Nurses and Pulmonary Disease
AN recently interviewed a pulmonary nurse at Temple Lung Center in Philadelphia, Pennsylvania.
Lung disease is very prevalent in the US. Many patients are admitted to hospitals with the primary diagnosis of respiratory distress. This is often a complaint from patients with lung disease. Lung disease encompasses many disease processes. One of the most common is chronic obstructive pulmonary disease or COPD. The death rates for patients with COPD is declining for those >60 years of age but the death rate for those younger patients in the 30-40 year range has actually plateaued.
AN recently discussed pulmonary disease with Michelle Vega-Olivo, MSN, CRNP, FNP-BC. Michelle is a pulmonary nurse practitioner at Temple Lung Center in Philadelphia.
Smoking is a huge risk factor for pulmonary disease. What resources do you use to get your patients to quit?
Yes, addressing this is important for patients who come in with COPD, asthma, pulmonary fibrosis, etc. When patients come in, we refer them either to the smoking cessation program Temple offers, which includes a pharmacist, RN, and pulmonologist, or a cessation program at another hospital or facility that may be more conveniently located for them. These programs provide information on medications, behavioral therapy and ways to wean off smoking. At Temple, we also have a smoking support group.
With the pulmonary patients, we see who smoke, we spend about 10 minutes during each visit discussing their smoking: their triggers, whether they feel ready to quit, what they've tried in the past, etc. It's not easy for these patients to stop smoking even though they know smoking affects their pulmonary conditions; they just can't always see it that way. They're addicted; it's hard, and it's definitely something they struggle with.
I also share information and resources with my patients during visits, such as the quit smoking hotline 1-800-QUIT-NOW which is available 24/7.
Patients are now living in the community on inotropes, flolan and other life sustaining meds. What should all nurses know about these meds?
There is a lot to know about these medicines and nurses should spend time learning about them, including how to administer them, how to discuss and address side effects, how to titrate medicines, knowing that some such medicines shouldn't be abruptly stopped, etc. Nurses also need to ensure they provide site care, monitoring patients' central lines for infections.
It's also important that nurses and patients discuss doing research before a patient travels with these types of medicines; we don't want patients to be restricted from traveling, but there are things to know. They should make themselves aware of where Pulmonary Hypertension (PH) Care Centers are located where they are traveling or carry an emergency supply of their medicines with them because not all hospitals will have them stocked.
I also encourage such patients to wear medical ID bracelets, in case something emergent happens, so responders will be aware.
What opportunities exist for nurses who want to go into pulmonary nursing?
- There are a lot of opportunities in pulmonary nursing:
- There's the acute setting, where you can work in an ICU or respiratory ICU.
- Many institutions also have a research department in which nurses enroll patients in clinical trials.
- You can also be a nurse educator and teach about diseases such as COPD and asthma.
- You can also become an outpatient nurse practitioner and see patients in clinic, or an inpatient nurse practitioner and follow transplant patients, for example.
What attributes or skills do pulmonary nurses need?
An ability to see each patient as an individual. While there is a standard of care for most disease states, it may not be right for all patients. Every patient is unique, and treatment plans should reflect patients' differences and what's important to them with regard to their lifestyle, goals and quality-of-life considerations.
Being open and accessible. Information about diagnosis and treatment can be hard to digest, so I encourage patients and their families to reach out to me with questions, or I follow up after appointments if I think they may have felt unsure about our discussion.
Being mindful, thoughtful and caring. In caring for patients, I try to put myself in a patient's or family member's shoes and treat them the way I would want me or my loved one to be treated.
Being proactive about learning. It's impossible to know everything about respiratory care and conditions, especially given continued advancements, but I work to learn and understand as much as I can because it helps me better care for my patients. To do this, I share information, discuss research and experience with my peers, participate in research at Temple and complete continuing medical education (CME).Last edit by traumaRUs on May 15
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