Chronic Obstructive Pulmonary Disease Rehabilitation
Realistic Case
Mike Tyson, a 66 years old male, has been a smoker for 30 years. His past 4-5 months were characterized by persistent coughing, which becomes worse when he is in a smoky place. In a visit to hospital, the doctor discovered that the patient had been inhaling at least 2 packs of cigarettes each day for 15 years. No chills or fever were reported but the shortness of breath after undertaking physical exercise is experienced currently. Mike’s medical history showed only hypertension that was managed using metoprolol, lisinopril, and hydrochlorothiazide, the patient was diagnosed with chronic obstructive pulmonary disease.
Chronic Obstructive Pulmonary Disease in Concerning Rehabilitation
Chronic obstructive pulmonary disease (COPD) is becoming increasingly common globally. Its prevalence intensifies with age and about 7% of all deaths occurring annually in the world are attributed to this illness (Marçôa et al., 2018). The disease has a long-term significant impact on the health of elderly people, it affects the overall wellbeing of an individual as well as the degree of physical activity. Patients are likely to suffer from anxiety, depression, guilt, fear, and isolation due to restricted movement. This paper discusses the interventions and role of nurses in the rehabilitation of people with this chronic condition.
The causative agents of this disease include environmental toxins, fumes, smoking cigarettes, dust, and noxious gases. In addition, individuals lacking the alpha-1 antitrypsin (AAT) gene are at risk of developing this condition. People living with COPD have difficulties in undertaking daily activities such as climbing stairs, and walking. For this reason, a rehabilitation program to build fitness and improve pulmonary functioning is undertaken. The interventions given to improve COPD constitutes improving breathing techniques, exercise, nutrition, group, and emotional support, relaxation, and undertaking strategies for living a better life quality.
Chronic obstructive pulmonary disease symptoms include limitations of daily routine activities and hypoxia induced by fatigue. A pulmonary rehabilitation program is recommended for patients with a moderate or mild conditions and those whose ability to move has been hindered due to breathing difficulties. In addition, it also reduces the severity, exacerbation frequency, and hospitalization rate. Although this intervention does not heal COPD or improve the functioning ability of the lungs, it aids in improving the length and quality of life.
The chronic obstructive pulmonary disease causes activity intolerance, thus, a rehabilitation program for this condition usually aims at improving functional goals relating to routine doings. For instance, an increase in ambulation is encouraged by inspiring patients to move using walking aids. Furthermore, exercise training that helps in strengthening lower and upper extremity muscles is undertaken to intensify exercise endurance. Necessary daily actions are managed using support devices and they are distributed throughout the day to minimize energy expenditure.
Interventions for Older Adult’s with Chronic Obstructive Pulmonary Disease
Chronic COPD is trajectory disease that exacerbates from optimum functioning level to instability period if not well controlled. It is critical to undertake a rehabilitation program maintain and improve airway patency. The strategies used for supporting elderly patients to adapt to the illness include monitoring and assessing breathing and respiratory sound and noting sound rates to detect other conditions such as stridor, crackles, wheezes, and tachypnea. Rapid and shallow respiration coupled with lengthy expiration relative to inspiration, which are common, need to be normalized to prevent a crisis that may lead to death.
The head midline position should be aligned with the flexion when the elderly is sleeping for the airway to be open. To ensure that the patient is comfortable, the head of the bed should be elevated to enable easier respiratory functioning through gravity. Additionally, the ill person legs and arms should be supported using pillows to help in expanding the chest and reducing muscle fatigue. Minimization of environmental polluting substances such as smoke, dust, feather pillows is critical.
Improvement of cardiac tolerance by encouraging the patient to take at least 3000 mL of tepid liquids per day is critical. This is because hydration facilitates expectoration and helps in decreasing secretion viscosity and bronchospasm. In addition, turning of sick persons for every two hours is done as an intervention to mobilize secretion and airway clearing. Bronchial tapping, which is an example of chest physiotherapy facilitates postural drainage when coughing, this method averts aspirations and complications.
The patient is encouraged to undertake pursed lip or abdominal exercises as a means of coping with dyspnea and reducing trapped air. Chronic obstructive pulmonary disease accompanied by persistent cough is common in debilitated and elderly individuals with this condition. Therefore, it is necessary to maintain effective coughing by demonstrating deep breathing techniques to maximize ventilation. Interventions such as administering bronchodilators are done to sustain airway patency in extreme conditions.
Nurse’s Role in Managing Chronic Conditions
The nursing priorities for COPD patients include assisting with actions that facilitate gaseous exchange and sustaining airway patency. In addition, prevention of condition exacerbations, by providing prognosis, process, and treatment regimen is an important aspect of care provided. Old patients are prone to other respiratory diseases such as Streptococcus pneumonia, and other Influenza nosocomial infections, thus, they should be encouraged to get immunization against the pathogen.
Nurses have a role of educating both the patient and their family on the importance of self-management practices to control COPD exacerbation. In addition, they usually strive to attain airway clearance by either using controlled coughing or drugs such as corticosteroids and bronchodilators (Eapen et al., 2017). Caregivers also facilitate breathing pattern improvement through demonstrating to the patient how to undertake inspiratory muscle training, diaphragmatic, and pursed lip breathing.
Nurses and patients need to recognize the symptoms and signs that indicate crisis onset. For instance, moist, scattered crackles with wheezing expiratory sound is a manifestation of bronchospasm, which obstructs the airway to cause breathing problems in people with COPD. A caregiver should auscultate breathing sounds to clear the respiratory path and avert a crisis. In addition, one has to note for the presence of dyspnea characterized by respiratory distress, air hunger, anxiety, and restlessness using a 0–10 scale of breathlessness scale. This is done to detect the onset of acute dyspnea indicating the presence of pulmonary embolus.
Opportunities to Improve People with Disability Wellbeing
Implementation of electronic health records (EHR) by the healthcare systems can improve the quality of care given to people living with a disability. This is because EHR ensures that the right information is easily accessible during emergencies. In addition, patients are able to track and have information concerning their condition frequently. An incapacitated person or a family caregiver can set clear achievable goal for self-management purposes based on the recorded data records and seek help when the need arises.
Adoption of community-based rehabilitation (CBR) is a better strategy that can be used to support people living with COPD. The program offers basic needs and improves disabled patients’ life quality by using different approaches such as poverty lessening, equity promotion, rehabilitation, and social inclusion. Combined efforts from communities, organizations, families, patients, education sectors, and caregivers are the required for successful implementation of this intervention. Currently, the World Health Organization is supporting CBR by developing and reviewing policies, building human resource capacity, and supporting direct implementation in the health care system.
The inclusion of disabled people in daily activities removes communication, physical, and attitudinal barriers that can hinder an individual from participating in society. Hospitals need to alter their systems and procedures to accommodate all people. This can be done by developing a community outreach program that educates the community to eliminate stereotypes associated with less capable individuals. Laws protecting incapacitated people include the Americans with Disabilities Act (ADA) of 1990, the Bipartisan Budget Act of 2018, and the Patient Protection and Affordable Care Act of 2010. In addition, the Centers for Medicare and Medicaid Services’ new rule of 2019 allows Medicare Advantage (MA) plans to be more flexible in providing supplemental benefits to the disabled (Anthony, 2018). Therefore, it is important for organizations of healthcare to adhere to these legislation and national policies that supports disadvantaged persons.
The Caregiver Advise, Record, Enable (CARE) Act needs hospitals to include caregivers in treatment plans by recording their contacts in the medical record and informing them when their patient is discharged. It is important to implement this rule because caregivers are provided with education and guidelines on medical duties to be performed at home (Anthony, 2018). The outcomes expected from this policy are improvement of the life quality of both caregivers and patients.
Conclusion
In conclusion, both nurses and caregivers interventions coupled with rehabilitation are critical aspects of care for COPD patients. In addition, the healthcare system have mandate of refining care of the elderly with disabilities by reducing barriers to the type of services needed and adhering to laws formulated to protect them. Nurses need to take an active role of advocating for quality care for the disabled and referring elderly people with COPD to rehabilitation program.
References
Anthony, M. (2018). The caregiver advice, record, enable (CARE) act. Home Healthcare Now, 36(2), 69-70. Web.
Eapen, M. S., Myers, S., Walters, E. H., & Sohal, S. S. (2017). Airway inflammation in chronic obstructive pulmonary disease (COPD): A true paradox. Expert Review of Respiratory Medicine, 11(10), 827-839. Web.
Marçôa, R., Rodrigues, D. M., Dias, M., Ladeira, I., Vaz, A. P., Lima, R., & Guimarães, M. (2018). Classification of chronic obstructive pulmonary disease (COPD) according to the new Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2017: Comparison with GOLD 2011. Journal of Chronic Obstructive Pulmonary Disease, 15(1), 21-26. Web.