UNIVERSITY OF LUZON

COLLEGE OF NURSING & MIDWIFERY

DAGUPAN CITY, PANGASINAN PHILIPPINES

Management of Patients With Chronic Pulmonary Disease

Name of Student: Ba Elaian, Ahmed Date: August 25,2021
Clinical Instructor: ma’am ktine Bustillo

1. Howard Long, 50 years of age, is a male patient diagnosed with

bronchiectasis. He has smoked 1 pack per day of cigarettes for 35 years. He
has a long history of recurrent bronchial infections. He has a chronic
productive cough with copious amounts of purulent sputum. The patient
complains that he is short of breath even at rest. He has clubbing of his
fingers. The chest CT scan reveals bronchial dilation.

a. How should the nurse explain to the patient and family the
pathophysiology of bronchiectasis as it is related to the symptoms the
patient is experiencing?

 The wall become for all time widened and change shape, which
makes it hard to clear bodily fluid from the lungs. The body's hack
reflex is utilized when there is iritation in the aviation.route, for
example, discharges. There is a lot of thick bodily fluid created
every day, which clarifies the perpetual hack endeavoring to
remove the bothering from the aviation routes.

b. How should the nurse explain to the patient and family the goals of
medical management that may be used to treat the bronchiectasis?

 Prform deep breathing and coughing excersizwes Pt should get flu shot
every year Smoking education

c. What does the nursing management for bronchiectasis entail?

 Rest during excersize when needed

 Stop smoking
 Hand hygiene
 Avoid bad air quality
 Eat little meals and snacks throught the day
 Promte aspiratory latrine
2. Sallie Thorp, a 21-year-old patient, presents to the physician’s office with
an asthma action plan form she acquired from a literature search on the
World Wide Web at
http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.pdf.
She states that she would like to develop the plan with the help of the nurse
and physician and review it at each appointment to keep it current. She has
had moderate persistent asthma for 5 years, and she has visited the
emergency department several times in the past year with severe asthma
attacks. She stated that she forgets to take her medications, because the
medications are at times that the hospital provided the inhalers (12 noon and
midnight), and she gets confused on which inhalers are the long-acting ones
and which inhaler is the short-acting rescue inhaler she is supposed to use
when she has an exacerbation. She stated that if she could, she would like to
take the inhalers at 8 AM and again at 8 PM. The patient stated that she has a
flow meter and that a respiratory therapist at the hospital taught her how to
use it in the past, and he wrote down her personal best peak flow, which is
400 L/sec. The nurse reviews the patient’s medical chart and discovers that
she has been prescribed the following from today’s visit:
 Use albuterol (Proventil): 2 to 4 puffs every 20 minutes for up to 1
hour as rescue inhaler. If symptoms improve, then take the inhaler
every 4 hours for 1 to 2 days. If no improvement after 2 days, call
the physician
 Salmeterol (Serevent): 50 mcg every 12 hours
 Fluticasone (Flovent): 88 mcg or 2 puffs every 12 hours
 Cromolyn sodium (Nasalcrom): one spray to each nostril once daily
and before being exposed to known asthma triggers. You may use
the spray up to every 4 hours
 Measure peak flow meter every morning before using inhalers and
record. Use peak flow meter, as needed, if you develop symptoms,
such as cough, shortness of breath, wheezing, chest tightness; use
of neck and chest muscles to breathe; problems talking or walking
because of extreme shortness of breath
 Follow-up in 3 months
 Have the nurse provide education on asthma self-management and
fill out the action plan that the patient brought with her today and
have the physician review it and sign it

The nurse also notes that the medications have not changed from the last
visit.

a. Explain the medications to the patient and practice filling in the

asthma action plan.
 Albuterol is indicated for the treatment of bronchospasms associated
with: asthma, COPD, allergic reactions, and toxic inhalation.
 stimulates beta2 - adrenergic receptors in lungs, results in relaxation
of bronchiole smooth muscle
  Fluticasone reduces the accumulation of surface basophilic cells
resulting in a localized anti- inflammatory effect
 Mast cell stabilizer, inhibits release of histamine. Treat severe
bronchial asthma or allergic rhinitits
 Prophylaxis of exercise induced bronchospasm
b. Explain ways to evaluate the patient’s mastery of the content?
 Ask questions
 Observing patient during teaching
 Watch patient do the skills

Health Care Delivery and Evidence-Based Nursing Practice

1. Suzanne Jones, 76-year-old patient with COPD is admitted to the

ICU. Mrs. Jones is placed on mechanical ventilation to assist with her
breathing. After 2 days on the ventilator, Mrs. Jones is extubated and
then transferred to a medical-surgical unit. The medication regimen is
adjusted during the hospitalization. Mrs. Jones is discharged home
after 6 days. She and her family are pleased with the care she
received in the hospital. (Learning Objectives 3 and 5)

a. Describe the quality performance tools that may be used to

demonstrate that the care and treatment rendered are both
cost-efficient and of high quality.

Chronic Obstructive Pulmonary Disease (COPD) is an umbrella name

that represents a group of lung diseases to include asthma, chronic
bronchitis and emphysema. The quality performance tools that may be
used in the above scenario to demonstrate that the treatment
rendered are both cost-efficient and of high quality may range from
insurance, hospital performance and clinical performance.

 Health insurance: Often, access to health care is hindered by

funding especially in a situation where a patient does not have
health insurance plan in place. An affordable health insurance
plan with adequate coverage and benefit is important prevention
and treatment.
 Hospital performance: The outcome of treatment can depend on
the performance of the hospital in terms of its manpower
strength, supplies, equipment and technology. A hospital's
performance enhances the quality of care that is available to
 patients and; nowadays, technological advancement goes hand
in hand with reduced cost. High performance hospitals seem to
provide efficient care with an affordable cost to patients. Low
cost of treatment emanates from reduced length of stay in
hospitals and promoting outpatient visits/procedures rather than
inpatient services.
 Clinical performance: Excellent clinical performance is achievable
when health care nrofessionale annlu knowledde-haead care
Clinical nerformanra ie meaenrad when clinicians use all
available expertise derived from their own experience,
awareness and understanding of patients' preferences in
assessment and treatment in individualized patient care. In the
above scenario, clinical expertise and skills was applied in
assessing, Mrs. Jones' condition, symptoms control and adequate
monitoring of vital signs.

b. Describe the quality performance tools that may be used to

demonstrate that the nursing care utilized is evidence-based
care and high quality, resulting in patient satisfaction and good
patient outcomes.

evidence-based practice was used:

 To form a diagnosis of COPD: The care team recognized the

symptoms and ascertained what the patient is suffering from
which helped the treatment team to be focused in planning and
providing the right and, adequate treatment.
 To determine the type of intervention: by placing her on a
mechanical ventilation to assist with her breathing.
 Evaluating the outcome of intervention. The patient was
evaluated after 2 days of being on the ventilator; Mrs. Jones was
extubated and then transferred to a medical- surgical unit.

2. The registered nurse working in the cardiac care clinic is tasked with
implementing quality improvement measures. To educate the clinic
staff, the nurse plans an in-service program to introduce concepts of
quality improvement and evidence-based practice. Additionally, the
role of the case manager will be included in the presentation. The
nurse plans on using care of the patient with Congestive Heart Failure
as a template, and prepares sample clinical pathways, care maps, and
multidisciplinary action plans. (Learning Objective 3)
 a. Describe how clinical pathways are used to coordinate care of
caseloads of patients.

Clinical pathways are tools used to facilitate evidence-based healthcare

by reducing harm and ensuring patients' safety. Clinical pathways are
detailed care plans used as a step-by- step and timely guide in caring
for patients with specific clinical problems. Clinical pathways are
designed to address conditions with variability of treatment options
and outcomes. Clinical pathways are used to coordinate care because
it serves as a sense of direction for the healthcare team toward
achieving the goals of select caseloads. This is because, it describes
the care required to be provided at a given time, within a time frame,
with the aim of achieving satisfactory result.

b. What is the role of the case manager in evaluating a patient’s

progress?

The case manger is the coordinator of all services to be delivered to

the patient from the time of admission or initial time of care, to
discharge and follow-up/consultations where necessary. The
responsibility of the case manager is to eliminate duplication of role
among care givers, make sure that care is delivered as planned and up
to specified standard. In a nutshell, the case manager is the "go-
between" patient and providers who communicates the needs of the
patient and progress and; follow-up to see that gals are met
satisfactorily in terms of service quality, and cost efficiency.

c. What are examples of evidence-based practice tools used for

planning patient care?

Some examples of evidence-based practice tools that are necessary

care planning include but not limited to the following:

 Infection control.
 Oxygen use in patients with.
 Noninvasively measuring Blood Pressure in Children
 Intravenous Catheter Size and Blood Administration

It is pertinent to state that for successful implementation of the above

tools, the below areas of concentration must not be overlooked, viz:
 Communication involving changes in a patient's status.
 Soft skills that improve patient interaction.
 Training and onboarding new nurses.
 Shift scheduling and the effect on care.