follow up discussion one paragraph with intext citation and reference respond tho the below discussion to add information or comment
First off, chronic obstructive pulmonary disease (COPD) refers to a group of diseases that cause airflow blockage and breathing-related problems. It includes emphysema and chronic bronchitis (cdc.gov, 2018). In many cases, people suffer from COPD where they have not been diagnosed and may not receive treatment for their disease. Since COPD is not a curable disease, supportive treatment is recommended with follow-ups and adjustments to a plan of care as needed. An interdisciplinary team with multiple focuses would be best for a patient like this. For instance, controlling and maintaining a chronic disease is not easy for one person to handle. Therefore, the roles of nurses, physicians, and respiratory therapists would be included in a comprehensive plan of care, while also involving family and anyone else involved in home care. Since each patient would have different goals and desired outcomes of treatment, each case should be treated with individuality and specific to improving the quality of life for each.
For this discussion, my patient is a 73-year-old female who has smoked cigarettes for the past 50 years while developing chronic breathing problems with frequent emergency department admissions. Since the initial visit, this patient has exhibited a resistance to smoking cessation programs offered and continues to smoke cigarettes when she is not in the hospital. This trip to the ED, the client is using accessory muscles for breathing, is short of breath, and reports dyspnea with minimal exertion. She states, I have not had a cigarette in 36 hours, I feel like I need to light up to make myself feel better. This only furthers the need for education related to smoking cessation, since it seems this patient may not understand what smoking cigarettes is doing to her body. She is taking a blood pressure medication along with other supplemental vitamins. She has been told by previous providers that home oxygen therapy would help but has refused these offers due to financial reasons. However, the client mentioned she does not use her inhaler unless her breathing is causing severe pain. Her vitals are as follows: BP 128/72, HR 118, RR 30, Temp 99.0, Pain – 7/10, and SpO2 88% on room air. Specific interventions are aimed at providing structure for a smoking cessation program, reconciling discharge information to update her plan of care based on her exacerbations, while including direct and prompt communication between healthcare professionals and coordinated follow-up care (Drummer & Stokes, 2020). Improved health outcomes would incorporate reduced hospitalizations, improved measures of continuity of care, and improvement of quality of life and satisfaction of the patient. Along with education about smoking cessation, this client should receive a respiratory therapy consult, pulmonologist referral, and information about who to seek care with after she leaves this hospital facilities in regard to follow-up care. While educating the patient of the need for follow-up care, it would also be important to incorporate the spouse on how things are expected to work, along with determining their own cooperation to ensure comprehensive care ensues. This might include how to set up appointments, how to check equipment for proper functioning, or to witness the cooperation exemplified by both client and spouse in terms of home healthcare.
Part 2:
I: Good morning Dr. XYZ, this is Mack, and I am the nurse performing the home care visits for Mrs. ABC.
S: Upon arrival, it seems she is having an exacerbation related to her COPD and has yet to stop smoking cigarettes per our previous recommendations. She is short of breath, having pain upon minimal exertion, and accessory muscles are in use while she is visibly struggling to catch her breath. Her oxygen saturation was 85% before placing her on 2 L via nasal cannula.
B: Mrs. ABC has been to our ED 3 times in the past 8 months for exacerbations of COPD, she has no known allergies, and an insignificant medical and surgical past other than chronic COPD issues. Her baseline oxygen saturation has been around 93% based on her recorded vitals.
A: BP 130/76, RR 32, HR 108, SpO2 85% now on 2L O2, Pain 4/10, and Temp 98.6. Patient reports pain upon inspiration and exertion, as she is also in a tripod position after moving from the couch to the kitchen. No fall risks are present within the house and a clear record of past vital signs is written.
R: If hospital admittance is not requested, I would recommend oxygen therapy while at home for episodes of acute hypoxemia. I would also recommend a respiratory therapist comes twice a week to help with nebulizing treatments and ensuring the patient is following treatment guidelines as requested. Smoking cessation brochures should be left for the patient to review at their convenience, along with a recommendation to adhere to those brochures.
CDC.gov. (2018). Chronic Obstructive Pulmonary Disease. National Center for Chronic Disease Prevention and Health Promotion. Retrieved from: https://www.cdc.gov/copd/index.html
Drummer, J. & Stokes, T. (2020). Improving Continuity of Care of Patients with Respiratory Disease at Hospital Discharge. Breathe. DOI: 10.1183/20734735.0161-2020. Retrieved from: https://breathe.ersjournals.com/content/16/3/200161
