Care Plan for an 82-Year-Old Patient with Respiratory Problems and Melancholia - Case Study Example

Based on the patient’s history and physical examination, the patient has a chronic airway obstruction, not elsewhere classified, with concomitant clinical depression. Thus, the three main nursing diagnoses of the patient are 1) ineffective airway clearance related to pneumonia and chronic obstructive pulmonary disease (COPD), 2) impaired gas exchange related to acute and chronic lung disease, and 3) displaying symptoms of depression due to respiratory illness. It is highly possible that her respiratory condition is caused by her history of smoking.

Cigarette contains noxious chemicals that irritate the respiratory lining. These protective mechanisms include the increased production of mucus layers the epithelium to prevent the chemicals from reaching the cells, causing further damage. In addition, the respiratory cells to divide in a faster rate to try to compensate for the chemical-induced tissue injury. As a result, the normally one-cell thick respiratory epithelium that is able to facilitate gas exchange between the atmosphere and blood is now converted to a thick epithelium with multiple cell layers, which decreases the amount of air passing through.

This clinically presents as ineffective airway clearance, causing impaired gas exchange, thus explaining the shortness of breath experienced by the patient, and the need for supplemental oxygen to meet the demands of the body (Reilly, Silverman & Shapiro, 2012, pp. 2153-2154). Addressing the first two nursing diagnoses should be prioritized because these two are the ones causing the depression. In fact, it is estimated that almost one-third of individuals suffering from a chronic medical condition present with signs of depression.

When a person acquires a chronic illness, he or she must adjust both to the disease and to its treatment. Consequently, the health condition can affect a person’s independence, quality of life and perception. These changes cause significant stress that can push a person to abnormal levels of sadness, causing depression. Although a lesser priority, this nursing diagnosis should also be addressed since the loss of interest, sleep disturbance and repeated thoughts of death or suicide can adversely affect the management of the concomitant respiratory disease (Cleveland Clinic, 2009).