A REFLECTIVE PIECE ON A PATIENT WITH CHRONIC OBSTRUCTIVE
In this reflective piece of writing I will be explaining how chronic obstructive pulmonary disease (COPD) affects the patient physically, psychologically ,and socially ,I will also explain how the disease affects his daily routine and how it impacts on his family life. I will give an overview of the clinical signs and symptoms, how the disease alters the pathphysiology of the lungs, and what these changes cause within the body. I will be using the reflective model “What, So What, Now What “ (2007). The patient I have chosen to write about is a seventy year old male who has been married for nearly fifty years. He has two grown up sons, both married with children of their own. Mr Woods has Chronic Obstructive Pulmonary Disease diagnosed ten years ago. Prior to this disease Mr Woods was a lifelong smoker, beginning at the age of fourteen years, smoking up to thirty cigarettes per day. Mr Woods condition has progressively worsened over the past few years, and he now requires home oxygen therapy.
A patient was brought into the emergency department by the paramedics complaining of difficulty in breathing. On arrival he was tachypnoeic, had a respiratory rate thirty two and was found to have an audible wheeze. He stated that he had a productive cough and was expectorating green coloured sputum. The patient felt warm to touch. He looked pale, was sat upright, slightly leaning forward in a rigid posture on the ambulance stretcher. I was delegated the role of undertaking Mr Wood’s initial assessment, which included ensuring the patient was undressed ready for examination by a doctor, and also carrying out a baseline set of observations. I was happy to undertake this task, because I had the required training, skills and was deemed competent to carry out the necessary care required to look after Mr Woods. The nurse in charge informed me of Mr Woods medical history prior to me entering the cubicle, including what had precipitated his attendance to the emergency department which on that particular day had been his worsening shortness of breath. On entering the cubicle, I helped Mr Woods get undressed and into a hospital gown because any slight exertion made him more short of breath. I carried out a baseline set of observations. His blood pressure was 165/95, he had a pulse rate of 125 beats per minute, a temperature of 38.2c, a respiratory rate of 32, on 2 litres of oxygen his saturation level was 88%, and his blood glucose level was 4.4mmol/l. Although some of these observations are not within ‘normal’ range, for a person with COPD some of these observations maybe acceptable because the disease affects the path physiology of the lungs. The airways leading to the lungs, the bronchi, become inflamed. The inflamed airways produce too much mucus (sputum) which can lead to a persistent cough, wheeze and increasing shortness of breath. This happens because the air sacs (alveoli) become overstretched, rupture and merge which causes them to lose their elasticity. This causes the oxygen absorbing surfaces to be reduced, and with the narrowing of the airways gas exchange is less efficient (Parker, 2009). The lungs over inflate which reduces the air volume moving in and out of the lungs which can lead to tachypnoea (abnormally rapid rate of breathing), breathlessness on exertion, respiratory distress, abnormal posture I.e. leaning forward to help open the airways (Nursing Standard, 2001). Patients with Chronic Obstructive Pulmonary Disease can have a tendency to have low oxygen saturation levels, usually around 88% on air. In healthy patients their levels are usually between 95%- 100%. COPD patients often need supportive treatment of 2 litres of oxygen to maintain oxygen saturations normally acceptable for that specific patient. However oxygen therapy higher than 2 litres may cause their carbon dioxide (CO2) levels to rise (Abrahams, 2009). As Mr Woods COPD had...
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