Mr Artuso, a sixty-three-year-old electrician, reported to the emergency room complaining of peripheral edema, shortness of breath, and morning cough. Upon further consultation, Mr Artuso revealed that he had smoked one pack of cigarettes every day for the last three decades. Additionally, his shoes are usually tight in the evening. He has difficulty breathing when he walks and has been sleeping on a recliner to ease breathing. Mr Artuso underwent a physical examination and diagnostic studies. This paper analyzes the client’s history and how it contributed to the disease. The paper also interprets the objective data from the physical examination and diagnostic studies, identifies critical issues that should be addressed during patient education, and recommends suitable nursing interventions for chronic obstructive pulmonary disease (COPD) with exacerbation.
Mr Artuso’s History
According to Hardin et al. (2017), cigarette smoking is the most significant environmental risk factor associated with COPD. The susceptibility and presentation of COPD differ between men and women. Women exhibit a higher likelihood to complain of dyspnea and cough than men. The accelerated decline in lung function associated with COPD is greater in women who smoke than in men. Additionally, COPD's risk differs between various ethnicities when adjusted for sex, age, and smoking status. Gilkes et al. (2017) reported that COPD risk is lower in South Asian and black people than white people. The disparity can be associated with smoking intensity, which differs among different ethnic groups. Smoking prevalence and intensity is higher among white ethnic groups compared to others. A higher smoking intensity results in a higher risk for COPD. Smoking status and smoking intensity equally influence the risk for COPD. Therefore, Mr Artuso’s cigarette smoking history is associated with the pulmonary problems he developed.
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Mr Artuso’s Arterial Blood Gases (ABG’s)
ABG’s is a reliable tool in diagnosing COPD. However, the test is painful and risky since it can cause injury to the vessel wall, thrombosis, hemorrhage, formation of an aneurysm, nerve injury, infection, and ischemia of the distil extremity. Additionally, an ABG’s test is performed severally, making venous blood gases (VBG’s) a suitable alternative. VBG’s test is simpler and easily accessible. Through arterial blood gases, direct measurements of pH, PCO 2 , PO 2 , and HCO 3 can be obtained. The values are used to determine base excess, alveolar-arterial gradient, and anion gap indirectly. The measured variables provide critical information about the metabolic and respiratory functions utilized for diagnosis, treatment, and patient monitoring. COPD with exacerbation causes chronic inflammation, causing chronic airflow limitation. The changes associated with COPD with exacerbation lead to respiratory failure and acidosis (Nusrullah et al., 2018). Mr Artuso’s ABG’s indicate that he is acidotic. He has a high PaCO 2 level, which indicates poor respiratory function since he is retaining CO 2 . Therefore, the client has respiratory acidosis. Additionally, the PaO 2 and SaO 2 values of 86% and 70 are indicative of hypoxemia.
COPD Medical Diagnosis and Pathophysiology
The most likely diagnosis for Mr. Artuso is COPD with possible acute exacerbation. COPD damages air sacs and airways in the lungs, thus reducing lung function. Healthy air sacs are elastic and healthy. Several physical problems associated with COPD with exacerbations cause less air to flow in and out of the airways (Eapen et al., 2018). Some of these problems include loss of stretchiness in airways and air sacs, partial or complete damage of the walls between air sacs, inflamed or thickened airway walls, and increased mucus production in the airways, which leads to clogging.
COPD incorporates refractory asthma, chronic bronchitis, emphysema, or a combination of all these conditions. Each condition results in reduced lung function. When the airways' lining is always irritated and inflamed, the lungs fail to move mucus easily, making breathing difficult due to chronic bronchitis. Emphysema damages the air sacs and causes them to trap air, which results in shortness of breath. Sudden blockage in the airways makes worsens COPD symptoms (Eapen et al., 2018). An infection in the airways triggers exacerbations, which cause further lung damage.
Mr Artuso also has cor pulmonale, which is indicated by tight-fitting shoes at the end of the day due to edema. The pulmonary vessels constrict in response to alveolar hypoxia, which results in pulmonary hypertension. Subsequently, acidosis develops and potentiates vasoconstriction. Pulmonary hypertension causes increased pressure on the right side of the heart. Consequently, right-sided heart failure occurs, leading to peripheral edema.
Assessment Data and Diagnostic Test Results
Dyspnea with exertion, morning cough, orthopnea, labored respirations with prolonged expiration, and increased anterior-posterior diameter are some of the physical assessment results that led to the COPD diagnosis. Additionally, the ABG values decreased FEV1, and Hyperinflation of the chest x-ray are some of the diagnostic test results that led to the COPD diagnosis. The priority nursing diagnoses for Mr. Artuso are ineffective breathing pattern, excess fluid volume, impaired gas exchange, imbalanced nutrition, ineffective self-health management, and activity intolerance.
Patient Education
Patient education should focus on disease exacerbation, which results from infection. Some teaching needs that should be considered in Mr. Artuso’s case include measures to reduce the risk of infection. For example, Mr. Artuso should be taught hand hygiene and cautioned from interacting with people with cold or flu symptoms. Additionally, Mr. Artuso should be sensitized on the importance of annual flu vaccinations and five-year pneumonia vaccinations. Patient education should include instructions on prescribed medication, energy conservation techniques, participation in sexual activity, how to get adequate sleep, and when to seek medical attention. Mr. Artuso should also be sensitized to the manifestations of heart failure and infection to ensure that he seeks prompt medical attention. Another critical teaching need in Mr. Artuso’s case is smoking cessation, which will slow down the accelerated decline in pulmonary function.
Education on the self-management of COPD improves a patient’s quality of life and reduces hospital admissions. Additionally, hospital readmission rates are lower for patients who undergo education on the self-management of COPD. Collinsworth et al. (2018) found that patients who participated in a two-month comprehensive self-management and education program had fewer readmissions at twelve months than patients who failed to attend the program. Therefore, Mr. Artuso’s care plan can include motivational interview-based health coaching, exercise advice, and an action plan for exacerbations.
COPD Nursing Interventions
Some of the suitable nursing interventions indicated for Mr. Artuso include administration of bronchodilators that relax airway muscles increase lung ventilation, administration of continuous low-flow oxygen to support breathing, reducing CO 2 retention, and/or easing the workload on the heart, and chest physiotherapy (percussion, vibration, and postural drainage) to assist in the removal of excessive bronchial secretions. Additional interventions include breathing retraining, including pursed-lip breathing and nutritional therapy to provide balanced nutrition required to meet heightened metabolic needs and attain a healthy weight. Breathing training prolongs exhalation and inhibits bronchiolar collapse and air trapping,
Conclusion
Mr Artuso has COPD with exacerbations, which is indicated by his ABG test results (acidosis), dyspnea with exertion, morning cough, orthopnea, labored respirations with prolonged expiration and increased anterior-posterior diameter, decreased FEV1, and hyperinflation of the chest. One chief factor that is associated with the diagnosis is Mr Artuso’s smoking status. Gender and ethnicity are other risk factors that are associated with his condition. Patient education should focus on smoking cessation, reducing the risk of infection, and seeking medical attention. One possible intervention for COPD includes the administration of bronchodilators.
References
Collinsworth, A. W., Brown, R. M., James, C. S., Stanford, R. H., Alemayehu, D., & Priest, E. L. (2018). The impact of patient education and shared decision making on hospital readmissions for COPD. International Journal of Chronic Obstructive Pulmonary Disease , 13 , 1325. 10.2147/COPD.S154414
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Nusrullah, M., Younus, M., & Nasir, Y. (2018). Relationship between arterial and venous blood gases in patients presenting with chronic obstructive pulmonary disease. Annals of King Edward Medical University , 24 (1), 684-688. https://doi.org/10.21649/akemu.v24i1.2343
