Pharmacological Management of Chronic Obstructive Pulmonary Disease

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Preparing for Nancy to go home

The way ahead…

Three days later Nancy has improved and is being discharged home. She is being discharged into the care of Phil, her husband, who is going to come and pick her up.

Nancy is still tired, and her ability to manage her activities of daily living is reducing.

Read this carer story

Carer story: Jeanette Rogers

Although this story is not about a husband caring for his wife such as would be the case for Nancy and Phil, think about the similarities regarding the issues and the effect on the carer who as to acre for someone with a debilitating chronic condition such as Nancy’s.

Investigate and reflect

• What needs to be done to help Nancy stay well and out of hospital?

What do I know? What else do I need to know?

• Write down the issues that you can identify and the key questions you need to investigate further to enable planning for Nancy’s discharge.

What are the critical elements of care for Nancy? Who needs to be involved and how?

• Identify the priorities of care for Nancy, and the family and health team members who will be involved in her car

What is the evidence for your planning decisions?

What evidence can you provide to support your conclusions? (Remember, evidence for your decisions and conclusions as a practising health professional needs to be grounded in reputable research.)

Build your response

• Outline and briefly discuss THREE issues that you consider priorities in Nancy’s ongoing care.
• Provide evidence from peer reviewed sources to support your discussion.

◄ Previous: But a crisis develops… Next: Recorded lectures ►

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Table of contents

• Learning outcomes
  • Nancy’s medications
• Nancy is brought to hospital
• Nancy is assessed and her care begins
• But a crisis develops…
• Preparing for Nancy to go home
• Recorded lectures
• Extra resources

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Nancy’s medications

What were the medications that came to hospital in Nancy’s bag?

Nancy is brought to hospital

Two days ago, Nancy visited her GP…

Her emphysema seems to be getting worse. She explains she has been sleeping in a chair at home because she is having trouble breathing lying down. She doesn’t want to disturb her husband. She feels exhausted. The GP prescribes Spiriva and Amoxycillin and sends her home.

However, Nancy gets worse. Two days later, she is admitted to the medical ward.

On the ward

It is afternoon shift on the medical ward when you take a call from the Pleasantville family practice telling you that a Mrs Nancy Gray will be arriving by ambulance this afternoon. She has an exacerbation of COPD with a suspected superimposed infection.
Soon Nancy arrives. She is brought into the ward in a wheelchair by the ambulance officer. You hear her breathing as she is wheeled towards you. She is perched on the edge of the chair, clasping an oxygen mask to her face. You bend down to speak to her she is clutching a paper bag with her medications. She shakes her head, concentrating on breathing. You notice she is pale, her lips are tinged with blue. You support her with your hand, noticing her skin is moist and cool. The muscles in her neck and shoulder bulge as she breathes. She tries unsuccessfully to stifle a hacking cough.

The ambulance officer reports that Nancy, now aged 68, has experienced COPD for many years. She has been progressively getting worse over the last few weeks and now has a productive cough, poor appetite and sleeplessness. Click the image to investigate the contents of the bag.

Review and investigate

• What does this information tell you about Nancy?
• What additional information do you need?
• What is your response as a nurse? What actions should be taken? Who should be consulted?

Find resources and interpret information

What do I know?

• What do you know about COPD? How does this fit with this situation?
• Begin by writing down what you know about the situation and identify the cueson which you have based your appraisal.

What else do I need to know?

Identify any gaps in your understanding of obstructive respiratory disturbances such as COPD.

How are you going to find out what you need to know?

Find some resources to assist you to further develop your knowledge and understanding of assessment and management of patients with COPD.

Build your response & Report findings

• Record your initial learning, responses and conclusions in your personal forum. That is make your own study notes of what you discover about obstructive respiratory disturbances. This is in order to clarify your own thinking for later as you begin to build your responses for assignment 2.
• Reading: Chapter 25 ‘COPD’ in Brown, Edwards, Seaton & Buckly (2015). Lewis’s Medical-Surgical Nursing (4th edn)