Nursing_Assesment_and_Theory_to_Care_for_a_Patient_with_Copd

The aim of this essay is to review one patients’ health condition and to assess his needs and how the nurse can help to meet his needs during his stay in hospital. By doing this the nurse will use a number of different nursing assessments and theories. To maintain confidentiality for the patient he will be referred as Tim Jones throughout this essay (Nursing and Midwifery Council (NMC), 2008). Mr Jones is a 69 year old male and was admitted to hospital with exacerbation of chronic obstructive pulmonary disease (COPD) due to a chest infection. This patient has no allergies and a past medical history of COPD and bullous emphysema. Mr Jones lives at home in a ground floor bungalow with no social work services. He is now a non-smoker - been stopped for 15 years. Mr Jones requires oxygen therapy and regular nebulisers and inhalers. He is independent and continent, his mobility is good although nursing staff have noticed a decrease since admission. Mr Jones is a retired farmer, he did not wish to retire but due to his COPD he felt he could no longer manage. The nursing theory being used to assess Mr Jones will be the Roper, Logan and Tierney Model for Nursing. The assessments being used will be the regular admission assessments (Malnutrition Universal Screening Tool (MUST), The Waterlow Assessment Tool and the COPD Assessment tool (CAT)). On admission Mr Jones’ vital signs were recorded. He weighed in at 62.3kg and a height of 6’0”. His BMI (body mass index) was scoring at a 19. His respirations were 23 breaths per minute, his oxygen saturations were at 82% on 2 litres of oxygen, blood pressure was 129/67, heart rate was between 80-90 beats per minute and his temperature was 36.2 degrees Celsius. This was all recorded on his SEWS chart (Scottish Early Warning System). Using the MUST screening tool (figure 1) we assessed Mr Jones’ malnutrition risk and he scored a 2. This score was calculated using his BMI, weight loss score and acute disease score. This score means the Mr Jones was at a high risk of becoming malnourished, due to his COPD he found it quite difficult to perform strenuous activities of daily living and eating was one of them and the more Mr Jones did not eat the less energy he had to even attempt to eat. In Britain, it is said that six out of ten people over the age of 60 are at a risk of becoming malnourished in hospital due to the MUST screening tool not being applied correctly. (Age Concern, 2006). This tool allowed the nurses to keep observing Mr Jones making sure he was keeping himself well hydrated , as he was on oxygen therapy and regular nebulisers these treatments for COPD also can dry out a persons’ mouth and can also make it very sore, so keeping himself hydrated he was also ruling out other difficulties. The MUST score has to be re-assessed every week, as it may show signs of improvement or deterioration (DH and Nutrition Summit Stakeholder Group, 2007). The second assessment used to assess Mr Jones’ needs was the Waterlow Risk Assessment (Waterlow, 1985) (figure 2), this tool is used to highlight whether the patient is at risk of developing pressure ulcers. Due to his high MUST score; the patient was at risk of skin breakdown. This tool uses different factors of the patient -weight, sex, continence, mobility – to assess the risk, Mr Jones scored a score of 16, this means he is at a risk of skin breakdown, but not a high risk. Nurses applied holistic care here, by changing the regular mattress to a pressure relieving mattress and also making sure the patient kept changing his position and was keeping himself well hydrated. Finally the CAT (figure 3) was used to assess Mr Jones’ needs regarding management of his COPD. According to the World Health Organisation (WHO) by 2030 COPD will become one of the most frequents causes of death (WHO, 2008). Mr Jones scored a 32 on the CAT assessment, this shows that he is not managing his COPD well. So a referral to the respiratory nurse was needed to educate Mr Jones on how he can make his life and illness more manageable. Patients who have frequent exacerbations of COPD are more than likely to score higher on the CAT (Jones et al, 2009). The patient needs to redo this assessment once a week as it is a good way to show signs of improvement in the exacerbation (Rennard et al, 2002). Using all of these tools helps to identify the needs of the patient, to write appropriate care plans and to help to monitor progress or deterioration and manage the patients COPD. Using these tools and the information given on admission Mr Jones’ needs were identified as: Keeping his nutrition levels and hydration levels adequate, reducing his risk of reoccurring exacerbation and making sure his skin is in good condition so that he does not develop any pressure sores. His needs at home was assessed by the occupational therapy and they concluded that he would need help with many activities of daily living in order to keep a good quality of life and to help manage his COPD at home. The Roper, Logan and Tierney model of nursing practice is a good nursing theory to help identify the needs of Mr Jones with activities of daily living. The activities of daily living (ALs) Mr Jones needs the most help with are: breathing, personal cleansing and dressing and mobilising. Breathing is supposed to be an effortless task and is almost silent (Richards and Edwards, 2003) however Mr Jones’ breathing ability is limited due to his COPD. Mr Jones is requiring oxygen for when he is at home due to his breathing making other activities of daily living quite difficult and tiresome. The model states that someone who is often suffering from exacerbations will benefit from having regular oxygen therapy as this will increase their quality of life and will also make meeting his other needs more easy (Roper et al, 2008). The second AL is personal cleansing and dressing. In hospital, Mr Jones requires assistance with this as he is unable to manage on his own due to the difficulty in breathing that he experiences. Mr Jones said on countless occasions that he could manage on his own, but whilst he was in hospital it was clear to the nurses and staff that he was not able as he was often inappropriately dressed. With further assessment from the occupational therapist and observations from nursing staff it was clear that he was struggling with this activity as he would often become breathless. Mr Jones agreed to carers going into his home twice daily to help with this activity as it would make his life a bit easier and it would also prevent worsening of his COPD. Thomson and Norman (2006) state that even with this slight help in this particular activity can help reduce exacerbations by 27%. The final AL is aid in Mr Jones’ mobility. He was assessed by the physiotherapist on the ward and she suggested that he would benefit with the use of a zimmer frame. Without his oxygen Mr Jones always became quite breathless on exertion, although the oxygen helps with his breathlessness, it does not eliminate the problem completely. It is said that the use of oxygen therapy in those with COPD can help the person able to mobilise effectively for longer distances and live a more fulfilled life (Long et al, 2001). On the independence – dependence continuum (Roper et al, 2008) Mr Jones is scoring about the middle for all of these ALs as he is not fully independent but he is also not fully dependant as he can still manage parts of these activities independently. Mr Jones expressed on admission that he was scared about going home as he was not sure how he would cope. He feels fear could stop him from doing day to day activities and on extension this could lead to Mr Jones suffering from depression as he is not getting the social experience that a person should get. Depression affects 10-16% of people over the age of 65 (Mental Health Foundation, 2013). He also expressed sadness about having to retire early than planned due to the increasing difficulty to manage his COPD. Due to the physical activity required in Mr Jones’ job, controlling the decrease of exacerbations would be difficult, so he was advised by his GP to retire early as it would better for his physical health although Mr Jones has stated that he feels a decrease in his mental health as he isn’t out and about as much as he used to, due to increasing difficulty with managing independently. Isolation is also a big psychological factor in people over the age of 65 as research states that 27% of people suffer from isolation due to decreasing physical health (Age UK, 2013). With the help of social services and family members, Mr Jones should be able to experience the social aspects of a healthy life with COPD as well as managing his exacerbations well with the advice given by nurses and doctors. Mr Jones was discharged with a full care package and information on social groups around his hometown that should help with his prevention of becoming isolated and depressed. In conclusion, nursing assessment and theories helped nursing staff assess the needs of Mr Jones and help make reasonable adjustments to his ALs and home circumstances, making these adjustments has made Mr Jones feel a lot more confident about being discharged from hospital and managing his COPD effectively at home. Also with nursing staff just talking to Mr Jones helped to understand the psychological fears that he had about returning home and managing his COPD, but with reassurance and information available he seems a lot happier about maintaining a good quality of life but at the same time reducing the risks of continuing exacerbations.