Pathophysiology And Management Of COPD: A Case Of Bill McDonald

Pathophysiology of COPD

Chronic Obsessive Pulmonary Disorder (COPD) is a common terms for different forms of progressive lung diseases such as asthma, bronchitis and emphysema. The most common symptoms of COPD include increase in breathlessness, frequent coughing, wheezing and chest tightening. It is mainly caused by smoking, inhaling pollutants like fumes, chemicals and dust. Genetic factors also play a role in the development of COPD. There are many issues surrounding the diagnosis and better management of patients with COPD (Aaron, 2014). The essay develops understanding related to the pathophysiology of COPD and management of exacerbation in such patients through the analysis of case of Bill Mcdonald, a 65 years patient who has been diagnosed with COPD. The assessment of his presenting condition, treatment and health status will help to plan home care consideration and education plan for Bill.

Bill McDonald who has been diagnosed with COPD has a long history of recurrent bronchial infection. He has been smoking one pack cigarette per day for 35 years. When he was admitted to the hospital, he was found to be short of breath, he was lethargic and had chronic productive cough with purulent sputum. The rational for this acute and chronic symptoms present in Bill is understood by the pathophysiology of COPD. All the above symptoms is seen in patients due to chronic inflammation of the airways, structural changes in the airway and mucociliary dysfunction. Inflammation of the airways and lung tissue is mostly seen due to exposure to tobacco smoke. As Bill is a chain smoker since the last 35 years, it is evident that chronic symptoms is seen in patient due to exposure to tobacco smoking. Tobacco smoke act a irritant which when inhaled caused inflammatory cells like neutrophils, T lymphocytes and macrophages to accumulate. The activation of these inflammatory cells initiates the inflammatory cascade that results in the release of inflammatory mediators like fibrinogen and C-reactive protein. This cause severe tissue damage and structural changes in the lungs (Celli, 2014).

COPD is associated with pathologic changes in the central airways, bronchioles and lung parenchyma and these results in condition like chronic bronchitis, emphysema and chronic asthma. Bill McDonald has also been found with a history of recurrent bronchial infection and chronic productive cough. Cough may be an indication of progressive disease in patients who continue to smoke. Substantial airway inflammation and numerous inflammatory mediators have direct implications in cough reflex activation and cough secretion in COPD patients. Cough and phlegm is also known to cause mortality and lung dysfunction in patients. Hence, respiratory causes of death are higher in patients with cough and sputum production (Putcha et al., 2014). Sypmtoms like breathlessness is seen in patients due to narrowing of the airways. This occurs because of building up of scar tissue due to the damage of the airways and the multiplication of the epithelial cells lining the airway. Parenchymal destruction also causes conditions of breathlessness due loss of lung tissue elasticity (Mitchell, 2015). Hence, reduced lung capacity and obstruction of the airflows exacerbate symptoms of patients.

Management plan for patients with acute exacerbation of COPD

Another condition resulting in the development of COPD includes the mucociliary dysfunction. This occurs when continous smoking and inflammation enlarges the mucous glands lining the airway walls. Bill might have developed chronic symptoms of COPD due to overexposure to smoke. Such mucociliary dysfunction cause goblet cell metaplasia, condition in which health cells are replaced by excessive mucus-secreting cells. Inflammation in COPD also destroys the mucociliary transpory system due to which patients feel difficult in clearing the mucus from the airways (Fahy & Dickey, 2010). Therefore, blocking of airways due to mucus secretion deteriorates airflow in COPD patient.

Exacerbation of COPD causes acute deterioration of respiratory symptoms resulting in increased breathlessness, cough and production of purulence sputum. It may also involve other symptoms like increased fatigue, chest tightness, peripheral oedema and other symptoms (Uzun et al., 2013). Bill McDonald was also struggling with shortness of breath, unusual lethargy and wheezing productive cough. These symptoms suggest that Bill is a patient with acute exacerbation of COPD. In such case, it is necessary that patient with exacerbations of COPD are adequately managed.

The main goal of management plan for patients with exacerbation of COPD is to reduce the frequency of acute symptoms by giving patient appropriate bronchodilators, corticosteroids and inhaled corticosteroids. In case of patients like Bill who have purulent sputum with cough, antibiotic treatment is necessary to provide relief to patients. Positive expiratory pressure mask is also provided to selected patients to clear the sputum. Sputum is also sent for culture to isolate bacteria and determine appropriate antibiotic therapy for them. When patients have symptoms of dyspnoea, sputum production and sputum purulence, it is regarded as a cause of bacterial infection. Similarly, viral or other infection might also be the cause of exacerbation of symptoms. Hence, sputum colour and type of infection determines the antibiotic treatment in COPD (Soler, & Torres, 2013).

Nurse involved in care of COPD patients has the responsibility to regularly assess sysmtoms of patients. They monitor arterial blood gas pressure to identify symptoms of hypoxemia and respiratory acidosis. Bill’s O₂ saturation level at room temperature was less than 88% and PaO₂ was less than 55. As normal PaO₂ value is between 75 to 100 mm Hg, Bill’s ABG report suggest he has impaired gas exchange. In such cases, nurse plays a key role in assessing the need for supplemental oxygen and promote patients acceptance to the therapy. To manage ineffective airway clearance, nurse teaches patient appropriate coughing technique and posture. To manage effective breathing pattern, nurse also have a role in teaching controlled breathing teachniques like purse-lip breathing and abdominal muscle breathing (Roberts et al., 2016).

Home care considerations for Bill

The management of patients with exacerbation of COPD is also done with the use of oxygen therapy in COPD. Oxygen therapy was also recommended for Bill post discharge from the hospital. Long term oxygen therapy has survival benefits for patients as it helps to manage sever chronic hypoxemia. Chronic hypoxemia gradually leads to other complications like pulmonary hypertension and other clinical deterioration. Oxygen therapy has been found to reduce complications and improve survival rate in patients with hypoxemia. Supplemental oxygen therapy over 15 hours per day works to reduce respiratory rate and tissue carbon dioxide and reduce tidal lung volume (Fraser et al., 2016).

Another part of nursing responsibility is to minimize the exacerbation of COPD by teaching self-management skills to patient to manage exacerbated symptoms. (Zwerink et al., 2014) regarded self-management intervention in COPD patients to be important in order to improve health related to reduce the health related quality of life and prevent frequent hospital admission. Self-management is also necessary because symptoms of COPD tend to worsen over the years, which leads to loss of well-being in patients. The main aim of self-management training is to help patients acquire necessary skills to conduct disease specific routine and guide them to manage their health behavior. Emotional support is also given as part of self-management intervention to support patient in efficiently controlling their diseases. This form of intervention provides patient confidence to manage their health and sustain new behavior for their health benefit (Lenferink et al., 2015). 

  At the time of discharge of Bill from the hospital, the immediate home care needs for him is to make arrangement for oxygen therapy at home. He needed home oxygen at 2 litres per minute per nasal canula. As the nurse is involved in collaboration with community nurse to supply the oxygen equipment, they have a role in considering home care needed to continue the therapy successfully at home and provide follow-up home care. The main equipments needed for the oxygen therapy such as oxygen concentrator, portable tank of concentrated oxygen and oxygen regulators like tubing and nasal cannulas needs to be supplied to the home of Bill as soon as possible. The next step is teach patients and family member adequate skills to handle the equipment and avoid any risk or injury. This is necessary to promote adherence to supplemental oxygen therapy at home to patients (Holm et al., 2016).

Another important action for nurses to provide oxygen therapy at home is to educate patients and family members regarding appropriate information to manage the therapy. First Bill and his family members must be taught about the ways to adjust oxygen flow at the prescribed rate, which was 2 litres per minute per nasal cannula. Oxygen therapy dries the nose membrane of patients and patients like Bill should be encouraged to use water soluble lubricants to avoid dryness and cracking. The nurse or the family members of Bill should make sure to provide new supply of oxygen once the oxygen source is one-fourth full (Hardinge et al., 2015). Secondly, safety precaution is also important as part of home care to avoid any risk to patients. This involves preventing people from smoking in patient’s room as oxygen is highly inflammable. Arrangement should also be made at Bill’s home to an all-purpose fire extinguisher to handle emergencies and patients family member’s should always be taught to check the volume of concentrator regularly (Hall, 2014).

As Bill McDonald is a patient with acute exacerbation of COPD, providing them information regarding the support resources available in the community will promote well-being for COPD people. There are many organizations that can provide knowledge to patients to better leave with COPD. For example the American Lung Assocation, American Asssociation for Respiratory Care and many other provide necessary support to patients. The COPD digest is also a good resource for knowing about latest development about COPD (COPD Resources for Patients, 2017). 

Education plan also has importance for patients with COPD to live a better life. For instance in patient who require oxygen therapy, patients should be taught about the ways to ensure that the oxygen supply never runs. Portable battery operated concentrators are also useful so that patients can easily travel with them. Hygiene practices should also be taught to prevent infection during the oxygen therapy. This involves replacing the cannula every 2 weeks and washing the plastic tubing once or twice a week. Patients should always stay in touch with oxygen therapy supplier to get regular refills. Patients should also immediately consult their clinicians once they observe symptoms of cyanosis, slurred speech and persistent headache (Walters et al., 2016). 

To effectively manage breathing patterns, nurses have the responsibility to teach patients forward leaning position to demonstrate effective breathing pattern (Borge et al., 2015). Techniques like pursed lip breathing is also helpful as it helps to reduce dyspnea in patients. Nurse have the role to teacj correct way to do pursed-leap breathing. This involves inhaling through the nose with mouse closed for some seconds and then exhaling slowly pursed lip held in a narrow slit. It promotes relaxation in the upper part of the body of patients and minimizes the use of accessory breathing. On the other hand, abdominal breathing technique improves breathing efficiency of patients by elevating the diaphragm. Environment also has an impact on ease of breathing COPD patients. For example, air conditioner reduces symptoms of dyspnea (Rossi et al., (2014).

Conclusion

The essay analyzed the case study of Bill McDonald and his presenting symptoms to determine the pathophysiology behind COPD and its relation with chronic symptoms of COPD patient. This discussion helped to understand the structural changes in the airway and lung tissues that leads to inflammation of the airways and consequently causing shortness of breath, cough and sputum production. Secondly, the management plan gave insight into the clinical and nursing intervention needed to manage patients with acute exacerbation of COPD. Self-help intervention has been regarded as valuable to enhance patient’s confidence in managing the disease and improve their quality of life. Furthermore, detail on home care consideration for COPD patients and support source available in the community for COPD patients will guide such patients and family members to seek adequate care service according to the disease process.

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