Nursing Assessments for Peter Newman

1. A nursing care plan comprises of several pertinent information related to patient diagnosis, and the purpose of delivering treatment services, in addition to particular nursing orders, and a comprehensive evaluation plan. While formulating a care plan for the patient Peter Newman, it must be taken into consideration that Peter has been a heavy smoker and social drinker all throughout his life. His smoking habits can be considered as a major risk factor that triggered the onset and development of COPD symptoms. In addition, he is also a Fly-In-Fly-Out employee. This method of employment focuses on providing job opportunities to people in remote locations by moving them to the work site temporarily. Peter is employed in a mining company that makes it difficult for him to meet the job responsibilities. Recently he also reported breathing problems. He currently resides with two teenage kids and his wife Marcy in the southern capital of the nation. His work schedule also comprises of working continuously for two weeks, followed by taking a two week leave. Hence, at the time of care plan formulation, his workplace circumstances, and family history, social history must be considered, with the aim of lowering his likelihood of being exposed to factors that might exacerbate his condition. 

2. Nursing assessments involve the procedure of gathering vital information related to the psychological, physiological, spiritual, and sociological status of patient, and is typically conducted by a registered nurse (Giger, 2016). The primary objective of conducting a thorough and comprehensive nursing assessment is to recognise pertinent health abnormalities that helps in prioritising necessary medical interventions. The three nursing assessments that need to be conducted upon Peter include (i) respiratory assessment, (ii) assessment of dyspnoea, and (iii) vital sign and/or neurological assessment. The respiratory assessment will encompass an external evaluation of patient ventilation, which in turn will comprise of observations of the respiration pattern, depth and rate. An accurate assessment of the respiratory functioning will depend on identification of abdominal and thoracic movements that generally gets affected in COPD (Des Jardins & Burton, 2019). Conducting an assessment for dyspnoea will involve assessing the airway patency, while listening to the lungs of the patient. This is vital since shortness of breath is a common manifestation of COPD due to obstruction in the lungs. Furthermore, according to Perez et al. (2015) presence of a subjective experience of discomfort in breathing that eventually consists of distinct sensations can also be attributed to exposure to allergens, which is prevalent in this case (work in mining site). In addition, conducting a vital signs assessment will provide a clear insight into the status of the life sustaining functions of the patient’s body. The measurements related to heart rate, blood pressure, pulse (heart rate), respiratory rate, and body temperature will help in determining whether COPD has created an impact on the general physical status of Peter, thus providing necessary clues to the disease (Villarroel et al., 2014). Neurological assessment will involve collection of subjective data, mini-mental state examination, and use of the Glasgow Coma Scale. It is vital since COPD has been found to exert a negative impact on thinking and memory. In addition, presence of low levels of oxygen in bloodstream might also cause neural damage.

Nursing Diagnosis for Peter Newman

3. The major nursing problem identified in the current scenario is COPD that leads to an impairment in exchange of respiratory gases, followed by shortness of breath, decrease in the amount of oxygen saturation levels, and increase in the amount of Pco2. The three priority nursing diagnosis that have been identified from the case scenario are namely, (i) reducing the impairment of gas exchange, (ii) lowering risks of septic shock, and (iii) enhancing the patient’s psychological functioning by lowering stress and anxiety levels. The table provided below contains the plan of care for Peter:

Table 1- Care plan for Peter

4. Discharge planning has the primary objective of enhancing the coordination of clinical services, and takes into account the needs of the patient within the community. Smoking has been identified as the major cause for COPD. Owing to the fact that heavy smoking results in a damage of the air sacs, lining of the lungs, and the airways, the oxygen flow to the cells through the lungs gets subsequently reduced, thereby causing shortness of breath in COPD (Zuo et al., 2014). Peter will be advised to quit smoking for protecting his lungs, and preventing further deterioration of the symptoms. He will be taught about the harmful impacts of smoking and will also be provided assistance for quitting smoking such as, medicines and nicotine replacement therapy. Referrals to support groups will also facilitate smoking cessation. Exposure to allergens and fumes at mining sites also affects lung function, thereby exacerbating the COPD symptoms (Hendryx & Luo, 2015). Peter will be advised to put on face masks at his workplace to prevent exposure to any kind of fumes or chemicals that might lead to a flare-up of the symptoms and result in more lung damage. While involving his family in the care process, they will also be asked to reduce the amount of secondhand smoke that he is exposed to. Patient education will also involve the concept of pulmonary rehabilitation that will bring about an improvement in his health and overall quality of life (Garvey et al., 2016). Peter will also be encouraged to participate in moderate physical activities and exercise that will improve signs of breathlessness. In addition, he will also be provided training on pursed-lip breathing that has been considered a mainstay management strategy for COPD (Rossi et al., 2014). Education will also encompass encouraging him to change the working pattern of two weeks on and two weeks off roster. Taking breaks in between weeks will reduce his exposure to the mining site, thus decreasing the pressure on the lungs and airways. 

Discharge Planning for Peter Newman

5. Allied Health team members typically comprise of chiropractors, occupational therapists, exercise physiologists, osteopaths, orthoptists, prosthetists, podiatrists, psychologists, sonographers, hospital pharmacists, and social workers. An exercise physiologist will play an important role in this case scenario since they will help the patient understand the benefits of participation in exercise activities, thus facilitating Peter to gain optimal fitness, and increasing the quality of life. This allied health professional will be involved in assessing exertional oxygen, while encouraging Peter to show adherence to exercise rehabilitation, which in turn will improve arm movement and enhance pulmonary capacity and function. A dietician will also play an important role during care delivery and discharge planning since breathing needs a conscious effort among most patients. Owing to the fact that a poor diet will prevent the patient from compensating for increased energy demands, thus resulting in subsequent loss in weight (Nordén et al., 2015). There is mounting evidence for the association between continuous smoking and deficiency of serum vitamin C levels (Zendedel et al., 2015). Having adequate nutrition will prevent malnutrition and also enhance the pulmonary status of the patient. Hence, a dietician will recommend the daily intake of food and drinks to Peter in order to meet his energy needs and avoid weight loss. An occupational therapist will also be involved in educating and monitoring Peter in techniques of energy conservation by prioritisation and conscious planning (Corhay, Dang, Van Cauwenberge & Louis, 2014). The therapist will teach Peter ways to maintain balance between rest and activity, and usage of alternate breathing techniques. Peter will also be provided training on body positioning, adjusting tempo, and breathing techniques. A counsellor will also be involved in the care giving process and will provide much needed psychosocial support to Peter for handling the consequences of COPD, and the alteration in participation abilities, and activities. Counselling will also prove beneficial in encouraging Peter for smoking cessation (Marques et al., 2015).  

References

Corhay, J. L., Dang, D. N., Van Cauwenberge, H., & Louis, R. (2014). Pulmonary rehabilitation and COPD: providing patients a good environment for optimizing therapy. International journal of chronic obstructive pulmonary disease, 9, 27. doi: 10.2147/COPD.S52012

Coyne, I. (2015). Families and health?care professionals’ perspectives and expectations of family?centred care: hidden expectations and unclear roles. Health expectations, 18(5), 796-808. https://doi.org/10.1111/hex.12104

Des Jardins, T., & Burton, G. G. (2019). Clinical manifestations and assessment of respiratory disease. Mosby. https://books.google.co.in/books?hl=en&lr=&id=cdiCDwAAQBAJ&oi=fnd&pg=PP1&dq=respiratory+assessment&ots=Co0UEzbXfN&sig=ve3N4871gTNbwvUkVIyxZiuJAPI#v=onepage&q=respiratory%20assessment&f=false 

Garvey, C., Bayles, M. P., Hamm, L. F., Hill, K., Holland, A., Limberg, T. M., & Spruit, M. A. (2016). Pulmonary rehabilitation exercise prescription in chronic obstructive pulmonary disease: review of selected guidelines. Journal of cardiopulmonary rehabilitation and prevention, 36(2), 75-83. https://doi.org/10.1097/HCR.0000000000000171

Role of Allied Health Team Members in Peter Newman’s Care

Giger, J. N. (2016). Transcultural nursing: Assessment and intervention. Elsevier Health Sciences. Retrieved from https://books.google.co.in/books?hl=en&lr=&id=XCWKCwAAQBAJ&oi=fnd&pg=PP1&dq=nursing+assessment&ots=Ub4dBiESwJ&sig=-bERHkF1D0uIdrwESIO2aLW_1T4#v=onepage&q=nursing%20assessment&f=false

Hendryx, M., & Luo, J. (2015). An examination of the effects of mountaintop removal coal mining on respiratory symptoms and COPD using propensity scores. International journal of environmental health research, 25(3), 265-276. https://doi.org/10.1080/09603123.2014.938027

Herigstad, M., Hayen, A., Evans, E., Hardinge, F. M., Davies, R. J., Wiech, K., & Pattinson, K. T. (2015). Dyspnea-related cues engage the prefrontal cortex: evidence from functional brain imaging in COPD. Chest, 148(4), 953-961. https://doi.org/10.1378/chest.15-0416 

Kubota, S., Endo, Y., Kubota, M., Ishizuka, Y., & Furudate, T. (2015). Effects of trunk posture in Fowler’s position on hemodynamics. Autonomic Neuroscience, 189, 56-59. https://doi.org/10.1016/j.autneu.2015.01.002

Marques, A., Jácome, C., Cruz, J., Gabriel, R., Brooks, D., & Figueiredo, D. (2015). Family-based psychosocial support and education as part of pulmonary rehabilitation in COPD: a randomized controlled trial. Chest, 147(3), 662-672. https://doi.org/10.1378/chest.14-1488 

Murphy, P. B., Rehal, S., Arbane, G., Bourke, S., Calverley, P. M., Crook, A. M., … & Hurst, J. R. (2017). Effect of home noninvasive ventilation with oxygen therapy vs oxygen therapy alone on hospital readmission or death after an acute COPD exacerbation: a randomized clinical trial. Jama, 317(21), 2177-2186. doi:10.1001/jama.2017.4451

Nordén, J., Grönberg, A., Bosaeus, I., Forslund, H. B., Hulthén, L., Rothenberg, E., … & Slinde, F. (2015). Nutrition impact symptoms and body composition in patients with COPD. European journal of clinical nutrition, 69(2), 256. https://doi.org/10.1038/ejcn.2014.76 

Perez, T., Burgel, P. R., Paillasseur, J. L., Caillaud, D., Deslée, G., Chanez, P., & Roche, N. (2015). Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease. International journal of chronic obstructive pulmonary disease, 10, 1663. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4547644/

Rossi, R. C., Vanderlei, F. M., Bernardo, A. F., Souza, N. M. D., Goncalves, A. C. C. R., Ramos, E. M. C., … & Vanderlei, L. C. M. (2014). Effect of pursed-lip breathing in patients with COPD: linear and nonlinear analysis of cardiac autonomic modulation. COPD: Journal of Chronic Obstructive Pulmonary Disease, 11(1), 39-45. https://doi.org/10.3109/15412555.2013.825593

Sadaka, F., Juarez, M., Naydenov, S., & O’brien, J. (2014). Fluid resuscitation in septic shock: the effect of increasing fluid balance on mortality. Journal of intensive care medicine, 29(4), 213-217. https://doi.org/10.1177%2F0885066613478899

Schub, E., & Schub, T. (2015). Sepsis and septic shock. CINAHL Nursing Guide. Retrieved from https://www.farmerhealth.org.au/wp-content/uploads/2014/03/Sepsis_and_Septic_Shock.pdf 

Sterling, S. A., Miller, W. R., Pryor, J., Puskarich, M. A., & Jones, A. E. (2015). The impact of timing of antibiotics on outcomes in severe sepsis and septic shock: a systematic review and meta-analysis. Critical care medicine, 43(9), 1907. doi: 10.1097/CCM.0000000000001142

Tremayne, P. (2014). Using humour to enhance the nurse-patient relationship. Nursing Standard (2014+), 28(30), 37. DOI:10.7748/ns2014.03.28.30.37

Villarroel, M., Guazzi, A., Jorge, J., Davis, S., Watkinson, P., Green, G., … & Tarassenko, L. (2014). Continuous non-contact vital sign monitoring in neonatal intensive care unit. Healthcare technology letters, 1(3), 87-91. DOI:  10.1049/htl.2014.0077

Zendedel, A., Gholami, M., Anbari, K., Ghanadi, K., Bachari, E. C., & Azargon, A. (2015). Effects of vitamin D intake on FEV1 and COPD exacerbation: a randomized clinical trial study. Global journal of health science, 7(4), 243. doi: 10.5539/gjhs.v7n4p243

Zuo, L., He, F., Sergakis, G. G., Koozehchian, M. S., Stimpfl, J. N., Rong, Y., … & Best, T. M. (2014). Interrelated role of cigarette smoking, oxidative stress, and immune response in COPD and corresponding treatments. American Journal of Physiology-Lung Cellular and Molecular Physiology, 307(3), L205-L218. https://doi.org/10.1152/ajplung.00330.2013