Case Study on COPD

[Sugar637]

I have a questioned I'm doing a case study on COPD my patient has Emphysema and has been smoking for 25 + years. For a COPDder how do I Identify four strategies that might improve his caloric intake?

This is his history:

Patient D.Z. has a past medical history of hypertension and a diagnosis of pneumonia yearly for the past 3 years. His admitting diagnosis is COPD chronic emphysema with an acute exacerbation. He is experiencing shortness of breath and reported a cough that is productive with thick yellow-green sputum. He has trouble sleeping at night.

He has lost 35 lbs and is retired.

Thanks. :wink2:

[Daytonite, BSN, RN]

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

[Sugar637]

Thanks for your help, my problem is, that this is a case study given to me as a final for my medsurg class. I have to use the information I was given and come up with the answers...the patient has lost 35 lbs. and cannot tolerate much food due to the constriction in his lungs as he trys to eat and breath at the same time.

[Daytonite, BSN, RN]

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.

[Sugar637]

Thanks this has been very helpful.

[Daytonite, BSN, RN]

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.

[Sugar637]

actually i've done all this already, i've done an assessment, i've determined his medical problems, i'm working on his plan of care, i've done patient teaching, i wasn't given much, it's a case study. i'm not working with an actual person. our instructor gave us two case studies to work on. we have to use the information we were given and come up with our own. i'm almost with this one but the other one is harder. this is my third time working on a case study so it's all new to me. i really appreciate the time you're taking out to help me understand this better.