Chronic obstructive pulmonary disease (COPD) is a combination of chronic conditions that impact the individual’s ability to breathe normally. This paper presents a case study of a patient who came into emergency room (ER) with severe shortness of breath and wheeziness. COPD was diagnosed and treated. The patient maintains a range of other co-morbidities. He has to manage these with medication and will have to manage COPD in the long term as well with medication. It is strongly recommended that the patient not only adhere to the medication plan but make significant lifestyle changes. Nursing interventions include patient education and evaluation structure to find the best approach for him. The patient is showing minor progress and has demonstrated improvements in health indicators.
COPD Patient Case Study
A patient arrived at the ER with severe shortness of breath, persistent coughing, wheezing, and complaining of overwhelming fatigue. It is a 54-year-old white male, not a smoker. There has been no diagnosis on the patient, but the ambulance provided him with oxygen-fearing hypoxia. The nursing intervention should focus on evaluating and connecting the symptoms to determine the best management of the condition, which is a chronic obstructive pulmonary disease.
Pathophysiology
Chronic obstructive pulmonary disease is a group of lung diseases that are chronic and inflammatory, obstructing lung airways and making it difficult to breathe over time. In a healthy human, the air sacs of the lungs are elastic, stretching out as a person breathes in the air and deflating when breathing out. In COPD, multiple problems may arise which restrict this motion, and airflow is restricted. There are two primary types of COPD: emphysema and chronic bronchitis. In emphysema, the airways and walls of the air sacs (alveoli) become damaged and less elastic. With fibers between alveoli being destroyed, they cannot recoil when exhaling, making it more difficult to remove carbon dioxide from the lungs. This leads to hypercapnia as well as low blood oxygen levels (hypoxemia) that progress with the disease severity (Loscalzo et al., 2022). Chronic bronchitis is characterized by a consistently irritated and inflamed lining of the lungs and excessive mucus production. Due to air trapping occurring in exhalation, it may cause breathlessness (dyspnea) during physical activity (Loscalzo et al., 2022). The airflow limitation is based on the impact of the inflammation and development of fibrosis within the airway, with the presence of secretions such as mucus.
History
The patient is obese, with a BMI of 36, and has a long history of eating disorders. He has attempted to manage obesity with diets and small exercise but does not see long-term adherence. Approximately 8 years ago, the patient was diagnosed with Type 2 diabetes but does not require insulin, managing his blood sugar with medication such as metformin. The patient has had high cholesterol levels in recent years, with total cholesterol of 244. The patient periodically complains of high blood pressure, taking Lisinopril once a day as prescribed to manage it. The patient has also had complaints of varicose veins and signs of osteoporosis.
Nursing Physical Assessment
Vitals
- Temperature: 97.8 F
- Respiratory rate: 30
- Heart rate: 128 (resting)
- Blood Pressure: 170/110
- Oxygen saturation: 87%
- Pain level: 4/10
Physical
The patient is breathing heavily, despite resting seated for some time, with wheezing sounds being clearly heard. The patient looks slightly pale, with tints of blue on the lips, combined with their oxygen saturation, they are provided oxygen via nasal cannula. The patient can walk and move without assistance but notes strong dizziness. Visibly, the patient is slightly shaking. The patient demonstrates consciousness and responsiveness to stimuli. No other abnormalities were observed.
Related Treatments
The patient was given oxygen to compensate for low blood oxygen saturation to stabilize it to levels of at least 88%, which is within normal ranges for COPD but should be raised above 90%. The tests that were done were a chest X-ray in order to identify emphysema which is the more common of the causes of COPD, also allowing to rule out other potential issues with the lungs and heart. A lung pulmonary function test in the form of spirometry was also performed once the patient was stable to measure the amount of air that could be inhaled and exhaled to confirm COPD. The patient was also given a short-acting bronchodilator to reduce coughing and shortness of breath and then a steroid to reduce inflammation and prevent exacerbation.
Nursing Diagnosis and Patient Goal
The primary nursing diagnosis is COPD – a chronic condition that should be addressed. It can be managed with long-acting bronchodilators and inhaling steroids. The goal of COPD treatment is to manage symptoms and reduce the risk of exacerbation (Vogelmeier et al., 2020). This should be done through pharmaceutical and non-pharmaceuticals interventions. COPD is a condition that thrives within the context of other co-morbidities. The diabetes, high blood pressure, and high cholesterol levels contribute to the severity of COPD. These conditions are also the consequence of the patient’s obesity, which in turn is a result of his poor lifestyle choices. Therefore, non-pharmaceutical interventions would be to improve diet and quality of physical activity with the goal of losing weight. Pharmaceutical interventions will have a cascading by potentially improving the situation around blood sugar, cholesterol, and blood pressure.
Nursing Interventions
First, it is necessary to educate the patient regarding their condition. COPD may seem overwhelming and terrifying based on the symptoms, but as with other chronic diseases, it can be managed. It is also crucial to relay to the patient the exacerbating effect that each of his chronic conditions has on each other, and the only means to reduce flare-ups or to treat the disease in the long-term is through meaningful lifestyle change, along with adherence to medication and treatment plans assigned.
Adherence to treatment and lifestyle recommendations consists of two concepts compliance and persistence, meaning first these must be followed and then done so on a constant basis for a period of time. Furthermore, there should be a system that evaluates and measures adherence and determines what works for the patient and what does not (López-Campos et al., 2019). A cyclical model of reviewing symptoms/exacerbations/mistakes proposed by Vogelmeier et al. (2020), identified reasons ranging from wrong technique to emotional distress, and finally adjusting to make improvements. The cycle repeats until a system is found which is best appropriate and fits the patient, and could ensure long-term adherence and goal attainment.
Evaluation
The patient came in for a follow-up visit twice within the next 6 months. He was able to successfully manage his COPD without major exacerbations. He also began making small lifestyle changes resulting in minor weight loss and better indicators. His blood pressure was bothering him less, and Hb1C, along with cholesterol levels dropping slightly. He generally felt better and was excited to continue improving his outcomes.
Recommendations
Managing chronic disease means that long-term adherence to care plans and lifestyle improvement is critical. The patient should strive to manage his chronic conditions through prescribed medication, which will likely persist due to his age and health, but attempt to improve his quality of life and longevity for himself. From a nursing and provider perspective, it is important to continue monitoring and supporting the patient with manageable and achievable goals and provide the necessary resources to achieve them.
References
López-Campos, J. L., Quintana Gallego, E., & Carrasco Hernández, L. (2019). Status of and strategies for improving adherence to COPD treatment. International Journal of Chronic Obstructive Pulmonary Disease, 14, 1503–1515.
Loscalzo, J., Fauci, A. S., Kasper, D. L., Hauser, S. L., Longo, D. L., & Jameson, J.L. (2022). Harrison’s principles of internal medicine (21st ed.). McGraw Hill.
MayoClinic. (n.d.). COPD.
Vogelmeier, C. F., Román-Rodríguez, M., Singh, D., Han, M. K., Rodríguez-Roisin, R., & Ferguson, G. T. (2020). Goals of COPD treatment: Focus on symptoms and exacerbations. Respiratory Medicine, 166(1), 105938.