Question

The patient is a 64 year old man with COPD who lives with his wife of 35 years. He retired 2 years ago when his disease interfered with his job as a carpenter. He also quit smoking about a year ago. Since then, his disease has remained stable; however, he now reports that he thinks his wife is preparing for widowhood by taking over all the home chores that he always performed including driving and bill paying. Limiting his interaction with friends, and making all decisions. He is angry and depressed. Routine assessment with pulmonary function testing show his FEV to be 40% of his predicted value, which is an improvement over the 32% value of FEV last year.

What severity classification is his COPD? Provide a rationale for your choice.

How should you respond to his statement about the wife probably preparing for widowhood?

Should he continue to drive and pay bills? Why or why not?

What psychosocial assessment of this patient and his situation should you make?

Should you include the wife in any part of this discussion? Why or why not?

Answer 1

The COPD is classified into four stages mild(no actibe symptoms,per form daily activity without difficulty, almost normal) ,moderate(breathing difficulty after doing activities, exercises, cough) ,. severe(dyspnea present in mild activity,ADL are affected) ,very severe(need O2,exaggerated severely) The patient is in moderate stage as his FEV1 is 40%

Provide him a brief knowledge about the disease condition .He can be reassured that she is trying to bring his workload down and give him a stress free life which can help him to lead a quality life

He cannot continue to drive (air pollution) and pay bills(stress) because this can aggrevate his condition.

The psychosocial assessment like his method of interaction with friends, neighbours, relatives .This gives a clear ideas of his relationship with others and how his quality of life can be improved.

The wife can be included in the discussion, this helps to get a complete history of patient's psychological and physical ptoblem and help in planning an effective care.