Beruflich Dokumente
Kultur Dokumente
Deseret Bruno
Nursing 322
Sister Ardern
Ms. Bloomfield is a 38-year-old female. She presented to the doctor with complaints
of a mild occasional productive cough that has been going on for 3-4 months. She also
reports shortness of breath when she exercises. Results of a physical exam and chest x-ray
of predicted and her FEV1/FVC to be 65%. Ms. Bloomfield is diagnosed with early mild
Background
Ms. Bloomfield smoked a pack of cigarettes and has been doing so for 20 years. In
the last week of her diagnosis, she has reduced her intake to 10 cigarettes per day. She has a
diseases that cause airway obstruction (Pietrangelo, 2015). The two most common diseases
that COPD encompass are emphysema and chronic bronchitis. This can include one or both
of these diseases (Pietrangelo, 2015). COPD is progressive and irreversible. This means that
there is no cure, and no way to fix the damage it has already done. However, it can be
treated to lessen the symptoms and slow the progression (Stark, 2014). COPD is the third
leading cause of death in the United States. There are more than 15 million diagnosed cases
in the United Sates, and more than 210 million globally. It is more prevalent in older adults
aged 75 years or older (How Serious is COPD, n.d.). The main cause of COPD is tobacco
smoking. Other causes can include: second-hand tobacco smoke, exposure to harmful fumes,
and although rare, alpha-1-antitrypsin (AAt) deficiency (Pietrangelo, 2015). Risk factors
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 3
include: genetics (being susceptible to the AAt gene), gender (female), childhood chronic
lung infections, and occupation (occupations that come in contact with dusts, vapors,
chemicals and fumes) (Rosenberg, Kalhan & Manino, 2015). Signs and symptoms of COPD
(Stark, 2016).
Concern 1:
Ms. Bloomfield reports that after four weeks of being diagnosed with early mild COPD she
has cut her cigarettes down to 10 per day. She is really motivated to quit.
Praise Ms. Bloomfield for cutting her cigarette intake. Her decrease in the amount of
Teach Ms. Bloomfield the importance of creating a cessation of smoking plan, and
have her write down a week by week plan to eliminate the 10 cigarettes she is
smoking per day. The goal of this plan should be abstinence from smoking. Plans
that involve tapering off cigarettes have proven successful. Tapering off cigarettes
means cutting the number of cigarettes smoked each day (Siegel, 2015).
Teach Ms. Bloomfield the three Ds of quitting smoking: delay, deep breathing, drink
water. When a craving comes to Ms. Bloomfield, she should delay smoking, practice
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 4
deep breathing while counting to ten, and drinking at least eight fluid ounces of water
(Siegel, 2015).
Teach Ms. Bloomfield about options for medications that are designed to help her
stop smoking. One medication that has been proven effective is varenicline
Bloomfield would need to talk to the doctor to see if it is right for her. Other
become unbearable. This could also be a time to teach Ms. Bloomfield that her
medications used for hypertension should be continued and do not have bad effects
Give Ms. Bloomfield contact information to support groups that are aimed to help
Concern 2:
Ms. Bloomfield is an amateur astronomer. Whether this be for work, or as a hobby, this
sometimes puts her in situations where she is exposed to the smoke produced by forest fires.
Ms. Bloomfield has not been willing to quit this activity. Because forest fires produce
Nursing Diagnosis: Risk for prone health behaviors as related to exposing oneself to harmful
fumes.
Goal: Ms. Bloomfield will identify ways to reduce her risk prone health behaviors.
Interventions:
CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD) 5
Teach Ms. Bloomfield that the harmful effects of the fumes she is exposing herself to
by participating in astronomy during peak forest fire seasons can cause her COPD to
Instruct Ms. Bloomfield to research when forest fires are occurring in the area, and if
Encourage Ms. Bloomfield to wear a mask or scarf over the mouth and nose if there
is no other way to prevent contact with dangerous fumes (EHS: Nursing Care
Planning, n.d.).
Concern 3:
Ms. Bloomfield reports shortness of breath when she exercises and a mild occasional
of breath.
Goal: Patient will voice and demonstrate ways to reduce shortness of breath.
Interventions:
Give the patient positive feedback for exercising, because exercising enhances
Teach Ms. Bloomfield pursed-lip breathing, and have her demonstrate proper
Bloomfield can use this method during her exercise, and it can also be very effective
acting inhaled beta-2 agonists (SABA), and long-acting beta-2 agonists (LABA)
(Stark, 2014).
Concern 4:
Patient asks if there is anything else that can be done to help her.
manifested by asking if there is anything else that can be done to help her.
Goal: Patient will voice the causes of COPD, and commit to make healthy lifestyle changes.
Interventions:
At this point, Ms. Bloomfield knows that smoking and exposure to forest fire fumes
worsen symptoms of COPD. However, it is also important to teach her that second-
hand smoke can also worsen the symptoms. Because there is a chance that perhaps a
family member or close friend smokes tobacco as well, it is important to teach her to
avoid being around them while they are smoking. This could be accomplished in
many ways such as setting a rule that no smoking is allowed in the house, and
educating family members of the effects that COPD has on Ms. Bloomfield (Stark,
2014).
Another lifestyle change that Ms. Bloomfield can be taught is to avoid respiratory
infections. These infections can worsen her case of COPD. To avoid these
infections Ms. Bloomfield should be taught to: wash her hands frequently, avoid
people who are sick, and to receive preventative shots such as the flu shot and the
References
Chandy, D., Aronow, W. S., & Banach, M. (2013). Current perspectives on treatment of
EHS: Nursing Care Planning Guides - Care Planner: Diagnosis: Knowledge deficit or Altered
http://www1.us.elsevierhealth.com/SIMON/Ulrich/Constructor/diagnoses.cfm?did=2
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How Serious Is COPD. (n.d.). Retrieved June 11, 2016, from http://www.lung.org/lung-
health-and-diseases/lung-disease-lookup/copd/learn-about-copd/how-serious-is-
copd.html
Kalhan, R., Mannino, D., & Rosenberg, S. (2015). Epidemiology of Chronic Obstructive
Respiratory and Critical Care Medicine Semin Respir Crit Care Med, 36(04), 457-
469. doi:10.1055/s-0035-1555607
Pietrangelo, A. (n.d.). COPD by the Numbers: Facts, Statistics & You. Retrieved June 11,
Stark, S. D. (2014). Chronic obstructive pulmonary disease (COPD). Magills Mecial Guide
(Online Edition).