Chronic Obstructive Pulmonary Disease - Haddenis Case Study - Nursing Assignment Help

Assignment Task:

Case study: Chronic Obstructive Pulmonary Disease

• Haddenis a 63 year old man who has moderate chronic obstructive pulmonary disease (COPD). He is a current smoker (40 pack years) which means he has smoked approx. 20 cigarettes per day for 40 years.–(days x years/20 = pack years). Risk factors for COPD includes genetic factors, 2ndhand or biomass smoke but would not normally include environmental factors such as living in built up areas

• He was discharged from hospital 3 weeks ago following treatment for (L) lower lobe pneumonia. He was reviewed 4 days ago by his GP who diagnosed a viral infection causing an acute exacerbation of his COPD

• His medical history includes mild hypertension (nil medications currently prescribed) and obstructive sleep apnoea for which he requires the use of CPAP (continuous positive airway pressure)

• When visited by the respiratory nurse, he states that he gets breathless with minimal exertion and cannot attend to his activities of daily living as easily and feels generally unwell

• His current medications include: 

• Trelegyellipta100/25/62.5 micrograms 1 puff /day mane

• Salbutamol 200 micrograms inhaled with spacer prn

• Augmentin Duo Forte 875/125mg bd

• Prednisolone 50mg daily for 5 days mane

• Nicorette patches 15mg/16 hours daily mane

• He is on home oxygen 2Lpm min for 18 hours per day via NP. His SpO2is 87% when off 02, 80% on waking and 92% on 02

• He has an Advance Health Directive and is not for resuscitation 

Focused Assessment

Apply clinical reasoning to determine the nursing assessment, immediate care planning and ongoing management including self management requirements for Hadden

Assessment would include a comprehensive health history:

• Hadden has noticed increasing dyspnoea with minimal exertion and is requiring his oxygen

• Physical examination: Hadden was flushed in appearance and stated he been fatigued during the day. He was moderately breathless when speaking. His RR is 34 bpm, BP 132/88 and HR 90 bpm and SpO292% on 2Lpm of O2. He is noted to be coughing up green colored, tenacious sputum

Diagnostic tests: 

• What diagnostic tests may be considered necessary for Hadden?

• Hadden identifies his main concern as anxiety regarding the chronic, ongoing worsening symptoms of his COPD

• He discloses that he continues to smoke and has not been using his oxygen as often as he doesn’t like feeling “attached” to anything. He also mentions that he does not take his oxygen out of the house as people stare at him

• He reports taking his medications when he remembers them

• Hadden and the nurse collaborate to establish realistic goals and strategies to control his current symptoms and prevent further severe exacerbations 

• These strategies include: increasing Hadden’s understanding of his condition, understanding the actions and rationales of medications prescribed, understanding the rationales and benefits for the use of home oxygen and CPAP, ensuring adequate fluids and nutrition, importance of smoking cessation and attendance at pulmonary rehabilitation

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