Assignment 2 Symptom Mgt

Mr B is a 69-year-old man admitted in the Medical ward due to complaints of difficulty in breathing associated with a wheeze, severe cough with the production of mucoid sputum, weakness, feeling discomfort. Mr B is unable to perform his daily activities due to shortness of breath and cough. Also, he reported that large amount of sputum since 4 months, chest tightness, weight loss (7 kilogram in 2 months’ time) and swelling of ankles (Burkhardt, & Pankow, 2014). Proper history collection is essential to determine the aetiology of shortness of breath that includes family history of asthma, occupational history, alcohol and smoking history, medication history, episodes of cough whether it is productive or not, any heart problems (WebMD, 2019). He was a construction worker and retired 4 years ago. His history reveals that he was a chronic smoker from the past 20 years and consumed nearly thirty cigarettes daily, although patient quit smoking 6 months ago. The physical examination and various diagnostic tests to confirm the disease is Chronic Obstructive Pulmonary Disease (COPD). COPD is the fourth leading cause of mortality in the world (Jenkins, Athilingam, & Jenkins, 2019). COPD is a group of progressive lung disease that causes obstructed air flow from the lungs (World Health Organisation (WHO), 2019). COPD is the combination of asthma, emphysema and chronic bronchitis (Luckner, 2018. COPD has specific pattern of symptom clusters and cluster analysis are used to identify symptom clusters based on the severity of symptoms (Lim, Kim, Kim & Kim, 2017)  Mr B experiences multiple symptom clusters distress such as dyspnoea- physical functional status and dry mouth, anxiety-depression, insomnia – fatigue ((Jenkins, Athilingam, & Jenkins, 2019). Respiratory difficulty cluster included shortness of breath, shallow breathing, hard to breathe, gasping for breath, numbness, and mucus congestion which is consistent in COPD patients (Jenkins, Athilingam, & Jenkins, 2019).Mr B’s condition has deteriorated rapidly, and he is having difficulty in breathing (dyspnea) and frequent exacerbations. Mr B’s smoking history could be speculated that this was the trigger for his condition, as smoking is the one of factor for developing COPD( Laniado-Laborín, 2009). However, only a quarter of all smokers develop COPD (Crapo, 2010), Dyspnea is the cardinal symptom of COPD complex phenomenon that differ from person to person with unpleasant, persistent laboured breathing is triggered by increased ventilation secondary to increased work of breathing( American Nurse today, 2012) .It also has psychophysiological components, triggered by such factors as anxiety and fear (American Nurse Today, 2012). According to Medical research council (MRC) the severity of dyspnea is graded into five, Mr B’s symptom of dyspnea categorised into fourth grade as he could not walk more than 100 meters due to dyspnea (Knott & Gronow,2019). Mr B is using wheelchair mobility for long distances due to dyspnea. According to Global Initiative for Chronic Obstructive Lung Disease (GOLD), diagnosis of COPD should be considered in patient who has dyspnea with a long-term sputum production, and/or a history of smoking, exposure to lung irritants like chemicals (Leader, 2019). According to American Thoracic Society, dyspnea is a subjective experience of breathing discomfort that consists of distinct sensations that vary in intensity (Wahls, 2012). COPD is characterized by the limitation of airflow that is not fully reversible. This means less air flows in and out of your lungs because of factors such as the air tubes and alveoli lose their elasticity and are unable to stretch when breathe (Leader, 2019). Patients explanation of feeling of dyspnea would be helpful but associated symptoms and risk factors, such as smoking, chemical exposures, and medication history should be considered (Wahls, 2012). Dyspnea is the core symptom of COPD and patient describes that heaviness or tightness in chest, grasping for air, feeling suffocated or they verbalise like, “I can’t breathe” (Morrow, 2018). The subjectivity of dyspnea is one of the challenges facing the clinician to determine the diagnosis and assess the severity of the underlying condition (Morrow, 2018). The antecedents of dyspnea such as Physiological, psychological, and situational factors affect the patient’s performance, including functional status, cognitive functions, and physical performance to make breathing more intensive and disrupt gas exchange( Ann-Britt, 2017). One of the biggest reported limitations of this schema is its inability to describe ways in which dyspnea’s consequences can negatively impact a person’s quality of life (Victorson, Anton, Hamilton & Yount, et al.: 2009). Hyperinflation, increased airway resistance, and decreased lung compliance are the antecedents and often difficult to treat once dyspnea has developed (Victorson, et., 2009), The consequences of dyspnea are divided into physical aspects such as decreased activity of daily living (ADLs) and fatigue, psychological such as depression, role loss, and sociocultural aspects like isolation and occupational (Victorson, et., 2009). When compared to acute dyspnea in which psychological aspects such as fear and panic plays a major role in precipitating an exacerbation, and in chronic dyspnea, psychological aspects such as depression are more the consequence of living with persistent distress (Victorson, et., 2009). Unexpected exacerbations, other infections and unawareness of managing exacerbation, resistance towards care like patient’s personal attitude, context and personality will result in refusal of care (Russell et al., 2018). For example, some patients did not want further help from caregivers because they wanted to be left alone, while others refused it because of the wish to live life the way they wanted, thereby accepting the consequences ((Russell et al., 2018). Also, lack of communication between patient and health care provider, lack of knowledge of treatment option, reluctance to receive therapy, poor treatment compliance, inability to quit smoking despite awareness of its consequences, ignoring advice of practitioners are factors in refusal of therapeutic response. Limited social interaction due to fear of breathlessness that resulting in low mood is also a barrier to effective therapeutic response (Russell et al., 2018). The key facilitators of proper therapeutic care of symptoms as peer group involvement, clients physical and social environment including their experiences of symptoms and approach towards treatment, maintaining a daily routine and establishing habits, self-monitoring and giving feedback to clinician was commonly reported as beneficial (Robinson, Williams, Curtis, & Bridle, et al., 2018)

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