Chronic Obstructive Disease: A Case Study

Weekly Journal

Clinical Week 11
Clinical Date: Monday, November 10 2014 Working with a patient living with and experiencing chronic obstructive disease (COPD) I feel it is necessary to better understand the dyspnea. COPD is a respiratory disorder mainly caused by smoking, characterized by progressive, partly reversible airflow obstruction, systemic manifestation, and increasing frequency and severity in exacerbations. Cardinal symptoms experienced by patients with COPD are dyspnea, difficulty breathing, or shortness of breath and activity intolerance (Lewis et al., 2010). The RNAO communicates dyspnea should be considered as the sixth vital sign for persons living with COPD, as it is considered the disabling symptom of COPD (2005). Dyspnea
892). Dyspnea is further described as a subjective symptom of challenging or uncomfortable breathing, which cannot be measured objectively. Dyspnea must not be confused with observable changes in the rate or depth of respiration, which may not harvest a subjective experience of breathlessness (RNAO, 2005). As nurses, it is important to be able to assess and treat the patient who is experiencing dyspnea. The assessments used by nurses to measure the presences of dyspnea are visual analogue or numerical rating scales. Both types of assessment tools are beneficial in assessing the effectiveness of an intervention like as medication, breathing exercises, position change, or relaxation exercises. Nevertheless, these assessment tools do not aid explanation of what functions the patient is capable of, or what activities are avoided to prevent dyspnea (RNAO, 2005). The visual analog scale (VAS) is an assessment tool often used. Using the VAS can aid patients in making an objective assessment
The patient I care for currently uses medication, controlled oxygen therapy, and nutritional strategies to aid in alleviating his dyspnea. However, I believe this patient could benefit from breathing retraining strategies, positioning and relaxation techniques. Breathing techniques are discussed as techniques to improve ventilation and oxygenation. The three basic techniques are deep breathing and coughing exercises, pursed-lip breathing, and diaphragmatic breathing (Potter & Perry, 2010). Diaphragmatic breathing, however, is not a recommend breathing exercise for COPD patients as studies have yet supported its use (Lewis et al., 2010). Relaxation therapies are often forgotten about in nursing practice scenarios. According to The American Thoracic Society, relaxation guidance may improve dyspnea in the short term, but has not been shown to have long-term effects (as cited in RNAO, 2005). Relaxation techniques often taught are progressive muscular relaxation, positive thinking and visualization, use of music, yoga, and humour. However, in the hospital setting not all of these techniques are facilitated. The progressive muscular