The Story You are an LPN working in a community health clinic on a team of professionals that includes a medical assistant, RN, and nurse practitioner. The clinic is just opening for the day on a day that is particularly hot and humid. A woman runs into the clinic with an older gentleman yelling, “he can’t breathe.” The client appears flushed (reddened skin), unable to speak, and very short of breath. The client’s wife tells you that he has “emphysema” and refuses to put the air conditioning on in their home because he is afraid the electric bill will be too high. She also tells you that he ran out of his medications, including his inhalers and prednisone, almost two weeks ago. The client has a respiratory rate of 44 and an O2 Sat. of 84% on room air. His blood pressure is 168/100. Question 1: List two nursing interventions that should be done immediately. (2-3 sentences) Question 2: What environmental factor(s) do you think contributed to the client’s current situation? (2-3 senten

COPD Exacerbation

Nursing Interventions That Should Be Done Immediately

Emphysema is a type of chronic obstructive pulmonary disease (COPD) that affects the lungs and causes breathing difficulties (U.S. National Library of Medicine, n.d.). The nursing interventions that should be done immediately include placing the client on a bed in a semi-sitting position and administering corticosteroids and bronchodilators to improve airway clearance. Secondly, pursed lip breathing should be encouraged to slow exhalation and prevent the small airways from collapsing; this improves breathing patterns.

Environmental Factors That Contributed To The Client’s Current Situation

The environmental factors that may have contributed to the patient’s condition include occupational exposure to air pollutants, dust, or even chemicals (Tennessee State Government – TN.gov., n.d.) for a prolonged time, which was made worse by the fact that the day was extremely hot and humid, yet he didn’t have the air conditioner on in his house.

The Danger the Client, Could Face By Abruptly Stopping Prednisone

Prednisolone is an anti-inflammatory steroid similar to cortisol, a hormone produced by the adrenal glands. If a person is on the drug for several weeks, the body reduces the amount of cortisol it produces. Therefore if the client abruptly stops using prednisolone, he may experience symptoms similar to those of adrenal insufficiency. They may include but are not limited to lethargy, weight loss, and joint pains. These symptoms are experienced because the body cannot produce enough cortisol to compensate for missing prednisolone (Wahab et al., 2020).

Importance of Compliance In Managing Chronic Diseases such as COPD

Compliance is vital in managing chronic obstructive pulmonary disease (COPD). Compliance reduces the hospitalization period, which reduces healthcare expenses. Secondly, it improves the quality of life of a patient and gives them a longer life. Thirdly, compliance also prevents the escalation of therapy, which is described as the process by which a patient escalates from treatment with drugs of low side effects or efficacy to being treated with drugs with potentially higher side effects or efficacy (Bourbeau & Bartlett, 2008).

What Should Be Addressed In the Client’s Next Clinic Visit

On his next visit, he should be examined to determine whether he is responding to medication and whether the symptoms have improved. Consistently, his housing condition should be addressed; he should always be advised to have the air conditioner on, mostly when the weather is extreme, for the refusal to do so would lead to a flare-up of his condition. Additionally, he should be enlightened on the importance of drug adherence and the side effects of abruptly stopping medication without consulting his doctors.

References

Bourbeau, J., & Bartlett, S. J. (2008). Patient adherence in COPD. Thorax, 63(9), 831–838. https://doi.org/10.1136/thx.2007.086041

Tennessee State Government – TN.gov. (n.d.). COPD and the environment. Retrieved February 13, 2023, from https://www.tn.gov/health/cedep/environmental/data/healthdata/chronic-obstructive-pulmonary-disease/copd-and-the-environment.html