Question

Disease teaching

TOPIC:           COPD

Write the following summary of the disease, making sure to include all of the points below. Your lesson should include:

• Pathophysiology of the disease: In your own words, write the pathophysiology of the disorder and relate the clinical manifestations of each back to the pathophysiology based on the information you taught your peer.

• Clinical manifestations of the disease (at least two assessment findings)

• Two nursing diagnoses: Discuss 2 nursing diagnoses common to patients and the interventions you chose for each diagnosis.

• Treatment plan (at least two interventions: intraprofesional and nursing care) and the rationale for interventions

• Four patient teaching points for this disease: Include the disease, the treatment plan, and the evaluation of the effectiveness of your teaching.

Answer 1

Answer:

Pathophysiology of COPD:

COPD includes two main conditions: chronic bronchitis, emphysema, or a combination of both.

Chronic bronchitis is the result of an increase in swelling and mucus production in the breathing tubes or airways. The lining of the airways remains irritated and inflamed. The additional swelling and mucus leads to a reduction of the inside of the breathing tubes, causing them to be smaller than normal. This makes it more difficult to breathe.

Emphysema causes damage to the air sacs in the lungs. The walls between many of the air sacs are damaged, causing them to lose their shape. This causes the sacs to lose their stretchiness and trap air instead.

It becomes increasingly difficult to push all of the air out of the lungs and they no longer empty efficiently. This cause more air than normal to be present. This phenomenon is called air trapping and causes hyperinflation in the lungs. Extra air in the lungs and the additional effort needed to breathe adds to shortness of breath.

Air obstruction occurs because the air sacs that typically support the airways and the breathing process are unable to open properly during inhalation or exhalation. The damage can also destroy the walls of the air sacs, resulting in fewer and larger inefficient air sacs instead of the normal tiny ones. This leads to a reduction in gas exchange within the lungs.

People with COPD have difficulty emptying the air out of their lungs, which can lead to shortness of breath or feeling extremely tired because the body is forced to work harder to breathe.

Clinical manifestations of the disease:

People with COPD have less air flowing in and out of their airways, which can be linked to several possible reasons:

• The airways and air sacs have lost their stretchiness
• The walls between the air sacs are damaged or have been destroyed
• The walls of the airways become inflamed and thickened
• More mucus is produced in the airways, causing them to clog

People may experience:

Cough: can be dry or with phlegm

Respiratory: frequent respiratory infections, shortness of breath, or wheezing

Whole body: fatigue or inability to exercise

Also common: chest pressure, loss of muscle, or weight loss.

Two nursing diagnosis and interventions:

1) nursing diagnosis:

Ineffective airway breathing related to obstruction and smoking.

Intervention:-

Helping patients help themselves

Smoking cessation

However severe the disease, smoking cessation will lengthen life (BTS, 1997), as cessation slows the accelerated decline in lung function. Unfortunately, lost lung function cannot be regained, so patients need to be aware that stopping smoking will not return them to health. Some patients may feel that the years gained may not be worth the effort, especially if they are already severely disabled.

Smoking cessation is difficult, and most smokers try several times before they succeed. Nicotine replacement therapy and bupropion do increase success rates (Silagy et al., 2002) and both are now readily available on prescription. Most nicotine replacement products are safe to use in COPD.

The inclusion of smoking cessation services as part of the National Service Framework for Coronary Heart Disease has benefited respiratory patients considerably (DoH, 2000). These services have developed over the past three years, and smoking cessation clinics and specialist advisers have now been established in every health authority. Smoking cessation guidelines (Raw et al., 1998; West et al., 2000) give clear and structured guidance for health professionals: all patients should be asked if they smoke, advised to quit if they do, offered help with quitting, and followed up.

Helping COPD patients to stop smoking is a vital part of the nurse’s role even if that help is referring the patient to specialist services. Many practice nurses have been trained in smoking cessation techniques and can offer patients a great deal of support. Similar skills are now developing in secondary care, although it may be more difficult to offer ongoing support in hospital.

2) Nursing diagnosis:-

Impaired nutrition related to increased work load or difficulty breathing

Intervention:-

Nutrition

Many patients with advanced COPD are underweight, while some are overweight. Obesity increases the workload of breathing, and reducing weight will help patients cope with disability (BTS, 1997).

Measuring body mass index (BMI) is simple and should be a routine part of assessing patients with COPD. A low BMI suggests a poorer prognosis (Landbo et al., 1999), especially in those whose disease is advanced, while an increase in BMI with treatment improves prognosis (Schols et al., 1998). Why patients lose weight is not clear, although it is widely accepted that weight loss occurs when energy demands exceed energy intake.

Dietary supplementation may help, but this should not replace a normal diet. Patients with severe disease should be advised to eat little and often, particularly if eating increases the sensation of breathlessness.

Treatment plan

How will COPD treated:

Your healthcare provider will examine you and ask you questions about your health. You'll be given one or more simple tests that can give information about how well your lungs are working. Your healthcare provider then decides how to treat you based on your test results. Possible treatments include medicine and oxygen to help you breathe better.

Patient teaching:

What can I do to take care of myself?

* If you smoke, stop. Your healthcare provider can help you quit and provide information on support groups. There are also prescription and over-the-counter medicines that can help you to quit.

* Learn breathing techniques, such as pursed-lip breathing, that will help you breathe easier, especially when you feel short of breath.

* Stay away from fumes, smoke, and dust. Leave your house if it's being painted or sprayed for insects. Stay in air--conditioned rooms if it's hot outside. Listen to weather reports and stay inside when the air quality is poor.

* Take your COPD medicine the way your healthcare provider tells you, or it may not help you. Tell your healthcare provider if your medicine doesn't seem to be working as well as it used to. Don't stop taking your medicine or change the dose without talking to your healthcare provider first.

* Make a list of all your medicines and keep it with you in case you need to go to the hospital suddenly.

* Exercise regularly. Ask your healthcare provider for an exercise plan that's right for you.

* Eat healthful foods and watch your weight. Lose weight if you're too heavy. If you need to gain weight, your healthcare provider can recommend supplements.

* Drink a lot of noncaffeinated, nonalcoholic fluids(as long as your healthcare provider isn't restricting your fluids) to keep mucus in your lungs from getting thick.

* Avoid sick people. Stay away from anyone who has a cold or the flu. Get a flu vaccine each year. All adults with COPD should receive a pneumonia vaccine.

* Pace yourself. Do things slowly and do them sitting down, if you can. Plan rest periods. If you need help with chores and errands, ask family and friends.

* Call for help if you feel worse. Call 911 if you can't breathe, your fingertips turn blue or gray, your heart feels as if it's pounding in your chest, or you have trouble talking or walking.