Care of Patients With Exacerbation of Chronic Obstructive Pulmonary Disease - Assignment Example

Care of patients with exacerbation of Chronic Obstructive Pulmonary Disease al affiliation Introduction Chronic obstructive pulmonary disease (COPD) is major cause of morbidity and mortality. COPD is characterised by progressive and partial irreversibility of airflow limitation. The airflow limitation is associated with a chronic inflammatory process in the airways and lung parenchyma and pulmonary vasculature in response to noxious particles especially in tobacco smoking. OCPD is also characterised by infiltration of the airways by neutrophils, macrophages and CD8+ T cells. An exacerbation of COPD would mean a sustained worsening of the patient’s condition from stable state leading to in onset and necessitates a change in regular medication in a patient with underlying COPD (Hanania & Sharafkhaneh 2011). According to the Nursing and Midwifery Council (NMC) I shall use the name Sue to protect the patient’s confidential information. Sue is a 76 year old who was admitted to the hospital had increased breathlessness associated with increased coughing and sputum and with change in colour and viscosity of the sputum. She also had fatigue, wheezing and chest pain. It was confirmed that she had an exacerbation of COPD. She is married with three children who are very supportive and willing to support in any hospital requirements. She requires adequate medical since exacerbation of COPD can lead to respiratory failure, possibly admission to hospital. Repeated exacerbations may also lead to declined health status of the patient both physically and emotionally (Hansel 2001). In COPD, the chronic and recurrent obstruction of airflow in the airways is usually progressive accompanied by airway hyperactivity and may be partially reversible. COPD encompasses enlargement of air spaces and destruction of lung tissue (emphysema) which leads to hyperinflation of the lungs producing an increase in total lung capacity. Emphysema is caused by smoking and an inherited deficiency of α1-antitrypsin which protects the lung from injury. Chronic obstructive bronchitis is characterised by increased mucus obstruction, obstruction of small airways and a chronic productive cough. Sue was experiencing overlapping features of both emphysema and chronic bronchitis. The mechanisms involved in pathogenesis of COPD are multiple and include inflammation and fibrosis of the bronchial wall, hypertrophy of the sub mucosal glands and hyper secretion of mucus and loss of elastic lung fibres and alveolar tissue. Inflammation and fibrosis of the bronchial wall along with excess mucus secretion and destruction of elastic fibres which normally provide traction and hold of the airways open, impairs the expiratory flow rate, increases air trapping and predisposes to airway collapse (Porth 2011). Understanding patients with exacerbated COPD Assessment of COPD on Sue would be done by clinical and physical assessment. First, Sue’s vital signs should include measurement of body temperature, pulse, respiration and blood pressure. She had a temperature of 102o F, her pulse was at 95 beats per minute and showed a high blood pressure. Sue would undergo exercise testing which can be done outside the laboratory. Breathlessness during the exercise could be measured by a Borg scale or visual analogue scale. Exercise testing is usually done before and after pulmonary rehabilitation. Blood tests can be used to identify polycythaemia in severe COPD. However blood tests have very little use in COPD. Spirometric tests may be useful to assess an acute exacerbation of COPD and can be used to monitor progress. Radiology and computed tomography can be used in diagnosis and quantification of emphysema (Hanania & Sharafkhaneh 2011). Sue can be diagnosed effectively by spirometry. It assess the lung function by measuring the volume of air that can be expelled from the lungs following maximal inspiration. To make diagnosis, detects presence of airflow obstruction and making a definitive diagnosis of COPD. In diagnosis, the postbronchodilator forced expiratory volume in 1 second (FEV1) forced vital capacity (FVC) ratio needs to be Read More