Chest Infection Formative Scenario

CHRONIC OBSTRUCTIVE PULMONARY DISEASE(COPD)

Chronic obstructive pulmonary disease is the 5th killer in the USA of all ages. People

with COPD usually do not show signs and symptoms during middle age, and the

incidence of COPD increases with age. Although certain aspects of lung function tend

to decline with age (e.g., vital force and forced breathing volume of 1 second [FEV1]),

COPD emphasizes and accelerates these physiological changes.

The ABCDE method is the most appropriate way to diagnose a patient because it is a

progressive approach to treating all critically ill patients. It prioritizes the most important

symptoms that can kill a patient first, which will enable me to evaluate each of the

patient's vital organ systems namely: airway, breathing, blood circulation, paralysis,

and exposure. The purpose of using the ABCDE method of patient evaluation will help

me to identify and stabilize the patient's life-threatening problems first, before moving

on to the next important process for clinical progress to purchase time for further

treatment and diagnosis. It empowers the patient to come up with more interventions

and further investigations.

Chronic Obstructive Pulmonary Disease is a disease characterized by a completely

unstable airway obstruction. COPD can include infections that cause obstruction (e.g.,

emphysema, chronic bronchitis) or a combination of these problems. In COPD, airway

obstruction develops and is associated with an abnormal lung response to harmful

particles or gases. The inflammatory response occurs throughout the airways,

parenchyma, and vasculature of the lungs.

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Chest Infection Formative Scenario

AIRWAY(A)

The patient is cyanosed, has difficulty in breathing has depressed consciousness and

the respiratory rate is high, which is 32 per minute. This indicates that the patient has

airway obstruction. Critically ill patients, miserable awareness often leads to airway

obstruction. It is a medical emergency; therefore, I will suction the patient airway,

rationale: It sucks possible solid or liquid materials e.g., mucus in the patient breathing

pathway hence leading to free airflow to the lungs.

BREATHING (B)

Immediate breathing assessment is vital to establish and treat immediately severe

diseases e.g., severe asthma, pulmonary oedema, and pneumothorax.

On looking, listening, and touching peripherals for the general signs of respiratory

distress, the patient is appearing confused and distressed and also look cyanosed.

The patient has a respiratory rate of 32 breaths per minute while the normal is 12-20

breaths per minute. This shows that the respiratory rate of the patient is high, therefore

it is indicating that may deteriorate suddenly.

On assessing the patient for every breath, the rhythm of respiration, and expansion of

the chest, the rhythm of respiration was not normal. The patient was tachypnoea, the

respiratory rate was at 30 breaths per minute.

The patient-inspired oxygen concentration is 84% in the room environment, the patient

is hypercapnia as evidenced by flushed skin, confusion, and high oxygen oximetry

reading.

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Chest Infection Formative Scenario

Listening to the patient’s breath sounds a short distance: the patient has a presence of

secretions present in the airway as evidenced by rattling airway noises caused by

airway obstruction related to laboured breathing.

As I percussed the chest of the patient, it was dullness indicating that there is a

presence of pleural fluid in the lungs.

On auscultation of the chest, there was a reduction of chest sounds, this suggests that

there is a significant amount of fluid in his chest.

The location of the trachea in the suprasternal notch is deviated to left or right side

indicating mediastinal alteration due to pleural fluid present in the lungs.

Circulation (C)

The patient's colour of the peripherals, that is, hands and digits was pale and bluish in

colour. This indicates cyanosis as it is evidenced by patient appearance.

The patient felt warm when I assessed his hands as evidenced by the patient high

temperature of 38 degrees Celsius. The patient is hyperthermic, high temperature

above normal. He has a low-grade fever.

Capillary refill time of the patient is less than 2 seconds, this is within the normal

showing that the patient’s peripheral perfusion is good.

On assessing the patient's state of veins, they were collapsed, this indicates that the

patient may be hypovolemia as evidenced by urine output of 40mls for the last one

hour.

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Chest Infection Formative Scenario

The patient blood pressure of the patient is high as evidenced by a blood pressure of

159/94 mmHg. This indicates that the patient is hypertensive. I will administer

nifedipine, rationale: It is a Vasodilator, it dilates blood vessels by acting directly on

smooth muscle cells through no autonomic mechanisms. Vasodilatation results from 4

key mechanisms: the release of nitric oxide, opening of potassium channels leading to

hyperpolarization blockade of calcium channels.

On assessing the heart rate, it was a high rate of 105 beats per minute. This indicates

that the patient is on tachycardia. I will administer verapamil, rationale: it is a calcium

blocker, it blocks Ligand gated-type Ca2+ channels in smooth muscle of the heart and

the heart, thus decreasing intracellular Ca2+. Reduced intracellular ca 2+ results in

decreased contractility of the heart muscle and vascular smooth muscle, therefore,

reducing the heart rate.

DISABILITY(D)

I reviewed the patient ABCs, I will treat the patient hypoxia, administer moist oxygen

therapy via a ventilator. Rationale: aims to provide a partial pressure of oxygen of at

least 10mmHg. At the cellular mitochondria level.

The patient Alert Verbal Pain Unresponsive, the patient responded to voice, the Glasco

coma scale was 12. This indicates that the patient was on a good consciousness scale.

EXPOSURE(E)

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Chest Infection Formative Scenario

The patient's privacy was well attended to, the patient was inside the screen and his

dignity was well respected.

Diagnosis, pathophysiology, nursing management

Smoking depresses the activity of scavenger cells and affects the respiratory tract’s

ciliary cleansing mechanism. Smoking also irritates the goblet cells and mucus glands,

causing an increased accumulation of mucus. Also, carbon monoxide (a by-product of

smoking) combines with haemoglobin to form carboxyhaemoglobin Haemoglobin that

is bound by carboxyhaemoglobin cannot carry oxygen efficiently. The patient was a

cigarette smoker and with evidence of cyanosis. Therefore, a patient has a chronic

obstructive disease.

Pathophysiology

In COPD, airway obstruction develops and is associated with an abnormal response in

the lungs to very dangerous particles or gases. The inflammatory response occurs in

all airways, parenchyma, and vasculature of the lungs. over time, this process of injury

and repair causes red tissue formation and a decrease in airway obstruction and as a

result of parenchymal damage observed with emphysema, alveoli disease. In addition

to inflammation, processes associated with protein imbalance and antiproteases in the

lungs can counteract airway obstruction. In the case of severe inflammation, proteinase

and other substances can be released, damaging the lung parenchyma. In COPD, a

strong reaction causes lung changes in arteries vasculature. These changes may be

caused by exposure to second-hand smoke or by the removal of mediators

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Chest Infection Formative Scenario

NURSING MANAGEMENT

Exercise Breathing; Breathing curled lips helps to reduce shortness of breath, prevents

small airways, and helps the patient to control the intensity and depth of breathing.

Respiratory Muscle Training; This program needs the patient to breathe while holding

the breath for 10 to 15 minutes daily without stopping in between.

Pacing activity

Ways to Cope: A nurse helps a patient to cope with the condition and teaches the

patient to increase lung function to restore normal breathing function.

Health Care.

Oxygen therapy.

Physical condition; Rehabilitation strategies include exercise and regular exercise

aimed at conserving energy and increasing lung capacity

Self-Care activities

MEDICAL MANAGEMENT

Fluid is removed and antibiotics, in large doses, are prescribed.

Sterilization of the empyema requires 4 to 6 weeks of antibiotics.

The flow of pleural fluid depends on the stage of the disease and is achieved in one of

the following ways:

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Chest Infection Formative Scenario

Thoracentesis with a thin percutaneous catheter, if the volume is small and the fluid

not more purulent or heavy.

Thoracostomy for localized or complex pleural effusions.

Open chest drainage via thoracotomy: decortication

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Chest Infection Formative Scenario

NURSING CARE PLAN

assessmen diagnosi Desired intervention rationale evaluatio

t s outcome n

Ineffective Ineffectiv Patient will Suction Suctioning Patient

airway e airway maintain clear was able

clearance clearance airway secretions to breath

related to patency that obstruct effectively

productio with breath the airway .

n of sounds therefore

secretion clear. improves

s as Will oxygenation.

evidence demonstrat Demonstrate Helps

d by e effective maximize

sputum behaviours coughing and ventilation.

secretion. to improve deep-

airway breathing

clearance, techniques.

e.g., cough Assist the Movement

effectively patient to turn aids in

and every 2 hours. mobilizing

expectorate If ambulatory, secretions to

secretions. allow patient facilitate

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Chest Infection Formative Scenario

to ambulate clearing of

as tolerated. airways.

Impaired Impaired Demonstrat Monitor Restlessness Patient

gas gas e improved changes in , agitation are was able

exchange. exchange ventilation the level of common to stabilize

related to and consciousnes manifestation peripheral

altered adequate s and mental s of hypoxia. tissue

oxygen oxygenation status. When it is perfusion.

supply as of tissues by ruled out.

evidence CBGs within

d by normal Provide moist Administering

capillary range and oxygen as moist oxygen

blood gas be free of prescribed. prevents

of symptoms drying of the

6mmols/L of airways,

respiratory losses, and

distress. improves

compliance.

Thick,

copious

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Chest Infection Formative Scenario

secretions is

source of

Encourage impaired gas

expectoration exchange in

of sputum: small

suction when airways.

needed. Deep

suctioning is

needed when

the cough is

ineffective for

spit of

secretions.

Code of ethics

I practiced with empathy and respect for the patient's natural self-respect. A high level

respect for all members of the family, I treated them with respect and used my medical

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Chest Infection Formative Scenario

communication skills when interacting with family. I have maintained family and patient

relationship technology.

Basic commitment to the patient, without gaining favour. The patient should always be

in the lead. There was no conflict of interest, the main focus was on how patients were

treated in my mind. Understanding the limitations of professionalism and how it relates

to the outcomes of patient care was essential.

The nurse promotes, protects and protects the patient's rights, health and safety. I

needed to keep all the privacy guidelines regarding patient care and patient

identification. To become a nurse, the skill must be demonstrated in the clinic and in

document consolidation.

The nurse has the authority, the obligation, and the obligation to act as a nurse” makes

decisions: and takes steps in line with the obligation to provide quality patient care. I

did well to think, plan, and deliberately make responsible decisions. I have made my

mission respectful of the action and the final outcome to come.

The nurse has the same responsibilities as others, including the obligation to promote

health and safety, to maintain integrity, to uphold skills, and towards promoting

individual and specialised development. I felt that I was more concerned about the

patient's health than about myself.

Through individual and participatory efforts, the establishment, improvement of work

ethic and working conditions conducive to safe, quality health care. I provided the family

with education and did research on the clinical state of the patient.

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Chest Infection Formative Scenario

A nurse works with other health specialists and the municipal to protect human rights,

promote health dialogue, and reduce health inequalities. I have partnered with other

nurses, laboratory staff to do research, and support staff to ensure we cooperate and

care for the patient.

The nurse should continue to form committees to organize groups where they can

participate and evaluate the accuracy and continuity of the work, including the

principles of social justice. I have organized strategic committees and groups where

they share and evaluate accuracy and performance standards.

(American Nurses Association. (2015). Code of conduct with translation statements.

Silver Spring, MD.)

ABC Prioritization

ABC prioritization uses the first three letters to set your priorities right and straight and

increase organization all around. Therefore, using is the most appropriate and effective

to plan a care plan.

A: This means that the work would go in the critical and urgent section of the

Eisenhower Matrix. This task must get done, and if not there will

consequences. B: these are similar to Eisenhower’s critical, but Not Urgent box.

These tasks are urgent but do not require attention right now as there are not severe

consequences for not getting it done at the moment. C: these are the same as the Not

Urgent box of the Eisenhower Matrix. If not done, there will be no consequences.

Prioritizing my care enabled the perfect care plan of the patient in that patient stabilized

his vitals within a stipulated time. We were able to prevent his health condition from

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Chest Infection Formative Scenario

deteriorating. Establishing priorities is necessary to complete everything that needs to

be attended to with perfection without much confusion and poor care plan of the patient.

It is important because it allows you to give attention to the task that is important and

urgent so that I can later focus on the lower priority. If you can’t prioritize, it will be hard

getting things done on time, stress about how you will finish everything on your list, and

not productive.

The chronic obstructive pulmonary disease has affected approximately 32 million

persons in the United States. (Zab Mosenifar, MD, edited by John J Oppenheimer MD,

COPD Medscape). Majoring in these case scenarios will give me the best diagnosis

and management of ill patients with chest infections. It is a very confusing case to

diagnose in clinical practice, most of these cases go misdiagnosed ending up in wrong

management of the disease. A lot of patients have died while oxygen therapy living

nurses at a glance of what happened later turning out that the patient was not to be

100% oxygen therapy simply because the patient uses hypoxic ventilatory drive to

breathe.

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Chest Infection Formative Scenario

REFERENCES

Fletcher, M. J., & Dahl, B. H. (2013). Expanding nurse practice in COPD: is it key to

providing high quality, effective and safe patient care? Primary Care Respiratory

Journal, 22(2), 230-233.

Eriksson, E. Ö., Hillervik, C., & Ehrenberg, A. (2008). Effects of COPD self‐care

management education at a nurse‐led primary health care clinic. Scandinavian

journal of caring sciences, 22(2), 178-185.

Jonsdottir, H. (2008). Nursing care in the chronic phase of COPD: a call for innovative

disciplinary research. Journal of clinical nursing, 17(7b), 272-290.

Tønnesen, P., Mikkelsen, K., & Bremann, L. (2006). Nurse-conducted smoking

cessation in patients with COPD using nicotine sublingual tablets and behavioral

support. Chest, 130(2), 334-342.

Sanjari, M., & Zahedi, F. (2008). Ethical codes of nursing and the practical necessity

in Iran. Bijani, M., Ghodsbin, F., Fard, S. J., Shirazi, F., Sharif, F., & Tehranineshat,

B. (2017). An evaluation of adherence to ethical codes among nurses and nursing

students. Journal of medical ethics and history of medicine, 10.

McCrory, M. C., Aboumatar, H., Custer, J. W., Yang, C. P., & Hunt, E. A. (2012).

“ABC-SBAR” training improves simulated critical patient hand-off by paediatric

interns. Paediatric emergency care, 28(6), 538-543.

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Chest Infection Formative Scenario

Bloomer, M. J., Clarke, A. B., & Morphet, J. (2018). Nurses' prioritization of enteral

nutrition in intensive care units: a national survey. Nursing in critical care, 23(3), 152-

158.

Tume, L. N., Coetzee, M., Dryden-Palmer, K., Hickey, P. A., Kinney, S., Latour, J. M.,

... & Curley, M. A. (2015). Pediatric critical care nursing research priorities—Initiating

international dialogue. Pediatric Critical Care Medicine| Society of Critical Care

Medicine, 16(6), e174-e182.

Daly, J. M., Buckwalter, K., & Maas, M. (2002). Written and computerized care

plans. Journal of gerontological nursing, 28(9), 14-23.

Lee, T. T. (2006). Nurses’ perceptions of their documentation experiences in a

computerized nursing care planning system. Journal of Clinical Nursing, 15(11), 1376-

1382.

Miravitlles, M., Soler-Cataluña, J. J., Calle, M., Molina, J., Almagro, P., Quintano, J. A.,

... & Ancochea, J. (2012). Spanish COPD Guidelines (GesEPOC): pharmacological

treatment of stable COPD. Archivos de Bronconeumología (English Edition), 48(7),

247-257.

Caramori, Gaetano, Ian M. Adcock, Antonino Di Stefano, and Kian Fan Chung.

"Cytokine inhibition in the treatment of COPD." International journal of chronic

obstructive pulmonary disease 9 (2014): 397.

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Chest Infection Formative Scenario

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