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Chronic Obstructive Pulmonary Disease (COPD) in the Elderly

As a response of two main factors, which are ageing populace and contact with associated risk factors, the prevalence of persistent obstructive pulmonary disease (COPD) is increasing worldwide. Actually, the condition is a task for public health insurance and health care system because it needs high costs (Lisspers, Johansson, Jansson, Larsson, Stratelis, Hedegaard, & Stallberg, 2014). Besides, the North american Lung Relationship (2013) reinforces that the COPD is the 3rd leading cause of death in the United States. Data from 2007 exhibited that almost 125, 000 deaths nationwide occurred in response this disease, so it represents one COPD death around every four minutes. Furthermore, underlined in these quantities, many clients aren't diagnosed or been able correctly, so the process to educate your client and your client knowledge are key to eliminate risk factors and promote better quality of life for whom has been diagnosed with this pulmonary disease (Lisspers, et al. , 2014). Throughout the span of this paper, some information will be described as the next: client's information, explanation and clinical manifestation the client's disease, the client's prescription, and nursing diagnoses and intervention, which applies to this client.

Client's Information

Firstly, fundamental information about the client is necessary to be investigated and realized to continue the diagnose and manage. Client's history must definitely provide knowledge to link present manifestations to past situations, and these will conduct to raised management and campaign for future interventions. Patient Mrs. S. , 82 years old, married, retired, catholic, and degree of education restricted (not concluded senior high school). She was hospitalized therefore of pneumonia after being identified as having productive cough, which was with yellow secretion; and her temp was 38. 5oC. In her health background, she related that she was identified as having serious obstructive pulmonary disease (COPD) although Mrs. S. could not specify the time when these diagnoses took place. Mrs. S. was not alcoholic and smoking. She has related that at home, she uses medication (not specified) to relieve pain when it's necessary. In addition, she's related that she was not hypersensitive and was responding well front the hospitalization.

During her physical examination, she provided as following information: patient was LOC and verbalizing with difficulty because of gas exchange. She was using air therapy by the spectacle-type sinus catheter with 2L/min; RR 32 and tachypnea; HR 81 bpm and normocardic; BP 130/70 mmHg and normotensive; temperature 38, 5oC and febrile; and saturation SpO2 90%. Skin area: dehydrated, normal colored, turgor characteristic of her age group, hematoma in member superior remaining because of the catheter for serotherapy. In the moment, the catheter was salinized. The stressed reflex was preserved, full and strong pulse, rhythmic. Cranium: it had not been present alterations and was hygienic. Pupils were isochoric and image reactive. Thorax: plan, symmetric, thoracic expansion kept, symmetrical breasts characteristic of senescence. Lung: vesicular murmur and stridor offered in bilateral basis; pulmonary auscultation: normal does sound, regular rhythm in regular tempo of two. Stomach: it was plan, palpable in ascending loop, Blumberg/Cystic/McBurney negatives. Genito- urinary: paravaginal and perianal presented dermatitis. Eliminations: faeces double by day with pasty aspect. Urine in grand amount in diaper, dark yellow and characteristic smell, not related pain to urinate. Alimentation: hyposodic diet, dental, preserved appetite. Water ingest around one liter by day. Activity and sleeping: restrict movements and perambulation - with family help - difficulty to rest. Security and safeguard: Braden's range with 16 factors - low risk. Comfort: related pain - number six - in the right shoulder.

Client's Physiopathology

Secondly, understanding the Mrs. S's history and results of the physical assessment can provide an overview about the physiopathology since it must define associations among disease way. These associations are linked to the quality of life to know better about pneumonia and COPD. Pneumonia can be an swelling of the lung parenchyma caused by different microorganism realtors (Hinkle & Cheever, 2010). In relation to Mrs. S. the in line with the drugs recommended the hypothesis is that the pneumonia is caused by a type of bacterias, which is inhaled by ambient air, where an higher airway bronchoaspiration occurred with colonization this bacteria, so this kind of bacteria does a migration to lower airway and colonization in the bilateral second-rate lobule region.

For example, some risk factors can be applied for pneumonia. Two age ranges at highest risk are newborns/children and older people. These risk factors can be a persistent disease, for example, asthma, COPD, and cardiovascular disease; suppressed disease fighting capability, which may be developed by drug treatment and/or diseases (HIV/Helps), and surgery; smoking; and customer being placed over a ventilator during hospitalization. Still, some indication and symptoms presented because of pneumonia are fever, sweating, hypothermia (in more aged adults and people with weakened immune system), coughing (can be successful or not), chest pain during coughing and/or yoga breathing, shortness of breathing, fatigue, muscle aches, nausea and vomiting (most frequent for infants/children), and mental understanding (most typical for seniors) (Hinkle & Cheever, 2010).

Another pathology offered in Mrs. S. was Chronic Obstructive Pulmonary Disease is seen as a Lewis, Dirksen, Heitkemper, Bucher & Camera (2014) as an air flow restriction, which is not reversible. This air flow limitation is intensifying and related with an excessive inflammatory response of the lungs to noxious allergens or gases. COPD is composed of three different pathologic processes, which can possibly combine to build up the clinical circumstance. They are: chronic bronchitis, emphysema, and asthma.

The pathophysiology involves gradual damage of alveolar septum and damage of the lung parenchyma, which boost the incapacity to provide gas exchange among alveolus and blood vessels. The definitions of the three possible pathology are: a) serious bronchitis: it identifies as an unnecessary development of mucus in the bronchial tree, and it has chronic productive coughing or recurrent during unless three months by 12 months, which is 2 yrs consecutive; b) emphysema: it is comprehended how an anatomic alteration, which is characterized with abnormal alteration in the air spaces distal to the terminal bronchioles, and it is completed with destructives alterations in the alveolar surfaces; c) asthma: this can be a chronic inflammatory disease, which is characterized with lower airway hyper responsiveness and variable restriction in the air flux. It can be spontaneously reversible or with treatment. Asthma has clinical manifestation by repeated shows of wheezing, breathlessness, upper body tightness, and coughing (Hinkle & Cheever, 2010).

Furthermore, matching to Hinkle & Cheever (2010) some risk factors are related to COPD can be: first, cigarette smoking, which is definitely the major risk factor. Second, occupational chemicals and dusts, which require two main factors - polluting of the environment and illness - air pollution is problems for urban people although a comparison among cigarette smokers and air pollution, the first has a high level of affect. Thrid, heredity, which really is a deficit in the О±1 -Antitrypsin (AAT) deficiency autosomal recessive disorder), but it is merely 1% - 2% in america. Last one, increasing age: where some extent of emphysema is common in more mature parents, even non-smokers. Also, some indicators and symptoms must be present in your client, that has COPD. These alerts and symptoms can be shortness of breathing, wheezing, upper body tightness, chronic cough, which produces excessive mucus, respiratory an infection, insufficient energy, cyanosis, and weight reduction, which must be in the chronic stage. These symptoms and signs must varies individual to individual, plus they can be there on worse level in some regions of the day.

After all, an association is applied between COPD and pneumonia. Both diseases have a rouge hyperlink. First, COPD provides to the people, who've this pulmonary disease, a center to written agreement pneumonia and difficult to detect pneumonia because of similar alerts and symptoms. Also, COPD does indeed a difficulty treat pneumonia because the individual has a limitation in his/her disease fighting capability, so the antibodies cannot provide the adequate defense. Another situation is inflammation and irritation within the lungs of COPD, so pneumonia raises these both factors and restricts more the respiration and air exchange. With regards to the diagnoses, if pneumonia is diagnosed early on, the restoration can be more acceptable although COPD restricts it. In fact, management with antibiotics to promote better recovery and care must be applied, and protection must be looked at by the client and doctor, so vaccine can be used a method of prevention (Lewis et al, 2014).

Client's Prescription

Thirdly, the medical professional provided prescriptions to the client. Mrs. S's. medical professional provided a medical prescription based on her diagnosed (COPD and pneumonia) to provide enough management and restoration. The physician requested lung X-ray, which showed the occurrence of opacity in the lower thirds as a result of pneumonia. The medications were: 1- Dipyrone 2ml + 10 ml of distilled normal water (IV), every 6 time if pain or fever; 2- Omeprazole 20mg (oral) on an empty stomach, in the morning; 3- Rocephin 1g + 100ml (IV) of saline 0. 9%, every 12 hours; 4- Levofloxacin 500mg (IV), every a day; 5- Bamifylline 300 mg (oral), 8 a. m. and p. m; 6- Nebulization remedy with saline 0. 9% 5ml + Atrovent 35 drops + Berotec 5 drops (inhalation), every 6 hours; and 8- Oxygen remedy by spectacle-type sinus catheter with 2L/min if saturation ‰ 90%.

Consequently, some interventions can be comprehended by this prescription. The medication aspects understand that Mrs. S. was doing management of the presented and the subsequent disease. Medication for pain really helps to relieve the soreness brought on by the difficult to inhale and the intercostal muscles, and bronchodilator drugs help to facilitate the air way, so the air level in top of the and low airway and gas exchange in the alveolus increase, and it can help in the chronic disease keeping a bronchodilation the airway (advertising of medical conditions). Antibiotic medication works to get rid of the pathologic agent, which provided pneumonia. The medicine referent to proton pump inhibitors is useful to prevent stomach traumas because of antibiotic therapy (Deglin & Vallerand, 2013). Nebulization really helps to humidify airway. Air therapy offers a supplement of air to boost the available volume in the alveolus (Potter & Perry, 2009).

Likewise, breasts x-ray was asked to clarify and provide satisfactory diagnostic for Mrs. S. , and it proved what part and the development of the lungs experienced pneumonia (existence of opacity in the lower thirds). Another factor to require this exam is as a result of COPD, so it helps the physician to evaluate shortness of breathing, support the identification, and analyzes for advanced emphysema (Kee, 2010).

Furthermore, pharmacology must have focus on Mrs. S. because she got a variety of medications during hospitalization, so nurses got to know medication information such as main impact and nursing look after this client. The relating with Deglin & Vallerand (2013) Mrs. S' medications are described as follows:

  1. Dipyrone - 2ml + 10 ml of distilled normal water (IV), every 6 time if pain or fever.
  1. Main effect: it can be an analgesic and antipyretic.
  2. Nursing good care:
  1. Teaching your client about the medial side results related to use this medication. Unwanted effects that are more prevalent are allergy and/or deep breathing discomfort; if it is present, the nurse immediately communicates the doctor.
  2. This medication must be administrated if the patient relates pain or fever, so the nurse is dependable to verify essential indicators and pain level.
  • Omeprazole - 20mg (oral), an empty stomach, in the morning.
  • Main impact: it offers cover for the gastric wall membrane due to high quantity of medicaments administrated.
  • Nursing attention:
  • The nurse asks the patient about allergy.
  • Nurse administrates one hour before breakfast time (according to the physician's prescription).
  • Rocephin - 1g + 100ml (IV) of saline 0. 9%, every 12 hours.
  • Main result: it can be an antimicrobial to act in gram negatives.
  • Nursing treatment:
  • Medicament reconstruction must maintain saline 0. 9%.
  • The administration needs to be poor (minimum 30 minutes).
  • Levofloxacin 500mg (IV), every 24 hours.
  • Main impact: it can be an antimicrobial. It is utilized for the treating pneumonia.
  • Nursing health care:
  • The nurse must administrate the medication gradually.
  • The nurse should orient your client about side results such as nauseas and vomiting.
  • The nurse should never administrate other antimicrobial medicine in the same time.
  • Bamifylline 300 mg (oral), 8 a. m. and p. m.
  • Main result: this can be a bronchodilator.
  • Nursing care:
  • The nurse should monitor for medicine hypersensitivity.
  • The nurse should determine for low bone relative density and routinely during therapy.
  • Nebulization therapy with saline 0. 9% 5ml + Atrovent 35 drops + Berotec 5 drops (inhalation).
  • Main effect: Atrovent functions as a bronchodilator (parasympathetic nervous system), and Berotec functions as a bronchodilator (sympathetic stressed system).
  • Nursing care and attention:
  • Nebulization needs to be done in line with the physician's prescription.
  • The nurse should screen for side effect such as tachycardia.

Nursing Diagnoses and Interventions

Finally, Wilkinson & Ahern (2009) stress that nurses provide their actions using the Nursing Health care Systematization, which consists in to evaluate the afflicted client's conditions and also to implement actions to revive his/her normal conditions of lifestyle. Indeed, Mrs. S' medical diagnoses and interventions could be applied, so these actions are described as a follower:

  1. Ineffective Breathing Structure: inspiration and expiration that do not provide sufficient ventilation, which is characterized by increased restlessness, oxygen saturation decreased, and using accessories muscles for deep breathing. Thus, the target is to provide adequate venting pattern.
  1. Interventions:
  1. Keeping superior airway clear, so it can be done utilizing a suction catheter where necessary.
  2. The position of the patient where he/she seems a relieve in dyspnea. Your client has a recurrent stimulating change of position during intercourse, keeping elevation in the headboard, and stimulating deep breathing and coughing.
  3. If necessary, your client can use air therapy, which is conform physician's prescription. It could be proposed by spectacle-type sinus catheter. This catheter must be altered every a day if the existence of secretion. The nurse should monitor humidification the air for oxygen remedy.

2- Inadequate Airway Clearance: client's lack of ability to clear secretions or obstructions from the respiratory system to keep a airway when it's shown, which is characterized by adventitious breath noises, changes in the respiratory rate and rhythm, cyanosis, dyspnea, and absent cough. As a result, the target is to keep or perform a clear airway.

a) Interventions:

i. Teaching your client how to provide enough coughing. It could use specific ways to perform such as tapotement.

ii. Encouraging ambulation, so it helps your client to get rid of lung's secretion and facilitate deep breathing.

iii. Encouraging the client does indeed a deeply inhaling and exhaling, coughing, and teaching him/her the value to do this.

iv. Verifying for client's hydration, it must be adequate because dehydration difficult to breath and eliminate airway secretion.

3- Risk for Contamination: it relates to increased environmental and pathogens exposition, intrusive steps, and a deficit in knowledge to avoid pathogen's exposition. Therefore, the target is to prevent hospital infections or sepsis.

a) Interventions:

i. The nurse should screen and look for local and systemic signs or symptoms of infection.

ii. Providing sufficient hydric and nutritional ingest. The nurse can stimulate the client to keep enough alimentary ingest, orient the client and his/her family about the need of sufficiently ingest of fibers, vitamins, protein, and normal water.

iii. The nurse must instruct the client and his/her family about signs and symptoms of infection, so they can visit a health professional, who will examine it.

The discharge plan and education about health behaviors must be presented and constructed through the hospitalization with the client and his/her family, so that it will provide adequate management and quality of the life span for your client (Ackley & Ladwig, 2014).

In short, in the following paper was explained Mrs. S's historical and physical exam, her physiopathology, her exams and medicaments, and nursing diagnoses and interventions about COPD and pneumonia once both diseases were shown by Mrs. S. Besides these procedures, nurses provide their diagnoses and interventions in the heath intend to care and provide promotion and avoidance for your client, who was identified as having pulmonary disease. Nurses must continue steadily to implement their medical diagnoses and interventions with doing research because it is important for the health care system to boost quality of recovery and life for clients and their family.

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