Purpose

With the global burden of disease, right-sided heart failure has emerged as the leading cause of premature morbidity every year. Heart failure along with COPD is considered as one of the most crucial public health concern, accounting for 10 million deaths every year (Ko et al., 2016).   The recent report of National Health Survey suggested that 464,000 people individuals experience chronic obstructive pulmonary disease in Australia (Jones et al., 2016).  1 individual out of 20 individuals experiences chronic obstructive pulmonary disease, accounting for 4.8% of the death in Australia. Majority of the population with the chronic obstructive pulmonary disease often subjected to death due to right-sided heart failure (Www.aihw.gov.au. 2020). The case scenario represents COPD and associated right-sided HF of a 76 years old woman Gladys, who presented in the clinic due to swollen leg, wheezing and increased breathlessness. She was experiencing difficulties in mobilization. The purpose of the essay is to discuss the chronic pathophysiology, diagnosis, complication, knowledge consideration along with management in the following paragraphs.

The scenario represents COPD and associated right-sided HF of a 76 years old woman Gladys, who presented in the clinic due to swollen leg, wheezing and increased breathlessness. Chronic obstructive pulmonary disease is defined as a respiratory illness that characterised by obstruction of airway that inhibits with inhalation (Tay et al., 2017). Shortness of breath is considered as the hallmark clinical manifestation of COPD (Jones et al., 2016). Shortness of breath directly contributed the right-sided heart failure because of low oxygen level of the body increase pulmonary hypertension and provide extreme strain on the right ventricle that results in  signs and symptoms such as swollen feet, oedema at thigh and abdominal (Stafyla et al,2018). 

Considering the pathophysiology, due to risk factors such as smoking, genetics, asthma, occupational exposure to the chemical, the airway of lungs irritated which leads to obstruction (Jones et al., 2016). The inflammation of lungs results in the secretion of IL9, IL5 and IL13 and secretion of mucous. The mucous secretion narrowed the airway passage which hindered the normal movement of oxygen and shortness of breath. The inadequate oxygen due to shortness of breath reduced the normal function of lungs for transporting oxygen (Finks, Rumbak & Self, 2020). The inadequate oxygen results in pulmonary hypertension since the lungs experience an increase in blood pressure rapidly. Pulmonary hypertension posed extreme pressure on the right ventricle and weaken the heart muscle (Granger, Morris & Holland, 2019). The weak heart muscle due to rise to pulmonary hypertension followed by R-sided congestive heart failure (Ko et al., 2016). Wheezing observed in Gladys since congested air passages of lungs covered with excessive mucus which results from inflammation and it appeared as musical sounds (Izbicki et al., 2019). The swollen feet is typical represents of COPD followed by right heart failure. In this case, pulmonary hypertension and impaired right ventricle blocked the blood and fluid in the veins throughout the body (Ko et al., 2016). The fluid slowly accumulated to different parts of the body. Fluid gradually moves to gather in the lower extremities of the body. 

Objectives

To gain an understanding of the COPD and associate heart failure the patient, the relevant diagnosis is to evaluate the lungs function by using spirometer. Chest x-ray along with computerized tomography (CT) can be used for a diagnosis to assess the condition of the heart and lungs (Dennis et al., 2017). In order to measure the capability of heart for pumping blood, an echocardiogram can be used which will provide the idea of heart failure severity. Moreover, an arterial blood test can be done for measuring acidity, carbon dioxide and oxygen level of blood from the artery since the acidity the level will indicate the capability of the lungs to transport oxygen to blood and eliminate CO2 at the same time. It will also indicate pulmonary arterial hypertension (Yang et al., 2017). The laboratory test relevant to the diagnosis of the patient is tested for B-type natriuretic peptide (Tromp et al., 2018). It will indicate severity because heart releases B-type natriuretic peptide as a biomarker when heart incapable of pumping blood.

The most frequently observed potential complications that negatively impact the quality of life include depression and respiratory infection. The individuals with the COPD  often catch cold followed by pneumonia results in difficulties of breath and damages to the lungs tissue. Without immediate action, the patient may experience respiratory failure (Yang et al., 2017). In this context, flu vaccination against pneumonia can prevent such complication. Niyonsenga et al. (2018), highlighted that anxiety and agitation are common amongst patients with COPD since COPD results in shortness of breath and hinder patients to involve in daily activities. In this context, the patient leaves alone and experience difficulties mobilization due to shortness of breath and swollen feet that led to anxiety. Prolong anxiety can give rise to depression. 

The case scenario indicated that the patient had COPD associated with heart failure that results in swollen feet, deep breathing and she lacks skills to cope with it. At this juncture, the identified psychosocial factors which impact health illness include immobility because of swollen feet, sedentary lifestyle that results in social exclusion and lack of social support (Knight, 2017). The case scenario indicated she lived away from the son which might contribute to the anxiety. According to psychosocial development theory of Erik Erikson’s, she was in a stage of Ego Integrity vs. Despair where social disconnection and involvement with the community common instances due to low productivity and health condition (Knight, 2017). Therefore, this stage is required to consider as a part of literacy. In this context, cultural consideration for health literacy would be the identification of cultural beliefs, traditional practice as health conditions and lifestyles are greatly shaped by cultural value and beliefs (Heraganahally et al., 2016). Health literacy would be provided using pamphlet and PowerPoint where she will be explained the psychosocial factors that impact her health. She would be provided with an explanation of COPD and associated heart failure, possible self-management skills for anxiety, medication adherence, and proper nutritious along with options for traditional practice (Jones et al., 2016). 

Part A: Written Case Analysis Essay

The case study suggested that patient experienced breathlessness, swollen feet and anxiety that restricted her recovery. Therefore, three nursing management are following:

1. Dyspnoea:

 She experienced breathlessness due to tightened airways associated with bronchospasm. It is considered as the hallmark characteristics of COPD (Jones et al., 2016). In this context, the most appropriate management would be the administration of salbutamol, a selective beta-2 adrenergic receptor agonist that will reduce shortness of breath. It works by acting on relaxing airway smooth muscle responsible for bronchoconstriction and widen the airway (Dispas et al., 2017). Additionally, oxygen therapy can be provided for delivering adequate oxygen so that shortness of breath can be reduced.  

1. Swollen feet:

Swollen feet is the result of fluid build-up in the feet due to functional impairment of the heart and lungs. Therefore, the second priority is the management of swollen feet of the patient. Before providing any management interventions, TOTAP (Touch, Observe, Talk, Active Movement and Passive Movement, and Skill Test) assessment is required to conduct for gain an understanding of the severity of swollen feet. After the evaluation, the patient must be supported with physiotherapy with the assistance of physiotherapist so that she can walk freely (Hoaas et al., 2016). As compression stocking is effective in decreasing blood clot of the patients and the possibility for a further clot, it can be provided to her. Additionally, her dietary habit can be altered by eliminating salts from her diet and incorporating fruits and vegetables. 

1. Anxiety:

May and Pridmore (2020) highlighted that anxiety is often common amongst patients who experience server shortness of breath and have no skills for management of it as observed in this case. In this context, the severity of her anxiety can be measured through the Hamilton Anxiety Rating Scale so that appreciate intervention can be provided (May & Pridmore, 2020).. After the assessment, she can be involved in relaxation techniques such as yoga and deep breathing as it reduces anxiety, negative thought and boost self-esteem.  

Conclusion:

To conclude, it can be said COPD and associated heart failure is considered as most frequently occurring public health issues that lead to premature mortality every year. The essay involves a patient of 76 years with COPD and associated R sided HF that results in swollen feet, shortness of breath and anxiety. COPD developed due to exposure to the smoke, chemicals and other triggers which results in bronchoconstriction. The bronchoconstriction increases pulmonary hypertension followed by increasing stress on the right ventricle and right-sided heart failure. In this case, the most relevant diagnosis are chest X-ray, echocardiogram, arterial gas test and B-type natriuretic peptide test. She can be provided with cultural literacy, developmental and health literacy so she can be involved in self-management. Lastly, for addressing her health condition, she can be provided with salbutamol for shortness of breath, compression stockings for swollen feet and relaxation therapy for anxiety.

Task Part B – Patient Information Resource

References:

Dennis, S., Reddel, H. K., Middleton, S., Hasan, I., Hermiz, O., Phillips, R., … & Zwar, N. (2017). Barriers and outcomes of an evidence-based approach to diagnosis and management of chronic obstructive pulmonary disease (COPD) in Australia: a qualitative study. Family practice, 34(4), 485-490. https://doi.org/10.1093/fampra/cmw103

Dispas, A., Desfontaine, V., Andri, B., Lebrun, P., Kotoni, D., Clarke, A., … & Hubert, P. (2017). Quantitative determination of salbutamol sulfate impurities using achiral supercritical fluid chromatography. Journal of Pharmaceutical and Biomedical analysis, 134, 170-180. https://www.sciencedirect.com/science/article/abs/pii/S0731708516308299

Finks, S. W., Rumbak, M. J., & Self, T. H. (2020). Treating hypertension in chronic obstructive pulmonary disease. New England Journal of Medicine, 382(4), 353-363. DOI: 10.1056/NEJMra1805377

Granger, C. L., Morris, N. R., & Holland, A. E. (2019). Practical approach to establishing pulmonary rehabilitation for people with non?COPD diagnoses. Respirology, 24(9), 879-888. doi: 10.1111/resp.13562

Heraganahally, S. S., Wasgewatta, S. L., McNamara, K., Eisemberg, C. C., Budd, R. C., Mehra, S., & Sajkov, D. (2019). Chronic Obstructive Pulmonary Disease In Aboriginal Patients Of The Northern Territory Of Australia: A Landscape Perspective. International journal of chronic obstructive pulmonary disease, 14, 2205–2217. https://doi.org/10.2147/COPD.S213947

Hoaas, H., Zanaboni, P., Hjalmarsen, A., Morseth, B., Dinesen, B., Burge, A. T., Cox, N. S., & Holland, A. E. (2019). Seasonal variations in objectively assessed physical activity among people with COPD in two Nordic countries and Australia: a cross-sectional study. International journal of chronic obstructive pulmonary disease, 14, 1219–1228. https://doi.org/10.2147/COPD.S194622

Izbicki, G., Teo, V., Liang, J., Russell, G. M., Holland, A. E., Zwar, N. A., Bonevski, B., Mahal, A., Eustace, P., Paul, E., Phillips, K., Wilson, S., George, J., & Abramson, M. J. (2019). Clinical Characteristics Of Patients With Asthma COPD Overlap (ACO) In Australian Primary Care. International journal of chronic obstructive pulmonary disease, 14, 2745–2752. https://doi.org/10.2147/COPD.S220346

Jones, R. L., Noble, P. B., Elliot, J. G., & James, A. L. (2016). Airway remodelling in COPD: It’s not asthma!. Respirology, 21(8), 1347-1356. https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.12841

Knight, Z. G. (2017). A proposed model of psychodynamic psychotherapy linked to Erik Erikson’s eight stages of psychosocial development. Clinical psychology & psychotherapy, 24(5), 1047-1058. https://onlinelibrary.wiley.com/doi/abs/10.1002/cpp.2066

Ko, F. W., Chan, K. P., Hui, D. S., Goddard, J. R., Shaw, J. G., Reid, D. W., & Yang, I. A. (2016). Acute exacerbation of COPD. Respirology, 21(7), 1152-1165. https://onlinelibrary.wiley.com/doi/pdf/10.1111/resp.12780

May, T., & Pridmore, S. (2020). A visual analogue scale companion for the six?item Hamilton Depression Rating Scale. Australian Psychologist, 55(1), 3-9. https://doi.org/10.1111/ap.12427

Niyonsenga, T., Coffee, N. T., Del Fante, P., Høj, S. B., & Daniel, M. (2018). Practical utility of general practice data capture and spatial analysis for understanding COPD and asthma. BMC health services research, 18(1), 1-15. https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-018-3714-5

Preston, W., & Kelly, C. (Eds.). (2016). Respiratory nursing at a glance. John Wiley & Sons. https://books.google.co.in/books?hl=en&lr=&id=IipECwAAQBAJ&oi=fnd&pg=PR8&dq=respiratory+and+allergic+disease+nursing+book&ots=yKftGbJVhR&sig=5mTVtpVGv5AS8N-Z2sCfjCBj8eM&redir_esc=y#v=onepage&q=respiratory%20and%20allergic%20disease%20nursing%20book&f=false

Stafyla, E., Kotsiou, O. S., Deskata, K., & Gourgoulianis, K. I. (2018). Missed diagnosis and overtreatment of COPD among smoking primary care population in Central Greece: old problems persist. International journal of chronic obstructive pulmonary disease, 13, 487–498. https://doi.org/10.2147/COPD.S147628

Tay, T. R., Bosco, J., Gillman, A., Aumann, H., Stirling, R., O’Hehir, R., & Hew, M. (2016). Coexisting atopic conditions influence the likelihood of allergic bronchopulmonary aspergillosis in asthma. Annals of Allergy, Asthma & Immunology, 117(1), 29-32. https://doi.org/10.1016/j.anai.2016.04.024

Tromp, J., Richards, A. M., Tay, W. T., Teng, T. H. K., Yeo, P. S. D., Sim, D., … & van Veldhuisen, D. J. (2018). N?terminal pro?B?type natriuretic peptide and prognosis in Caucasian vs. Asian patients with heart failure. ESC heart failure, 5(2), 279-287. DOI: 10.1002/ehf2.12252

Wang, F., Ni, S. S., & Liu, H. (2016). Pollutional haze and COPD: etiology, epidemiology, pathogenesis, pathology, biological markers and therapy. Journal of thoracic disease, 8(1), E20. doi: 10.3978/j.issn.2072-1439.2015.11.62

Watanabe, Y., Koshiyama, M., & Yanagisawa, N. (2017). Treatment of leg and foot edema in women. Women Health Open J, 3(2), 69-74. https://www.openventio.org/Volume3-Issue2/Treatment-of-Leg-and-Foot-Edema-in-Women-WHOJ-3-124.pdf

Www.aihw.gov.au. (2020). Chronic obstructive pulmonary disease (COPD), COPD – Australian Institute of Health and Welfare. Retrieved 18 March 2020, from https://www.aihw.gov.au/reports/chronic-respiratory-conditions/copd/contents/copd

Yang, I. A., Brown, J. L., George, J., Jenkins, S., McDonald, C. F., McDonald, V. M., … & Dabscheck, E. (2017). COPD?X Australian and New Zealand guidelines for the diagnosis and management of chronic obstructive pulmonary disease: 2017 update. Medical Journal of Australia, 207(10), 436-442. https://espace.curtin.edu.au/bitstream/handle/20.500.11937/59403/257564.pdf?sequence=2