it decreases platelet aggregation.
Gastrointestinal bleeding
Distress, nausea
Abdominal pain
Anorexia
Anemia, hemolysis
anaphylaxis
P.O- 325-1000mg 3 times a day.
In prevention of transient ischemic attack: 50-325mg once daily.
Hypersensitivity to patients with asthma, allergies and nasal polyps.
Assess fever and note the associated signs(diaphoresis,
Rapid heart rate, malaise or chills)
Atorvastatin (lipitor)
Therapeutic: lipid-lowering agents.
Pharmacologic: HMG-Coa reductase inhibitors(Davis drug index 4.1.0).
Inhibits 3-hydroxy-3-methylglutaryl coenzyme A reductase an enzyme responsible for catalyzing an early step in thesynthesis of cholesterol(Davis drug index 4.1.0).
Dizziness
Headache
Bronchitis
Chest pain
Peripheral edema
Constipation
Rashes
Nausea(Davis drug index 4.1.0)
P.O- 10-20mg once daily initially for up to 4 weeks.
Use doses more than 20mg with caution.
Obtain a diet history of the patient.
Monitor the liver function tests.
May cause high alkaline phosphatase and bilirubin levels.
Nursing Diagnosis
Impaired gaseous exchange related to altered oxygen supply due to the obstruction of the airway by the secretions evidenced by the patient’s abnormal ABG values (hypercapnia and hypoxia). The lungs usually have the adaptive characteristics that enable it to effectively carry out the process of gaseous exchange, they have a large surface and moisturized surfaces. The most desired upshot is to adhere to the treatment regimen of this individual. Also, the nurse should guarantee the patient is relaxed in a prone position to improve perforation by elevating the bed and education on proper breathing patterns. When patients are in good position, they always tend to relax their bodies thereby causing an increased rate of breathing. Overload in fluid volume related to a decreased cardiac pump as evidenced by the edema in the patient’s limbs. The patient should, therefore, record no edema in the lower extremities within the next 48 hours. Put the patient on a restricted diet of 1500ml fluid and monitor the intake and output ratios.
There is the menace of gastrointestinal bleeding due to an aneurysm as evidenced by occult blood in the stool. The patient recognized signs of bleeding and notified the healthcare professional. The nurse should examine the patient’s blood pressure and heart rates because low blood pressure and faster heart rates are initial compensatory mechanisms usually associated with bleeding. The condition of OCPD is often characterized by the irregular breathing system, at sometimes, the patient showed a low rate of breathing which was characterized by the low pulse rate within and outside the body. The irregular intake of gas or breathing lowers the rate of respiration in the body, a condition which adversely affects the general health.
Interventions
The Chronic obstructive pulmonary disease has several interventions aimed at reducing the effects in the body. If the disease is not controlled at the right time, it may lead to the death of the patient. There are several interventions that can be taken in different health facilities to help in reducing the effect of the disease if not curing. In most cases, prevention is better than cure and the doctors and other medical professionals to regularly attend medical facilities for the preventive measures. The interventions also involve putting the patients in the right position or posture to enable them adopts good breathing system. The COPD can sometimes become critical that the role of the nutritionist become significant. The nursing care plans should involve several interventions that can help in eradicating the disorder.
Effective airway clearance is one way of reducing the effect of COPD, a clean airway will guarantee the intake of uncontaminated air, and it also removes the obstacles that may be accidentally present in the tracheae and other surfaces of gaseous exchange. Regular testing of blood samples to identify abnormal balances of minerals and salts in the body is also an essential intervention process that enables patients to acquire healthy condition. Ensuring an effective breathing pattern is another intervention that aid in ensuring the correct amount of air intake. Maintaining balance in the breathing system also protect the surfaces for gaseous exchange. Interventions can help the medical professionals in carrying out diagnosis and even the administration of medication depending on the condition of the patient. The COPD This bacterial infection can result from decreased immunity, wound sepsis and also as an opportunistic infection secondary to another disease.
Interdisciplinary (ID) Care
Many patients with COPD usually have a predicament of maintaining a healthy body weight. A dietician or nutritionist should always aspire to help out the patient maintain a healthy body physique by regulating the patient’s diet. They can always provide and educate on the formulation of a diet that well suits the right amount of energy requirements for the patient. A respiratory counselor is also a key member for this treatment. They teach the patients on the effects of COPD to the lungs and the rest of the body. They are essential in providing support and guidance during the treatment and healing plan. They also give the necessary advice on how to quit smoking and the use of safe oxygen therapy. It is also important to note that they educate the patients on proper breathing habits and how to deal with COPD attacks.
The nutritionists can also play a role in regulating the patient’s diet that maintains the body weight to a normal level. The interdisciplinary care involves putting the patients in the right position or posture to enable them adopts good breathing system. The COPD can sometimes become critical that the role of the nutritionist become significant. The regulation of blood sugar level or salt is aided by the intake of mineral salts and the correct amount of water. The nutritionists play a greater role in the above case, they help keep that patient's under the correct dietary condition to help them regain from the mineral deficiencies. The nutritionists also provide the list of foods that can enable the patients in regaining the normal body operation especially during diagnosis and treatment procedures by the medical experts.
Nursing role reflection
It is without a doubt that nurses are the key stakeholders in the healthcare sector and they are much involved in diagnosis and treatment. Good preparation of the patient before, during and after surgeries is crucial in the patients’ health. Administration of drugs and watching their effects in a patient’s body should be carried out with caution and proper judgment on the next step to be taken. Nurses complete blood cell count and test them for various purposes. In the above case, the nurses involved in the treatment found White blood cell count to be 9.42 with a normal range between 4.5 and 10. According to the nurses, the patient had a slightly higher count of white blood cells which is an indicator of the UTI infection. Higher white blood cell count can also be a result of immune system disorder or a bone marrow disease (mayo clinic, 2017). The red blood cell count was within normal limits (WNL). However, the hemoglobin level was found to be 7.5 with the normal usually between 12 and 16, a clear indication of anemia.
The development of a therapeutic relationship between the nurse and the patient should be upheld to wall off the guilt often experienced when reflecting whether you helped the patient improve their condition towards the final stages of their lives. The major role of nurses in the patient care is to ensure the provision of the correct medication and diagnosis criterion. In most instances, the nurses assist the patients in taking the right medication as prescribed by the doctors or any other medical professional. In the above case, nurses carried out test samples of blood to identify abnormal balances of minerals and salts in the body. The tests are often done to monitor the effectiveness of treatments and also to detect the proper functioning of the body organs.
Conclusion
Once a diagnosis is made, it's the nurse to provide the required support and aid the patient towards full recovery. Nurses should always maintain a professional rapport with the others including the nutritionist, the physician, counselor et cetera. They should always collaborate and share ideas that will provide positive support to the patients. Nurses should be the pillar in assuring the patients, family members, and relatives to allay any anxiety that may be caused by the condition.
References
Liu Y., Pleasants R. A., Croft J. B., Wheaton A. G., Heidari K., Malarcher A. M., Ohar J. A., Kraft M., Mannino D. M., Strange C., 2015: Smoking duration, respiratory symptoms, and COPD in adults aged ≥45 years with a smoking history. Online journal 2015 Jul 21. doi: 10.2147/COPD.S82259 retrieved fo October 21, 2017, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4516194/
Mayo Clinic Staff, 2017: Complete blood count (CBC). Retrieved on 21 October 2017, from https://www.mayoclinic.org/tests-procedures/complete-blood-count/details/results/rsc-20257186
Calverley PMA, Macnee W., Pride N., Rennard S., 2012: Chronic Obstructive Pulmonary Disease, edited 2Ed CRC Press, Florida, USA 11 Dec 2012. Print
Davis drug guide index: 2016,The Davis’s Drug Guide for Nurses Fifteenth Edition application 4.1.0 obtained on October 21, 2017, from: https://play.google.com/store/apps/details?id=com.usbmis.reader.dadg&hl=en
