Chronic Obstructive Pulmonary Disease Case Study

Introduction

          Chronic Obstructive Pulmonary Disease (COPD), is a study about common respiratory conditions primarily in the lungs. It is chronic inflammatory lung disease that may have caused obstructed airflow from the lungs (Mayo Clinic, 2017). Mr. George Singh, a 76-year-old male, on an Indian heritage has been admitted due to the existing complications of his COPD. Information to be considered in this report contains the main aspects related in the development of the ailment includes smoking, genetic factor and environmental pollutant. This case study will examine Mr Singh’s prescribed medications such as Tiotropium Bromide, Salbutamol and Budesonide Turbuhaler and its outcome along with the nursing intervention in drug administration. In addition, nursing initiatives to enhance patient safety and results will also be described in conjunction with the critical role played by nurses in creating the practice and atmosphere of cultural safety.

Aetiology of the Disease Process

          Tobacco smoking is the major cause of Chronic Obstructive Pulmonary Disease (COPD). COPD manifests itself in developing countries in people exposed to smoking from the burning gas used in heating and cooking in poorly ventilated buildings. At least 20-30 percent of negative smokers are estimated to be able to create chronic COPD (Palange and Simonds, 2013).

Nonetheless, a significant number of smokers with a prolonged smoking history may severely reduce the functioning of the lungs. Although, in some cases, smokers may be identified with less typical lung problems that may be misunderstood as COPD until a physician does critical analysis.

In a conventional breathing system, as air travel down the trachea to the lungs, the oxygenated air passes via blood vessels that enter into the bloodstreams. Consequently, the carbon dioxide, a waste gas due to metabolism is exhaled (Halpin & Tashkin, 2009). Therefore, the lung depends on the elasticity of the air sacs and brochure tubes to force carbon dioxide out of the lungs. However, in the manifestation of COPD, the brochure tubes and the air sacs lose their natural elasticity and expand thus leaving a lot of trapped air in the lungs. In most observed cases, an excessive and long-term cigarette has been cited as the primary cause of lung damage leading to COPD (Fodor and Tóth, 2009). It is marked that the more an individual smokes, the more he/she is higher risk of contracting COPD. Other irritants that may lead to COPD may include piper smoke, cigar smoke, workplace exposure to dust, or fumes, and air pollution.

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However, COPD may be as a result of genetics since as earlier mentioned, about 20-30% smoker has chance to develop the problem. Approximately, one percent of people suffering from COPD, the ailment may be as a result of genetic disorder that leads to a minimized level of a protein referred to as alpha-1-antitrypsin (Abramovitz, 2015). The former is produced in the liver and secreted in the bloodstream to assist in protecting the lungs. Henceforth, a deficiency in alpha-1-antitrypsin can have a severe impact on both the liver and the lungs. Lung damage can as well take place in infants and kids, and not necessarily on long term smokers. In Mr. Sigh’s case, he is an ex-smoker that consumed at least three packs a day for the past 50 years. The high rate of smoking daily was critical in the manifestation of COPD in his body.

Medication Management

Mr Singh has been prescribed certain kinds of medications that would assist him reduce his symptoms of COPD. The administered medication includes:

Salbutamol MDI

          Salbutamol is a short-acting drug, selective beta2-adrenergic receptor that can help relieve in exacerbation in COPD and asthma. This medication helps to soothe the airway muscles, increases airflow and provides fast relief of asthma symptoms. The treatment’s normal impacts are usually about 10-15 minutes. Treatment doses for 20 minutes in an hour includes 4-10 puffs with spacer. The quantity of drugs used can improve respiratory flow of people who are suffering from COPD generally lasts 3-4 hours and is excreted through the urine or faecal tract. Although it must take precautionary steps in administering medications such as Mr. Singh as he is diabetic and may boost his amount of blood glucose. (Ullmann, N., Caggiano, S., & Cutrera., 2015)

Tiotropium Bromide Mane

          The Tioropium Bromide medication usually comes in the form of an inhaler to relax the muscles of people who are suffering from COPD around the airways. It helps to relieve shortness of breath and coughing and making it simpler to breathe. Depending on the severity of the COPD disease, short-acting Tiotropium Bromide may be required before participating in any activity. Henceforth, the Tiotropium Bromide is a long-acting drug that can be used daily by people with COPD. It is an antimuscarinic that has a comparable overall affinity to muscarinic receptors from M1 to M5. The pharmacological effect in the aiway is showin by inhibiting muscarinic receptors through its contribution to relaxing bronchial smooth muscle. (Tiziani, 2013)

Budesonide Turbuhaler BD

Drugs used to avoid and regulates symptoms such as shortness of breath and wheezing induced by COPD are Budesonide Turbuhaler drugs. It is a part of a medication classification known as corticosteroid. (Nici & ZuWallack, 2018). The drug goes straight to the lungs, making it simpler to breathe by minimizing airway swelling swelling and irritation. This sort of medicine, however, must be used commonly to be helpful as it does not work immediately and should not be used likewise to relieve a sudden COPD attack. As stated previously, COPD is a negative condition typically found in elderly patients with comorbidities that require treatment that complicates their diagnosis and therapy. In healthcare team, nurse practitioner plays and important role in handling the continuing therapy of a patient with COPD. Nurse practitioners are accountable for examining the tolerability and safey issues of the patient, which may guide the improvement of therapy adherence. Similarly, nurse practitioners should inform patients about the efficient use of inhaled medicines and the quantity of the inhaled medicines remaining to prevent their use. It is important for the nurse practitioner to establish continuing communication with patients in orer to comprehend their condition and concerns, as well as to provide practical understanding of their illness and strategies for managing and treating it. (Bulcum, Ekici, Ekici & Kisa, 2013).

Nursing Considerations

          As a health care professional, it is our duty to take care of our patient, Mr. Singh, in terms of his COPD safety medications and to know his disease impacts in his physical, psychological and social outlook in order to effectively provide nursing management. Evidence suggests that when respiratory failure and pneumonia occur, patients with COPD are hospitalized for exacerbations and potential complications. Factors to be considered during the evalutation include the present amount of patient symptoms measured by the COPD evaluation test, the severity of the disease, the increased risk reflected in the spirometric classification and the existence of comorbidity of Mr Singh’s diabetes mellitus type 2. (Tselebis, A., Pachi, A., & Illias, I., 2015). Because of several modifications in lifestyle, psychological consideration is essential when caring for patients with COPD as they respond to powerful emotional reactions such as being lonely, frustrated and isolating themselves in some way. Mental, spiritual, cultural and emotional reactions of patients are needed to foster a caring and thorough atmosphere. It is essential to transmit to their family a feeling of caring and comprehension for the experience of the patient’s disease and the emotional toll. For instance, unsafe cultural practice must be prevented by avoiding judgemental attitudes and stereotypical obstacles that demean a patient with chronic disease’s cultural identity and well-being. There are clear, value-free, open and respectful communication strategies that can assist nurses to be culturally secure. This will not only enhance patient’s safety and results, but will also create confidence in encouraging a socially, emotionally and spiritually secure workplace.

Conclusion

COPD is a chronic disorder triggered by various variables, but primarily caused by tobacco smoking. For its manifestation in the body to be noted, it requires a person to smoke for an extended period of time. The COPD destroys both the brochure tube and air sacs elasticity, which normally force air out during breathing. Drugs such as Tioropdium Bromide, Budesonide Turbuhaler and Salbutamol have now been used to help patients who are suffering from COPD syimptoms such as wheezing and coughing. Nevertheless, the prescription of these drugs gives the nurses excellent enlightenment to the patients in order to prevent their illegal use. In order to prevent confrontation, nursing professionals should consider particular problems such as patient’s culture during drug administration.

References

• Mayo Clinic, (2017). COPD. Retrieved: https://www.mayoclinic.org/diseases-conditions/copd/symptoms-causes/syc-20353679
• Nici, L., & ZuWallack, R. (2018). Integrated Care in Chronic Obstructive Pulmonary Disease and Rehabilitation. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(3), 223-230. doi: 10.1080/15412555.2018.1501671
• Tiziani, (2013). Tiotropium Bromide: Nursing Guide to Drugs (9^th ed.). Chatswood, NSW: Elsevier Australia
• Tselebis, A., Pachi, A., & Illias, I., (2015). Strategies to improve anxiety and depression in patients with COPD: a mental health perspective: Psychiatric Department, 12:297-328. doi: 10.2147/NDT.S79354
• Ullmann, N., Caggiano, S., & Cutrera, R., (2015). Salbutamol and around: Italian Journal of Pediatrics, 41(Suppl 2): A74. doi: 10.1186/1824-7288-41-S2-A74
• Abramovitz, M. (2015). COPD. Farmington Hills, Mich: Lucent Books.
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• Cazzola, M. (2009). Acute exacerbations in COPD. Oxford: Clinical Pub.
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• Fodor, K., & Tóth, A. (2009). Handbook of pulmonary diseases: Etiology, diagnosis and treatment. New York: Nova Biomedical Books.
• Halpin, D., & Tashkin, D. (2009). Defining Disease Modification in Chronic Obstructive Pulmonary Disease. COPD: Journal of Chronic Obstructive Pulmonary Disease, 6(3), 211-225. doi: 10.1080/15412550902918402
• Halpin, D. M. G. (2011). COPD. London: Mosby.
• Nici, L., & ZuWallack, R. (2018). Integrated Care in Chronic Obstructive Pulmonary Disease and Rehabilitation. COPD: Journal of Chronic Obstructive Pulmonary Disease, 15(3), 223-230. doi: 10.1080/15412555.2018.1501671
• Palange, P., & Simonds, A. K. (2013). ERS Handbook of respiratory medicine. Sheffield: European Respiratory Society.
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