UNIVERSITY OF LUZON

COLLEGE OF NURSING & MIDWIFERY

DAGUPAN CITY, PANGASINAN PHILIPPINES

Management of Patients With Chronic Pulmonary Disease

Name of Student: DIVINA G. PARAGAS Date: 08/25/21
Clinical Instructor: DIVINA-GRACIA CORRIGAN

1. Howard Long, 50 years of age, is a male patient diagnosed with

bronchiectasis. He has smoked 1 pack per day of cigarettes for 35
years. He has a long history of recurrent bronchial infections. He has a
chronic productive cough with copious amounts of purulent sputum.
The patient complains that he is short of breath even at rest. He has
clubbing of his fingers. The chest CT scan reveals bronchial dilation.

a. How should the nurse explain to the patient and family the
pathophysiology of bronchiectasis as it is related to the
symptoms the patient is experiencing?
 As the nurse caring for this patient, I would first explain
that bronchiectasis is a condition in which the airways
have been damaged as a result of inflammation and/or
infection of the bronchi (airways) and as a result, he is
experiencing his symptoms. I would further explain to
my patient that his history of chronic bronchitis and
current symptoms of chronic cough with copious
sputum, shortness of breath and clubbing of his fingers
are indicative of his diagnosis and chronic obstructive
pulmonary disease. I would encourage my patient to
cease smoking as this is his greatest risk factor with his
diagnosis.

b. How should the nurse explain to the patient and family the goals
of medical management that may be used to treat the
bronchiectasis?
 I would explain to my patient that his goals should be to
participate in COPD management and management of
his symptoms to attain and maintain. The medical
management may include the following:
 Drug therapy – I will discuss the differences between
short acting drugs and long term control therapy
 drugs to my patient. I will ask my patient to
verbalize his understanding of the medications and
which are used for acute attacks vs. prevention of
attacks.
 Laboratory assessment – I will explain to my patient
that his management plan may include lab tests such
as arterial blood gases to assist in understanding
current ventilation capabilities, pulse oximetry
monitoring to measure blood oxygen saturation,
sputum cultures to check for infection, and blood
tests to assist with determining infections, fluid and
electrolyte status, as well as other tests to help
identify treatment needs.
 Lifestyle therapy – I will teach my patient that the
incidence and severity of bronchiectasis or COPD
would be greatly reduced if he could achieve
smoking cessation.

c. What does the nursing management for bronchiectasis entail?

 Monitoring changes in respiratory status
 Breathing techniques
 Effective coughing
 Proper positioning for effective ventilation
 The use of oxygen therapy
 Exercise conditioning
 Hydration

2. Sallie Thorp, a 21-year-old patient, presents to the physician’s office

with an asthma action plan form she acquired from a literature search
on the World Wide Web at
http://www.nhlbi.nih.gov/health/public/lung/asthma/asthma_actplan.p
df. She states that she would like to develop the plan with the help of
the nurse and physician and review it at each appointment to keep it
current. She has had moderate persistent asthma for 5 years, and she
has visited the emergency department several times in the past year
with severe asthma attacks. She stated that she forgets to take her
medications, because the medications are at times that the hospital
provided the inhalers (12 noon and midnight), and she gets confused
on which inhalers are the long-acting ones and which inhaler is the
short-acting rescue inhaler she is supposed to use when she has an
exacerbation. She stated that if she could, she would like to take the
inhalers at 8 AM and again at 8 PM. The patient stated that she has a
flow meter and that a respiratory therapist at the hospital taught her
how to use it in the past, and he wrote down her personal best peak
flow, which is 400 L/sec. The nurse reviews the patient’s medical chart
and discovers that she has been prescribed the following from today’s
visit:
 Use albuterol (Proventil): 2 to 4 puffs every 20 minutes for up
to 1 hour as rescue inhaler. If symptoms improve, then take
the inhaler every 4 hours for 1 to 2 days. If no improvement
after 2 days, call the physician
 Salmeterol (Serevent): 50 mcg every 12 hours
 Fluticasone (Flovent): 88 mcg or 2 puffs every 12 hours
 Cromolyn sodium (Nasalcrom): one spray to each nostril once
daily and before being exposed to known asthma triggers.
You may use the spray up to every 4 hours
 Measure peak flow meter every morning before using inhalers
and record. Use peak flow meter, as needed, if you develop
symptoms, such as cough, shortness of breath, wheezing,
chest tightness; use of neck and chest muscles to breathe;
problems talking or walking because of extreme shortness of
breath
 Follow-up in 3 months
 Have the nurse provide education on asthma self-
management and fill out the action plan that the patient
brought with her today and have the physician review it and
sign it

The nurse also notes that the medications have not changed from the
last visit.

a. Explain the medications to the patient and practice filling in the

asthma action plan.
 For an acute attack, you will take Albuterol (Proventil) 2 to
4 puffs every 20 minutes for up to 1 hour as rescue
inhaler. If symptoms improve, then take the inhaler every
4 hours for 1 to 2 days. If no improvement after 2 days,
call the physician.
 For long-acting maintenance medications, you will your
other inhalation medications as follows:
 At 8am and 8pm, you will take Salmeterol
(Serevent) first as prescribed (50mcg). By taking
this medication first, it will promote
bronchodilation and better absorption of the
Fluticasone (Flovent).
 At 8:05am and 8:05pm, you will take Fluticasone
(Flovent) as prescribed (88mcg or 2 puffs).
  If you are going to be exposed to your known asthma
triggers (you indicated those included animal dander,
pollen/outdoor mold, tobacco smoke, and smoke, strong
odors and sprays), you will take your intranasal medication
as follows:
 Before being exposed to known asthma triggers, you
will take Cromolyn sodium (Nasalcrom), one spray to
each nostril. You may use this medication up to
every four hours if you continue to be exposed to
known asthma triggers.

b. Explain ways to evaluate the patient’s mastery of the content?

 I will have Ms. Thorpe review her asthma action plan and
provide me with information regarding:
 What to do if she is experiencing an acute asthma
attack.
 What medications she will take prior to exposure of
known asthma triggers.
 What is a green zone peak flow and what is a red
zone peak flow.
 How she would call for medical assistance in the
event of danger signs.
 What medications she takes for long acting
maintenance of her asthma.

Health Care Delivery and Evidence-Based Nursing Practice

1. Suzanne Jones, 76-year-old patient with COPD is admitted to the

ICU. Mrs. Jones is placed on mechanical ventilation to assist with her
breathing. After 2 days on the ventilator, Mrs. Jones is extubated and
then transferred to a medical-surgical unit. The medication regimen is
adjusted during the hospitalization. Mrs. Jones is discharged home
after 6 days. She and her family are pleased with the care she
received in the hospital. (Learning Objectives 3 and 5)

a. Describe the quality performance tools that may be used to

demonstrate that the care and treatment rendered are both
cost-efficient and of high quality.
  Quality performance tools are the prepared strategies to
render effective care. The health care institution should
prepare and follow the protocol according to their
organization. Following a specific protocol helps to give
proper care and there by can avoid faults in treatment. In
that way protocol is one of the quality performance tool.
For example in these case, for treating COPD the
institution should have the protocol for patient treatment
strategies in providing ventilators and other medicines and
period of stay in ICU's and other wards if they have a
specific protocol like this the care and treatment provided
will be always in efficient manner for all clients getting
admitted in the hospital and the patient progress will be
better because of good quality care. Following and
maintaining protocol is the efficient quality performance
tool in a cost effective way.

b. Describe the quality performance tools that may be used to

demonstrate that the nursing care utilized is evidence-based
care and high quality, resulting in patient satisfaction and good
patient outcomes.
 Quality performance tool for nursing care can be a
checklist or protocol. For example an important sessions of
treatment can be prepared as a checklist and all nurses
are asked to fill the checklist after every shift therefore, it
will clearly shows the missed treatment or care. It also
helps to find the level of nursing care. And it makes nurses
to render proper care in aright time it will make good
patient outcome and patient satisfaction.

2. The registered nurse working in the cardiac care clinic is tasked with
implementing quality improvement measures. To educate the clinic
staff, the nurse plans an in-service program to introduce concepts of
quality improvement and evidence-based practice. Additionally, the
role of the case manager will be included in the presentation. The
nurse plans on using care of the patient with Congestive Heart Failure
as a template, and prepares sample clinical pathways, care maps, and
multidisciplinary action plans. (Learning Objective 3)
a. Describe how clinical pathways are used to coordinate care of
caseloads of patients.

 Most of the clinical pathway are computerized and usually

part of the patient’s record. They direct the entire health
care team in the daily care goals for select caseload of
patients. They also describe the care a patient requires at
a specific time, hence helping the health care team
manage different caseloads at the same time and work
towards a desired outcome within the estimated length of
stay.

b. What is the role of the case manager in evaluating a patient’s

progress?

 A case manager assesses the individual needs, coordinated

services and evaluates the progress, in evaluating, the
case manager will communicate with the health care
provider about the patient’s specific needs, his or she short
term and long-term goals, and whether they have been
met.

c. What are examples of evidence-based practice tools used for

planning patient care?

 Algorithms
 Clinical guidelines
 Care mapping