Nursing Care of Dyspnea, Essay Example

Introduction

Nursing is a noble career as epitomized by Florence Nightingale and offers new challenges consistently, which makes a person capable of thinking intelligently and responding correctly to emergent situations. At the same time it inculcates the qualities of care, compassion and patience which help one build a balanced personality. It is a profession which requires technical excellence as well as hard work. In order to create an optimal healing environment an interaction between the people, place and processes takes place (Zborowsky & Krietzer, 2009). The nurse plays a vital role in this interaction as she has to assess the patient’s physical as well as psychological condition in order to ensure his or her well being, removing the identified harmful aspects in the process. The patient’s individual condition, circumstances and influences leading to distress need to be identified and documented. Appropriate strategies then need to be developed and deployed in order to counteract the negative factors. The patient’s environment needs to be modified, physically (‘ventilation, light, nutrition, medicine, stimulation, room temperature, etc.’) as well as psychologically (‘avoiding chattering hopes’ and unnecessary or excessive advice), in order to obliterate the negative influences which might be interfering with the healing process. The client’s family, community and social setup are aspects which need to be probed in order to determine whether they are in any way responsible for his health deterioration. If the client is capable of understanding what is good for him then he needs to be educated and guided to comply with the recommendations suggested for his well being. In case the client fails to comprehend the knowledge imparted by the nurse or the physician, then a substitute decision maker such as a close friend or immediate family member should be empowered to ensure compliance with the therapeutic recommendations. The nursing practitioner should be able to guide a chronically ill patient out of despair and hopelessness during the course of treatment as well in the post discharge period in order to improve their quality of life. She should establish a positive relationship with the patient right at the admission stage and coordinate the interaction of the patient with herself, relatives and other healthcare staff so that hope is rekindled within the patient and he or she faces the situation with a positive frame of mind. Adequate feedback mechanisms should be employed to ensure that the patient does not relapse into a depressive state. The following case illustrates how nursing care was used effectively to treat a patient suffering from Chronic Obstructive Pulmonary Disease (COPD).

Clinical case

Case History

Deborah is a 36 years old woman, 5’ 4” tall and weighs 120 lbs. She is a patient of asthma and has frequent attacks of an on, which occur all of a sudden. She is allergic to some unidentified component in Chinese food which she is otherwise fond of. Her husband has been away for military duty for the last two years which has contributed to the rising depression and loneliness due to the separation. She has a six year old school going son who is often neglected and is not performing well in his studies. Although her husband sends her a regular monthly allowance, she is financially compromised. Due to this reason she has a student as a tenant who is habituated to smoking. The emotional distress, anxiety and her allergies have reduced her quality of life significantly. She uses a Salbutamol inhaler during an asthmatic attack which provides immediate but temporary relief.

COPD

The therapeutic outcome in patients suffering from Chronic Obstructive Pulmonary Diseases (COPDs) which are being encountered in the clinical setting at a high frequency in the present era depend upon a combination of avoidance of precipitating factors, proper medication and expert clinical handling of the patient. The patient needs to be educated about the need for self care and compliance with the physician’s recommendations in order to maintain good quality of life after treatment. COPDs rank fourth in the leading causes of death in the US (Ries, 2007). The author reports that death rates from these disorders have risen alarmingly in women as compared to men as per the latest figures (Increased by 282% in women/13% in men from 1980 to 2000). In Canada, 3.9% of the population above 35 years has probable COPD though the actual figures could be much higher as 50% of the patients remain undiagnosed in the community setting (Grinspun, 2005). COPDs encompass all conditions leading to respiratory distress such as chronic asthma, chronic bronchitis and emphysema. The usual symptoms are shortness of breath, chronic cough, noise while breathing and productive cough. Pulmonary Rehabilitation is an effective strategy in control and treatment of COPDs which requires expert nursing assistance and patient training to handle the disorder (Man et al, 2004). Modifying factors, such as patient environment, nutrition, medication compliance and avoidance of precipitating factors during hospitalization and after discharge therefore assume a high priority in holistic nursing practice.

Patient’s Diagnosis, Treatment & Follow Up

Deborah was brought to the emergency unit of the hospital after suffering a severe asthmatic attack bordering on status asthmaticus. She was treated with parenteral corticosteroids which reversed the status asthmaticus. The patient was hospitalized as a precaution for one week, monitored for vital signs and evaluated for her nutritional and psychological status. Appropriate therapeutic modalities were employed and nursing care was provided until discharge. Regular follow up for ensuring compliance with the therapeutic regimen and the proposed lifestyle and environmental changes were monitored.

Deborah’s case elicits feelings of piety and deep compassion. She was an ideal candidate for psychological support and encouragement which were essential to bring her out of the desperation she felt. Her helplessness and desperate state required a gradual and persistent effort to win over her confidence and make her realize the importance of proper nutrition, avoidance of allergens precipitating asthmatic attacks and the need for bringing about necessary changes in her immediate environment at home. As she was suffering from depression, appropriate medication along with psychotherapeutic interventions were suggested which were partially successful in their desired ends. The human angle in this case highlights the need for an effective nursing measure needed to win over her confidence in order to understand the state of her mind and the precipitating factors for her depression. As an emotional angle is involved in the precipitation of asthmatic attacks, she needed to be made more emotionally secure and capable of handling her depression by participating in social and other activities which might appeal to her. She needed to be encouraged to adopt a more positive attitude towards life. Her tenant was contacted and explained how he could contribute towards Deborah’s recovery by not smoking inside the dwelling as it was one of the precipitating factors for asthma. The environmental changes needed at her house include a thoroughly dust free and clean aerial environment with adequate ventilation and lighting. The patient was convinced to change her diet pattern and avoid the foods to which she was allergic. She was asked to play a more active role in raising her son which could divert her attention from herself.  She was meticulously explained the proper method of using the inhaler and educated about the frequency and dosage of medicine. She was encouraged to participate in some socially productive useful hobby which could contribute towards acquiring a more optimistic view of life.

Conclusion

Changing the patient’s environment and modifying other associated factors contributing to frequent asthmatic attacks and reduced quality of life should be effectively handled by providing appropriate nursing interventions in congruence with the identified and documented factors leading to frequent asthmatic attacks and general deterioration of her health. The patient needs to be encouraged all along to nurture hope and believe in the capability of the caregivers and the power of the modern medicines which can ensure a pleasant and healthy life even in case of life threatening situations. The patient needs to be gradually cajoled into optimism by the power of suggestion and adequate communication at the most difficult junctures during the treatment at hospital as well after discharge. Depression, if encountered needs to be handled with appropriate medication and the patient should be encouraged to be self reliant until he or she acquires the capability of managing the handicaps associated with their condition.

References

Grinspun, D, 2005. Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD) RNAO Best Practice Guidelines

Man William D-C, et al (2004), Community pulmonary rehabilitation after hospitalization for acute exacerbations of chronic obstructive pulmonary disease: randomized controlled study, BMJ, 329; 1209

Ries, A.L., 2007. ACCP/AACVPR Evidence-Based Guidelines for Pulmonary Rehabilitation: ROUND 3: Another Step Forward, Journal of Cardiopulmonary Rehabilitation & Prevention, Volume 27, Number 4, Pages 233 – 236

Zborowsky, T & Krietzer, M J, 2009. People, Place, and Process: The Role of Place in Creating Optimal Healing Environments, Creative Nursing, Volume 15, Number 4, 2009, Pages 186-190