i need help with my nursing managent on discharge planning

[datamini]

Case: A 65yr old male had a mild sorethroat, runny nose & fever for 2days. Since last night, he c/o difficulty in breathing, chest tightness & cough with productive whitish sputum. He was treated & stabilized before admission to your ward for acute excerbation of COPD.

Temp: 37degrees

Pulse: 105bpm

Respiration: 24bpm

SAO2: 96% on room air

General condition: fair, able to speak in short sentences

Inspection: Looks breathless with use of accessory muscles, Audible wheezing heard. Barrel-chested. Productive cough. BMI 16.

Percussion: Hyperresonance throughout both lung fields.

Palpation: No significant findings.

Auscultation: Wheezing heard upon expiration.

Pt has h/o "breathing problem" for the past 8yrs.He has been on regular "puffing medicine". He has been smoking since he was 16yrs old.The physician ordered salbutamol & ipratropium bromide nebuliser & oral prednisolone for him.

This is what i've come up with my discharge plan:

1) Sit up (prop-up) when feeling breathless

...currently i'm still thinking for more plans..hope to get ur help out there..thanks

[Daytonite, BSN, RN]

You have a patient here with a whole lot of symptoms of his disease and problems. COPD (Chronic Obstructive Pulmonary Disease) is actually a broad category of several pulmonary diseases. This patient's symptoms are most closely similar to emphysema which has the symptoms of:

• barrel chest
  
• pursed-lip breathing
  
• use of accessory muscles
  
• cyanosis
  
• clubbed fingers and toes
  
• tachypnea
  
• decreased tactile fremitus
  
• decreased chest expansion
  
• hyperresonance
  
• decreased breath sounds
  
• crackles
  
• inspiratory wheeze
  
• prolonged expiratory phase with grunting respirations
  
• distant heart sounds

Here is more information on COPD

• http://www.nlm.nih.gov/medlineplus/ency/article/000091.htm - Chronic Obstructive Pulmonary Disease
  
• http://www.medicinenet.com/chronic_obstructive_pulmonary_disease_copd/article.htm - Chronic Obstructive Lung Disease

As part of your nursing treatment plan you need to know what the doctors are ordering for the patient as well. For your plan of care, you treat the symptoms the patient is having. Some of the symptoms can be grouped into categories. For instance, the coughing and his ability to only speak in short sentences has to do with his inability to keep secretions cleared from his respiratory tract. If you were using nursing diagnoses this would be called Ineffective Airway Clearance. His wheezing and use of accessory muscles to breathe have to do with his inability to get adequate ventilation (air) into his lungs with each breath. The nursing diagnosis for this is Ineffective Breathing Pattern. These are two nursing problems the patient has and you would develop nursing interventions (treatments) for the coughing, difficulty speaking, wheezing and use of the accessory muscles when breathing as part of your nursing care plan. There are a number of things you can do for each of these things.

Your discharge plan needs to include:

• that he needs chest physiotherapy and that he gets it
  
• has adequate hydration (drinks enough fluids)
  
• follows a high protein high calorie diet, usually small frequent meals are better
  
• does not over perform activities and has frequent rest periods
  
• takes his medications as ordered and knows what each medication is for and why he needs to take it
  
• starts a smoking cessation program if he hasn't quit smoking already
  
• patient teaching
  • about COPD, it's diagnosis and treatment
    
  • all medications being taken and their potential adverse reactions
    
  • when the patient needs to notify the doctor of any problems he is having
    
  • how to conserve his energy
    
  • why he needs to stop smoking and to keep out of areas where others are smoking
    
  • the need to stay away from others who might have respiratory infections
    
  • how to deep breathe and cough
    
  • how to use handheld inhalers
    
  • how to use oxygen if it has been prescribed as well as the safety rules for its use
    
  • the importance of an adequate fluid intake
    
  • the signs and symptoms of a pneumothorax

That should get you started with this.

[datamini]

Thanks for providing me the info i needed. It has been a great help to me. I'll work on the guidelines u've given and see if i have anything else to add on to it. :smilecoffeecup: