Mrs. TT seventy three-year old has a long history of chronic obstructive pulmonary disease (COPD). She came to the medical ward as shortness of breath, wheezing and a cough for the last 5 days. Her sputum was more productive and a green-brown color. Her vital signs on admission follow: blood pressure 135/75 mmHg, pulse 87bpm, respiratory rate 26, oxyhemoglobin saturation 85 on room air and temperature 37.8 Celsius and not unknown allergy. This article is going to discuss the three prioritized nursing care needs of her care plan (See Appendix 2). The nursing cares management is aligned with nursing competence domain 2 and includes collaborative aspects of care related to competence domain 4.
The initial physical assessment (See appendix 1) and vital signs were taken when she came. X-ray and blood test were done. Nursing assessment contributes to facilitate the collection of data to develop cares (Nursing Council of New Zealand, 2009). The prioritized of nursing cares were airway management, oxygen therapy and infection treatment. Physiotherapists involved in the patient care to teach her deep breath. Nursing cares collaborate with the other health team members improve patients' life quality (Nursing Council of New Zealand, 2009).
The following nursing diagnosis for Mrs. TT was ineffective airway clearance. The signs of breathlessness on admission, respiratory rate 26 and ineffective cough (Ellstrom, 2006). Her gas exchanged in the blood is impaired because her oxygen saturation is 85 on the room air. The oxygen saturation below 87% is considered moderate hypoxia (Stacy & Maiden, 2004). She also had a chest infection. According to Waikato laboratory test reference guide, her white blood cells are higher than the normal ranges, and X-ray shows shadow of lungs. Changes of phlegm color can be the sign of chest infection (The Asthma and Respiratory foundation of New Zealand, 2008). Her decreased pulmonary function and ineffective airway clearance are related to the chest infection (Brown & Edwards, 2010).
The goal for Mrs. TT is to reduce the signs and symptoms of exacerbation of COPD to achieve her normal living function. The expected outcomes include maintaining airway clearance. Her level of respiratory function can return to prior to acute exacerbation. Her oxygen saturation valves demonstrate improved within normal limited ranges on room air. Also, her chest infection is minimized (Brown & Edwards, 2010). The expected outcomes have been discussed with and have been told to Mrs.TT. She agreed with it and verbalized to cooperate with nurses. Nursing cares collaborates with clients to plan care and clients have the right of informed the consequence of treatment (Nursing Council of New Zealand, 2009).
To manage the airway clearance, Mrs.TT has combivent and spiriva to relax the muscles in the breathing passages, and beclomethason that helps reduce mucous production in the airway to make breathing easier (Bullock, Manias & Galbraith, 2007). Nurses administer the medication as charted to facilitate clearance of retained secretions to ease of breathing (Brown & Edwards, 2010). A physiotherapist and nurses assist the patient to slow, deep breath and effective coughing to manage airway clearance (Ellstrom, 2006). Nurses work with other health professionals about the prescribed interventions or treatments to provide comprehensive cares to the clients (Nursing Council of New Zealand, 2009). The physiotherapist teaches deep breathing skills to help patients control breathlessly (Respiratory Outreach, 2008). Nurses can encourage Mrs. TT to practice the deep breathing consciously. Mrs. TT has extra phlegm. A physiotherapist can teach the patient use "Active Cycle of Breathing Technique" to clear phlegm (The Asthma and Respiratory Foundation of New Zealand, 2008). Nurses instruct Mrs. TT to cough followed the physiotherapist's methods to move sputum out of airway; nurses encourage Mrs. TT regularly intake fluid to liquefy secretions (Brown & Edwards, 2010).
Mrs. TT takes spiriva and beclomethason in inhaler. Nurses should arrange for review patients' techniques of using inhaler devices (Respiratory Outreach, 2008). Nurses provide the needs of health education for clients (Nursing Council of New Zealand, 2009). Nurses can instruct Mrs.TT use and care the devices. Also, nurses could educate Mrs. TT about signs and symptoms of acute exacerbation of COPD like shortness of breath, coughing and spitting up mucus because starting treatment as soon as possible can avoid a serious development or respiratory failure (The Asthma and Respiratory Foundation of New Zealand, 2008). Health education is the benefit for clients to maintain and promote health (Nursing Council of New Zealand, 2009).
Oxygen therapy is effective for Mrs. TT to maintain oxygen saturation greater than 90%. Nurses administer oxygen as charted and set up the equipment to ensure the oxygen administered through a warm and humidified system (Brown & Edwards, 2010). Nurses confirm the oxygen delivery device is properly positioned and it deliveries the correct concentration oxygen for Mrs. TT (Celli & MacNee, 2004). Nurses measure Mrs. TT's oxygen saturation and pulses every 4 hours. Nurses could encourage Mrs. TT rest as possible as she can, which minimizes the consumption of oxygen to prevent desaturation. Patients perform procedures only as needed and adequate rest between various produces (Stacy, 2004). To promote secretion clearance is an effective intervention to optimize oxygen and ventilation as well, including adequate fluid intake, humidify oxygen supplement and coughing (Stacy, 2004).
Treatment of infection and minimizing the risk of infection is significant for Mrs. TT. Nurses administer the prescribed antibiotics on time to treat chest infection for 7-10 days (Respiratory Outreach, 2008). Deep breathing and coughing contribute to prevent stasis of respiratory secretion in airway, (Brown & Edwards, 2010). Nursing interventions also involve minimizing the risk of infection, such as hand washing before and after patient care to reduce the transmission of microorganisms and provide oral care every 4 hours to avoid accumulation (Stacy, 2004). Month care is essential for Mrs. TT because she inhales baclomethasone that can cause minor infection in the mouth (Respiratory Outreach, 2008).
Following the cares, Mrs. TT respiratory rate is 22, depth and breathing sounds appear clear, which shows normally. Nurses monitor respiratory rate, rhythm and depth, and checking her breathing sounds to assess respiratory status (Lippincott Williams & Wilkins,2005). Mrs. TT can demonstrate how to use inhaler correctly; she could describe the signs and symptoms of COPD. Nurses do ensure that the client can understand the relevant information (Nursing Council of New Zealand, 2009). Her oxygen saturation is about 93 on room air and pulses maintain 72bpm, which is in the normal limited ranges (Brown & Edwards, 2010). Her lab test of partial pressure of oxygen and carbon dioxide in the blood is in the normal limited ranges. Nurses use pulse oximeter to monitor patients' oxygen saturation and take blood tests as needed aiming to evaluate the oxygen therapy (Lambert, 2008). Her white blood test result is above the normal range, but it is lower than admission. Her sputum color still appears light green, and her lungs' X-ray shows shadow, which means she has chest infection. She needs medication for the treatment. According to nursing competence, nurses have the responsive to evaluate the effectiveness of the clients' response to the treatments, interventions and the health education (Nursing Council of New Zealand, 2009).
When I cared Mrs.TT, I followed the care plan that emphasized the medical care so if I could take care patients with COPD in the future, I would look after their mental health. People with COPD feel depressed, irritable and anxious because of changes in their work, roles in the relationship and physical appearance; the anxiety and depression can worse COPD (Respiratory Outreach, 2008). I would help patients to cope with stressful. Also, I could explain the oxygen therapy to patients and family to avoid their worries. I could arrange a session for patient and family to discuss the treatment plan and provide information about COPD to support them.
Mrs. TT was admitted to the medical ward as the exacerbation of COPD. Nursing cares aim to relief the signs and symptoms of COPD and to return to her normal functions. Physiotherapists and nurses involve in the recovery. Physiotherapists technically assist Mrs.TT deep breath and effective cough. Nurses encourage Mrs.TT use the skills to maximum ventilation. Nurses administer the medication and oxygen to make her ease breathing and treat infection. Also, nurses monitor her vital signs and respiratory pattern to ensure treatment is effective, and lab tests and X-ray to evaluate the nursing care. To reflect on my nursing cares, I would notice the mental health of patients with COPD and give more support to patients and family.