Based on Orem’s Theory of Self-Care, respiratory illnesses affect several aspects of a patient’s ability to provide care to themselves and maintain independence. A patient with end-stage COPD may be unable to be without oxygen supplementation, they may not have the ability to cook or clean themselves without being exhausted from their lack of oxygen. Just the task of sitting up and eating a meal can be difficult when their every breath is a gasp through their nose and mouth to get the next little bit of air their lungs will allow in. Many patients with significant lung disease require a bedside commode due to their inability to walk to the toilet, which cuts out Orem’s Universal Self Care Requisite of activity and rest and social interaction. In short, attaining a level of health and normalcy for a patient with this level of lung disease is difficult. Nursing assessment in this type of patient would include:
•palpation of the head, neck, and chest for use of accessory muscles or chest wall contraction indicating distress •observe nail beds for cyanosis and capillary refill
•look for cyanosis around the mouth and lips
•observe respiratory pattern and watch for variances in chest wall motion •auscultation of breath sounds
Additionally, a patient in new or increased distress may require arterial blood gas evaluation to determine possible changes in their status.
Hartsborn, J., Sole, M., Lamborn, M., (1997). Introduction to critical care nursing (2nd Ed.).Philadelphia, PA: W.B. Saunders.