Case Study of a COPD Patient

Patients’ education in controlling and treating any disease is very much assistive. Proper education about controlling any chronic disease helps a patient to live a better life by managing it. Various chronic diseases are there and one of them is COPD. It stands for Chronic Obstructive Pulmonary Disease. In this physical condition patients find difficulty in breathing and completely emptying the air from the lungs (Sin et al. 2016). It is very common health issue but can be very dangerous and it is considered as one of the biggest disease that causes massive illness and deaths among the patients (Karrasch et al., 2016). This paper is going to review a case study of a COPD patient. Considering the main health concern, topics for client education will be discussed in the paper. Different appropriate educational strategies to educate patient about the disease will also be described. Finally, the paper will conclude with the evaluation of patient’s satisfaction and reflection on the study.  

In the case study, the patient, Mr. George Polaris is an Italian who has been diagnosed with Chronic Obstructive Pulmonary Disease and he has been admitted to the chest infection department with fever and shortness of breath along with some productive cough. Due to his illness he has lost several kilograms from his body and he is depressed that he might have got old and will no longer be able to work anymore as he works as a labourer in a construction industry. George is having a background of gastro-oesophageal reflux disease (GORD) and he has been prescribed intravenous antibiotics, IV therapy as well as bronchodilators.  George is a smoker since when he was 14 years old and even he used to smoke 20 cigarettes per day. However, he is not alcoholic and has no known allergies. From the assessment of his condition, it has been found that his body temperature is 36.7 degree Celsius, his blood pressure is 135/88 mmHg, pulse rate is 100 beats/min, and respiratory rate is 22 breathe/min. He takes Esomeprazole magnesium (Nexium) 40 mg PO OD and now he has been prescribed for Salbutamol (Ventolin)100 micrograms MDI, 2 puffs when required up to 4 times daily and Tiotropium (Spiriva) 18 mcg inhaled by mouth OD.

It is important to identify the primary health concern of any patient in order to begin or prepare a proper nursing care strategy. From the various health issues, the main issue is identified and after that, the nursing plan is set as per the priority. The client in this case has different types of health problems and he is already under medication for his gastro-oesophageal reflux disease. But, the main issue, for which he has been admitted to the hospital, is his shortness of breath along with fever and cough. He has been diagnosed with COPD. His smoking pattern is mostly associated with his disease and his professional life can also be hampered if it is not controlled properly (Marks, 2018). He has also been prescribed with many new medicines which needs some knowledge about how to use that. So, keeping the main health concern regarding the COPD in mind, some topics of client education will be provided.    

Identifying the Primary Health Concern

Removing the root cause of lung inflammation is the main method of treating COPD. For most of the people, the main cause of COPD is smoking cigarettes. There is no good way to recover the lung damage, but stopping the bad habit of cigarette can slower down the loss of lung function (Corsonello et al., 2015). It is important for all the patients of COPD to stop smoking as soon as they have been diagnosed with the disease. Medicines can also help a COPD patient to control the disease and in such case, medicines are provided in the form of inhaler which directly helps to reach the medication at a good amount in the lungs. Several types of medications are used in this disease and they are bronchodilators, steroids, phosphodiesterase , antibiotics, oxygen therapy, and others. Apart from that, vaccination, pulmonary rehabilitation program can help a COPD patient in managing the disease (Mendoza & Cooper, 2016). In some extreme cases, lung volume reduction surgery and transplantation can be helpful in the condition of the patients with severe COPD. However, the condition of COPD worsens slowly and it causes permanent lung damage and even heart failure which can take the lives away too (Von Nussbaum et al., 2016). So, controlling COPD is highly recommended and it helps a patient to live a better life. Simultaneously, with the medication process some self-management techniques are required too. These techniques can be achieved with a proper knowledge and education. In this case, topics of client education of George as per his condition will be described.  

George has been admitted to the ward of chest infection and he is suffering from the issues of COPD and considering his health condition, two different topics of client education can be included. These topics can be helpful in the self-management process for this disease and it can provide knowledge to the patient which will be helpful in getting some relief also. From many studies, it has been found that COPD patients are educated with various programs and plans that can address the primary health concern (Melzer et al., 2017). These topics generally form the education component of a pulmonary rehabilitation program and at the very beginning of the programs the topic are included. However, various factors are associated with the disease which requires knowledge and education to control but from those the main issues are chosen as per their priority and effectiveness. So, for this patient, two different topics for client education can be,

1. The role and correct use of medication
2. Breathing techniques to manage breathlessness.

Treating COPD

The following section discusses how these topics can address the health concern for the client with COPD and how this can assist the patient in the self-management for his chronic illness will also be discussed (Melzer et al., 2017).

Breathing techniques

Pulmonary rehabilitation program is highly beneficial for the COPD patients. In this multidisciplinary approach, breathing exercise training and education about the proper usage of medicines can be extremely helpful for the patients in improving functional capacity and lowering the mortality rate of the disease (Hyland et al., 2016). The breathing exercise technique includes pursed lip breathing and diaphragmatic breathing.

In pursed lip breathing, the patient will be more focused and stay calm which should be used during and after any action or exercise (de Araujo, Karloh, Reis, Palú & Mayer, 2015). In this method, a patient needs to blow out through the lips pursed as if he is blowing out a candle (Damle, Shetye & Mehta, 2016). In a study that compared health-related equality, it has been found that after eight to twelve weeks of training and execution, pursed lip breathing showed a significant improvement among the patients in the dyspnea domain (Roberts, Schreuder, Watson & Stern, 2017). Diaphragm breathing technique helps the patient to use their abdominal wall instead of using the chest wall (Lee, Cheon & Yong, 2017). Studies revealed that, after four weeks of training, the method improved dyspnea and a six minute walk test also proved that this technique improves the functional capacity among the patients (Roberts, Schreuder, Watson & Stern, 2017).

Usage of inhaler devices

Inhaler devices are used in the medication of COPD patients, but assessing correct use of inhaler can be problematic among patients. So, education is a critical factor to distinguish the use and the misuse of the inhaler devices. With the proper use of inhaler devices, a patient gets relief in a faster way (Jolly, Mohan, Guleria, Poulose & George, 2015). Studies related to this revealed that patients who cannot use inhaler properly, are more likely to suffer from the affects of the disease (Pothirat et al., 2015). Therefore, patients’ education about the proper usage of inhaler devices is highly necessary.  

Two education strategies

In order to educate George about the topics which are addressing the main health concern two different education strategies can be chosen. Considering the condition of George, he can be educated individually and in group session. Educating the patient about the proper usage of inhaler devices will be done in individual training and in order to educate the patient about the methods of breathing exercises, he will be participating in a group session along with his family.

Educational Strategies for COPD Patients

Principles of patient education

In order to motivate the patients who are suffering from COPD and their families to adopt the behaviours to address and improve their health, an effective education and teaching is necessary (Arora et al., 2014). To achieve effective teaching, the educator must learn the necessity of the patient and educator must acquire some appropriate methods to motivate the patients and their families to learn the change process. So, it is actually a guiding process that helps in the acquisition of knowledge and adopting new behavioural practices (Arora et al., 2014).  

Individually

George will be taught about the usage of inhaler devices during an individual training session. In this method, some inhaler devices will be used for demonstration. The registered nurse will demonstrate the optimal usage of inhalation devices. In this case, the patient has been prescribed Salbutamol and Titropium which consists of inhalation devices and these are new for patient.  Considering the prescribed medicines, demonstration devices will be collected from the manufacturers. Some relevant videos will be shown to the patient to visually describe the patient about the way of using that. Some free handouts will be provided to the patient that will describe the process in a step-by-step method. The language will be understandable to the patient. After the demonstration, the patient will be asked to show how he will use the device to crosscheck if he has acquired the technique effectively or not. It will also reflect if he is having any difficulty while using the device.  

In group session

In order to teach the patient about the breathing techniques, he will be called for a group discussion session along with his family members. In the group session, many COPD patients will participate. Some videos and charts will be shown. There will be lecture about the effectiveness of the usage of breathing techniques. Group education is very much helpful in the intervention of COPD patients (Sanchis, Gich, Pedersen & Team, 2016). Flip-board with large sheets of paper, erasable markers, and some materials relevant to the group session such as copies of the action plans for COPD, brochures to give the patients and their families etc. will be used in the group session. Discussing important practical experiences will also be included in the group session. At the closing of the session, patients will be suggested for some homework exercises to integrate the learned skills.

Teaching Proper Usage of Inhaler Devices

Evaluation patients’ satisfaction

At the end of the sessions, patient will be asked some questions regarding the whole learning procedure to assess how it has helped to acquire the knowledge to manage COPD.

Reflection using Gibbs Cycle

Being a registered nurse, I believe that my culture, language and behaviour can influence the whole interactive session as Mr. George Polaris was from Italy. Even, mismanagement can hamper the education session too.

Feelings

I was alarmed with the existence of cultural differences that could slower down the teaching process. So, I assured the patient about the language. Even, my attitude and behaviour also differs from the patient’s culture.

Evaluation

Teaching George was extremely challenging for me as the main barrier was the language difference. So, I tried to arrange the whole session in a language, which will be clearly understandable by both of us. Stopping the patient from smoking was also difficult so I used some practical examples to describe the negative outcomes of cigarettes.

Analysis

COPD is a common health issue and the education strategy to provide knowledge about the self-management technique is very useful. Teaching patients with cultural difference is challenging but nurses learn to value all the cultures while providing care.

Conclusion

Looking back at the incident, I can see that valuing all the cultures is very much important. Patients can be sensitive about their cultural beliefs so while providing care, nurses should be highly attentive.

In future, I will try to develop my assertive skill in this regard in order to ensure the patients’ satisfaction and I will try to discuss with my mentors to learn more strategies while dealing with such COPD patients

References

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Karrasch, S., Brüske, I., Smith, M. P., Thorand, B., Huth, C., Ladwig, K. H., … & Schulz, H. (2016). What is the impact of different spirometric criteria on the prevalence of spirometrically defined COPD and its comorbidities? Results from the population-based KORA study. International journal of chronic obstructive pulmonary disease, 11, 1881.

Marks, G. B. (2018). Guiding policy to reduce the burden of COPD: the role of epidemiological research.

Corsonello, A., Scarlata, S., Pedone, C., Bustacchini, S., Fusco, S., Zito, A., & Antonelli Incalzi, R. (2015). Treating COPD in older and oldest old patients. Current pharmaceutical design, 21(13), 1672-1689.

Mendoza, N., & Cooper, A. (2016). What is the most effective corticosteroid regimen for treating COPD exacerbations?.

Von Nussbaum, F., Karthaus, D., Anlauf, S., Delbeck, M., Li, V. M. J., Meibom, D., & Lustig, K. (2016). U.S. Patent No. 9,359,362. Washington, DC: U.S. Patent and Trademark Office.

Melzer, A. C., Ghassemieh, B. J., Gillespie, S. E., Lindenauer, P. K., McBurnie, M. A., Mularski, R. A., … & Au, D. H. (2017). Patient characteristics associated with poor inhaler technique among a cohort of patients with COPD. Respiratory medicine, 123, 124-130.

Hyland, M. E., Halpin, D. M., Blake, S., Seamark, C., Pinnuck, M., Ward, D., … & Seamark, D. (2016). Preference for different relaxation techniques by COPD patients: comparison between six techniques. International journal of chronic obstructive pulmonary disease, 11, 2315.

Roberts, S. E., Schreuder, F. M., Watson, T., & Stern, M. (2017). Do COPD patients taught pursed lips breathing (PLB) for dyspnoea management continue to use the technique long-term? A mixed methodological study. Physiotherapy, 103(4), 465-470.

Pothirat, C., Chaiwong, W., Phetsuk, N., Pisalthanapuna, S., Chetsadaphan, N., & Choomuang, W. (2015). Evaluating inhaler use technique in COPD patients. International journal of chronic obstructive pulmonary disease, 10, 1291.

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Sanchis, J., Gich, I., Pedersen, S., & Team, A. D. M. I. (2016). Systematic review of errors in inhaler use: has patient technique improved over time?. Chest, 150(2), 394-406.

Jolly, G. P., Mohan, A., Guleria, R., Poulose, R., & George, J. (2015). Evaluation of metered dose inhaler use technique and response to educational training. Indian J Chest Dis Allied Sci, 57(1), 17-20.

Damle, S. J., Shetye, J. V., & Mehta, A. A. (2016). Immediate Effect of Pursed-lip Breathing while Walking During Six Minute Walk Test on Six Minute Walk Distance in Young Individuals. Indian Journal of Physiotherapy and Occupational Therapy-An International Journal, 10(1), 56-61.

de Araujo, C. L. P., Karloh, M., Reis, C. M. D., Palú, M., & Mayer, A. F. (2015). Pursed-lips breathing reduces dynamic hyperinflation induced by activities of daily living test in patients with chronic obstructive pulmonary disease: A randomized cross-over study. Journal of rehabilitation medicine, 47(10), 957-962.

Lee, H. Y., Cheon, S. H., & Yong, M. S. (2017). Effect of diaphragm breathing exercise applied on the basis of overload principle. Journal of physical therapy science, 29(6), 1054-1056.