UNIVERSITY OF LUZON

COLLEGE OF NURSING & MIDWIFERY

DAGUPAN CITY, PANGASINAN PHILIPPINES

Management of Patients With Chronic Pulmonary Disease

Name of Student: DELA CRUZ JESTIAN RYLL
Date: 8/25/21
Clinical Instructor:

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?
Explain to the client that bronchiectasis causes scarring
of the bronchi due to long term effect caused by various
lung infection or inflammation in the pass. These scarring
makes the passage or walls to be more thicker causing
difficulty of air to enter (that’s why the client is
experiencing cyanosis), mucus also accumulates through
the thick wall due to reduce elasticity of the walls
(productive cough with purulent sputum). Theres also
bronchial dilation due to destruction of the wall of the
airway which causes accumulation of mucus making the
passage narrower.

b. How should the nurse explain to the patient and family the goals of
medical management that may be used to treat the bronchiectasis?
COPD are known to be irreversible. So the main focus of
the treatment should the management of the symptoms
and slow down the progress of the disease. The medical
management of the disease will include drug therapies,
lifestyle therapies, and regular laboratory assessment.
The nurse will play a major role on providing education to
the client and its family to reduce the incidence of
increasing the progression of the disease. Example of
health teaching is proper breathing exercises, education
regarding the effects of smoking cessation.
c. What does the nursing management for bronchiectasis entail?
 The nursing management should focus on managing the
symptoms of the condition and improving the lifestyle of
the client. Some of these are: Proper breathing exercises,
teaching the client to monitor the respiratory status rate,
depth. Sputum (color, texture, odor), Proper use of
oxygen therapy, proper body positioning, effective
coughing methods, etc..

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.pdf.
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.
IF YOU EXPERIENCE AN ACUTE ATTACK OF ASTHMA USE THE
ALBUTEROL 2-4 PUFFS EVER 20 MINUTES FOR 1 HR, AND IF
THE SYMPTOMS IMPROVE, YOU CAN USE THE INHALER 4 HRS
FOR 2 DAYS. IF SYMPTOMS DIDN’T IMPROVE FOR 2 DAYS CALL
THE PHYSICIAN. FOR THE LONG ACTING MEDICATIONS, USE
YOUR INHALERS (MEDS) AS FOLLOWS (8AM & 8 PM). AT 8 AM,
TAKE FIRST THE SALMETEROL (50 MCG) AS IT DILATES THE
BRONCHI WHICH PROMOTES BETTER ABSORPTION OF THE
FLUTICASONE 2 PUFFS/12 HRS (88 MCG). AT 8 PM, DO THE
SAME PROCESS. BEFORE GOING OUTSIDE OR ENCOUNTERING
THINGS THAT CAN TRIGGER ASTHMA, SPRAY THE MEDICATION
CROMOLYN SODIUM TO EACH OF YOUR NOSTRILS ONCE DAILY
BUT YOU CAN USE IT EVERY 4 HRS IF NEEDED.
b. Explain ways to evaluate the patient’s mastery of the content?
What she will do if she have an asthma attack?
What long term maintenance medication will she take first and
what time or interval?
What are the parameters needed for her to call her physician?
What medication will she take when encountering things that
can triggers 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.

*The client stay at the hospital is limited which means the

cost of the hospitalization is also at low cost.
 *The client stayed at the ventilator for a short period of
time which is a large deduction of the payment knowing
that mechanical ventilations have a large price.

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.

*Clients are putted on mechanical ventilators to assist

clients breathing and provided with sufficient amount of
oxygen based on the clients need.

*Clients are extubated after assessing the clients GCS

(alertness), responding to commands, coughing strongly,
can breathe without assistance.

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.

The clinical lane are organized in a way that will assist in proper
fulfillment of the clinical instruction and protocols. It minimizes
the errors and copy of the deed. It assist to know the identity of
the issue from onset and rectify it appropriately. It leads to
achieve at developing the distinct of care through a numerous
disciplinary approach, thus equalized the care render to different
client base on their diagnosis or caseload.

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

progress?
 Assist the clients or people who are in hard situation. Case
manager assist with advise. Assist to sought the best service,
helps in modifying plan of care for treatment and recovery. They
also correlates with other healthcare providers to monitor client
progress during the care and the treatment plans.

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

planning patient care?

Use of oxygen for Congestive Heart failure client

- This evidence based practice curve the hypoxia

and continuous organ failure. Oxygen supply to
client with congestive heart failure is a treatment
based on evidence to boost their life expectancy.

I and O Monitoring

- Input and output are very crucial to clients with

congestive heart failure as it affects the workload
in the heart. Avoiding fluid overload can result to
lower workload on heart.