This assignment will explicate the pathophysiology of the disease procedure chronic clogging pneumonic disease (COPD). It will analyze how this disease affects an single looking at the biological, psychological and societal facets.
It will carry through this by mentioning to a patient who was admitted to a medical ward with an aggravation of COPD. Furthermore with aid of Gibbs theoretical account of contemplation (as cited in Bulman & A ; Schutz. 2004) it will show how an experience altered an attitude. In conformity with the Nursing and Midwifery Council. (NMC) Code of Professional Conduct (NMC. 2005) sing safeguarding patient information no names or topographic points will be divulged. Therefore throughout the assignment the patient will be referred to as John. John is a 57 twelvemonth old gentleman who has been married to Mavis for two old ages. John was admitted to the ward with terrible shortness of breath cough and inordinate phlegm production. By looking through John’s notes it was discovered this was an aggravation of COPD.
To understand John’s status it is utile to look at how the normal respiratory system works. The map of the respiratory System is to provide the organic structure with O and take C dioxide (Marieb. 2004). Harmonizing to Waugh and Grant (2004) it besides helps keep organic structure temperature and extinguish extra H2O from the organic structure.
The Respiratory system consists of the oral cavity. rhinal pit. throat. voice box. windpipe. bronchial tube and the lungs (Seeley. Stephens & A ; Tate. 2000) . Air enters through either the oral cavity or olfactory organ which humidifies and cleans the air. (Cohen & A ; Wood. 2000) unifying into a common chamber called the oropharynx (Watson. 2000). Air so leaves to the throat. a short. funnel-shaped tubing that transports air to the voice box (Waugh & A ; Grant. 2004). The air enters the voice box which is lined with mucose membrane and returns to the windpipe. which is formed of semi-circular gristle rings. The interior membrane of the windpipe contains hair cells and mucose cells which trap atoms and brush them toward the bronchial tube. The bronchial tube are besides lined with mucose membrane and ringed with gristle (Marieb. 2004).
Each bronchial tube is lined with mucose membrane. (Martini. 2000) and extends into a lung where it subdivides organizing smaller bronchioles (Watson. 2000). Bronchioles terminate with the air sac which are the functional units for gas exchange and are thin. moist and surrounded by capillaries (Clancy & A ; McVicar 2001). Inhaled air travels through these air passages to the air sac. Blood is pumped out of the bosom through the pneumonic arterias to the capillaries environing the air sac. (Shaw. 2005) The O of the inhaled air diffuses out of the air sac into the blood. while C dioxide in the blood moves into the air sac to be exhaled (Tortora & A ; Grabowskie. 2003). The oxygen-rich blood is returned to the bosom through the pneumonic venas.
The lungs can spread out and contract without clash during take a breathing due to the pleura. a thin membranous construction (Tamir. 2002). The splanchnic pleura surround the lungs. while the parietal pleura line the wall of the pectoral pit. These pleura are separated by a little fluid-filled infinite called the pleural pit. Ventilation requires work and before the lungs can go hyperbolic. a force per unit area alteration must take topographic point. The elastic belongingss of the lung let airing to take topographic point more expeditiously and the fluid in the pleural pit serves as a lubricator that allows the lungs to skid against the chest wall (Marieb. 2004).
John notified the staff that he was diagnosed with COPD twelve months ago by his general practician (G. P.). He added that he repeatedly went to his G. P. as he had been experiencing breathless. which was going worse and was present every twenty-four hours. more so when he exercised. This shortness of breath he revealed was accompanied by a cough alongside phlegm production. John’s G. P inquired if he smoked and how many. John informed him he has smoked around 30 coffin nails a twenty-four hours for 42 old ages. The physician so gave John a lung map trial utilizing a spirometer. John was notified by his General practitioner that he had COPD which. John was informed. was both chronic bronchitis and emphysema (National Lung Health Education Program. 2005).
The World Health Organization (WHO) (2006A) defines COPD as a disease province characterized by airflow restriction that is non entirely reversible. The airflow restriction is normally both progressive and associated with unnatural inflammatory response of the lungs to noxious atoms or gases. John’s chronic bronchitis is defined. clinically. as the presence of a chronic productive cough for 3 months in each of 2 consecutive old ages. provided other causes of chronic cough have been ruled out. (Mannino. 2003). The British lung Foundation (BLF) (2005) announces that chronic bronchitis is the redness and eventual scarring of the liner of the bronchial tubing which is the account for John’s dyspnoea. The BLF (2005) believe that when the bronchial tube become inflamed less air is able to flux to and from the lungs and one time the bronchial tubings have been irritated over a long period of clip. inordinate mucous secretion is produced. This increased sputum consequences from an addition in the size and figure of goblet cells (Jeffery. 2001) ensuing in John’s inordinate mucous secretion production. The liner of the bronchial tubings becomes thickened and an annoying cough develops. (Waugh & A ; Grant 2004) which is an extra symptoms that toilet is sing.
Emphysema affects the parenchyma of the lung through devastation of the alveolar walls. taking to lasting expansion of air infinites distal to the terminal bronchioles (Sandford. Weir & A ; Pare. 1997). The walls between next air sac interrupt down. the alveoli canals dilate and there is loss of interstitial elastic tissue (Watson. 2000) This consequences in dilatation of the lungs and loss of normal elastic kick. therefore pin downing and stagnancy of alveolar air (National Emphysema Foundation. 2006). As alveoli merge there is loss of surface country for gaseous exchange (Alexander. Fawcett & A ; Runciman. 2004) ensuing in less O. This loss of country for gaseous exchange is an extra account for John’s dyspnoea.
John was referred to the physical therapist to assist relieve his shortness of breath and mucous secretion production. Turner Foster & A ; Johnson (2005) pronounce physical therapists are cardinal members of the intercession squad. can education and give John practical counsel on how he can take a breath comfortably and efficaciously. (United Kingdom Parliament. 2005). Van der Schans. Postma. Koeter & A ; Rubin (1999) suggest physical therapists facilitate John’s mucous secretion conveyance by utilizing take a breathing techniques. percussion and postural drainage. Furthermore they can educate John on organic structure placement as this is cardinal with people with COPD (Gosselink. 2003).
Additionally John was referred to the Occupational Therapist (OT) who assessed his current degree of fittingness and so formulated a plan of activities which will better his overall strength and staying power. The OT can besides give advice to John to pull off his status with the least hurt and break of day-to-day life (Turner Foster & A ; Johnson 2005). Furthermore the National Institute of Health and Clinical Excellence (NICE) (2004) urge patient with COPD should be on a regular basis asked about their ability to set about activities of day-to-day life and how breathless they become when making these.
John was informed that his COPD was perchance caused by smoking. Kanner (1996) believes that the major environmental factor of COPD is tobacco fume. The Global Initiative for Chronic Obstructive Lung Disease (GOLD) (2005) concurs and provinces cigarette smoke is by far the most of import hazard factor for COPD. This harmonizing to the National Heart Blood and Lung Institute (NHLBI) (2006) is because smoking irritates the lungs. which causes the air passages to go inflamed and narrowed. Additionally Verra. Escudier. Lebargy. Bernaudin. De Cremoux & A ; Bignon (1995) adds that enzymes released because of the redness breaks down elastin. the protein of import for structural unity of the lungs. making take a breathing air in and out of the lungs more hard (NHLBI. 2006)
However D’hulst. Maes. Bracke. Demedts. Tournoy. Joos & A ; Brusselle (2005) states non all tobacco users develop clinically important COPD. which suggests that familial factors must modify each individual’s hazard (WHO. 2006B). John continues to smoke although he has reduced his consumption ; nevertheless NICE (2004) guidelines suggest all COPD patents who continue to smoke should be encouraged to halt. and offered aid to make so. at every chance because. smoking surcease is the individual most effectual manner to cut down the hazard of developing COPD and halt its patterned advance (WHO. 2006B). John was encouraged to halt. given counsel on how to halt. was informed about a smoke surcease group that he could go to and in add-on offered nicotine spots ; nevertheless he refused and told staff that he would discontinue in his ain clip.
John explained to the nurse that for the past few months he has been experiencing low. can non concentrate and has a deficiency of involvement in anything. he says he does non understand why he is experiencing this manner. Gross (2001) believes these symptoms could be a mark of depression. Harmonizing to Kunik. Roundy. Veazey. Souchek. Richardson. Wray & A ; Stanley (2005) many CODP patients develop psychological symptoms in add-on to physical ailments. Harmonizing to Kunik & A ; Densmore (2002) this is because of the nature of the disease and the fright of being breathless. The BLF (2005) concur and believe take a breathing trouble can incite anxiousness and depression. Other causes stated by Ohri & A ; Steiner (2004) include body image. increased solitariness. deficiency of societal support. and low self-pride. Kunik et Al (2005) study that depression and anxiousness are two to three times more prevailing in COPD patients than in the general population and the account for this is because of the sustained and relentless feelings of defeat. hopelessness and weakness.
John’s depressed temper could take down his degree of energy needed to get by with his chronic unwellness. which. in bend. could do his symptoms less tolerable. (Singer. Ruchinskas. Riley. Broshek & A ; Barth. 2001) Depression besides can take to increased badness of John’s medical symptoms since feelings of depression can do a individual to be less active. and. in bend. may worsen physical impairment. which can escalate the psychosocially disabling effects of COPD (Van Ede. Yzermans & A ; Brouwer. 1999). However a survey by Engstrom. Persson. Larsson. Ryden & A ; Sullivan (1996) found that quality of life is non significantly affected in patients with mild to chair COPD. perchance due to get bying and/or pneumonic modesty capacity.
John was given the chance to speak to a head-shrinker since mental wellness specializer can name depression and supply appropriate intervention. One intervention that was suggested was pneumonic rehabilitation. Mahler (1998) states these plans incorporate psychosocial and behavioural constituents. Emery. Leatherman. Burker & A ; MacIntyre (1991) agree and suggests that it can besides heighten cognitive operation and psychological wellbeing. Surveies by Withers. Rudkin & A ; White (1999) repeat this and demo that degrees of anxiousness and depression were significantly enhanced by pneumonic rehabilitation.
John was 56 when he was diagnosed with COPD. He stated he was forced to take early retirement from his employment where he assisted in the fix. installing and care of H2O and sewer lines. This. he believes was because of the clip lost at work caused by his dyspnoea. Mavis declared she besides had to vacate from her portion clip occupation as a cleansing agent to take attention of John since she is his lone carer and is exhausted. Their income is from authorities benefits and a little pension and they say they are happening it hard to pull off on the sum of money they receive. Strassels. Smith. Sullivan. & A ; Mahajan (1987) reported that the typical COPD patient was more than 65 old ages old and had limited work loss straight related to his or her disease. However a survey by Tinkelman & A ; Corsello (2003) indicated that COPD is non merely a disease of the aged. They province a big per centum of patients with COPD are unable to work. and those who do work lose yearss as a consequence of their disease. This state of affairs they believe is of great concern to the single worker who may lose his occupation as a effect of inordinate absenteeism.
Chronic unwellness and disablement are strongly category related (Taylor & A ; Field 1993) and those in the lower socio-economic groups are the most affected. Smoking. the greatest hazard factor for COPD and exposure to occupational factors from manual unskilled occupations. such as excavation and foundry working are highest amongst males in the lower socio-economic groups (Parnell. 2000). COPD patients and their households tend to be members of this group and are frequently aged as symptoms become intrusive in the fifth and 6th decennaries of life which is John’s state of affairs. Webb & A ; Tossell (1999) maintain that pensions frequently reflect an individual’s category and societal position and as a consequence more adult females. retired manual workers and cultural minorities are disproportionately represented in old age as being on the borders of poorness.
A trust on province benefits may be a effect if forced to retire early and carers may non be entitled to benefits in their ain right. The fiscal load is increased by the costs of disablement such as place changes and aid in the place or conveyance (Young. 1995). To assist John and Mavis a societal worker was involved who assisted with place attention aid when John was discharged so Mavis could hold some clip for herself. Additionally the OT was involved and provided equipment to assist John keep his independency (Trombly & A ; Radomski 2000).
Although I was witting. through survey. other wellness professionals and through nurse preparation. that smoke can be damaging to wellness and can do diseases such as malignant neoplastic disease (Newcomb & A ; Carbone 1992) atherosclerotic diseases (McBride. 1992) and COPD (British Thoracic Society. 1997) I was unwilling to give wellness publicity and smoke surcease advice since I smoke myself. Several surveies show that I am non entirely in this thought. Surveies by Dore & A ; Hoey (1998) and Adriaanse. Van Reek. Zandbelt & A ; Evers (1991) show that high smoke rates among some populations of nurses may decrease their willingness and effectivity as possible suppliers of smoking surcease attention. An extra survey by Nardini. Bertoletti. Rastelli. Ravelli & A ; Donner (1998) demonstrated that smoking wonts influence the attitude of wellness staff toward patient reding about baccy smoke. I considered that it was non my topographic point and felt hypocritical if I attempted to give advice on halting smoke. On meeting John my feelings did non alter despite the fact that I could see the effects that COPD had on John’s external respiration.
However on disbursement clip with John and Mavis my attitude altered. I realized that if John stopped smoking so his status. although his lost lung map would non be regained. (Booker. 2005) will be slowed down (Osman & A ; Hyland. 2005). I became cognizant of the fact that I was in a premier place to assistance John in keeping his independency. to educate and to assist better John’s quality of life through wellness promoting and advice on smoking surcease. Although John decided non to give up this did non discourage me on giving wellness publicity advice on smoke. On speaking to other patients I took the chance to speak about halting smoking although I did non make this sharply (Seedhouse. 2004). This experience with John changed my feelings sing wellness publicity and smoke. Although I still feel slightly hypocritical. I acknowledge the importance of my place and how it can ease patients and their lives. I believe I understand the troubles patients face when trying to discontinue. possibly more than a womb-to-tomb non tobacco user. I will go on to supply smoking surcease advice throughout my preparation and besides throughout my calling.
In decision this assignment has explained the pathophysiology of COPD through presenting a patient. It examined how this person has been affected holistically. Finally it demonstrated how an experience encountered altered an sentiment with aid from a brooding theoretical account.
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