This assignment will be highlighting the nursing care provided to an individual

This assignment will be highlighting the nursing care provided to an individual that suffers with a long-term health condition. It will also explore their journey throughout the health care system, involving all professionals from the multidisciplinary team. For the purposes of this assignment, a pseudonym will be used to maintain confidentiality. This is in accordance with the Data Protection Act 2018 (GOV.UK, 2018) and the Nursing and Midwifery Council (NMC) standards, Professional Code of Conduct which states “As a nurse, midwife or nursing associate, you owe a duty of confidentiality to all those who are receiving care” (NMC, 2018). This patient will be referred to as Mrs Robertson. Before I began my research, verbal consent was also given by the patient. This assignment will go in depth about the nursing care that Mrs Robertson received from her diagnosis up until her most recent discharge from hospital, which was due to an acute exacerbation of her Chronic Obstructive Pulmonary Disease (COPD). Mrs Robertson experiences frequent episodes of her COPD. COPD is not a disease in itself but is an umbrella term for a number of conditions that make it harder to empty air out of the lungs due to a narrowing of the airways (British Lung Foundation [BLF], 2019). Chronic Bronchitis is one of the main lung conditions and is what Mrs Robertson suffers from along with emphysema. Chronic bronchitis is an ongoing condition which cannot be cured. Bronchitis is when the bronchial tubes become inflamed and produce an abnormal amount of mucus (McIntosh, 2019). Emphysema is damage to the Alveoli (air sacs) when they become stretched and cause a persisting cough, often make it very hard to breathe (MacGill, 2017). There is no cure for COPD, however there are ways to control symptoms and help slow down the condition making everyday life slightly easier. Throughout this essay it will discuss these possible treatments and how it is imperative that nurses can deliver individualised patient care to those experiencing living with a long tern health condition. Mrs Robertson was starting to notice that she was becoming breathless really easily after doing small tasks around the house which for her was unusual. Her activities of daily living, such as getting washed and dressed in the morning, were becoming increasingly difficult, taking much longer as she needed to have frequent periods of rest. After putting off for several weeks she decided to go to her General Practitioner (GP) in the year 2010 to discuss her shortness of breath, chest pains and yellow coloured sputum. Mrs Roberston has been a smoker for 19 years and thought this may be the cause of her symptoms therefore was reluctant to go and get checked. Throughout the appointment the GP discussed Mrs Robertson’s symptoms and tried to gain background knowledge by asking questions of previous family history relating to any respiratory conditions such as COPD or Asthma. The GP also asked about Mrs Robertson’s lifestyle and any factors that may have triggered the symptoms, Smoking was the main concern. Cigarette smoking causes 40%-70% of cases of COPD (BMJ, 2018). It is essential that health professionals can easily access medical records as it provides them with a fuller understanding of the patient and their families in order to give the best possible care and treatment (Kelley et al, 2013). One week after Mrs Robertson’s initial appointment with her GP she was referred to see a practice nurse at her local hospital to discuss her symptoms further. There are many tools that can be used to assess a breathless patient including the ABCDE assessment tool which can indicate any signs of obstruction or circulation problems. Noises such as snoring or gurgling may suggest the airway is blocked (Oxford Medical Education, 2019). Mrs Robertson was asked to carry out a spirometry test at the appointment. This will measure how much air is being inhaled, how much is being exhaled and the speed of which the air is being exhaled at (Mayo Clinic, 2017). For the spirometry test to be successful, it will be repeated several times to gain an average score and get the most accurate results. The nurse explained to Mrs Robertson that the test can also be used to show how well an individual is managing their respiratory condition and if symptoms are alleviating. The results of the test showed a significant decline in her respiratory function, this was the diagnosis and beginning of Mrs Robertson’s COPD journey. After speaking about the patient’s lifestyle, the practice nurse explained to her that her long-term condition would only worsen if she did not significantly reduce her smoking habits and should try and stop altogether, as tobacco smoking is the primary cause of COPD (World Health Organization [WHO], 2019). The nurse took a blood gas test from Mrs Robertson. This involves measuring the levels of oxygen (O2) and carbon dioxide (CO2) in the blood stream. It can also show the Potential Hydrogen (pH) levels of the blood, or how acidic it is. This is known as an arterial blood gas (ABG) test (Nall, 2019). This test will allow the nurse to see how well the lungs and kidneys are functioning and whether or not her body is retaining CO2 (Hypercapnia), which can be extremely dangerous. In this situation, it is a vital role for nurses to monitor COPD patients receiving oxygen therapy. If CO2 is retained in the body, the patient is a much higher risk of entering respiratory failure. Mrs Robertson was given a bronchodilator inhaler to help with her shortness of breath. This medication dilates the airways making it easier for her to get a breath with an adequate amount of oxygen into her lungs. It was important for the nurse to inform Mrs Robertson of how essential it was for her to attend her follow up appointments with a respiratory specialist nurse to regularly review her COPD, and how she was coping with the self-management aspect. Having a care plan in place allows the nurses to keep the patient’s COPD as stable as possible, but also allows the patient to be in control and lead a more independent and better-quality life. The Long-Term Conditions Alliance Scotland came up with the “Guan Yersel” strategy. This strategy is set up to let patients take an independent approach to their healthcare but also have the support from nurses and a unique care plan in place if their health was to deteriorate (Scottish Government, 2008) it is a great way for nurses to provide the best possible person-centered care. Having these appointments can also support patients with other aspects such as quitting smoking. The nurse can provide support and alternatives that may make it easier to cut down and eventually stop smoking altogether. Not only smoking but the nurses can answer any worries or questions the patient may have and give guidance on things that they may be finding difficult. For example, if Mrs Roberston was finding her symptoms would flare up in the evening, she may decide that it would be easier for her to sleep in the chair in the living room as she did not want to walk up the stairs and become very breathless. This would be putting Mrs Roberston at a much higher risk of developing pressure sores on her skin (Margolis et al, 2003). If she was not elevating her legs, then the poor circulation may cause Oedema which is swelling and fluid in the legs, ankles and feet (NHS Choices, 2018). This is when the nurse plays a vital role in contacting social services to ensure that Mrs Roberston has any home adaptations in place that she may need such as a stairlift, to prevent further deterioration. Mrs Roberston was experiencing regular flare ups in the winter months. The nurse explained to the patient that during these times, the immune system is weaker and that a patient with COPD is more susceptible to respiratory infections like pneumonia (Leader, 2019). The nurse must make sure that Mrs Robertson is using her bronchodilator properly for maximum benefit and may ask her to demonstrate how she uses it. Educating a patient on their condition is just as important as treating it. The care plan for the patient may be reviewed and changed if needed at any time. In August 2019, Mrs Robertson was enduring rapid breathing and what she explained as someone squeezing her chest very tightly. Her bronchodilator was not making much of a difference, so she panicked and went straight to Accident and Emergency (A&E). Once there Mrs Robertson was seen by an A&E doctor and given a long acting bronchodilator. Due to having a high Fife Early Warning Score (FEWS) the doctor decided to keep Mrs Robertson in over-night for close monitoring. FEWS is a communication tool to help health professionals quickly identify if a patient is deteriorating (eHealth News, 2012). Mrs Robertson was admitted to a medical admissions ward where the nurses would be able to monitor her vital signs closely. The nurses found Mrs Roberston to have a FEWS of 5. Her oxygen saturation was at 84 percent, heart rate at 99 beats per minute and a respiration rate of 30 breaths per minute. Mrs Robertson had a high score due to suffering from Hypoxia (Low oxygen saturation), Tachycardia (high heart rate) and Tachypnoea (high respiration rate). With the bronchodilator not successfully opening her airways, the nurses decided to start her on oxygen therapy to try and increase her oxygen saturation levels. As Mrs Robertson is a COPD patient her saturation levels differ from someone who does not have COPD. The normal aim is 95%-100%, whereas in COPD patients the aim is between 88%-92% (National Institute for Health and Care Excellence [NICE], 2016). When patients receive oxygen therapy it is common for their mouth to become dry and sore. Nurses should be assisting and prompting patients to carry out this task. It is important to notice any changes in oral hygiene while giving treatment such as cracked lips or a coated tongue and treat it immediately (Nursing Times, 2018). This is a fundamental part of nursing care. Mrs Robertson’s vital signs were being closely monitored to ensure she was not deteriorating and did not stay in hospital longer than necessary. The nurses began to wean her off the 2 litres of oxygen she was receiving via nasal canula, ensuring she was able to maintain the correct oxygen saturation on room air. After completing this successfully, the nurses began the discharge process as Mrs Roberston was back to her previous health status before the admission. The medical and nursing staff were happy with Mrs Roberston’s recovery and sent her home with new bronchodilators. After Mrs Roberston returned home from her acute exacerbation of COPD, it was recommended that she joined a pulmonary rehabilitation programme within 4 weeks of her hospital discharge. This is a standard set out by the Royal College of Physicians. These programmes aim to help those with severe COPD by giving lifestyle and dietry advice, educate patients of their long-term condition and help promote exercise to improve circulation and lower blood pressure levels (NICE, 2016). It has been highlighted that Mrs Roberston received the best possible, person-centered care whilst being in hospital. There were many significant nursing interventions which prevented her condition from worsening. Nurses not only have the medical staff to work with but also can give input to social services if any home adaptations may be required and pass the concern onto an occupational therapist who will do a home assessment (Scottish Government, 2011). In conclusion, this essay has explored in detail the nursing care Mrs Roberston received from various healthcare professionals. The journey of her Chronic Obstructive Pulmonary Disease throughout the care continuum was made much less stressful, and by taking a holistic approach, these professionals made her so thankful for the current National Health Service. Mrs Roberston now feels much more educated about her long- term condition. Being diagnosed with a chronic illness can put a lot of strain onto an individual’s life and make daily tasks much more complicated. By offering the self-management strategy it allows patients to keep in control but still have the support from nurses when needed. Although there is no cure for COPD, the rehabilitation programme reduces the risk of acute exacerbations meaning a lower risk of being re-admitted to hospital, leading a much more independent, better quality of life.

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