Exploring COPD Health Services

Introduction

The long-term condition (LTC) is the health situation in which the individuals suffers from a certain illness for a long-term which cannot be cured but is controlled through changes in lifestyle along with implication of medication and treatment (Whitehead and Seaton, 2016). In this essay, management of a patient suffering from chronic obstructive pulmonary disorder (COPD) as LTC who is been cared is to be analysed and discussed. For this purpose, case study of the patient is to be presented and services and tools used for health management of the patient is to be discussed.

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Patient case study

According to NMC Code of practice, no personal information of the patients are to be shared without their prior consent and data regarding them are to be stored in safe and secured way to avoid any harm or abuse towards them (NMC, 2018). Thus, the pseudonym J would be used to maintain confidentiality and anonymity of the patient. J is a 77 years old male who is currently living alone. J’s son is living abroad and remains in contact through telephonic conversation every day. J is found to continue smoking 10 cigarettes a day even after diagnosis with COPD for the past 10 years though the doctor recommended avoiding smoking. He is reported to irregularly take medication suggested for COPD and avoiding follow proper diet suggested by the health physician as well as remain at home though previously being social. In current situation, J is responsible to manage everyday chores in the house but he is facing hindrance to execute the chores out of severe breathlessness. This has led him to get admitted to the hospital recently where he reported increased chest tightness, wheezing, extensive coughing with sputum and fatigue apart from breathlessness as health issue. The condition indicates J may be suffering from relapsed COPD symptoms and thus chest X-ray and spirometry test was executed. Moreover, when J was referred for care he was seen to be less communicative, lethargic and expressed mood swings. J is currently living on his pension.

Aetiology and Disease progression

The Chronic Obstructive Pulmonary Disorder (COPD) is referred to the chronic inflammation of the lungs which obstructs the free airflow from the lungs leading to create difficulty in breathing (Patchett et al. 2017). As mentioned by Riesco et al. (2017), in active COPD patients with long-term history of smoking the inner lining of the bronchial tubes in the lungs is irritated and damaged that leads to produce increased amount of mucus. This is because persistent irritation of the inner lining of lungs creates oversized mucus glands and increased abundance of goblet cells with damaged pseudostratified columnar epithelium leading to develop of mucus. As argued by Shen et al. (2017), mucus development blocks the pathway of the lungs making the airways narrowed leading to hindered inhale and exhaling of air which creates shortness of breath and chest tightness in COPD individuals. Thus, through coughing COPD patients try to clear the pathway of the lungs to allow proper breathing (Tashkin, 2019). This indicates that irritation and damage of the inner lining of the lungs of J as a result of prolonged and extensive smoking has led him to develop coughing, chest tightness, production of increased sputum and breathlessness which are key symptoms of COPD.

Holistic Assessment of Patient

The holistic assessment of the patient J is to be executed with the help of Ropert-Logan- Tierney Nursing Model where the physical and social challenges faced in activities of living by J is to be determined. According to Ropert-Logan- Tierney Nursing Model, the key physical and social activities of living include breathing, temperature control, managing safe environment, mobility, communication, eating, working and playing, elimination, expressing sexuality, washing, dying and sleeping (Williams, 2017). Moreover, the social and psychological assessment of J is to be made to determine his social and mental health condition due to COPD.

Physical challenges

In COPD patients, it is seen that they suffer from extensive shortness of breath and coughing along with chest tightness which leads to interfere the normal breathing efficiency of the patient (Miravitlles and Ribera, 2017). In the case study, it is seen that J is suffering from COPD and as a result of breathlessness is facing physical challenge to take responsibility for everyday household chores. As criticised by Kouijzer et al. (2018), COPD patients develop fatigue because of forced effort to breathe and increase coughing. This poses physical challenge for COPD patients to develop weakness and unable to execute extensive work. In case of J, it is seen that he is feeling fatigued as has expressed issues with working inside the house indicating he is facing issues with activities of livening regarding working and playing.

In COPD patients, the presence of irritation in lungs and shortness of breathing causes issues with face swallowing (Mendes et al. 2019). In case of J, it is seen that he expresses effective physical ability to swallow and eat. On further physical assessment of J, it is revealed that he has no issues with mobility and elimination but requires assistance with washing and drying as shortness of breath due to COPD is making him inefficient to perform the activities on own. As a nurse, to check J’s breathing efficiency on admission to the hospital the spirometry test is done as the initial assessment done for COPD patients. The National Institute of Health and Excellence (NICE) mentions that normal spirometry result shows FEV1(Forced Expiratory Volume1)/FEV6(Forced Expiratory Volume6) (FVC) ration to be equal or more than 70 % and people having lower percentage are regarded to be suffering from COPD (NICE, 2018). The spirometry results for J revealed FEV 1 /FEV6 (FVC) ratio of 58% indicating the individual is suffering from relapsed condition of COPD. The Chest X-ray was further done for J to determine the extent of further damage caused to his lungs due to COPD compared to before. This is because in chest X-ray condition of air sacs and inner lining of lungs is shown to understand the extent of inflammation and damage caused as a result of COPD (Bhuvaneswar and Therese, 2020). The chest X-ray of J shows that increased areas of inner lining of lungs inflamed and presented a more flattened diagram compared to 10 years before indicating increased damage is caused due to uncontrolled COPD.

Social and Family Challenges

The social challenge faced by COPD patient is that due to shortness of breath and increased coughing they face issues with continuing long conversation and travel long distances. It leads them to remain confined at homes and avoid interacting with other as it relapse their symptoms (Iyer et al. 2018). In case of J, it is seen from the case study that though he has no mobility issues but experiences breathlessness and executes frequent pauses in conversation due to breathlessness. Thus, it would create social challenge for J to remain confined at home and avoid interacting with others being unable to hold prolonged conversation making him isolated from society. The case study revealed that J is solely responsible to care for household chores. However, J’s breathlessness condition and extensive coughing due to COPD would make him face challenge to managing the activities without support from the family.

Psychological Challenges

The patient suffering from long-term condition like COPD due to social limitation often develop depression out of inability to effectively socialise with enthusiasm and share their emotions with others (Sheikh, 2019). In case of J, it is seen that he has remained confined in home for prolonged time and avoided to socialise which indicates that he may be facing issues with coping the illness. As criticised by Pelgrim et al. (2019), people suffering from COPD as long-term condition develop low mood and anxiety out of their inability to normally lead life due to continuous experience of physical challenges like breathing, chest tightness and coughing. In case of J, it is found that he is suffering from similar symptoms due to COPD for the past 10 years which may have created mental challenge to cope with the condition and express anxiety and low mood as mentioned in the case study.

Managing patient condition

In COPD patients, smoking cessation activity is essential as exposure to any amount of smoke causes adverse effect of the lungs, in turn, develop deteriorated and relapsed symptoms of the disease (Strulovici-Barel et al. 2016). The NICE guidelines for managing stable COPD inform that proper advice and encouragement by the nurses are to be provided to COPD patients so that they develop intention to quit smoking. The guidelines mention nurses to provide varenicline or bupropion medication to patient for smoking cessation. Moreover, nicotine replacement therapy is to be provided if appropriate for the patient to help them cease smoking (NICE, 2018). In case of J, the nurses are to offer him varenicline or bupropion by analysing his health to help him quit smoking that is essential for his health. As argued by Benli et al. (2017), the side-effect of varenicline or bupropion medication includes sleepiness, loss of taste, stomach pain and others. This is going to further create deteriorated health condition for J as he would unable to manage proper health. Thus, in this condition talk therapy or group session can be arranged for J which is recommended by NICE for smoking cessation. In smoking cessation group therapy, patients are able to meet like-minded individuals to understand the way they are trying to cope with addiction and develop personal advice from the counsellor regarding the way to quit smoking (NICE, 2018). Thus, the group therapy may lead J to feel proper urge to quit smoking without fear of any side-effects which in turn would benefit him to permanently cease smoking to ensure better health condition with COPD.

The person-centred care is focussing on the specific needs and demands of the patients on the basis of their health condition. The person-centred care is essential as it makes the patient develop effective rapport with the nurse as well as trust regarding care as the care support is provided as per their need and satisfaction (Santana et al. 2018). In case of J, in regard to person-centred care approach, effective actions to be taken so that burden of work for household and care can be resolved to some extent. For this purpose, social services are to be used to appoint a service provider for J who is going to help him perform household chores and assist in washing and managing proper hygiene. The patients with COPD are provided bronchodilators which are substances that help to dilate bronchioles and bronchi of the lungs facilitating improved breathing and lower chest tightness (Beeh et al. 2017). Since J is suffering from chest tightness and breathing issues, the bronchodilators would be effective person-centred approach to ensure his improved health by promoting his breathing efficiency. The phosphodiesterase-4 inhibitors are used for lowering inflammation of the breathing pathway (Grundy et al. 2016). J’s chest X-ray show increased inflammation of the inner lining of lungs, thus the medication is to be provided to improve the condition of his lungs regarding COPD.

Strategies to promote self-care and self-management of patient

The self-care and management in patient with LTC are to be promoted to make them develop believe in taking own care without being burden of care on others (Matarese et al. 2020). The blood oxygen sensor is a device is used by COPD patients as assistive technology that indicates their blood oxygen level. It makes the patient understand the pace at which they are to work or walk so that they do not develop breathlessness (nihr.ac.uk, 2019). This device is to be provided to J to make him keep track of his oxygen level to understand at pace he can walk and to what extent he can perform work so that he does not develop the issue of breathlessness ensuring self-care and management for COPD. J is to be informed regarding the way to use medication reminder alarm on phone such as Med Minder, Pill Pack others to keep proper track of time to take his medication and avoid discontinuation like previously done to ensure self-care for COPD. The complementary therapy such as yoga and meditation helps COPD patient control anxiety and develop relaxation which in turn more oxygen to be transported to the blood enhancing their breathing (Wu et al. 2018). Thus, yoga and meditation are to be provided to J to help him control his emotional turmoil regarding COPD as LTC and enhance breathing along with resolve chest tightness.

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Conclusion

The above discussion informs that J is suffering from relapse condition of COPD which is been detected 10 years ago. This is because he avoided quitting smoking and discontinued medication. Thus, NICE guidelines for smoking cessation activity are to be followed by nurses to help him stop smoking as the activity further deteriorated COPD condition. Moreover, medication like bronchodilators is to be provided to J along with blood oxygen sensor and other assistive technology to support his self-care and management.

References

Beeh, K.M., Burgel, P.R., Franssen, F.M., Lopez-Campos, J.L., Loukides, S., Hurst, J.R., Fležar, M., Ulrik, C.S., Di Marco, F., Stolz, D. and Valipour, A., 2017. How do dual long-acting bronchodilators prevent exacerbations of chronic obstructive pulmonary disease?. American journal of respiratory and critical care medicine, 196(2), pp.139-149.

Benli, A.R., Erturhan, S., Oruc, M.A., Kalpakci, P., Sunay, D. and Demirel, Y., 2017. A comparison of the efficacy of varenicline and bupropion and an evaluation of the effect of the medications in the context of the smoking cessation programme. Tobacco induced diseases, 15(1), p.10.

Bhuvaneswari, P. and Therese, A.B., 2020. Feature extraction and classification of COPD chest X-ray images. International Journal of Computer Aided Engineering and Technology, 12(3), pp.301-317.

Grundy, S., Plumb, J., Kaur, M., Ray, D. and Singh, D., 2016. Additive anti-inflammatory effects of corticosteroids and phosphodiesterase-4 inhibitors in COPD CD8 cells. Respiratory research, 17(1), p.9.

Iyer, A.S., Wells, J.M., Bhatt, S.P., Kirkpatrick, D.P., Sawyer, P., Brown, C.J., Allman, R.M., Bakitas, M.A. and Dransfield, M.T., 2018. Life-space mobility and clinical outcomes in COPD. International journal of chronic obstructive pulmonary disease, 13, p.2731.

Kouijzer, M., Brusse-Keizer, M. and Bode, C., 2018. COPD-related fatigue: Impact on daily life and treatment opportunities from the patient's perspective. Respiratory medicine, 141, pp.47-51.

Matarese, M., Barbaranelli, C. and Riegel, B., 2020. Reply to Comment on: Self-Care Evaluation in COPD. Evaluation & the Health Professions, 43(1), pp.64-65.

Mendes, L.P., Moraes, K.S., Hoffman, M., Vieira, D.S., Ribeiro-Samora, G.A., Lage, S.M., Britto, R.R. and Parreira, V.F., 2019. Effects of diaphragmatic breathing with and without pursed-lips breathing in subjects with COPD. Respiratory care, 64(2), pp.136-144.

Miravitlles, M. and Ribera, A., 2017. Understanding the impact of symptoms on the burden of COPD. Respiratory research, 18(1), p.67.

Patchett, K.K., Hausenblas, H.A. and Sapienza, C.M., 2017. Expiratory muscle strength training for dysphagia in chronic obstructive pulmonary disease: a meta-analysis and systematic review. J Prev Med Healthc, 1, p.1013.

Pelgrim, C.E., Peterson, J.D., Gosker, H.R., Schols, A.M., van Helvoort, A., Garssen, J., Folkerts, G. and Kraneveld, A.D., 2019. Psychological co-morbidities in COPD: Targeting systemic inflammation, a benefit for both?. European journal of pharmacology, 842, pp.99-110.

Riesco, J.A., Alcázar, B., Trigueros, J.A., Campuzano, A., Pérez, J. and Lorenzo, J.L., 2017. Active smoking and COPD phenotype: distribution and impact on prognostic factors. International journal of chronic obstructive pulmonary disease, 12, p.1989.

Santana, M.J., Manalili, K., Jolley, R.J., Zelinsky, S., Quan, H. and Lu, M., 2018. How to practice person‐centred care: A conceptual framework. Health Expectations, 21(2), pp.429-440.

Sheikh, M.A., 2019. Confounding, Mediation, or Independent Effect? Childhood Psychological Abuse, Mental Health, Mood/Psychological State, COPD, and Migraine. Journal of interpersonal violence, p.0886260519844773.

Shen, W., Liu, J., Zhao, G., Fan, M., Song, G., Zhang, Y., Weng, Z. and Zhang, Y., 2017. Repression of Toll-like receptor-4 by microRNA-149-3p is associated with smoking-related COPD. International journal of chronic obstructive pulmonary disease, 12, p.705.

Strulovici-Barel, Y., Staudt, M.R., Krause, A., Gordon, C., Tilley, A.E., Harvey, B.G., Kaner, R.J., Hollmann, C., Mezey, J.G., Bitter, H. and Pillai, S.G., 2016. Persistence of circulating endothelial microparticles in COPD despite smoking cessation. Thorax, 71(12), pp.1137-1144.

Tashkin, D.P., 2019. Heroin smoking and COPD: a case for targeted screening spirometry. Chest, 155(2), pp.247-248.

Whitehead, L. and Seaton, P., 2016. The effectiveness of self-management mobile phone and tablet apps in long-term condition management: a systematic review. Journal of medical Internet research, 18(5), p.e97.

Williams, B.C., 2017. The Roper-Logan-Tierney model of nursing. Nursing2019 Critical Care, 12(1), pp.17-20.

Wu, L.L., Lin, Z.K., Weng, H.D., Qi, Q.F., Lu, J. and Liu, K.X., 2018. Effectiveness of meditative movement on COPD: a systematic review and meta-analysis. International journal of chronic obstructive pulmonary disease, 13, p.1239.


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