Posted at 01.10.2018
Keywords: copd exacerbation research, case study copd, copd case study
Introduction: A COPD exacerbation can be defined as "a meeting in the natural course of the disease characterized by a big change in the patient's baseline dyspnea, cough, and/or sputum, that is beyond normal day-to-day variations, is serious in onset and could warrant a big change in medication in a patient with underlying COPD, " in line with the Global Initiative for Obstructive Lung Disease (GOLD). COPD exacerbations are incapacitating, in and of themselves. The toll they take on patient's body can result in impairment and even fatality. Paying attention to signs and symptoms, taking better attention of themselves and taking steps towards reduction may ultimately help patients to avoid a COPD exacerbation.
Clinical Focus: Effective education to increase early rehabilitation for over 20y/o both female and male adult who diagnosed COPD with acute respiratory failing in ICU.
Overall Task Goal:
Overall goal is usually to be in a position to propose improvement early rehabilitation to achieve optimal wellbeing as well concerning promote proficient and effective do it yourself management for chronic disease.
Nursing Theory: Roy's version model of medical and Orem's self care mode
Patient more than 18 many years of age
Chronic obstructive pulmonary disease
Patients without sedation or catecholamine
Conscious and cooperative state
Ability for the individual to sit in a armchair
Non chronic obstructive pulmonary disease
Lack of patient involvement
Patients under guardianship
Unconscious and non cooperative state
Patients unable to trip in a wheelchair
Patients under justice safeguard
Using Orem's self applied good care model the college student will create needs examination tool predicated on the protocols of the organization and information obtained from medical health care team of Montefiore Medical center.
Introduce myself to Mr. Villarente. Consult with overall job goal
Student talks about overall job goal and an idea for examination tool.
Using Orem's do it yourself care model the student will establish needs evaluation tool predicated on the protocols of the institution and information collected from the health health care team of Montefiore Hospital.
Generalized all information accumulated from patient's graph with COPD, as well as the overview of patient's education sources.
An information form the Nurse Director, product nurses, allied team members such as Doctor of the machine, social staff member and clerk.
Introduce master intend to Mr. Villarente. Discuss about overall project of this thing. Unit orientation, discuss about task concept, theory software.
Review current project of the machine and goals.
*Overall final result: The university student records knowledge on COPD and task of theory using nursing theory which is Orem's home care model. Pupil also reports coaching rules and support rendered for COPD for Montefiore Medical center.
The student frequented Montefiore ICU and Med-Surg unit on the 5th floor with the preceptor and the medical practicum job was provided to the all available staffs by the student and the preceptor.
No specific and reasonable education guide was unearthed by the scholar.
The preceptor created ongoing task of the machine. The concept is 'decrease the pace of unscheduled extubation. ' The college student was able to combine her own view of the professional plan with the ongoing job in Montefiore Medical center.
Using Orem's personal health care model and Roy's adaptation model Student will identify what the obstacles are to using COPD recommendations for montefiore medical center patients.
Interview with 3patients and 3 device nurses at Montefiore Hospital about (insufficient) Understanding & knowledge-of what must change & why, (lack of) Motivation-drive & desire to boost good care, priorities, (insufficient) Approval & beliefs-perceptions of benefits vs costs of proposed change, (lack of) Skills Practicalities-(insufficient ) availability of resources, personnel Exterior environment-financial, political, and organizational.
(1. 5hrs for every single pt)
(1. 5hrs for each nurse)
*Overall final result: Student presents what the obstacles are with COPD patients and what COPC rules needs to change at Montefiore clinic.
The scholar interviewed 3 patients and 3 nurses to learn good interview skills as well to get their ideas or answers regarding COPD education.
The student found that there is no nursing specialist to teach about how to manage themselves for COPD to avoid exacerbation.
The nursing staffs have the ability to gain access to KRAMS which is patient education hand out via internet.
During interviewing with patients, the scholar found that solid hard hand out materials is not able to motivate pt to learn all of them.
Using Orem's do it yourself health care model and Roy's adaptation model College student will identify the actual obstacles are to using COPD rules for Montefiore medical center ICU patient.
Review 3patient's charts to gather information.
Interview with 3 patients about considering respiratory isolation to lessen risk of outbreak or epidemic.
Observe patient care and attention with major nurses
(1hrs for each pt)
*Overall final result: Student presents what the obstacles are with COPD patients and what COPC rules needs to change at Montefiore medical center.
The student examined 2charts and notice patient care with major nurse to assemble data regarding medical hx, status, medication, treatment, s/s, family hx, allergy symptoms, cigarette or medication uses, etc.
The patients were accepted for asthma and COPD exacerbation with complicated prognosis such as diabetes, bipolar disorder, CHF. All these diagnosis seemed to be related COPD exacerbation.
One of the interviewee who is 65y/o male stated "I know how to use inhaler to reduce my symptoms but I don't wish to accomplish that myself. "
The student found that we, nurses need higher awareness of and knowledge of COPD prognosis and monitoring suggestions and a knowledge of the practice in comparison to guidelines
Summary: Patients with stable COPD should be directed at improving standard of living by preventing severe exacerbations, alleviating symptoms and slowing the progressive deterioration of lung function. The specialized medical span of COPD is characterized by chronic impairment, with intermittent serious exacerbations that happen more often through the winter months. When exacerbations appear, they typically express as increased sputum creation, more purulent sputum and worsening of dyspnea. Although infectious etiologies take into account most exacerbations, contact with allergens, pollutants or inhaled irritants may also play a role
Today, COPD is a widely-spread disease that threatens to the life and health of several patients. The development of the effective treatment and reduction technique for COPD becomes of the utmost importance, considering the actual fact that COPD is a long-term disease. In this respect, Orem's self analysis model can be very effective considering the necessity of doing the self assessment by patients on the regular basis to control their health and any changes that eventually them.
The COPT personal assessment is particularly important for nursing because it opens large opportunities for the development of effective approaches to nursing care. To place it more specifically, patients can disclose the deterioration of their health due to the use of the self examination model, whereas nurses provides patients with the fundamental medical help immediately and, if required, the in-patient treatment starts. At this time, it will probably be worth mentioning the actual fact that nurses often suffer from the lack of having less the close assistance with patients because they fail to identify health problems and deterioration of their health in time. Because of this, the in-patient treatment may be needed and nurses must work hard to help patients, whereas the results of such treatment may be in danger, whereas the deterioration of health identified early facilitates the work of nurses and increases the efficiency of these work.
In reality, specialists () recommend using Orem's self evaluation model and Roy's adaptation model as effective tools that allow patients to carry out self diagnosis and monitor their health on the regular basis. The usage of these models is easy for patients simply need to fill in the proper execution and, with respect to the result, they may take action and charm for a doctor or carry on the standard treatment (See App). Many specialists argue that Orem's model works well because of the straightforwardness of its use. Alternatively, patients should remember that they actually need the regular guidance and control from the part of healthcare pros to avoid constant deterioration of their health.
In actuality, Roy's version model and Orem's home analysis model is very effective and beneficial to medical. In this esteem, it is important to place emphasis on the fact that the do it yourself assessment is very important because nurses can obtain the comprehensive information from patients related to their health insurance and provide nursing services just with time, in case of the deterioration of patients' health under the impact of the introduction of COPD. In most cases, Orem's self evaluation is a reliable strategy and nurses can count on results of such self-assessment, whereas the utilization of other less reliable models can raise issues in immediate diagnosing and provision proper medical services for patients.
At the same time, COPD self analysis is very important in regard to the development of the satisfactory treatment and can prevent the development of other diseases. In actuality, Orem's model of self examination can assist in preventing the introduction of complications that can lead to the constant deterioration of health in patients with COPD.
In such a situation, nurses should assist patients to build up the diagnosis plan. In this regard, nurses should provide patients with precise information on the process of self examination. To get this done, nurses can conduct the questionnaire to examine the educational level of patients. In most cases, classes may be the next step in the assessment plan development because they'll help to teach patients. From then on nurses should introduce the control system to judge the effectiveness of self analysis and introduce changes in the personal assessment model, if possible.