Chronic Obstructive Pulmonary Disease in a Male Adult Research Paper

Introduction

What could a man be suffering from when he has the following symptoms as cyanosis, coughing, weak, and observable exertion of effort jut to breathe? Could he be having an asthma attack? Did the man just simply choked with the obstruction still there? Or could already be having COLD? It’s not the simple cold that is caused by several viruses but the “COLD” meaning Chronic Obstructive Lung Disease or what we refer to as Chronic Obstructive Pulmonary disease. The above mentioned symptoms along with the other manifestations not mentioned are the signs and symptoms of a person having the Chronic Obstructive Pulmonary Disease.

What is COPD and how is this relevant to be studied? What could the prevalence of this disease in the US? Which age groups are more likely to be affected by the disease? Some questions that we may find significant to ask ourselves. “Could I be one of those who are at risk?”

Chronic Obstructive Pulmonary Disease (COPD) refers to the lung disorders which affects the airflow to and from the lungs (Black, 1993). This disease may include emphysema, asthma or chronic bronchitis.

By the year 2000, COPD physician-diagnosed cases reached about 10 million adults (Wise, 2003). This large population of the Americans is already diagnosed, how many more are yet to be diagnosed? The disease was linked closely to cigarette smokers, was common in men than with women, and that there were more number in males admitted compared to females but ironically in the year 2000, there were more women died due to COPD than in men (Wise, 2003).

What could be the process the lungs may be undergoing why this disease was called “a progressive disease”? Could a good prognosis be possible? What are the past and present treatments for COPD and can they actually lead the client into total recovery? What discomforts could a client have if there is an exacerbation of COPD and how effective can nursing interventions be to help alleviating the condition of the client?

Chronic Obstructive Pulmonary Disease, now a disease which is widely studied. It is the fourth leading cause of mortality in the US yet it ranked 27^th in the funding for research (Wise, 2003). What is then the significance for this disease to be studied? What could possibly researches about COPD do in helping in the dissemination of the information for the public to gain knowledge on COPD?

This case study would then present an in-depth research about what COPD really is. This case study would present a real case scenario of a client having exacerbation of the disease. Nursing interventions would be discussed according to the assessed needs of the client. A comprehensive Literature review would be presented to better understand the pathophysiology, the treatment, medications, and the diagnosis of Chronic Obstructive Pulmonary Disease.

This study then aims to answer questions about COPD that the general public have such as what COPD is and what are the risk factors that a person may develop the said disease. This would present the studies done by experts to help us better understand the disease and the processes that a person is undergoing in the course of the disease.

Assessment on the Patient Having an Exacerbation of COPD

The client is a 59 year old male, disabled and divorcee, with the diagnosis of Exacerbation of Chronic Obstructive Pulmonary Disease.

Physical Assessment

The client is 5’6” in height and 134 lbs in weight, Pupils Equal, Round, and Reactive to Light and Accommodation, with hearing aides in both ears, complaining of dyspnea, with positive chest x-ray, bowel sounds are present, extremities warm and dry, no edema, capillary refill of < 3 seconds, skin turgor normal, soft and with no pain on abdomen, wheezing on exertion, pain was 6/10 when breathing in both lungs on scale, sputum is yellow with small amounts with odor, with oxygen at 2 LPM, input and output normal with no signs of dehydration, activity is as tolerated, having trouble in sleeping, with positive chest x-ray result, all laboratory tests are normal except for WBC = 11 (high) and BUN = 23 (high), diet is AHA. The vital signs of the client are as follows: Blood Pressure = 142/77, Temperature = 99.2, Pulse rate = 81 and Respiratory rate = 22.

Psychosocial Assessment

In the theory of Abraham Maslow, he placed the human needs in an hierarchy. According to him, the higher levels of human needs are not met unless the lower levels of needs are met.

In the case of this client who is disabled may have limited resources to answer his needs. He may have surpassed this need due to government’s help. As he is disabled, he is prone to a lot of dangers as he only has limited access to what is around him. Thus he has not met the second stage in the hierarchy of Maslow which is the safety and security need. This could be one of the reasons he was not able to meet the next stage on the hierarchy which is the love and belongingness as he is a divorcee. According to Erik Erikson’s Psychosocial Development Theory, the 59 year old client is on the seventh stage where he belongs to Generativity versus Stagnation. In this stage of the theory of Erikson, adults may focus on their career and family, since the client is a divorcee, the family that he wanted to focus on is not complete and he may not successfully surpass this stage and may fall on stagnation. He may feel unproductive as well due to his disability thus making him fail to attain the skill to surpass this stage.

Clients Current Medications

Tylenol – 500 mg for pain

rocephin – antibiotic

zithromax – antibiotic

albuterol,- beta 2 agonist

advair – asthma medication

maxair z puff – beta agonist

Prednisone – corticosteroid

Literature Review

Studies have been done about COPD that tried to explain its occurrence, its causes, and how this disease develops. The doctors challenge themselves in finding new ways to treat COPD with medications and nurses faces a great challenge as well in taking care of clients with COPD.

In an article entitled “Corticosteroids for chronic obstructive pulmonary disease (COPD)”, it suggests that inhaling corticosteroids may improve lung function thus a help in decreasing exacerbations especially to those who already have severe COPD (Havens L. and Parks, R., 2006). Though the explanation of how inhaled corticosteroids help in decreasing the phases of exacerbations in patients with COPD, there are reports that this kind of medication helps in improving lung function and lessen exacerbations (Havens L. and Parks, R., 2006).

This then indicates that even establishment of why corticosteroids are effective in preventing COPD exacerbations; this is widely used to clients having the said disease. This may be one interesting points that studies be made to further dig deeper on the effects of corticosteroids to the lungs.

In another article entitled “Gender makes Difference for COPD” wherein a study was featured showing that women experience more shortness of breath. Although women have less severe emphysema than men, women more often had greater shortness of breath and they were also reported to have more depression and poor overall quality of life (Boyles, 2007).

This may be indicative that diagnosing of an exacerbation of COPD may then be affected by stress. Stress may not support why there is exacerbation but this may indirectly cause it.

In another article entitled “Pathophysiology of COPD” states that the pathophysiology of COPD is not clearly understood. The chronic inflammation of the lining cells in the bronchial tree brought about by infections is on cause of the disease. This has also been linked closely to smoking and inhaled pollutants that may stimulate an inflammatory response that may cause the narrowing and the hyperactivity of the airway. It also explains that the disease process in COPD includes increased airflow resistance, the loss of elastic recoil and the decrease of expiratory flow rate. The disease process then results to the increase in metabolic work of breathing thus dyspnea is more severe (Morgan, 2007).

This may then indicate that the reason why there is exacerbation of COPD is not really clear. Further study is needed to prove that smoking and air pollution is really a main cause for the disease.

In an article entitled “Common Bacterium May Cause COPD Flare-ups: Doctors” states that Scientists from University of Buffalo in New York a bacterium, Moraxella catarrhalis may be responsible for the 4 million flare-ups of COPD that occurs in the United States each year. Their study also states that this bacterium, after their research was done, is strongly associated with the onset of symptoms on an exacerbation of COPD. This bacterium also is found to be responsible for a lot of respiratory infections. Thus if proven to be really a major cause of COPD then the scientists suggest that a vaccine may be made as exacerbations cause enormous morbidity and health care costs (Martin, 2005)

If this is one way to lessen the exacerbation of COPD, then there is a must to have a vaccine. As COPD was the 4^th leading cause of mortality and morbidity in the US, there is really a need for a vaccine to save a lot of people. We are not just talking hundreds here but thousand of lives that could be saved by a vaccine.

In an article in Pharmacy Times entitled “COPD treated with Spiriva”, this states that clinical trial was done to see how effective this medicine is, it was proven that Spiriva relieves exacerbations of COPD thus shortening the time of clients with moderate to severe COPD in receiving treatments. The research also showed that patients treated with this kind of medicine had longer resting time before another flare-up occurs again (Farley, 2005).

This would be a great help for the client with COPD. Taking this medicine would greatly help in their functioning. Although, COPD may not be treated, at least it may alleviate the client’s condition by the gaps in between flare-ups.

In another article posted entitled “COPD”, this states that one cause may be stress. Stress may not directly cause exacerbations of COPD but stress negatively affects a person’s ability to cope with other illnesses thus managing stress may help in coping with COPD (2006).

In an article entitled “Leukocytosis”, it stated leukocytosis or increased in the number of white blood cells is caused by a reaction to a variety of infectious, inflammatory, and, in certain instances, physiologic processes such as extreme stress (Inoue,2006).

This is indicative of an infection present in the body. Although, this could be accompanied by fever, which would depend of what the root cause why there is increased in the leukocytes in the client.

These are just some studies that may be of help on the understanding of COPD. The disease is not really very clear on how it started but these literature reviews gave us a background of what to expect with COPD.

Nursing Care Plan for Clients with COPD

In the assessment one of the clients concern is having trouble in sleeping. To answer this concern here is the care plan:

Nursing Diagnosis: Sleep Pattern Disturbance related to dyspnea and external stimuli.

Nursing Interventions

1. Promote relation by providing a quiet environment and dim light room with enough ventilation and follow a routine during bedtime.Rationale: Hospital environment may interfere with the rest periods of the client thus using established routines during bedtime may increae relaxation.
2. Activities related to care should be scheduled to allow uninterrupted rest periods. Rationale: Most people may feel relaxed and rested having completed 4-5 sleep cycles (60-90 min) per night.
3. Instruct client about measures to promote sleep.
   1. Plan physical exercise during the day and passive, non stimulating activities in the evening. Rationale: Engaging in activities may increase the need for sleep and contributes to the feeling of tiredness.
   2. Give instructions to avoid stilulants such as caffeine containing food and drinks. Rationale: These stimulants may increase metabolism and inhibit relaxation.
   3. Maintain consistent bedtime and regular bedtime routine. Rationale: Consistency promotes relaxation and prevents disruptions of the biologic clock.
   4. Eat high protein snack before bedtime. Rationale: Protein digestion produces tryptophan, an amino acid that has a sedative effect.
   5. Use relaxation techniques such as meditation, massage, warm bath and warm beverage. Rationale: Sleep is difficult unless the client is relaxed.
4. If the client awakens during the night, suggest the use of a quiet diverting activity, such as reading, in another room. Rationale: Frustration over being awake will further deter sleep efforts. The bedroom should be mentally associated with sleep to enhance future sleep promotion.
5. If dyspnea is severe, place client on a moderate high back rest position. Rationale: Upright position facilitates ventilation.

After taking care of the patient, goal met. The client was able to sleep for about 4-5 hours during night time.

Another problem that was met during the assessment was the pain and so comfort was altered.

Nursing Diagnosis

Alteration in comfort related to pain when breathing rated 6 on a pain scale of 1-10.

Nursing Interventions

1. Instruct to divert attention by watching television or reading.
   • Rationale: Diversion of attention may take the clients attention away from the source of pain.
2. Instruct client to do pursed lip breathing.
   • Rationale: Pursed lip breathing may help the client to relax.
3. Instruct client to put pressure on pain site when breathing.
   • Rationale: Pressure on site may lessen pain.
4. Gave medication Tylenol 500 mg as ordered.
   • Rationale: Pain medications help in pain management.
5. Goal is met patient reported pain was on manageable level of 2.

Correlation

During the assessment of the client, he was found to be disabled and divorced. These two things could be a stressor in his life. In an article reviewed, it was stated that stress does not really cause the exacerbation of COPD but it could be a factor why there is exacerbation. Indirectly, stress can result to decrease coping of a client to any disease and that disease may cause an exacerbation of COPD.

As with the client that we assessed, he is under stress already due to his being disabled and divorced. Added to that is the difficulty in sleeping thus adding to the stress that he is experiencing. That study then may answer as to how stress affected the exacerbation of COPD.

Another thing is that corticosteroids are helpful in the alleviation of COPD exacerbation. Although there was no enough evidence on why this medicine is effective it is widely used in the treatment of COPD exacerbations.

In the client that we assessed, it was noted that he had prednisone as one of his medicines. This then indicates that the doctor caring for this patient really believes on the usage of inhaled corticosteroids.

In the study on leukocytosis, it indicated that this could be caused by several factors. One factor is stress and another may be infection.

As with the client that we assessed he may be having increased WBC due to both. The stress that he is undergoing because of the divorce and his being disable, may have caused the increase of his WBC in his laboratory examination. This client may be experiencing infection as well that may cause the exacerbation of his COPD but because he was already taking antibiotics, that may explain why he is not having fever. Either way, we cannot really tell why he has increased WBC count.

Pain in the lungs may not be common in COPD. Pain may be due to the force exerted by coughing but it should be located in the abdomen. Pain when breathing may be caused by pleurisy an inflammation in the pleura of the lungs. This may be caused by infection.

In the client that we assessed he was experiencing pain 6/10 on scale while breathing. As pain is not common to COPD, this client may have pleurisy at the same time. He may be experiencing it due to some previous infection.

Increased in BUN is not common to COPD patients as well but he may also have other disease that caused his level of BUN to increase. The BUN increase may be indicative of a kidney trouble and not a lung disease. This client may also be suffering a kidney problem as well. This may also be one cause why he is stressed.

The client that we assessed may have an overlapping signs and symptoms. He may be hospitalized due to an exacerbation of his COPD but he may have underlying diseases that was yet to be diagnosed. Or he may be experiencing other diseases that caused him stress thus in turn caused the exacerbation of COPD. Further assessment and diagnosis is needed for this client.

Summary

This case study discussed about what COPD is and the treatments of this disease. In the discussion included on the prevalence of this disease to men but ironically number of deaths caused by this disease was increased in women. This study also presented an in depth assessment of the client with Chronic Obstructive Pulmonary Disease (COPD). After the assessment, a care plan was formulated on the problems that were found out during the assessment of the client. As the client was complaining of difficulty in sleeping, some measures were taken to meet the goal that the client may be able to rest and sleep. With the interventions given such as promotion of relaxation and other interventions given, the client was able to sleep. Another problem found was pain, although this was not common in COPD, another disease such as pleurisy may have infected the client. Interventions were given including giving of medication was done to alleviate the pain into a tolerable level.

The literature review of this study centered on what are the new trends in the treatment of COPD, the pathophysiology of the disease and what could have caused exacerbation of the disease. One study found out that there medication such as inhalation of corticosteroids was effective in improving lung function. In another article, a certain medicine named Spiriva was seen to reduce the number of days in receiving COPD treatments since it already helps in the long gaps in between flare-ups of the disease. In another study, it was showed that COPD exacerbation may be caused by a certain bacteria called M. catarrhalis which is also a leading cause in most infections. The study conducted showed strong evidence linking this bacterium to the exacerbation. In answer to this finding, the scientist advised to invent a vaccine for this kind of bacterium. This may then help a lot of people to prevent the exacerbation of the disease.

These reviews were correlated to the findings in the patient that we cared for. The patient was disabled and divorced thus increasing the level of stress that he is experiencing. This may also explain why the client experienced exacerbation. Another thing is that the client’s WBC is increased and this may be caused by two things, one is a possible presence of infection and another is severe stress. Another laboratory result was an increased BUN which is not connected to COPD thus the client may then experience another disease process.

This study is very helpful to us since this would inform us and help us understand the disease COPD and the disease process itself. This may not present something new as to the treatment of the disease or the diagnosis but this would help us understand better what the client is going through thus we can formulate interventions that may help in the alleviation of the symptoms the client is experiencing. This is a one way to start in understanding the disease and increasing the personal awareness as well as the public awareness for us to be warned and help disseminate the information of what COPD is as it has high mortality rates all over United States.

References

Black, Joyce M.(1993). Luckmann and Sorensen’s Medical-Surgical Nursing: A Psychophysiologic Approach, 4^th ed., W.B Saunders Company

Martin, John C. (2005). Common Bacterium May Cause COPD Flare-ups: Doctors. Web.

Inoue, Susumu,MD. (2005). Leukocytosis. Web.

Morgan, Elizabeth. (2007). Pathophysiology of COPD. Web.

Farley, Susan. (2005). COPD Treated with SPIRIVA. Web.