Case study: Chronic Obstructive Pulmonary Disease
George Williamson is a 72-year-old man with a history of lifelong smoking, diagnosed with chronic obstructive pulmonary disease. Since his diagnosis, he has not stopped smoking and has not been using his PRN based medication as prescribed. George has reduced physical activity and spends most of his time sleeping in a chair. He now presents with symptoms of wheezing, pursed-lip breathing, and leaning forward, FEV1 levels of 36%, which is a drop from 46% in his last physical. His blood pressure is 125/60, with a pulse rate of 84 and feels as if his bowels are blocked. George also has other lifestyle symptoms that are relevant to his medical presentation. He has very little motivation for physical activity, sits all day, and still smokes cigarettes despite his diagnosis. George’s symptoms are fitting for two potential problems that interest nurses, chronic obstructive pulmonary disease exacerbation, and comorbid obesity.
Chronic obstructive pulmonary disease is a nationally recognized chronic disease associated with high morbidity and mortality. According to McDonald et al. (2017), smoking often causes chronic obstructive pulmonary disease and decreased physical activity, a marked reduction in functional capacity, and more mediocre health-related quality of life are all markers of obesity in chronic obstructive pulmonary disease patients. The comorbidity of chronic obstructive pulmonary disease with obesity results from the marked reduction in physical activity, which also contributes to difficulties in emptying bowels. Obesity has a paradoxical relationship with chronic obstructive pulmonary disease, with other researchers portraying it as a contributor to lower mortality for chronic obstructive pulmonary disease patients. According to Spelta et al. (2018), being overweight or obese has been associated with a better prognosis in subjects suffering from chronic diseases and that the lower FEV1 found in obese people may be linked to a restrictive defect rather than to an obstructive one. George’s FEV1 levels indicate he is at 36%, which may be a reason for restrictive respiration, causing the wheezing rather than an obstruction.
Obesity comes with adverse health effects and the reel of health issues. In an assessment of chronic obstructive pulmonary disease patients to determine their exercise capacity, Rodriguez et al. (2014) concluded that the patients who took the six-minute walk test displayed a negative association with sedentarism and age. George spends his time lying on a chair and has very little physical activity tolerance, which is telling his sedentary lifestyle’s contribution to the possibility of obesity. As Rutten et al. (2013) explain, obese individuals experience more exercise limitations than non-obese individuals. These symptoms owe to the studies that show the relationship between obesity and obstructed breathing.
George’s symptoms also support the potential diagnosis of chronic obstructive pulmonary disease exacerbation, characterized by a magnification of the disease’s symptoms as Burt and Corbridge (2013) opine, hallmark symptoms of exacerbation cause pursed-lip breathing to be more pronounced, as patients try to prevent air-way collapse and increase oxygenation. Non-adherence to medication also precipitates the exacerbation of chronic obstructive pulmonary disease symptoms (Burt and Corbridge, 2013). George’s granddaughter reveals that he has not been taking his medication faithfully and still smokes. Chronic obstructive pulmonary disease releases a myriad of other clinical comorbidities that may cause the progression of the disease when not taken care of effectively.
Chronic obstructive pulmonary disease is often comorbid with obesity and requires independent and collaborative nursing intervention to reduce effects. Nursing interventions for older patients require high geriatric knowledge and patience to work with senior patients. Studies propose that educational interventions that encourage mobility and improve feeding reduce the risk for acquired obesity and subsequent progression of chronic obstructive pulmonary disease (Gunn and Fowler, 2014). George refuses to engage in exercise activities, and to move around to encourage body activity, the nurse in charge of George’s geriatric primary care takes the responsibility to ensure he keeps up with mobility to reduce the imminent risk of obesity. Along with mobility and exercise, nurses provide nutritional support to the patients to ensure they take a balanced diet (Almagro and Castro, 2013). Other researchers corroborate and explain that collaborative intervention between nurses and nutritionists makes sure that nurses administer the right nutritional education to patients (Seo, 2014). Nurses play the role of ensuring that patients take the required amounts of food and keep their weight in check with every visit they make to the hospital. As Morais et al. opine, “patients with chronic obstructive pulmonary disease may show adaptations in the mobility of the upper quadrant related to impaired pulmonary function, which may be important to consider when developing rehabilitation interventions.” (Morais et al., 2016). Intervention strategies that ensure collaboration of caregivers in nutrition to ensure maximum strength, nurses to provide information to patients and physical therapists to ensure that the upper body exercises to reduce chances of immobility, which may contribute to obesity. Using this intervention results in a more enthusiastic attitude toward physical activity for Mr. George and would indicate its effectiveness and appropriateness.
George has difficulties to sit upright due to his difficulties in breathing; therefore, the nurse advises George on the importance of a healthy diet and its effect on mobility. It is also essential for George to consider physical exercise to help him reduce the risk for comorbid issues; in this case, obesity (Hillas et al., 2015). Exercise opens up the chest cavity and increases the ability to endure physical activity without feeling the strain. Nurses need to consider social cognitive influences of physical activities when dealing with chronic obstructive pulmonary disease patients and their will to engage in physical activity. According to Kosteli et al., self-efficacy beliefs contributed to patients’ attitudes towards physical exercise despite the positive outcomes associated with it (Kosteli et al., 2017). Barriers such as fatigue, pain, and disease-specific problems prevent older adults from engaging in physical activity. Besides, social cognitive perceptions and problems such as depression also enable their decisions to avoid physical activity, which edges them towards obesity and a myriad of new health issues (Duenas-Espin et al., 2016). One of the paramount roles of nurses in the healthcare system is providing accurate information to patients that promote their health. According to Stoilkova and Wouters, nurses, physicians, and physiotherapists deliver education programs for chronic obstructive pulmonary disease patients (Stoilkova and Wouters, 2013). Education programs, information, and strategies delivered by nurses to patients equip the patients with coping strategies such as healthy food intake, benefits of exercise, and the importance of communicating with your healthcare provider. Non-pharmacological nursing interventions are a go-to for obesity problems in chronic obstructive pulmonary disease patients with non-advanced obesity. As Braga et al. opine, that accurate information provided to patients during nursing consultation is crucial in controlling unhealthy eating habits and is proven to be effective in controlling the chances of obesity (Braga et al., 2018). Using motivational communication, the nurse encourages and offers George support to reverse his slip into obesity. Educational interventions serve to challenge the patient to change their behavior by informing them of possible consequences resulting from failure to follow medical advice.
Nurses are involved in the managing of chronic obstructive pulmonary disease at all stages, including the acquisition of comorbid conditions amidst dealing with the real disease. Fletcher and Dahl explain that nurse-led management interventions help patients cope with their condition and improve their quality of life (Fletcher and Dahl, 2013). They include patient education, guided self-management, smoking cessation, and pulmonary rehabilitation programs. It is futile to implement physician-led interventions without considering what the nurses know and the appropriateness of the intervention. Patient education, usually disseminated during nurse consultation, aims to ensure that patients know the risk of obesity and how to prevent it. As Sari explains, the main goal of patient education is to educate patients about the aspect of obesity in chronic obstructive pulmonary disease, teaching them coping strategies and to train them in non-strenuous physical activity (Sari and Osman, 2015). Education programs also prove useful in teaching chronic obstructive pulmonary disease patients who are preempted to obesity comorbidities how to manage themselves and to keep them updated on the development of their condition. Smoking cessation, a nursing-initiated program, is valid owing to the evidence of its use in a variety of cases. Education-based interventions include psycho-education methods, non-pharmacological and lifestyle interventions (Coventry et al., 2013). Lifestyle interventions are particularly crucial in the remedying of obesity problems in chronic obstructive pulmonary disease patients. George mainly benefits from this intervention to help him finally quit smoking and put an end to the possible progression of his condition and reduce the chances of comorbidity.
Physicians often characterize chronic obstructive pulmonary disease exacerbation as an emergency requiring holistic intervention from all healthcare facets. Nursing practitioners join multidisciplinary intervention programs and provide critical care to patients to ensure positive outcomes for them. Nursing practitioners provide frontline care to reduce symptoms and effects of chronic obstructive pulmonary disease exacerbation. According to Steindal et al. (2019), nurses help to control breathlessness in people with chronic obstructive pulmonary disease. Improved breathing is crucial for chronic obstructive pulmonary disease patients to alleviate symptoms that often cause them to experience inhalation difficulties. Pulmonary rehabilitation is an umbrella that encompasses exercises that help patients regain the ability to breathe with ease (Celli et al., 2016). Nurses have an education background that helps them to assist COPD patients to improve their breathing. Interventions for improved breathing during nurse consultations, improve breathlessness both at home and in the hospital (Steindal, 2017). Improved breathing is a collaborative intervention that may require cooperation between physicians and nurses to assess the level of obstruction and the topic of an appropriate remedy.
Nurses provide breathing training to patients to help control stressed breathing in emergencies. As Corhay et al. opine “Many pulmonary rehabilitation programs have been developed and provided by multidisciplinary teams and typically include components such as patient assessment, exercise training, education, nutritional intervention, and psychosocial support (Corhay et al., 2014). According to Fletcher and Dahl, nurses intervene to provide the patient with non-pharmacological intrusions, including pulmonary rehabilitation (Fletcher and Dahl, 2013). This nurse-initiated care program, which incorporates initial pulmonary rehabilitation and self-management education, provides a written personalized COPD action plan, and follows-up is evident in the patients’ resulting independence. The study indicated that these interventions were associated with a reduced need for unscheduled primary care consultations and a reduction in deaths due to COPD, self-management through prescribed medication and breathing exercises helps COPD patients to reduce exacerbation.
The leading cause of chronic obstructive pulmonary disease in American citizens is smoking, which is primarily practiced by the senior population. To reduce the acceleration from controlled COPD to exacerbation of the disease prompts nurses to provide intervention related to smoking cessation. Nurses engage in a collaborative program with psychologists and psychiatrists to facilitate smoking cessation and address issues of addiction. Moriyama et al. (2015) propose a nurse-led self-care program to achieve the prevention of exacerbations. Preventing exacerbation requires knowledge of the symptoms by both patient and nurse to prevent sudden emergencies and to track the disease’s progression and seek medical consultation. Telephone consultation to help identify and quantify symptoms is also crucial in helping the patients start the journey to the cessation of smoking (Tonnesen, 2013). Nurses leading telephone interviews prove the patient’s health and wellbeing (Billington et al., 2015). The feasibility of telephone education material in a nurse-led initiative yields positive results with both nurses and patients expressing satisfaction. As Lee et al. explain, using brief counseling strategies before patients can consider telephone counseling is a tool for information dissemination (Lee et al. 2015). Since smoking is one of the significant and dramatic causes of COPD, patients need help and lessons to quit smoking. Smoking cessation counseling by nurses during hospitalization plays a crucial role in quitting smoking, and evidence proves the effectiveness of this model. Smoke secession requires nurses to create patient-specific programs that suit the patient’s characteristic differences (Kazemzadeh et al., 2017). Follow-up of patients by a nurse is crucial as a strategy to continue the process of quitting smoking. The nurse should conduct at least six telephone follow-ups, especially in the first weeks after discharge or after the first visit. It is critical to develop a smoking cessation program as well as the effective use of smoking cessation interventions according to the client’s specificities.
Healthcare practitioners identify COPD as one of the leading respiratory diseases with high mortality. Often, it is caused by smoking or living in an area with abundant biomass gas. Patients with COPD may be hospitalized or may receive outpatient or at-home care depending on the advancement of their cases and the required level of medical attention. George’s case presents symptoms of different problems associated with patients with chronic obstructive pulmonary disease. Obesity and COPD exacerbation are potential problems that nurses would be interested in and possibly offset them. Using collaborative interventions involving nutritionists and physiotherapists, nurses play their designated role in information provision and providing care to the care while intervening in offsetting the problems. Nursing directed interventions such as pulmonary rehabilitation, require nurses to take the lead in training patients who have suffered COPD to regain normal breathing and teach them how to self-manage breathing problems. Nurses’ role is indispensable in the treatment of COPD patients because they play a role in all the stages of treatment. George benefits from these interventions because they cover all the possible causes of his distinctive symptoms, exercise, nutrition, exacerbation, and cognitive attitude.
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