According to Deane, "patients with chronic obstructive pulmonary disease follow a slowly-declining disease trajectory, punctuated by acute episodes of ill health, until the acute episode that proves to be the fatal one." “More often than not, death is sudden and unexpected”. The only solace to such patients would be to provide a comprehensive care which takes care of the physical, psychological, emotional, spiritual and religious needs of the patients so that they lead a peaceful life until their death. Such a care is known as palliative care. In this project various aspects of palliative care will be discussed which are individualized and tailor-made to a 85 year old patient by name James with chronic obstructive pulmonary disease in end-of-life situation.
Palliative care needs of patients with COPD
James is a known patient of chronic obstructive pulmonary disease and suffers from severe breathlessness, distress, despair and discomfort. Chronic obstructive pulmonary disease or COPD is a devastating medical illness which causes a great degree of human suffering (GOLD, 2008). It characterized by non-reversible airway obstruction due to either emphysema or chronic bronchitis or both. It is not only a major health issue but also a significant source of economic and social burden. (Fromer and Cooper, 2008). One of the most frightening and debilitating symptom of COPD is breathlessness which is progressive. The most common cause of COPD is cigarette smoking (Silvermann and Speizer, 1996). This condition affects about 15% of cigarette smokers (NICE, 2004). Many patients with COPD do not receive appropriate end-of0life care because of the unpredictable course of their disease (Deane, 2008). Along with these symptoms, patients with COPD have other co morbidities which need to be managed too (Deane, 2008). Though the clinical course of COPD is not predicable, end-of-life care is yet possible. In the last year of life, patients like James with COPD are likely to suffer from chronic dyspnea, low mood, weakness, easy fatiguibility and pain (Deane, 2008). COPD most commonly presents as acute infection of the lungs or cough that is productive. The disease is progressive and eventually, the patient develops breathlessness which, over the course of the disease because the most predominant and distressing syndrome. The patient also begins to suffer from exercise intolerance and also easy fatiguibility. All these symptoms make the life of the patient miserable and helpless. The main reason for breathlessness is poor oxygenation of the lungs and ventilation perfusion defects.