Assignment 1: Foundation to Clinical Scenario:

Robert is a 51 year elderly person who lives with his significant other in provincial Victoria. He has been conceded to your ward from the Intensive Care Unit (ICU), where he had a multi day stay for an intense compounding of COPD, brought about by local area procured pneumonia. He required a few days of non-obtrusive ventilation while in ICU. Robert discloses to you his better half (Jill) was extremely terrified when he was conceded to ICU, and he doesn't have any desire 'to get her through that any longer'. He might want some assistance to comprehend and deal with his COPD. Robert said he was determined to have COPD around year and a half back by his GP, yet concedes he was debilitated for 'some time' before that. He is a current smoker, and has smoked for around 40 years. He has ineffectively endeavored to stop on in excess of 5 events. Robert worked for a long time on his chicken ranch, yet now discovers he becomes short of breath effectively and Robert and Jill have needed to enlist a homestead assistant. Robert's prescriptions include:

 

Salbutamol 2 - 4 puffs PRN

 

Budesonide/Efomoterol fumarate dry out 2 puffs day by day

 

Metoprolol 25mg every day

 

Ibuprofen SR 100 mg every day

 

Pathophysiology.

 

1: Describe the pathophysiology of COPD. Remember for your answer the two sickness measures contained in the umbrella term ' COPD' and how they create.

 

Robert has been determined to have an extreme intensification of COPD, brought about by Community-Acquired Pneumonia.

 

2 Explain the term 'intense intensification of COPD'. What variables put patients like Robert at high danger for intensifications of COPD? What else may add to a compounding of COPD?

 

Question 3

Discuss widely the effects of Pediatric transfers that help kids live more, more typical lives?

 

Question 4

Question

 

Foundation to Clinical Scenario:Robert is a 51 year elderly person who lives with his better half in territorial Victoria. He has been conceded to your ward from the Intensive Care Unit (ICU), where he had a multi day stay for an intense worsening of COPD, brought about by local area gained pneumonia. He required a few days of non-obtrusive ventilation while in ICU. Robert reveals to you his better half (Jill) was exceptionally terrified when he was conceded to ICU, and he doesn't have any desire 'to get her through that any longer'. He might want some assistance to comprehend and deal with his COPD. Robert said he was determined to have COPD around year and a half prior by his GP, yet concedes he was debilitated for 'some time' before that. He is a current smoker, and has smoked for around 40 years. He has ineffectively endeavored to stop on in excess of 5 events. Robert worked for a long time on his chicken ranch, yet now discovers he becomes short of breath effectively and Robert and Jill have needed to recruit a homestead assistant. Robert's drugs include:

 

Salbutamol 2 - 4 puffs PRN

 

Budesonide/Efomoterol fumarate get dried out 2 puffs day by day

 

Metoprolol 25mg day by day

 

Anti-inflamatory medicine SR 100 mg day by day

 

Pathophysiology

 

1. Describe the pathophysiology of COPD. Remember for your answer the two illness measures contained in the umbrella term 'COPD' and how they create.

 

Robert has been determined to have a serious fuel of COPD, brought about by Community Acquired Pneumonia.

 

2. Explain the term 'intense fuel of COPD'. What variables put patients like Robert at high danger for intensifications of COPD? What else may add to a compounding of COPD?

 

3. Describe the pathophysiology of pneumonia. Remember for your answer the contrasts between Community Acquired, Hospital Acquired and Health Care Associated Pneumonia.

 

Pharmacology

 

The Respiratory Physician who explored Robert in ICU proposed a few changes to his present inhaler system. The doctor recommended that Robert stop his Budesonide/Efomoterol fumarate dry out, and start on Tiotropium 2 puffs every day.

 

4. For every one of the three inhalers (Salbutamol, Budesonide/Efomoterol fumarate get dried out and Tiotropium), depict the

 

Component of activity in COPD

 

Contraindications and Adverse Reactions

 

Nursing Considerations and Patient Education Points

 

Remember for your answer why the respiratory doctor may have changed Robert's medicine system.

 

Robert was determined to have Community Acquired Pneumonia, and Streptococcus pneumoniae was refined from his sputum.

 

5. Identify three anti-toxins that could be utilized to treat Streptococcus pneumoniae for Robert's situation. For every anti-infection, portray the

 

Instrument of activity

 

Contraindications and Adverse Reactions

 

Nursing Considerations and Patient Education Points

 

Psychosocial issues

 

6. Discuss three proof based intercessions to assist Robert with dealing with his COPD."

Pathophysiology

 Pathophysiology of COPD:

 

 Chronic Obstructive Pulmonary Disease (COPD) is an umbrella term that encompasses two main conditions: Which are chronic bronchitis and emphysema.

 Chronic bronchitis results in the inflammation of the bronchial tubes, and the consequent production of more mucus, coughing and constriction or narrowing of the velocity of air being transported into the lungs.

 Emphysema is characterized by the destruction of The alveoli, thus destroy the area that is used to exchange gases and the inability to expel air, in essence blowing up the lungs.

 The two lead to airflow obstruction which is chronic, partly reversible and is associated with breathlessness, recurrent periods of chest infection, and low oxygen saturation.

 Acute Exacerbation of COPD:

 

 Acute exacerbation of COPD therefore , means a worsening of the condition to a worse state than normal fluctuations that patients experience on a daily basis, which might be characterized by shortness of breath, cough and increased production of sputum.

 The triggers that are known to cause worsening of chronic obstructive pulmonary disease symptoms include smoking especially tobacco use, respiratory infections including influenza, air pollution, and other chronic diseases such as heart failure.

 Poor medication adherence and exposure to environmental irritants and untreated comorbid conditions are other causes of COPD exacerbations.

 Pathophysiology of Pneumonia:

 

 Pneumonia is an inflammation of the lung tissue characterised by the presence of alveolar exudate, which interferes with the exchange of gases.

 CAP is acquired in a non-hospital setting and S. pneumoniae is one of the sources that lead to it.

 HAP is a pneumonia that occurs 48 hours after admission to a healthcare facility and the etiologic agents are usually more resistant.

 HCAP is pneumonias in patients with history of exposure to healthcare facilities within the preceding 90 days and may involve MDR coccal pathogens.

 Pharmacology

 Inhalers in COPD Management:

 

 Salbutamol:

 Mechanism of Action: An SABer that is quick-acting selective agonist of the beta-2 receptors, helps in the relaxation of the bronchial smooth muscle.

 Contraindications & Adverse Reactions: Should not be administered for patients with allergy to salbutamol; side effects include increased heart rate, muscle shaking, and racing heart.

 Nursing Considerations: Look for features suggesting overuse, teach the correct way of using the inhaler, and check for improvement of symptoms.

 Budesonide/Formoterol:

 Mechanism of Action: Budesonide is an inhaled corticosteroid that inhibits the release of inflammatory mediators and ‘formoterol slow-release’ is an inhaled LABA that brings down smooth muscle tone in the airways.

 Contraindications & Adverse Reactions: Should not be given during an acute asthma attack or wind; known side effects are oral candidiasis, hoarseness, and potential system effects such as suppression of the adrenal axis.

 Nursing Considerations: Mind the client about the importance of rinsing the mouth after using the mouthwash to reduce the occurrence of oral thrush, check up on him/her for side effects, and remind him/her to stick to the prescribed regimen.

 Tiotropium:

 Mechanism of Action: An anticholinergic of long-acting stern, which prevents muscarinic receptor and as a result, leads to bronchodilation, and decreased mucus production.

 Contraindications & Adverse Reactions: Should not be used in patients with hypersensitivity to tiotropium or other anticholinergic agents; side effects associated with this drug are dry mouth, constipation and urinary retention.

 Nursing Considerations: Teach client/patient about the correct technique of using the inhaler, observe for side effects of anticholinergic agents and evaluate level of breathing.

 Rationale for Medication Change: It is viable to assume that because Formoterol is combined with Budesonide there is a need of a long acting bronchodilator with practically no systemic corticosteroid side effects for the long term treatment.

 Antibiotics for Streptococcus pneumoniae:

 

 Amoxicillin:

 Mechanism of Action: An antibiotic belonging to the group of beta-lactam which actually interferes with the synthesis of bacterial cell wall thus causing cell disruption and death.

 Contraindications & Adverse Reactions: Coadministration with erythromycin is reported to cause QT prolongation; other side effects include nausea, vomiting, diarrhoea and rash.

 Nursing Considerations: Safeguard nonadherence to the total course, supervise for allergy, and warn for side effects.

 Clarithromycin:

 Mechanism of Action: An erythromycin derived macrolide with bacteriostatic activity that works by binding to the 50S subunit of the bacterial ribosome.

 Contraindications & Adverse Reactions: Is contraindicated in sevelamer thus should not be used in patients with hypersensitivity to macrolides; the side effects include gastrointestinal disturbances, prolongation of the QT interval and there may be potential interactions with other drugs.

 Nursing Considerations: Watch and await for drug interactions, teach the patient, the effects of which are reduced with food intake, and consider the effectiveness of the medication.

 Ceftriaxone:

 Mechanism of Action: A third generation cephalosporin antibiotic that is bactericidal by blocking bacterial cell wall synthesis and triggering cell wall enlargement and ultimately cell autolysis.

 Contraindications & Adverse Reactions: Clinical use contraindicated for patients allergic to cephalosporin; side effects are gastrointestinal disturbances, allergy and phlebitis at the site of injection.

 Nursing Considerations: For the group that received an allergy shot / injection: observe for reactions and instruct on completion of the full course, and injection technique.

 Psychosocial Issues

 Evidence-Based Interventions for COPD Management:Evidence-Based Interventions for COPD Management:

 Smoking Cessation Support: Give advice and support to patients for smoking cessation which may involve counseling, use of nicotine replacement products or varenicline. Controlling the dependency on nicotine is a viable way of attenuating the diseases’ advancement.

 Pulmonary Rehabilitation: It is recommended that Robert attend pulmonary rehabilitation that involves exercise training, teaching as well as behavior modification aimed at enhancing physical fitness, lessening the ability of breathing difficulties and thereby improving the quality of life.

 Psychosocial Support: Provide counsel for psychological disorder like anxiety, depression, and fear that result from COPD. The who propositions, such as Jill, should be considered in the care plan to assist with coping with the affective stressors of chronic illness.