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Health Promotion Paper Title: COPD
Introduction– Overview of the problem and its Significance (incidence, factors that influence or impact) 6pts
The Problem 1– *Etiology/Pathophysiology of the problem 6pts
The Problem 2– Describe the clinical presentation that is most usually seen and what should be included in the patient assessment (focus for the PE, any labs or other diagnostic testing) 12pts
The Problem 3– What differential diagnoses are most commonly included when trying to determine this diagnosis or problem and why would you include each? 6pts
Clinical Management– Protocol for NP management of the problem, including: Treatment plan, which should include any clinical guidelines you used as a basis for management, medications used to treat the problem, patient teaching concerning the problem, and any health promotion concerns and prevention measures that should be utilized. (Specify the source of the clinical guidelines and whether they are evidence-based, talk about the choice of your meds and how they work/are metabolized. For such a significant number of points, this section should be fully developed) Also include interdisciplinary resources available to assist with guidelines and how the NP would utilize them. 30pts
Expected patient outcome– Discuss the expected treatment outcomes for this Health problem and the time frame for these outcomes. How would you determine that the expected outcomes were achieved? 10pts
Expected Patient Outcome– Discuss the point at which you as the NP would stop managing this as a complex problem and how you would plan to refer the patient (who would you refer to and why?) 10 pts
Paper Elements- Title page 1pt
Paper Elements– Use of Headings 1pt
Paper Elements– Grammar/Punctuation/spelling 10pts
Paper elements– APA format & references 8pts
Health Promotion Paper: Chronic Obstructive Pulmonary Disease (COPD)
Student’s Name
Institutional Affiliations
Health Promotion Paper: Chronic Obstructive Pulmonary Disease (COPD)
Chronic obstructive pulmonary disease (COPD) is causing public health concerns worldwide because it is associated with high morbidity and mortality. The World Health Organization (WHO) has listed COPD as the third leading cause of death worldwide. According to Sandelowsky et al. (2021), about 350 million people have COPD globally and several cases may still remain undiagnosed. Treatment of patients with COPD costs global healthcare systems about 100 billion United Stated Dollars annually. Poor management of patients increases morbidity and mortality risks. In the United States alone, COPD contributes to close to 18 billion United States dollars in annual costs (Sandelowsky et al., 2021, Choi & Rhee, 2020). A number of factors have been linked with an increased risk of developing COPD. A report by the American Lung Association (2022) indicates that smoking is the leading risk factor for COPD with about 85-90% of worldwide reported cases being linked to smoking. According to the agency, other factors that influence the development of COPD include exposure to air pollutants, a family history of COPD or genetics, inhalation of fumes, dust, and chemicals, secondary smoke inhalation, and advanced age.
The Problem 1: Etiology or Pathophysiology of COPD
The pathogenesis of COPD is triggered by prolonged exposure to the risk factors of the disease such as smoking and harmful chemicals. The irritants trigger chronic airway inflammation causing the airway walls to become thickened. This triggers an increase in mucus secretion subsequently causing the lung structure to change permanently (Yawn et al., 2021). Numerous changes in lung structure occur due to airway inflammation and they include the destruction of alveolar walls, loss of elasticity, and fibrosis of the walls (emphysema). Changes in the structure of the lung increases airflow resistance and hyperinflammation. A patient experiencing these structural changes in the lungs may present with excessive production of phlegm, cough, and breathlessness (Rodrigues et al., 2021). The prolonged inflammation of the lungs due to COPD triggers excessive production of neutrophils. The body also produces excess activated CD8+ T lymphocytes and activated macrophages (Yawn et al., 2021). Mild elevation of eosinophils also occurs in patients with COPD.
The Problem 2: Clinical Presentation, Patient Assessment, and Diagnosis
Symptoms of COPD may be confused with those of other respiratory illnesses. People are advised to seek medical advice early when they experience strange symptoms. The clinical manifestations that are commonly observed in patients with COPD include persistent cough, dyspnea, and phlegm production (Choi & Rhee, 2020). Patients may occasionally present with wheezing. In most patients, the diagnosis of COPD commonly occurs after a person experiences one or more exacerbations. A person’s symptoms may be confused to be those of recurrent bronchitis and this often contributes to delayed diagnosis. Clinicians should list COPD among the differential diagnoses for a patient who is aged 40 years and above and who reports recurrent coughs and bad colds that have lasted for several weeks (Yawn et al., 2021). COPD should be suspected in both smokers and non-smokers.
The diagnosis of COPD is achieved by collecting subjective data to understand the patient’s medical history and physical examinations to establish the physiological changes that might have been caused by the disease. To increase the likelihood of detecting COPD, the clinician often asks targeted questions aimed to understand the respiratory changes and a history of exposure to risk factors. For example, the healthcare provider may ask the patient whether he or she has ever experienced shortness of breath, dyspnea, or a persistent cough (Yawn et al., 2021). It is also important to collect data about smoking history, a history of exposure to harmful chemicals, and a family history of COPD including reasons for past hospitalizations if any.
Physical examination of patients suspected to have COPD should combine diagnostic tests and radiological examinations. While laboratory tests are not meant to directly detect COPD, they can be performed to rule out other possible causes of pulmonary complications. Patients are recommended for these tests after a comprehensive symptom evaluation and listing of COPD as a differential diagnosis (Yawn et al., 2021). Spirometry is an evidence-based diagnostic test for COPD. The test is conducted to obtain the forced expiratory volume in 1 second (FEV1) to forced vital capacity (FVC) ratio which shows the degree of airflow a. An FEV1 to FVC ratio of <0.70 is a confirmatory finding for COPD indicating a persistent limitation in airflow (Sandelowsky et al., 2021; Yawn et al., 2021). A pulmonary function test is usually performed to assess how well the lung is functioning. Radiological or imaging tests are conducted to establish the severity of the destruction of the lung structures. The specific imaging tests that are commonly performed include chest computed tomography (CT) scan, chest X-ray, magnetic resonance imaging (MRI), and Parametric Response Mapping (Choi & Rhee, 2020). Multiple tests are recommended to be able to rule out other respiratory conditions whose symptoms resemble those of COPD.
The Problem 3: Differential Diagnoses
Symptoms of some respiratory illnesses may resemble those of COPD. The differential diagnoses that are commonly included when trying to determine the presence of COPD include asthma, asthma-COPD overlap, and bronchiolitis obliterans (Choi & Rhee et al., 2020; Swaminathan et al., 2019). The healthcare professional would include asthma in the differential diagnoses list because clinical manifestations of asthma closely resemble those of COPD. However, asthma patients often present with less severe symptoms when compared with COPD patients (Choi & Rhee, 2020). Besides, asthma patients usually present with other symptoms which are not displayed by COPD patients and they include drowsiness, fainting, and severe wheezing. Asthma-COPD overcome is commonly considered when listing the differential diagnoses for COPD. The reason for this inclusion is the closeness between COPD symptoms and those of asthma-COPD symptoms (Roman-Rodriguez et al., 2021). However, as Choi & Rhee et al. (2020) indicate, for the presence of asthma-COPD overlap to be confirmed, a person must have a confirmed history of asthma and then later develop symptoms of COPD. Again, patients with asthma-COPD overlap are usually more asymptomatic, experience repeated exacerbations, and are hospitalized quite often when compared with COPD patients. The other condition that might be suspected in patients with COPD is bronchiolitis obliterans. This condition is included as a differential diagnosis because its primary symptom is progressive airway obstruction causing airflow limitation that resembles that observed in COPD patients (Swaminathan et al., 2019). In order to confirm the presence of COPD, the healthcare provider must conduct relevant diagnostic tests for each of the differential diagnoses to establish pertinent positives and pertinent negatives for each condition.
Clinical Management
The nurse practitioner (NP) plays a crucial role in the management of COPD. For example, the nurse develops a treatment plan for the patient, ensures that the patient gets treatment as outlined in the plan, provides patient education, and conducts follow-ups to assess the plan’s effectiveness. Nurse-led interventions for patients with COPD must follow evidence-based clinical practice guidelines (Aranburu-Imatz et al., 2022). The American Thoracic Society (ATS) guidelines and the American Family Physician (AFP) guidelines recommend the use of long-acting bronchodilators for the treatment of COPD. The commonly used medication under this category is tiotropium. Other medications that are recommended for use with COPD patients according to these guidelines are long-acting β-agonist (LABA) and inhaled corticosteroids (ICS) (American Academy of Family Physicians, 2022; American Thoracic Society, 2022). These drugs can be used either as monotherapies or as combination therapies.
The recommendations contained in the clinical practice guidelines are evidence-based. The reason is that numerous studies have confirmed the effectiveness of the recommended COPD medications in treating symptoms of COPD in patients. For example, Choi and Rhee (2020) reported that long-acting bronchodilators, particularly tiotropium, have positive effects on COPD symptoms. In another study, Sandelowsky et al. (2021) reported the desirable effects of inhaled corticosteroids (ICS), long-acting β-agonist (LABA), and long-acting muscarinic antagonist (LAMA) as a combination therapy for patients with COPD. According to the American Lungs Association (2022), the choice and dosage of medications depend on a number of patient factors such as disease severity, gender, and age. Age is a key factor when determining drug dosage because drugs are metabolized differently in people of different age groups and exacerbations (Sandelowsky et al., 2021). In this respect, the nurse must collect detailed information about the patient in order to understand unique factors that might influence drug choice and dosage.
The nurse should teach the patient about effective medication use, health promotion, and preventive strategies applicable to COPD. For example, following medication prescription, the nurse informs the patient about the disease, its symptoms, and complications and how each of the prescribed drugs will contribute to symptom improvement (Aranburu-Imatz et al., 2022). Additionally, the nurse educates the patients to adhere to the recommended regimen while also being careful to identify and report any medications side effects. It is important to note that educating the patient about health promotion and preventive measures for COPD is an effective way to enhance recovery, promote patient safety, and improve the patient’s quality of life (Yawn et al., 2021). The health promotion activities that the nurse should guide COPD patients about include; avoiding smoking, limiting exposure to chemicals and irritants, and dressing in warm clothing. Patients should also eat diets with a mix of nutrients, engage in age-appropriate physical activity, and cope with emotions or stress (American Lung Association, 2022). The nurse practitioner should ensure that the patient has emotional support, positive social support, and a proper plan to live with COPD.
Patients can benefit greatly from the care that is offered by members of interdisciplinary teams. For example, patients with COPD need emotional support that can best be provided by a trained mental health professional. Nurses should also work with insurance companies to help patients enroll for medical insurance to address any financial burdens (Young et al., 2021). Nurse practitioners should use available resources to ensure functional interdisciplinary performance. Some of the interdisciplinary resources include physician offices, community resources, pharmacies, as well as family and support networks (O’Toole et al., 2022). The nurse should monitor the patient’s progress to establish whether they are benefiting in any way from these programs.
Expected Patient Outcome
The best way to establish whether the recommended treatment interventions are effective is to evaluate their impacts on the patient’s symptoms. For example, the expected treatment outcomes for a patient with COPD should include an improvement in cough, dyspnea, wheezing, and phlegm production (Choi & Rhee et al., 2020). The patient should begin to experience an improvement in symptoms after 2 weeks of drug use. However, it is important to note that an improvement in symptoms will only occur when the prescribed drugs are effective and when they are used properly by the patient (American Lung Association, 2022). The patient and the nurse will determine that the expected outcomes are fully achieved when the patient no longer experiences symptoms of COPD.
Expected Patient Outcome
Nurse practitioners should understand the levels of severity of patients’ symptoms in order to determine whether they can manage them or refer them to a specialist for a high-level care. Patients with mild forms of COPD can easily be managed in outpatient healthcare settings. Those who require admission can be hospitalized for close monitoring (Sandelowsky et al., 2021). According to Yawn et al. (2021), the nurse practitioner should stop managing a patient with COPD and refer him or her to a lung specialist when there is evidence of rapid disease progression. The nurse should perform repeated spirometry to track the patient’s response to treatment. Symptoms that may signify rapid disease progression include excessive sputum production, an increase in cough severity, and severe dyspnea which continue to persist even during drug use (Yawn et al., 2021). Referring the patient to a lung specialist will ensure that the patient receives care from a professional who has been trained to handle and treat patients with lung-related complications.
References
American Academy of Family Physicians. (2022). COPD: Clinical Guidance and Practice Resources. https://www.aafp.org/family-physician/patient-care/clinical-recommendations/clinical-guidance-copd.html
American Lung Association. (2022). COPD causes and risk factors. https://www.lung.org/lung-health-diseases/lung-disease-lookup/copd/what-causes-copd
American Thoracic Society. (2022). Pharmacologic management of COPD: An official ATS Clinical Practice Guideline. https://www.thoracic.org/statements/guideline-implementation-tools/pharmacologic-mgmt-of-copd.php
Aranburu-Imatz, A., López-Carrasco, J. C., Moreno-Luque, A., Jiménez-Pastor, J. M., Valverde-León, M., Rodríguez-Cortés, F. J., Arévalo-Buitrago, P., López-Soto, P. J., & Morales-Cané, I. (2022). Nurse-Led interventions in chronic obstructive pulmonary disease patients: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 19(15), 9101. https://doi.org/10.3390/ijerph19159101
Choi, J. Y., & Rhee, C. K. (2020). Diagnosis and treatment of early chronic obstructive lung disease (COPD). Journal of Clinical Medicine, 9(11), 3426. https://doi.org/10.3390/jcm9113426
O’Toole, J., Krishnan, M., Riekert, K., & Eakin, M. N. (2022). Understanding barriers to and strategies for medication adherence in COPD: a qualitative study. BMC Pulmonary Medicine, 22(1), 98. https://doi.org/10.1186/s12890-022-01892-5
Rodrigues, S. O., Cunha, C., Soares, G., Silva, P. L., Silva, A. R., & Gonçalves-de-Albuquerque, C. F. (2021). Mechanisms, pathophysiology and currently proposed treatments of chronic obstructive pulmonary disease. Pharmaceuticals (Basel, Switzerland), 14(10), 979. https://doi.org/10.3390/ph14100979
Roman-Rodriguez, M., & Kaplan, A. (2021). GOLD 2021 strategy report: Implications for asthma-COPD Overlap. International Journal of Chronic Obstructive Pulmonary Disease, 16, 1709–1715. https://doi.org/10.2147/COPD.S300902
Sandelowsky, H., Weinreich, U. M., Aarli, B. B., Sundh, J., Høines, K., Stratelis, G., Løkke, A., Janson, C., Jensen, C., & Larsson, K. (2021). COPD – do the right thing. BMC Family Practice, 22(1), 244. https://doi.org/10.1186/s12875-021-01583-w
Swaminathan, A., Carney, J., Tailor, T. & Palmer, S. (2019). Overview and challenges of bronchiolar disorders. Annals of the American Thoracic Society, 17(3), https://doi.org/10.1513/AnnalsATS.201907-569CME.
Yawn, B. P., Mintz, M. L., & Doherty, D. E. (2021). GOLD in Practice: Chronic Obstructive Pulmonary Disease Treatment and Management in the Primary Care Setting. International Journal of Chronic Obstructive Pulmonary Disease, 16, 289–299. https://doi.org/10.2147/COPD.S222664
Young, M., Villgran, V., Ledgerwood, C., Schmetzer, A., & Cheema, T. (2021). Developing a multidisciplinary approach to the COPD care pathway. Critical Care Nursing Quarterly, 44(1), 121–127. https://doi.org/10.1097/CNQ.0000000000000345