COPD pathophysiology
The chronic obstructive pulmonary disease (COPD) has a rather varied pathophysiology, which provides for the need of numerous assessment data while diagnosing and assessing the needs of the COPD patients. Thus, according to McIvor (2004), the development of COPD is characterized by the increased levels of circulation of antinuclear (ANA), anti-tissue (AT), and anti-neutrophilic cytoplasmic antibodies (ANCA) (p. 167). Celli, B. et al. (2004) also name the increased arterial stiffness together with blood flow redistribution (BFR), secondary pulmonary arterial hypertension, and systematic inflammatory state among the sings of COPD pathophysiology (p. 935). Often accompanied by the increased carotid artery intima media thickness, the above listed assessment data prove the pathophysiological character of COPD.
COPD-related Diseases
The COPD is “synonymous with chronic airflow limitation, chronic obstructive lung disease, and chronic airflow obstruction” (McIvor, 2004, p. 20). This disease is characterized by the difficulty in breathing, and this difficulty has the progressive nature, which often results in deaths of the COPD patients, whose disease manages to develop to the terminal stage. Moreover, the COPD is the factor that facilitates the development of numerous other diseases that include asthma (permanent breathing complications accompanied by fits of suffocation), aspergilloma (the spreading of the fungi in the lungs, which causes the mutation of the lung cavities and the development of excessive ones), bronchiectasis (the state of the dilated large airways in the human bronchi), lung cancer, pneumonia, etc (Celli, B. et al., 2004, p. 940).
Clinical Manifestations of COPD
The COPD can be diagnosed according to its clinical manifestations, or symptoms. According to NIH (2009), COPD manifests itself by “cough; sputum (mucus) production; shortness of breath, especially with exercise; wheezing, or whistling sound when you breathe; and tightness in the chest”. The main causes of the disease include smoking, breathing the lung tissue irritants, unfavorable environmental conditions, etc (NIH, 2009). As the report by NIH (2009) states, the symptoms of COPD can be often misinterpreted by the physicians as the sings of influence, asthma, pneumonia, inflammation of lungs, etc. The reason for this is the progressive nature of COPD, because of which a person might start experiencing the first COPD symptoms years before the disease is diagnosed.
Subjective and objective data for COPD nursing assessment
The seriousness of the disease makes medical workers and nurses pay much attention to gathering preliminary subjective and objective data for nursing assessment. As for the former, a physicians or a nurse has to interview the patient suspected of having COPD about his/her medical history, possible smoking background or any other factors that might have caused COPD (NIH, 2009). Based on this data the nursing assessment should be carried out to provide the nurse with the following subjective and objective data:
- patient’s background (health record, smoking, etc);
- basic patient’s complaints and reported symptoms;
- data on the patient’s reaction to certain medications and medical tests.
Diagnostic studies to confirm the assessment results
In order to either confirm or reject the findings of the nursing assessment, the diagnostic studies and tests should be carried out. The most widely used one is “an objective assessment of airway obstruction through the use of spirometry” (McIvor, 2004, p. 20). As well, the physicians might resort to using the physical examination, i. e. considering the patient’s appearance, eyes, mouth cavity, hearing the lungs and heart rhythms (McIvor, 2004, pp. 20 – 21). Finally, COPD might be diagnosed through the radiological research during which the “posteroanterior and lateral chest radiographs” are made and examined. With the help of any, or all, of these diagnostic measures, COPD can be timely diagnosed and handled (McIvor, 2004, p. 21).
COPD special diet
The ways to deal with COPD differ and range from the use of traditional medication therapy to the implementation of special diets designed according to the needs of people, whose organisms are weakened by the disease. As for the latter, Cleveeland Clinic Health System (2005) has developed a nutrition recommendations according to which the people with COPD have to monitor their weight and avoid over- or underweighting, drink large amounts of fluid, and strictly structure their ration for the day. The approximate COPD diet might include the following items (Cleveeland Clinic Health System, 2005):
- drink 6 – 8 eight-ounce glasses of liquid daily;
- consume much high-fiber food (vegetables, dried peas and beans);
- limited salt use (substituted by herbal and non-sodium spices);
- exclude gas or bloating drinks from the ration;
- structure your eating process, drink after eating, eat slowly and in small portions (Cleveeland Clinic Health System, 2005; Celli, B. et al., 2004, p. 945).
Multidisciplinary team engaged in COPD client care
Drawing from all the above considered data on COPD causes, major symptoms, complications, and possible ways of diagnosing (including physical examination, radiological study, spirometry research) and treatment, it is now possible to outline the appropriate content of the multidisciplinary team that will be needed for taking care of a COPD patient. Thus, based on the various diagnosis and treatment requirements, the following specialist will be needed (Celli, B. et al., 2004, p. 942):
- a professional nurse for carrying out a nursing assessment (Celli, B. et al., 2004, p. 942);
- a physician to check the assessment results, conduct a patient’s examination, and guide the treatment process;
- laboratory tests specialists in spirometry research;
- radiological research professional;
- dietician;
- palliative care nurse (potentially, after discharge from hospital) (Celli, B. et al., 2004, p. 943).
Post-discharge Care
After discharging from the hospital, the COPD patient might still require care, treatment, and measures taken to monitor his/her health state. First of all, it is necessary to carry out the needs assessment for the patient before discharging him/her from the hospital (Celli, B. et al., 2004, p. 943). This will allow realizing what specific steps are needed in post-discharge care. The second measure will be to provide extensive oxygen therapy for patients whose recovery progress is not rather successful and who still experience the need of oxygen support. Pulmonary rehabilitation technique is another measure to provide discharged COPD patients with proper care (McIvor, 2004, p. 33). These steps should be followed by the needs reassessment and decisions about either repeated hospitalization of the patients or continuing outside monitoring of his/her state.
COPD Medications
Pharmacological way of treating COPD is also rather popular and considerably effective as Celli, B. et al. (2004) argue. Although there are serious negative consequences of the long-term use of such strong medications as bronchodilators and glucocorticoids (including addiction, liver and kidney damage, etc.), the medications are still widely used to treat COPD. Sablumatol is one of the most effective medications to treat COPD as it is a bronchodilator and belongs to the group of β2 adrenergic receptor agonists that influence the bronchi muscles, reduce the pressure caused on them by COPD, and make the air inflow easier for COPD patients (Cleveeland Clinic Health System, 2005).
Another effective COPD medication is prednisone, a steroid-hormone medication whose action is directed at suppressing the overactive immunity performance to treat COPD and other diseases caused by overactive immune system (Cleveeland Clinic Health System, 2005).
COPD Diagnoses
The following two diagnoses (in the form of three part statements) might be implemented in dealing with COPD:
- Chronic Obstructive Pulmonary Disease R/T air inflow complications caused by extensive and long-term smoking;
- Chronic Obstructive Pulmonary Disease R/T environmentally conditioned overactive immune system.
References
Celli, B. et al. (2004). Standards for the diagnosis and treatment of patients with COPD: a summary of the ATS/ERS position paper. European Respiratory Journal, 23, 932-946.
Cleveeland Clinic Health System. (2005). Nutritional Guidelines for People With COPD. Web.
McIvor, A. (2004). Comprehensive Management of Chronic Obstructive Pulmonary Disease. B.C. Decker.
NIH. (2009). COPD. NIH Senior Health. Web.