MANAGING LONG-TERM HEALTH CARE: CHRONIC OBSTRUCTIVE PULMONARY DISEASE (COPD)
9th, January, 2013
Managing Long-Term Health Care: Chronic Obstructive Pulmonary Disease (COPD)
The case scenario involves a 65 year old man called Mick Harris who was diagnosed with Chronic Obstructive Pulmonary Disease (COPD) 15 year ago. Although he stopped smoking (one of the major causes of COPD) 3 years ago, he has also been diagnosed with pulmonary fibrosis and mild osteoarthritis to both knees. Socially, Mick has a wife who is a receptionist and they have two adult children living locally, one of whom is 6 month pregnant. Some of the drugs that Mick has been using include steroids, bronchi-dilators, and intravenous antibiotics. Some of current symptoms that Mike is facing from the condition include general body weakness, breathlessness, and loss of weight. The condition has affected Micks family in different ways. The wife is depressed since Mick no longer wants to go back to hospital and prefers staying home to die around his family. The wife does not know how to discuss the issue with the entire family. Moreover, the family is financially challenged since Mick’s wife works as a receptionist while mick has not been able to work for several years. Additionally, the family was not benefitting from Social services although the family has started getting caregivers assistance and community Matron is expected to visit Mick.
Chronic Obstructive pulmonary disease (COPD) is a condition that affects the lungs and leads to eventual narrowing of the airways. This leads to limited passage of air into the lungs, which results in dyspnea or shortness of breath. The limited airflow condition is irreversible and worsens over time. This is due to floppiness of the air sacs. Common conditions characterized as Chronic Obstructive Pulmonary disease (COPD) include emphysema and bronchitis. This paper will make use of Mike case to discuss the pathophysiology of COPD and contributory causes. Provide rationale for appropriate nursing, inter-professional and interagency interventions, discuss ways to enable patient prevent complications associated with COPD, facilitate palliative treatment and prevent unplanned admissions. Additionally, the essay will discuss the effects and risks of the drugs administered, assess practice guidance and national frameworks that promote best practice, the legal, ethical, political and economic context of COPD care in the UK.
The Pathophysiology of COPD and Contributory Causes
In addition to being one of the major causes of death in UK, COPD leads to reduced quality of life since it causes functional impairment and eventual loss of independence. COPD pathophysiology is used in reference to functional alteration in the lungs resulting as the disease progresses. COPD affects the functionality of the lungs by causing inflammatory cells such as T-lymphocytes, and neutrophils to accumulate along the airways causing obstruction and airflow limitation. The inflammatory cell trigger influx of inflammatory mediator aimed at eliminating the irritants or foreign debris. However, continuous exposure to foreign debris such as smoke results in unrelenting inflammatory response changing the physiology and structure of the lungs, which worsens the condition. The changes include constriction of airways, excessive mucus production, dysfunction of cilia resulting in obstruction of airways characterised by chronic cough, dyspnea and wheezing. Mucus accumulates on the airway causing bacteria to grow and multiply on the airway, which eventually cause diverticula along the bronchial tree. Additionally the bacteria infect the lungs resulting in COPD exacerbation (Tsoumakidou, & Siafakas 2006).
Although the major cause of COPD is tobacco smoking, there are other causes, most of which are preventable. Air pollution, second-hand smoke and occupation causes such as exposure to coal, cotton and grain, are other major contributors of COPD cases. Therefore, COPD can be prevented through lifestyle change. Intervention programs should thus involve the community to prevent the disease in addition to treating the already infected individuals (Kosmala-Anderson, Wallace, & Turner 2010).
Appropriate Nursing and Inter-professional and Inter-Agency Interventions
COPD is one of the most common causes of chronic morbidity and mortality, which leads to considerable economic and social burden worldwide. In UK, about 1 million people are diagnosed with COPD while a large number is believed to have the condition but remains undiagnosed (Holmes, 2011). However, most healthcare providers underestimate the level of morbidity resulting from COPD, which has led to inadequate intervention programs in regions such as UK. (Kosmala-Anderson, Wallace, & Turner 2010).
COPD is caused by smoking and is thus preventable. Effective treatment and management of COPD should involve appropriate inter-professional and inter-agency interventions. This is because the high mobility and mortality resulting from COPD results in social and economic burdens that affecting different fields. To prevent the escalation of the burden measures such as promoting prevention of COPD in the society through education of the public should be enhanced. The programs should involve professions from different fields such as nurses, physicians, clinicians and social workers (Kara 2005).
Preventing Complications Associated With COPD
COPD leads to numerous complication the major one being difficulty in breathing. However, patients with COPD can live a less problematic life if the complications associated with COPD are minimised or eliminated. Like indicated in the case scenario, smoking is the predominant risk factor for COPD and the associated complications. Therefore, the major intervention program for patients with COPD should entail discontinuing smoking. This will reduce the rate of decline of the lung function and reduce exacerbations. Early detection of COPD is crucial and it can play a major role in determining the course of the disease. Since smoke is the major cause of complications, the intervention should involve removal of air pollutants within the patient’s vicinity. Avoiding smoking and pollutants prevents respiratory complications. To enable Mike prevent complications associated with COPD the caregivers should encourage the family members to ensure that the home environment is hygienic and free from pollutants that intensify COPD.
According to Wakabayashi, Motegi, Yamada, Ishii, Jones, Hyland, Gemmma and Kida (2011), older patients with COPD, like Mike, require to be educated on their condition to enhance self-management. When the patients are informed on their condition and what is required of them, they are able to cope better. Since other conditions have resulted, the intervention program should involve treatment and management of osteoarthritis through therapies that ease pain and inflammation since the condition is incurable. The care should also include treatment of pulmonary fibrosis, which could have been caused by excessive inflammation of the airways
Preventing Unplanned Hospital Admissions Due To a Crisis
Advanced stages of COPD are characterised by unrelenting symptoms with frequent acute exacerbations. According to Wakabayashi, Motegi, Yamada, Ishii, Jones, Hyland, Gemmma and Kida (2011), “Providing patients with planned, comprehensive, self-management program has been shown to contribute to improvement in knowledge and adherence and to reduce the rate of hospitalization among patients with COPD” (426). Therefore, the caregivers should understand the health status of the patients to enable them meet their information needs. The patients should be informed of the situations to avoid and their nutritional and exercise requirements to enable them deal with the condition. (Yohannes, Willgoss, Baldwin, & Connolly 2010). To enable Mike prevent unplanned hospital admissions due to a crisis the caregivers should ensure that Mike and his wife understand the basic ways to deal with symptoms related or unrelated OCPD that are affecting Mike. Moreover, the caregivers should educate the family on the appropriate nutrition and other measures that can be used to enable Mike deal with his condition.
Facilitating Palliative Treatment for COPD
Palliative care entails medical care given to patients by social workers, nurses and physicians to relief pain or sooth the symptoms of the disease. Like in case of mike, patients with COPD exhibit symptoms such as anxiety, painful breathing, and loss of weight, hopelessness and depression. According to Holmes (2011), multidisciplinary palliative care teams should attend patients in the late stages of COPD as well as their families. This is because the actual end stage of COPD cannot be easily detected. Palliative care for COPD patients should aim at relieving pain and other uncomfortable feelings, offering emotional support to the patient and the family improve appetite and make medical decisions. Moreover, the caregivers should focus on improving the personal hygiene conditions, which can be done by community social workers (Nordtug, Krokstad, & Holen 2011) like in the case of Mike. The palliative caregivers should conduct frequent checks to assess the level of airflow obstruction and the systemic consequences. This will enable them offer appropriate care and relieve the patients when necessary. To facilitate palliative treatment care for Mike, the caregivers should provide holistic care that should include care and treatment of osteoarthritis and pulmonary fibrosis, disease management, psychological care, social care and spiritual assistance.
Prednisolone is a form of corticosteroid medication, which has similar effects as those of the hormones in a person’s adrenal glands. These serve to suppress both inflammation and immunity, where one’s white blood cells attack their body tissues. In Mick’s COPD case, this medicine works the same way it does in asthma patients, to reduce conditions resulting from inflammation. The side effects and risks of this medicine depend on the amount of dosage taken. Generally, this results in swelling of limbs, as body fluid is retained in tissues, it also causes unstable moods, increases high blood pressure, and leads to weight gain in the neck, abdomen, and back of the neck (Hanania, 2011).
Augmentin is an antibiotic used to treat bacterial infections. Its side effects are also dependent on the amount of time a person uses the medicine, and the dosage taken. The mild effects of this drug include diarrhoea, indigestion, or vomiting, and oral thrush, including soreness of the mouth and tongue. Severe effects include fever, rashes, itchiness of skin, and sore throats. Paracetamol is the most common painkiller with rare side effects. These side effects include rashes, a drop in blood pressure; a condition known as hypotension, and damage of liver and kidney if medication is prolonged or in case of overdose. On rare cases, paracetamol results in blood disorders such as leukopenia and thrombocytopenia. On the other hand, Salbutamol is a drug that helps in relieving symptoms similar to those of Asthma, as it makes the airways to dilate. The risks and side effects include muscle cramps, low levels of Potassium in blood, flushing, and headaches. This drug does not result in severe side effects, apart from itching and dizziness (Hanania, 2011).
There are different levels of medicines management, which the concerned parties should observe and adhere to. From the perspective of the patient, they should know the purpose of the prescription given to them. Knowing when to take the medicine and the right dosage is necessary to avoid overdose or under dose of medicine, which is lethal to one’s recovery process. Additionally, a patient must be knowledgeable about the side effects of the prescribed medicines in order to avoid unnecessary panicking (Allegra & Blasi, 2000). Finally, the patient must be familiar with the kind of tests performed on them, and be able to understand their test results. These are the medicine management basics, which patients need to apply, for an uninterrupted recovery process. Medicine management also applies to primary healthcare level as well as the hospital level. This mainly serves to ensure that patients are given the correct prescriptions as well as the recording of a patient’s past medical history. This way, patients will be given accurate prescriptions, in accordance to their health need (Hanania, 2011).
Chronic obstructive pulmonary disease (COPD) results in a number of detrimental effects on the patient’s life, thus affecting their family too. Apart from the physical health effects, COPD also affects the patient and their families psychologically, additionally altering the patient’s social relationships, work, as well as the future. All these effects come in the negative light to both the patient and their family. Being an elderly person, Mick is prone to experience these effects at a higher level, and these will in turn affect his family in one way or another (Margereson, 2009).
According to Boyle (2009), there are limited research findings to show the effects of COPD on families of the patients, unlike the case of cancer, diabetes, heart disease, or dementia, which have numerous research data. However, researchers have found that dissatisfaction with life is a major effect of most COPD patients. These also become alienated and experience less social interactions. The physical disability COPD patients experience also hinders them from engaging in different activities, which require active body movements. This includes taking on jobs to earn a living, as most COPD patients are confined to their beds and homes. This to a bigger extent equally affects their mental health, as most COPD patients register a lower mental status. For the chronically ill husbands suffering from COPD, it is their wives mainly take care of them at home. Therefore, these wives tend to exhibit similar lowering in morale as the case with their ill husbands. The wives are most likely to experience a rather poor health, which emanates from the distress of taking care of a chronically ill husband (Boyle, 2009).
In the case of Mick, the COPD takes toll on him psychologically, as he loses interest in living, and thinks he might die anytime soon. This is a result of psychological distress, which he experiences, coupled with depression, and anxiety. Mick’s family has to be part of these challenges as the society expects chronically ill patients to be cared for by their families. Mick has therefore, puts a psychological strain to his family as they are expected to keenly monitor him in case of changes in his health, or more exacerbation. This puts Mick’s family in an uncertainty state, and emotional instability, as they are not sure of what to expect the next minute (Boyle, 2009).
Mick lost his work because of COPD, which has disabled him. This has deprived him his financial independence as he now depends on his wife for family provision. This in return results in lowering of his self-esteem and ego, as most men pride in being their family’s breadwinners. Such further heightens the level of his mental distress. Social relationships are all gone for Mick. Being confined to bed, he cannot meet and converse with his friends, and he has no workmates either. Additionally, Mick’s future is bleak, as he foresees death. From this, it is evident that COPD is a disheartening condition that leads to meaninglessness of life, especially in the chronic stages.
The Care Quality Commission (CQC) has been responsible for the identification of the best ways to improve the quality of care for the COPD patients in England. This is through the control of health services, in addition to social services provided to adults by the National Health Services (NHS), private health companies, local authorities, including the voluntary organizations. In UK, the NHS has collaborated with different stakeholders, including COPD patients, in order to identify ways through which an improvement in quality of healthcare can be achieved in the case of COPD (“National Health Services” 2011).
To ensure quality care of COPD patients, most clinicians have adopted a care model that comprises different stages in the prevention and management of COPD. First is ways of preventing COPD. This is mostly through encouraging people not to smoke or inhale dangerous gases and smoke, which can lead to lung infection. Secondly, early diagnosis of COPD is encouraged, to avoid the disease getting into the chronic stage, which becomes complex. If one is diagnosed with COPD, early management of the disease is important to curb its adverse effects. Support and care for the COPD patients experiencing acute exacerbations is necessary to prolong life, as well as care and support at the end of life for patients with chronic OCPD (“National Health Services” 2011).
In order to endorse this care model, NHS has developed a national strategy to improve quality of care for COPD patients. The main objectives of NHS in COPD strategy were published in July 2011 and these aim at care improvement. First is ensuring that all communities have good respiratory health. To achieve this, dissemination of information to people is necessary for people to appreciate better respiratory health. Third is the prevention of more premature deaths due to COPD, by endorsing the clinical care model of early diagnosis and management of COPD. Provision of a conducive care environment for COPD patient until their death will improve their quality of life. Finally is ensuring that COPD patients receive effective treatment to help in their recovery (“National Health Services” 2011).
People living with long-term conditions should still be considered as members of the society, even though their participation in societal activities is limited. As long as they still live, they are normal human beings, entitled to same human rights as everyone else. In the ethical context of people with long-term conditions, the virtue of justice need to be upheld by the people involved with the patients (Lloyd & Heller 2011). These patients should continue to experience a society where they are treated fairly just as the way they were treated before they got sick. Economically, even though most patients with long-term conditions plunge in financial dependence, they deserve to be cared and provided for by their families. Their wealth, which they had accumulated before getting sick should still be in their ownership unless they willingfully transfer this to different parties (George, Whitehouse & Duquenoy, 2012). Therefore, their proper share of resources and wealth must be guaranteed. Politically, the patients are still entitled to political rights such as participation in elections and voicing their concerns to political authorities. These must therefore, not be denied these rights. People living with long-term conditions are as well legally entitled to justice. The legal system in society must not discriminate against these people in their quest for justice, on the grounds of their health conditions. Generally, these people should be given a chance to live and bring in their positive contribution in society, no matter how small it might be. They should feel appreciated and of value in their local communities despite their condition (George, Whitehouse & Duquenoy, 2012).
Conclusively, this case scenario has been informative in the understanding of care and management of people with long-term health conditions, as this has been addressed in a practical manner. With special attention to COPD, this scenario has offered an in-depth insight in the interventions used in managing such long-term conditions. Additionally, it has become evident that families with people living with long-term conditions are equally affected psychologically, emotionally, or economically, yet this is hard to notice. However, best practice in healthcare provision is essential for the alleviation of deaths caused by OCPD and other long-term illnesses, as well as severe effects of such conditions. People living with long-term conditions can still live a satisfying life in society if their local communities consider them as part of society by granting them their rights and ensuring that their care still embraces legal, political, economic, and ethical contexts. This way, the affected people will live a fulfilling life, as well as prolong their life, since this reduces the alienation, which most of them face.
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