Case Study on COPD

when problem solving you must first determine what the cause of the problem is. if you know you want to improve this patient's calorie intake, then you must do a little investigation (assessment) first to find out why his intake has gotten so low so that he has lost this weight. is his intake down or has his caloric requirement increased? once you know that, then you can correctly come up with your four strategies. i have found a number of websites with information about copders and nutrition. you should be able to identify the cause of your patient's weight loss after going through this information (assuming you questioned the patient thoroughly about his diet and eating) and come up with 4 good strategies (interventions) for him. good luck!

• http://www.lungdiseasefocus.com/articles/emphysema/emphysema-treatment.php - "emphysema patients are often underweight. patients with advanced emphysema tire easily, and have weakened muscles. adequate nutrition is essential to maintain activity levels, perform daily tasks, and facilitate breathing."
  
• http://www.emphysema.net/mmedinfo.html#nutrition
  
  • http://www.aarc.org/patient_education/tips/copd.html - eating right: tips for the copd patient
    
  • http://www.lincare.com/patientedu/eat.html
    
  • http://www.apria.com/channels/1,2748,93-213,00.html - copd and nutrition
    
  • http://health.yahoo.com/other-other/eating-well-when-you-have-chronic-obstructive-pulmonary-disease/healthwise--ug2647.html - eating well when you have chronic obstructive pulmonary disease
    

  [*]from copd international website on diet: http://www.copd-international.com/library/diet-exercise_newguidelines.htm

Yes, that is the problem. The symptoms are the weight loss and that he can't tolerate eating much food. The cause for the Imbalanced Nutrition: less the body requirements is the inability to eat enough food secondary to the emphysema. I gave you all those websites so you could read about COPD (emphysema is one of the COPDs) and how it makes him not feel like eating. You can find reasons there as to why this man has lost so much weight. You also need to come up with some interventions, and there were some very good suggestions on these websites, for this man to increase his caloric intake while taking his breathing problems into account. These people have to eat around having coughing spells and fatigue from coughing. Its all in those websites. Please read them.

To do a case study, which is a care plan in essay form, you first assess the patient (list the signs and symptoms), then make a list of the problems (I already gave you the nursing diagnosis), write the goals and nursing interventions, state how you will implement the plan and then evaluate whether it was effective or not (were the goals met?). You specifically asked about strategies to improve the patient's caloric intake. That would involve nutrition and I pointed you toward a nutritional assessment and interventions.

when doing a case study you follow the nursing process when organizing the paper.

step 1 assessment - collect data from medical record, do a physical assessment of the patient, assess adl's, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology - write up information about the patient's medical diseases and conditions, their signs and symptoms, how they are diagnosed, their pathophysiology and how they are medically treated. this patient has 2 notable conditions and a complication as a result of his copd:

• copd (emphysema type)
  
  • pneumonia every year for the past 3 years
    

  [*]hypertension

  [*]smoker for 25 + years - this has contributed to his emphysema (copd)

step #2 determination of the patient's problem(s)/nursing diagnosis part 1 - make a list of the abnormal assessment data - we nurses can't do anything with a medical diagnosis - we have to break them down into their signs and symptoms - we also should have done a physical assessment of the patient and picked up on abnormal data which was not possible in this instance - abnormal assessment data was given to you

• shortness of breath
  
• cough that is productive with thick yellow-green sputum
  
• trouble sleeping at night
  
• has lost 35 lbs
  

step #2 determination of the patient's problem(s)/nursing diagnosis part 2 - match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use - using the above data a nursing diagnosis reference is consulted to figure out what nursing problems are present before goals and nursing interventions are decided upon

• ineffective airway clearance (shortness of breath, productive cough)
  
• imbalanced nutrition: less than body requirements (has lost 35 lbs)
  
• disturbed sleep pattern (trouble sleeping at night)
  
• risk for infection (the thick yellow-green sputum is potentially a sign of an infection)
  

step #3 planning (write measurable goals/outcomes and nursing interventions) - this is where you talk about your strategies (nursing interventions) for the symptoms the patient has. you also develop goals. goals are what you expect to happen as a result of your nursing interventions. often goals are a reversal of the symptoms, but not always. in people with chronic diseases like emphysema, a goal can be a simple as a symptom not getting any worse.