COPD Exacerbation Case Study

Introduction: A COPD exacerbation can be defined as “an event in the natural course of the disease characterized by a change in the patient’s baseline dyspnea, cough, and/or sputum, that is beyond normal day-to-day variations, is acute in onset and may warrant a change in medication in a patient with underlying COPD,” according to the Global Initiative for Obstructive Lung Disease (GOLD). COPD exacerbations are debilitating, in and of themselves. The toll they take on patient’s body can lead to disability and even death. Paying attention to signs and symptoms, taking better care of themselves and taking steps towards prevention may ultimately help patients to avoid a COPD exacerbation.

Clinical Focus: Effective education to increase early rehabilitation for over 20y/o both female and male adult who diagnosed COPD with acute respiratory failure in ICU.

Overall Project Goal:

Overall goal is to be able to propose improvement early rehabilitation to achieve optimal health as well as to promote knowledgeable and effective self management for chronic disease.

Nursing Theory: Roy’s adaptation model of nursing and Orem’s self care mode

Inclusion population

Patient older than 18 years of age

Chronic obstructive pulmonary disease

Patients without sedation or catecholamine

Conscious and cooperative state

Ability for the patient to sit in a armchair

Exclusion population

Non chronic obstructive pulmonary disease

Lack of patient involvement

Patients under guardianship

Unconscious and non cooperative state

Patients unable to ride in a wheelchair

Patients under justice safeguard

Date

Objectives

Strategies

Time frame

Outcomes

10/5/10

Using Orem’s self care model the student will establish needs assessment tool based on the protocols of the institution and information gathered from the health care team of Montefiore Hospital.

Introduce myself to Mr. Villarente. Discuss with overall project goal

1hour

Student explains overall project goal and a plan for assessment tool.

10/11/10

Using Orem’s self care model the student will establish needs assessment tool based on the protocols of the institution and information gathered from the health care team of Montefiore Hospital.

Generalized all information gathered from patient’s chart with COPD, as well as the overview of patient’s education sources.

An insight form the Nurse Manager, unit nurses, allied team members such as Doctor of the unit, social worker and clerk.

Introduce master plan to Mr. Villarente. Discuss about overall project of this object. Unit orientation, discuss about project concept, theory application.

Review current project of the unit and objectives.

2hours

2hours

2hours

1hour

1hour

*Overall outcome: The student reports knowledge on COPD and project of concept using nursing theory which is Orem’s self care model. Student also reports teaching guidelines and support rendered for COPD for Montefiore Hospital.

The student visited Montefiore ICU and Med-Surg unit on the 5th floor with the preceptor and the clinical practicum project was presented to the all available staffs by the student and the preceptor.

No specific and realistic education guideline was unearthed by the student.

The preceptor introduced ongoing project of the unit. The concept is ‘decrease the rate of unscheduled extubation.’ The student was able to merge her own view of the master plan with the ongoing project in Montefiore Hospital.

10/15/10

Using Orem’s self care model and Roy’s adaptation model Student will identify what the barriers are to using COPD guidelines for montefiore hospital patients.

Interview with 3patients and 3 unit nurses at Montefiore Hospital about (lack of) Awareness & knowledge-of what needs to change & why, (lack of) Motivation-drive & desire to improve care, priorities, (lack of) Acceptance & beliefs-perceptions of benefits vs costs of proposed change, (lack of) Skills Practicalities-(lack of ) availability of resources, personnel External environment-financial, political, and organizational.

Review literature

9hours

(1.5hrs for each pt)

(1.5hrs for each nurse)

1hour

*Overall outcome: Student presents what the barriers are with COPD patients and what COPC guidelines needs to change at Montefiore hospital.

The student interviewed 3 patients and 3 nurses to learn good interview skills as well to get their ideas or answers regarding COPD education.

The student found that there is no nursing specialist to teach about how to manage themselves for COPD to prevent exacerbation.

The nursing staffs are able to access KRAMS which is patient education hand out via internet.

During interviewing with patients, the student found that thick hard hand out materials is not able to motivate pt to read all of them.

10/18/10

Using Orem’s self care model and Roy’s adaptation model Student will identify what the barriers are to using COPD guidelines for Montefiore hospital ICU patient.

Review 3patient’s charts to gather information.

Interview with 3 patients about considering respiratory isolation to reduce risk of outbreak or epidemic.

Observe patient care with primary nurses

Review literature

3hours

3hours

(1hrs for each pt)

3hours

1hour

*Overall outcome: Student presents what the barriers are with COPD patients and what COPC guidelines needs to change at Montefiore hospital.

The student reviewed 2charts and observe patient care with primary nurse to gather data regarding medical hx, status, medication, treatment, s/s, family hx, allergies, cigarette or drug uses, etc.

The patients were admitted for asthma and COPD exacerbation with complicated diagnosis such as diabetes, bipolar disorder, CHF. All these diagnosis seemed to be related COPD exacerbation.

One of the interviewee who is 65y/o male stated “I know how to use inhaler to reduce my symptoms but I don’t want to do that myself.”

The student found that we, nurses need greater awareness of and familiarity with COPD diagnosis and monitoring guidelines and an understanding of their practice compared to guidelines

Summary: Patients with stable COPD should be directed at improving quality of life by preventing acute exacerbations, relieving symptoms and slowing the progressive deterioration of lung function. The clinical course of COPD is characterized by chronic disability, with intermittent acute exacerbations that occur more often during the winter months. When exacerbations occur, they typically manifest as increased sputum production, more purulent sputum and worsening of dyspnea. Although infectious etiologies account for most exacerbations, exposure to allergens, pollutants or inhaled irritants may also play a role

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Background of COPD Self Assessment

Today, COPD is a widely-spread disease that threatens to the life and health of many patients. The development of the effective treatment and prevention technique for COPD becomes of the utmost importance, taking into consideration the fact that COPD is a chronic disease. In this regard, Orem’s self assessment model can be very effective taking into consideration the necessity of conducting the self assessment by patients on the regular basis to control their health and any changes that occur to them.

Importance and relevance of COPD Self Assessment for nursing

The COPT self assessment is particularly important for nursing because it opens large opportunities for the development of effective approaches to nursing care. To put it more precisely, patients can reveal the deterioration of their health due to the use of the self assessment model, whereas nurses can provide patients with the essential medical aid immediately and, if necessary, the in-patient treatment starts. At this point, it is worth mentioning the fact that nurses often suffer from the lack of the lack of the close cooperation with patients because they fail to identify health problems and deterioration of their health in time. As a result, the in-patient treatment may be needed and nurses will have to work hard to help patients, whereas the positive effects of such treatment may be at risk, whereas the deterioration of health identified early facilitates the work of nurses and increases the efficiency of their work.

Literature review

In actuality, specialists () recommend using Orem’s self assessment model and Roy’s adaptation model as effective tools that allow patients to conduct self assessment and monitor their health on the regular basis. The use of these models is simple for patients just need to fill in the form and, depending on the result, they can take action and appeal for a doctor or carry on the regular treatment (See App). Many specialists argue that Orem’s model is effective due to the simplicity of its use. On the other hand, patients should remember that they do need the regular supervision and control from the part of health care professionals to avoid consistent deterioration of their health.

Roy’s adaptation model and Orem’s self assessment model

In actuality, Roy’s adaptation model and Orem’s self assessment model is very effective and helpful to nursing. In this respect, it is important to place emphasis on the fact that the self assessment is very important because nurses can get the detailed information from patients concerning their health and provide nursing services just in time, in case of the deterioration of patients’ health under the impact of the development of COPD. In actuality, Orem’s self assessment is a reliable technique and nurses can rely on outcomes of such self-assessment, whereas the use of other less reliable models can raise difficulties in immediate diagnosing and provision proper nursing services for patients.

Relationships between COPD self assessment and other factors

At the same time, COPD self assessment is very important in regard to the development of the adequate treatment and can minimize the risk of the development of other diseases. In actuality, Orem’s model of self assessment can help prevent the development of complications that may lead to the consistent deterioration of health in patients with COPD.

Assessment plan development

In such a situation, nurses should assist patients to develop the assessment plan. In this regard, nurses should provide patients with detailed information on the process of self assessment. To do this, nurses can conduct the questionnaire to assess the educational level of patients. In actuality, training courses may be the next step in the assessment plan development because they will help to educate patients. After that nurses should introduce the control system to evaluate the effectiveness of self assessment and introduce changes in the self assessment model, if necessary.