Question

Bill McDonald, 65 years of age, is a male patient diagnosed with chronic obstructive pulmonary disease (COPD). He is going to be discharged with home oxygen at 2 L/min per nasal cannula. According to Medicare guidelines, the patient falls into the group 1 patient category, the patient’s O2 saturation on room air was less than 88% and his PaO2 was less than 55 mm Hg, which was obtained from an arterial blood gas (ABG) at room air. The physician completed the script for the home oxygen therapy according to Medicare guidelines. The information that needed to be included on the script was the documented diagnosis, the prescribed liter flow, the frequency of use in hours per day, and the number of months in duration. The results of the pulse oximetry and the ABG were also included in the script to justify the need for the home oxygen therapy. The nurse needs to make arrangements with the social worker to obtain an agency to supply the oxygen equipment needed and to provide follow-up on a regular basis. The supplier makes arrangements to deliver an oxygen concentrator and portable tanks or concentrated oxygen and oxygen regulators, and needed supplies, including 50 feet of tubing, and nasal cannulas.

Question

complete an APIE (Assessment,Planning,Implementation and Evaluation)based on the care you would have rendered for this client during his hospitalization based on his diagnosis of COPD.

Answer 1

The COPD Assessment Test (CAT) is a new scoring system for COPD patients, which provides a simple method forassessing the impact of COPD on the patient`s health.
An effective COPD management planincludes four components: (1) assess and monitor disease; (2) reduce risk factors; (3) manage stable COPD; (4) manage exacerbations. The goals of effective COPD management are to: Prevent disease progression. Relieve symptoms.
Pulmonary rehabilitation (PR) is an effective intervention for selected patients with Chronic Obstructive Pulmonary Disease (COPD).
Chest x-ray: This test can help support the diagnosis of COPD by producing images of the lungs toevaluate symptoms of shortness of breath or chronic cough. While a chest x-ray may not show COPD until it is severe, the images may show enlarged lungs, air pockets (bullae) or a flattened diaphragm.

PR has been shown to reduce hospital admissions and mortality rates in patients post COPD exacerbation.

Proven benefits of PR:

relieving dyspnoeaenhanced exercise toleranceimproved quality of life.

One measure of COPD is achieved by spirometry grading. There are different grading systems, and one grading system is part of the GOLD classification. The GOLD classification is used for determining COPD severity and helping to form a prognosis and treatment plan.

There are four GOLD grades based on spirometry testing:

grade 1: mildgrade 2: moderategrade 3: severegrade 4: very severe

This is based on the spirometry test result of your FEV1. This is the amount of air you can breathe out of the lungs in the first one second of a forced expiration. The severity increases as your FEV1 decreases.

The GOLD classification also takes into account your individual symptoms and history of acute exacerbations. Based on this information, your doctor can assign a letter group to you to help define your COPD grade.

As the disease progresses, you’re more susceptible to complications, such as:

respiratory infections, including common colds, flu, and pneumoniaheart problemshigh blood pressure in lung arteries (pulmonary hypertension)lung cancerdepression and anxiety.
COPD tends to progress slowly. You may not even know you have it during the early stages.

Once you have a diagnosis, you’ll need to start seeing your doctor on a regular basis. You’ll also have to take steps to manage your condition and make the appropriate changes to your daily life.

Early symptoms can usually be managed, and certain lifestyle choices can help you maintain a good quality of life for some time.

As the disease progresses, symptoms can become increasingly limiting.

People with severe stages of COPD may not be able to care for themselves without assistance. They are at increased risk of developing respiratory infections, heart problems, and lung cancer. They may also be at risk of depression and anxiety.

COPD generally reduces life expectancy, though the outlook varies considerably from person to person. People with COPD who never smoked may have a modest reduction in life expectancy Trusted Source, while former and current smokers are likely to have a larger reduction.

Besides smoking, your outlook depends on how well you respond to treatment and whether you can avoid serious complications. Your doctor is in the best position to evaluate your overall health and give you an idea about what to expect.