The aim of this case study is for you to be able to demonstrate that you understand key issues involved in the diagnosis, assessment and management of somebody who has COPD. You must also demonstrate that you can access the relevant evidence and guidance, and can use that evidence and guidance, along with your clinical experience, to construct a plan for care. The structure of your case study should flow logically from a clear introduction through the content to a conclusion which draws together the key issues explored.
Remember to state that patient and organisational anonymity is ensured.
Discuss the holistic care of a patient in your area of work with a diagnosis of COPD. Your discussion of the care and issues involved should include a clear rationale for each suggested intervention, using relevant literature, research and evidence based guidelines to link theory to clinical practice
When writing your case study you should include:
Introduction: This should identify the background / key issues that you are going to discuss within the main body of the assignment and contain a clear statement that anonymity has been ensured as per professional body e.g. NMC, GMC guidance.
Main Body: This should form the bulk of your essay. This is where you can discuss and expand on the issues identified in your introduction. The main content should demonstrate learning objectives have been met and include.
1. History taking resulting in a diagnosis of COPD –if you were not involved in this you need to discuss how it was achieved and comment on any gaps to include an explanation as to the presenting symptoms, risk factors for COPD how the history taking, clinical assessment and exclusion of differential diagnosis (C1)
2. An explanation of patient’s symptoms should relate to the pathophysiology of COPD and how this can be utilised in patients education to enable informed decision making specific to self-management of both acute exacerbations and on-going management of COPD (A1, C1)
3. The psychosocial impact associated with the diagnosis of COPD on the patient, family and/or carers. Consider family dynamics, change in roles, financial impact, admission risk, risk of anxiety depression and how they may signpost patients to other services (C3)
4. The management of exacerbations to include self-management – self management should be discussed briefly in the context of your patient. If your patient has not had an exacerbation discuss this in general terms and what information/advice you would give for the future regarding self-management (B1)
5. Cost effective, appropriate and evidence based pharmacological and non-pharmacological treatment – this needs to demonstrate your knowledge and skills and should include non-pharmacological interventions to support your patient together with your patients current medications with discussion around class of medication, devices, drugs and doses chosen and why. You will be expected to discuss how you would review and assess the benefits or not of any intervention/ changes you have made and the reasons for those changes. An understanding of the roles of community teams, and how/why they might form a part of the holistic approach to care for patients with COPD (A2, B1)
V0118
6. A reflective evaluation of the diagnostic and assessment tools used both in diagnosis and review of on-going treatment which may result in referral to other teams. Reflectively evaluation of the care and treatment that patients with COPD receive and how this might have affected some of the key aspects of the plan for care.
Answer:
Introduction
Mary Gyne is a female aged 56 years old. She comes to the health facility complaining of shortness of breath, a persistent cough and chest tightness. She says that she is married and has three children; two daughters and one son. The children have moved out of the home and she now only lives with her husband, Jared. Mary states that she has experienced chest pains before, only that the current ones are severe. They also do not seem to even after taking a cough syrup based on self-prescription bought over the counter. Prior observation of the patient indicates that she may be having COPD, yet to be proven with further lab tests. There is the need to highlight the history of the patient, that led to her contraction of COPD. There is also the need to establish some of the deep symptoms associated with the health problem. It is also important to take note of the psychosocial effects of the health problem as well as how the problem could be well managed. Throughout the case study, anonymity of the patient by the NMC code of ethics. The paper provides a thorough discussion of the patient.
History taking resulting in a diagnosis of COPD
Taking note of the history of the patient was important. It was determined that she has been a frequent smoker and has been engaged in the habit for the last 15 years. She also has a history with COPD, her paternal grandfather having experienced the health problem before his demise. The family history of COPD, therefore, showed that there was a high likelihood of the patient having the health problem. The physician, therefore, had a health problem in mind and further tests would aim to confirm whether it was actually the health problem.
The patient was also asked whether she has ever experienced any symptoms consistent with COPD before (van Boven et al., 2015). It was determined that save for occasional chest pains and coughing; she had not experienced any major problem that may be tied to the development of the health problem. Since the patient is of advanced age, above 40 years, she happens to be at a point where she faces the risk of developing the health problem. Although she does not mention to have asthma, the consistent smoking may have had played a major part in the development of COPD. A CT scan was conducted on the patient in which it was determined that she had emphysema. There was a depiction of the inflammation of the alveoli, a condition that is consistent with emphysema in a patient. The inflammation of the airsacs leads to the impairment of the lung tissue, thereby, reducing upon its capability to function appropriately. While the emphysema is not a sole determinant of COPD, it is still an indication of chances of the problem in a patient (Rasmussen et al., 2017). Use of laboratory tests conducted a differential analysis. The blood tests showed that there was a high level of eosinophil in the blood of the patient. A sputum test was also conducted which provided positive indications of large eosinophil deposits. The results of the tests were, thus, imperative in confirming that the patient had COPD.
Owing to the accuracy of the findings that were obtained with the use of family history, symptoms of the patients as well as the CT scan and the differential analysis, there was no need to conduct further tests. The results available had already showed that the patient had the health problem that the physician had suspected. Some of the tests that were, therefore, not conducted included the depression score, the MRC score the CAT score and spirometry test.
Explanation of Patient’s Symptoms
Mary appeared to have some symptoms that are an indication of the presence of COPD. Some of them include chest tightness, wheezing, shortness of breath and constant energy lapse, in the recent times. It was also noted that the ankles of the patient were swollen (van Boven et al., 2015). Given the concept of self-management that the patient may adopt to take good care of herself, there is the need for the facility to prescribe to her drugs that are likely to ease on the chest pains. There is also the need to administer drugs that reduce the chances of edema that may lead to the swelling of the ankles (Magnussen et al., 2014). Some of the drugs that may be prescribed for the patient include theophylline, which has a chance of improving upon the breathing rate. There may also be the need for the administration of Phosphodiesterase-4 inhibitors which bear a chance to reduce the chances of inflammation of the airways. Being fully aware of the symptoms holds a huge chance of establishing the specific measures that may be applied to improve the health of the patient.
In regards to the acute symptoms, such as shortness of breath, there is the need to establish their frequency of occurrence. The measure is imperative in determining the right drug that may be used to deal with the health problem. As it relates to the chronic symptoms, associated with COPD, there is the need to determine some of the drugs that are associated with low chances of side effects on the patients (Toren et al., 2017). The prescription of such drugs to the patient will be important in ensuring that she has the willingness to follow through taking it to ease on some of the sufferings that she may be experiencing, as a result of the COPD. The patient will be in charge of determining some of the ways through which she could reduce the continued development of the health problem to levels that may be worse. The patient may also have the chance to report where it is clear that the situation has worsened and, therefore, in need of more specialized care.
Psychosocial Impact Associated with the Diagnosis of COPD
Mary may need to be under hospital care for COPD for some time until her condition has eased up. The situation will, therefore, be important in enabling her to go back to her earlier duties that she was used to. However, the diagnosis of the health problem bears some level of psychosocial impact upon her (Clark et al., 2015). For instance, there is a chance that she could miss being with her family, for some time, especially where she stays at the hospital for long. The continuous intake of drugs may also impact on her personal life. For instance, there may be the need for her to adjust her time for waking up (Apps et al., 2016). She may, therefore, need to start waking up much earlier than she has been used to take her drugs. The fact that she has been diagnosed with a chronic health problem is likely to take a heavy psychological bearing upon her. She may, therefore, need to go through some moment of denial, before being able to come to terms to her new situation (Chapman et al., 2018). Granted, there is the need for constant counseling of Mary to ensure she can follow the treatment regimen accorded for the health problem. The counseling will be important towards reducing the risk of depression in the patient.
Where there is stronger family support from her husband and children, there is a high chance that she may be in a good position to deal with her problem much better. For instance, they could inform her that she can deal with the new challenge that she experiences (Criner et al., 2015). They are also likely to guide her on the right mechanisms that she may seek to apply in a bid to adhere to the different drugs that she has been prescribed to in regards to dealing with her problems.
The health problem may also take a toll on her finances. She may, therefore, need to pay higher premiums for her insurance, since she has a chronic health challenge that needs to be addressed (Kirby et al., 2016). Granted, she may, therefore, some level of financial support from other family members concerning ensuring that she can deal with her situation better.
The Management of Exacerbations
There is the need for both self-management and hospital-based care. Self-management of the patient will be based on Mary ensuring that she takes drugs consistently and on time. She may also be willing to open up on some of the persistent symptoms that she might be having (Ancy et al., 2016). The patient may need to continue taking theophylline and Phosphodiesterase-4 inhibitors. The drugs will be important in reducing the chances of shortness of breath and chest pains in the patient. The patient will also need to share with her family, consistently ((Kirby et al., 2016). The family will, therefore, be keen to share with the physician on some of the areas that may need immediate attention. The use of team nursing in the care of the patient will be important in providing varied information as it relates to some of the developments that may be noted on her. The strategy will also be imperative in providing a more holistic approach as the different health professionals have a chance to provide their ideas in regards to some of the changes that may need to be adopted while caring for Mary.
Mary also needs to stop smoking cigarette. The measure will be important in reducing upon the chances of increase of the extent of the current problem that she experiences. She also needs to set up a plan for taking the drugs prescribed by the physician. The action will ensure that she takes the right dosage that is required of her and consistently. Thus, there is a high likelihood of reduction of the extent of the pain and discomfort that she could be experiencing. Mary also needs to share information regarding some of the complications that may come from the different drugs that she has been prescribed. The action will be important in making the necessary adjustments that will be important in reducing the suffering that she could be experiencing.
The use of CT Scan and laboratory tests are important in the diagnosis and review of ongoing treatment of Mary. The assessment tools are deemed to be both valid and reliable, owing to the high level of attention that has been used for their development. The use of Phosphodiesterase-4 inhibitors and Theophylline for easing on the suffering of the patient is also deemed appropriate in ensuring that the problem of COPD is well handled.
Conclusion
To sum up, Mary is a 56-year old lady who has been diagnosed with COPD. CT scan and laboratory tests were used as the main methods for diagnosing the health problem. At the time of visiting the health facility, Mary Gyne had been complaining of chest pain and shortness of breath. Although she had experienced the health problem before, it was not in the same level of severity as it currently is. She has a history of smoking, and her maternal grandfather had COPD. The use of Theophylline and Phosphodiesterase-4 inhibitors were determined as the best approaches to the drug. More home-based care needs to have been used for the patient.
References
Ancy, K. M., Leidy, N. K., Malley, K. G., Anderson, W. H., Barr, R. G., Bleeker, E., ... & Doerschuk, C. M. (2016). B43 COPD: PHENOTYPES AND CLINICAL OUTCOMES: How'stable'Is Stable COPD? Daily Symptom Variability Of Subjects Enrolled In The Spiromics Exacerbation Sub-Study. American Journal of Respiratory and Critical Care Medicine, 193, 1.
Apps, M., Mukherjee, D., Abbas, S., Minter, J., Whitfield, J., Field, S., ... & Ateli, L. (2016). A41 THE SPECTRUM COPD CARE: FROM IDENTIFICATION TO POLICY: A Chronic Obstructive Pulmonary Disease (COPD) Service Integrating Community And Hospital Services Can Improve Patient Care And Reduce Hospital Stays. American Journal of Respiratory and Critical Care Medicine, 193, 1.
Chapman, K. R., Hurst, J., Frent, S. M., Larbig, M., Fogel, R., Guerin, T., ... & Kostikas, K. (2018). Withdrawal of Inhaled Corticosteroids from COPD Patients Inhaling Long-Term Triple Therapy: The SUNSET Study. In A15. ICS IN COPD: THE PENDULUM KEEPS SWINGING (pp. A1009-A1009). American Thoracic Society.
Clark, T. W., Medina, M. J., Batham, S., Curran, M. D., Parmar, S., & Nicholson, K. G. (2015). C-reactive protein level and microbial aetiology in patients hospitalised with acute exacerbation of COPD. European Respiratory Journal, 45(1), 76-86.
Criner, G. J., Voelker, H., Albert, R. K., Bailey, W. C., Casaburi, R., Cooper, J. A. D., ... & Marchetti, N. (2015). B23 WHEN I GET HOME: CONFRONTING THE CHALLENGES OF COPD EXACERBATION: Cardiac Events And Relationship To Rates Of Acute Exacerbation In COPD. American Journal of Respiratory and Critical Care Medicine, 191, 1.
Kirby, M., Tan, W. C., Hague, C., Leipsic, J., Bourbeau, J., Hogg, J. C., & Coxson, H. (2016). CT Total Airway Count Explains Airflow Limitation In COPD Patients Without Emphysema. In C48. COPD: IMAGING (pp. A5202-A5202). American Thoracic Society.
Magnussen, H., Disse, B., Rodriguez-Roisin, R., Kirsten, A., Watz, H., Tetzlaff, K., ... & Chanez, P. (2014). Withdrawal of inhaled glucocorticoids and exacerbations of COPD. New England Journal of Medicine, 371(14), 1285-1294.
Rasmussen, D., Bodtger, U., Lange, P., & Jensen, M. (2017). Use of heart failure medications in outpatients with COPD and congestive heart failure: a Danish nationwide cohort study.
Toren, K., Murgia, N., Olin, A. C., Hedner, J., Brandberg, J., Rosengren, A., & Bergstrom, G. (2017). Validity Of Physician-Diagnosed Chronic Obstructive Pulmonary Disease (COPD) In Relation To Spirometric Definitions Of COPD In A General Population (scapispilot) Aged 50 To 64 Years. In A59. EPIDEMIOLOGY OF AIRWAYS AND CHRONIC LUNG DISEASES (pp. A2037-A2037). American Thoracic Society.
van Boven, J. F., Román-Rodríguez, M., Palmer, J. F., Toledo, N., Cosío, B. G., & Soriano, J. B. (2015). LATE-BREAKING ABSTRACT: Prevalence of comorbidities in patients with asthma-COPD overlap syndrome (ACOS) in primary care.
