(Running Header) CARE PLAN FOR A CRITICALLY ILL PATIENT 1

(Running Header) CARE PLAN FOR A CRITICALLY ILL PATIENT 1

CARE PLAN FOR A CRITICALLY ILL PATIENT

Nursing

(By Insert name)

Course Codes

Professor’s Name

Institutional Affiliation

Day Month Year

CARE PLAN FOR A CRITICALLY ILL PATIENT 2

Buy Paper @ www.nursingpapersmarket.com

My patient is 43 years old male 265 pounds weight, 6.0’ height and a long time long

distance truck drivers suffering from chronic obstructive pulmonary disease (COPD). COPD

commonly affects the lungs and it manifests itself through poor airflow to the lungs and the

whole body generally. Patients suffering from this disease exhibits symptom such as; shortness

of breath and sputum producing coughs.

At the ICU where most critical cases of COPD are handled, the patient describes the

experience as “feeling trapped in a life threatening situation surviving at the mercy of others”.

The patient is under controlled oxygen supply; bronchodilators once, twice or thrice per day are

also administered and at times accompanied with antibiotics (Torheim & Kvangarnes, 2014).

Before medical treatment begins taking effect on him, Noninvasive ventilation treatment (NIV)

is the breathing support given to a patient through a tightly hooked face or nose mask to

normalize breathing, is usually done. Whereas the mask is quite useful to the patient, he just like

many others experiences anxiety, and panic at times leading to loss of breathing control, unless

an explanation why the mask is necessary is made (Torheim & Kvangarnes, 2014).

To successfully offer good care for the patient, the nurse should understand that

important as it maybe, the patient cannot be put under the mask against their wish. However,

when patients are in unable to make decisions, their relatives should be involved and taken



through the process (Torheim & Kvangarnes, 2014). This eases the anxiety which could further

destabilize their already accelerated breathing. It is easy as a nurse to calm down the patient

because there is a level of trust among us, which goes a long way in improving their coping

techniques. It is the responsibility of the nurse or care giver to closely monitor the ventilator;

thus adjustments to the ventilator pressure levels can be made facilitating bi-level breathing (in

and out breathing) at any given time.

LABORATORY TESTS AND DIAGNOSIS:

Stethoscope: A complete physical examination has to be performed to the patient as the

first step of diagnosis and the stethoscope would be used to listen for abnormal breathing sounds.

Sputum examination: As noted above, COPD manifests itself in different forms like

persistent cough (productive). The sputum should be harvested and taken to the laboratory for

analysis and identify the cause of the patients’ breathing difficulties. As soon as the test is done,

some possibilities can be arrived at, others investigated further and where results are clear,

treatment commences immediately.

Spirometry: It is an easy and painless test conducted to determine the lung capacity of

the patient. The patient is given a tube to exhale into, that tube is connected to a machine-

Spirometer where results can be read.



Chest X-ray or CT scan: this is another test that can be done to a COPD patient.

Whereas both are imaging tests, CT scan creates a more detailed image than a standard x-ray. By

looking at the lungs images, the nurse or doctor is able to tell if there are signs of COPD.

Blood test: This test can only help determine if the patient’s symptoms are as a result of

an infection. An aerial blood gas test in particular is done and it is used to measure oxygen levels

in a patient’s blood (Torheim & Kvangarnes, 2014). Ultimately, the results of this test are to

establish whether the lungs are functioning well enough to supply the blood with enough amount

of oxygen making it an important one before COPD patient is put under a ventilator.

Antitrypsin test: When a patient has exhibited COPD symptoms and signs and they are

non-smoker and below the age of 50, then they should be checked antitrypsin levels (Torheim &

Kvangarnes, 2014). Antitrypsin is a protein that is produced by the liver and released to the

bloodstream to protect the lungs. This test helps the nurse or doctor to determine whether the

cause of COPD is genetic or not.

MEDICATION

As a nurse it is good to understand the best medicine to prescribe to the patient. The

reason behind this is to know what options are available in case one variety is not effective or



which are the stronger of the available brands. According to Kinman, (2014), COPD can be

treated in two broad categories of medication and as noted earlier, it is the prerogative of the

doctor prescribe the most effective medication all factors considered.

The first sets of medication are referred to as short-acting bronchodilators. This is a

category of medication the helps to clear the airways of a patient so that he/she can breathe with

ease. Therefore as a nurse, the first option would be to check whether the patient is able to breath

and if not, short-acting bronchodilators can be prescribed especially so in an emergency

situation. This makes them very suitable for ICU patients or patients with severe but short attacks

of breathing difficulties.

According to Kinman, (2014), some of these medicines which all come inform of an

inhaler or some liquid that can be added to a nebulizer to inhale include;

• Albuterol (Vospire ER, in Combivent, in Douneb)

• Levalbuterol (Xopenex)

• Ipratropium (Atrovent)

Some side effects include;

• Dry mouth

• Blurred vision

• Body tremors

• Cough



• A heart beating faster than normal, and for this reason, it cannot be used by patients

with a heart condition.

The other set of medication is long-acting bronchodilators. Just like the name literally

means, these medications are used over a longer period of time (Kinman, 2014). Their uptake

can be twice or thrice a day depending with the patients’ condition. They include;

• Tiotropium (Spiriva)

• Salmeterol (Serevent)

• Formeterol (Foradil, Perforomist)

• Indacaterol (Arcapta)

• Aclidinium (Tudorza)

They are however not very effective in an emergency rescue since they are used to gradually help

the patient breathe easily, (Kinman, 2014).

Their side effects include;

• Dry mouth

• Dizziness

• Tremors



• Runny nose

• An irritated or itchy throat

Some patients experience serious side effects such as rushes just like the one on an

allergic reaction, rapid heartbeat and blurred vision.

Olodaterol (Striverdi Respimat) is another medication which comes as an inhaler

administered once per day. Side effects are just like the above two though some patients

complain of diarrhea, back and joint pains.

Corticosteroids are another set of medication good for patients with inflamed airways

and difficulty breathing. This medication makes it easy for a patient to breathe with relative ease

by reducing body inflammation, thus having good flow of air in the lungs. According to

(Kinman, 2014), some of the medicines under this include;

• Fluticasone (Flovent) which comes with an inhaler, and its used twice or thrice a day.

• Budesonide (Pulmicort) comes as a powder, liquid or inhaler. Users experience colds

or mouth infection (thrush)

• Prednisolone, this comes as a pill or liquid or a shot and it is an emergency/ rescue

drug.



Phosphodiesterase-4 inhibitors: This is another inflammation relieving drug that helps

improve air flow to the lungs. Roflumilast (Dalirerp) is one such drug, a pill that is taken once a

day and it’s usually prescribed alongside a long-acting bronchodilator. According to (Kinman,

2014), side effects includes

• Tremors

• Weight loss

• Cramps

• Diarrhea

Note. The nurse should enquire if the patient has a liver problem before administering this

medication.

Methylxanthines: This is a drug for patients considered non responsive to first line

medication. It deals with inflammations pretty well by relaxing the airway muscles and is taken

along a bronchodilator. It is usually a daily pill or liquid taken alongside other drugs. Vomiting

and difficulty sleeping are some of the side effects (Kinman, 2014).

NURSING DIAGNOSIS



At the intensive care, many patients are dependent on care givers. Overtime, this sense of

dependency leads to patients believing that they are alive because of their care givers and would

therefore not agree to anyone else’s help (Torheim & Kvangarnes, 2014).

At one point after a horrible experience I asked him how it felt like and his words were

“it was horrible nurse, it was so difficult to breathe and a feeling of not getting sufficient air

made me think that I am dying, thanks for being there, you saved my life”. There are instance

that my patent is not able to speak, because of the pain, it is my responsibility to know what to do

other than just administering medication. There are instances when he is not able to eat com-

plains of feeling ill allover and often describing difficulty in breathing like “as though breathing

through a straw and then it is suddenly cut off”.

As a nurse, it is good to understand your patient and more so know what they need

especially when they cannot speak (Torheim & Kvangarnes, 2014). It therefore doesn’t help

much for patients to look around and see strange faces while under an attack, because this

increases their anxiety and disorients their breathing more. For that reason, it is good to help

them relax their minds by calming them down so as to breathe normally (Torheim &

Kvangarnes, 2014). One of the techniques I use calming him down is demonstrating slow

lengthy breathing in and out moments and within no time, breathing normalizes. The main aim is



trying to disconnect the patient’s thoughts, another way is telling him not to think about anything

at all, just breathe and this would normalize his breathing.

The patients in this unit can also be very observant and therefore nurses should avoid

their expressions being easily read by patients. Some of these expressions could be through

speech and therefore when giving sensitive information, expressions should be on check. When

nurses come running, slams the door and pulls the curtains, such can also send very strong

messages. It is also important to be when communicating to relatives, because in case they

overhear, it can break the trust and thus anger, claustrophobia, extreme anxiety manifests and it

doesn’t help them (Torheim & Kvangarnes, 2014).

INTERVENTIONS:

Most if not all treatments of COPD are administered through inhalers, which therefore

makes this device quite critical for this therapy. In order to receive optimal results of the

prescribed medication, correct inhaler technique is critical. This is particularly so for the elderly

who more often than not are cognitive impaired, who needs assistance so as not to error when

handling the inhaler (Matteo & Omar, 2015). For this reason, inhaler training becomes one

crucial intervention for those already diagnosed with COPD.



Inhalation flow and aerosol velocity is another intervention for those patients already

fighting COPD; this will ensure that they use the right dose to achieve optimal benefit thus fast

tracking recovery. Clinical efficacy is key on this intervention because lack of it thereof could

lead to adjusting the dose delivered to the patient paving way for potential greater toxicity not

forgetting adverse side effects that could otherwise be avoided by ensuring patients use their

devices correctly Matteo & Omar, 2015.

Interdisciplinary care: this patient just like many others is usually not able to make decisions

and his and so are nearly half of surrogates, who don’t understand the concept of surrogate

decision making. For this reason therefore, it would be prudent to discuss his preferences and

advanced care planning, unlike pulmonologists who mostly do not discuss patient’s preferences

in relation to issues like ICU admission, intubation and or tracheotomy (Matteo & Omar, 2015. It

is imperative to disseminate weighty information to patients regarding such decisions during

end-of-life discussions.

Some of the challenges at the advanced ICU care planning for COPD patients include a

desire to preserve patient’s hope of living which can be attributed to poor communication.

Whereas Pulmonologists could be very busy (little appointment time allocations) to discuss such

matters with the patient or relatives, there should be a way and person to communicate this



(Torheim & Kvangarnes, 2014). The other could be situations whereby the pulmonologists feels

they have communicated all they needed to; while patients feel they have not received enough.

Others are where patients are just reluctant to ask questions and the pulmonologists assumption

that they have understood.

To counter communication challenge, other people could be involved in the discussions,

patients and their families could be issued with handouts to read on their own. Preparing patients

and relatives upfront on risk of severe exacerbation and also explaining why ICU admission,

intubation and or tracheotomy are necessary could decrease psychological trauma at the ICU

(Torheim & Kvangarnes, 2014). To succeed on this, psychiatrics could be involved, and

eventually the patient will be comfortable and empowered with knowledge.

NURSING ROLE REFLECTION

At a stage where the patients feel completely dependent on you as a nurse, it can be

overwhelming but right attitude and good care brings about trust and accelerated recovery. When

their breathing support needs are met, COPD patients experience quality care. This is very



important to them because it lowers down anxiety levels making their breathing regular and non-

problematic (Torheim & Kvangarnes, 2014). The nurse has to gain good understanding of the

patients scuffle to breath and the disquiet that creep up their control over their breathing

consequently their lives.

According to Torheim & Kvangarnes (2014), when patients feels that their medical needs

are technologically taken care of with some sense of sensitivity, they feel safe. This consequently

renders the ICU to be perceived to be a good breathing space for patients where they are able to

regain their breath thus making that crucial step to better health.

Diversifying nurses’ knowledge about their COPD patients experiences during breathing

difficulties and exacerbation and the importance of maintain a good interaction and bond

between them and their patients could also be introduced in the nursing curriculum. This would

play a very big role in ensuring that nurses are aware of not just what to do but how.

In countering communication challenges between patients and doctors or specialists,

nurses, patients and their relatives could be involved in hefty discussions (Torheim &

Kvangarnes, 2014). If so done, patents will have someone they know around thus haring their

question or comment with courage. This progressive and positive interaction with the patient



improves their perceived care at the facility which translates to positive attitude and hope of a

health tomorrow.



Reference list

Kinman, Tricia. (2014). COPD drugs and medications. Healthline; Retrieved on 4, August 2016

from http://www.healthline.com/health/copd/drugs#Overview1

Matteo, B. & Omar, S. (2015). The importance of inhaler devices in the treatment of COPD.

Biomed Central. Retrieved on 4, August 2016 from

https://copdrp.biomedcentral.com/articles/10.1186/s40749-015-0011-0

Torheim, H. & Kvangarnes, M. (2014). How do patients with exacerbated chronic obstructive

pulmonary disease experience care in the intensive care unit? Scandinavian Journal of

Caring Science 28: Pp. 741-48. Retrieved from

http://onlinelibrary.wiley.com/doi/10.1111/scs.12106/pdf

https://copdrp.biomedcentral.com/articles/10.1186/s40749-015-0011-0



Documents

(Running Header) CARE PLAN FOR A CRITICALLY ILL PATIENT 1