Introduction
Chronic obstructive pulmonary disease (COPD) is a terminal condition that requires prolonged support and intervention. Majers and Warshawasky (2020) identify this disease as a chronic inflammation of the lungs that triggers airflow obstruction. The leading symptoms associated with it include cough, sputum production, breathing difficulty, and wheezing (Nossum, Johansen and Kjeken, 2017). The acute exacerbation associated with this illness is what causes shortness of breath.
SMART Goal
The intended SMART goal for the patient is to address his shortness of breath by helping reduce his respiratory rate of 32 breaths per minute (bpm) to around 16 bpm within 4 days.
Three Interventions
The ultimate aim of nursing practice is to maximize patients’ experiences and improve overall health outcomes. The patient’s case presents COPD as a major pulmonary disease capable of disorienting the lives of elderly citizens (Majers and Warshawasky, 2020). Having been admitted to the hospital, the patient is on 2 liters of oxygen and his bpm stands at 32. He has been observed to have shortness of breath due to acute exacerbation (Alex et al., 2020). The interventions outlined below are proposed to deliver the identified SMART goal.
Continued Oxygen Therapy
the patient is on 2 liters of oxygen due to his shortness of breath. The first intervention for the involved nurse is to monitor the controlled therapy and ensure that he has access to oxygen (Rabe and Watz, 2017). This would be achieved through the use of a nasal cannula capable of delivering 2 liters of oxygen per minute (Alves et al., 2022). During this intervention, the involved nurse will have to ensure saturation level is around 90 percent (Sepúlveda-Plata, García-Corzo and Gamboa-Delgado, 2018). This process needs to be continued until the patient shows signs of stability (Bauer and Schiffman, 2019). Additionally, the involved professional should not discontinue the ongoing oxygen therapy unless he or she has checked the patient’s arterial blood gases (ABGs).
The nurse will be required to measure this patient’s ABGs after every 60 minutes. If the recorded PaCO2 remains normal, it would be appropriate to increase the supplemental oxygen concentration to 94-97 percent (Hughes et al., 2020). Since the patient has been diagnosed with acute exacerbation of COPD, it would be appropriate to introduce additional interventions to ensure that timely results are recorded (Silva et al., 2017). This evidence-based strategy is practical and capable of meeting the patient’s current health problems (Coronado-Vázquez et al., 2020). While oxygen therapy is recommendable, the nurse would be required to stop the process once the patient shows signs of clinical stability (Agustí and Hogg, 2019). This would be considered if he can remain stable with reduced oxygen concentrations (Asmirajanti, Hamid and Hariyati, 2019). Monitoring for oxygen saturation should be done after every 5 minutes (Williams, 2018). The time period could be increased to one hour should the patient’s remain stable after undergoing oxygen therapy.
The rationale behind the use of oxygen therapy is that it remains an evidence-based approach for helping patients with breathing difficulties. This form of therapy can reduce the signs and symptoms associated with pulmonary diseases and lung infections (Agustí and Hogg, 2019). The patient’s current health situation is worsened due to shortness of breath. The move to put him on 2 liters of oxygen and make proper monitoring will ensure that he records positive health outcomes (FitzGerald and Hurst, 2017). This strategy borrows the insights of learning objective 1 whereby nurses need to be aware of policies and health promotion approaches for impacting patients across their lifespan. This intervention will support the objective, deliver the SMART goal, and help the patient record improved health outcomes.
Opening Airways
The primary symptom associated with the patient’s COPD is breathing difficulty. The second intervention capable of delivering positive results is working with the patient to maintain the patency of the airway (Rabe and Watz, 2017). The involved nurse will introduce the management practice immediately after the patient is out of oxygen therapy (Coronado-Vázquez et al., 2020). During this period, the professional will consider and avail inhalers because they have been proven to work efficiently in people with similar medical complications (Bauer and Schiffman, 2019). Some of the best alternatives would include epinephrine and bronchodilators (Coronado-Vázquez et al., 2020). Using such medications will ensure that the airways open rapidly, allowing adequate oxygen into the lungs.
The professional can guide the patient to practice muscle training. The patient can receive additional instructions for practicing diaphragmatic breathing since it has the potential to maximize the level of alveolar ventilation (Agustí and Hogg, 2019). This method will allow more air while improving the overall expiration rate (Asmirajanti, Hamid and Hariyati, 2019). Tracey should also be part of the process to make the intervention workable and encourage the patient to remain involved (Hughes et al., 2020). In line with learning objective 1, this intervention could amount to health promotion and impact the patient’s current health situation (Sepúlveda-Plata, García-Corzo and Gamboa-Delgado, 2018). With proper mechanisms to improve breathing, better health outcomes for this patient will be recorded.
The rationale behind this intervention is that the patient’s current condition is attributed to COPD acute exacerbation and has the potential to overcome his shortness of breath (Alves et al., 2022). The actions aimed at opening the airways would lessen the symptom and ensure that the patient is able to breathe in and out more efficiently (Silva et al., 2017). The first learning objective is guiding students to identify health policies and promotions and how they impact patients across their lifespan. This specific intervention will, therefore, work effectively towards ensuring that the patient benefits from the anticipated health promotion. While the approach helps the nurse achieve the above SMART goal, it will eventually positively impact the patient across his lifespan.
Short-Term Treatment
The third intervention is informed by the patient’s acute exacerbation. This medical problem requires nurses to provide timely treatment to minimize additional health problems (Rodgers, Hoon and McAllister, 2019). With the help of Tracey, the caregiver will guide and encourage the patient to start taking the right medications to manage the condition (Gundry, 2019). In most of cases, exacerbation results in wheezing and tightness in the chest. The nurse would need to have a nebulizer in place for the intervention to be successful (Aghera et al., 2018). Additionally, inflammation of the lungs is possible due to COPD exacerbation.
The professional would need to consider whether the patient has recorded any form of lung infection. This inspection would help determine whether antibiotics are appropriate (Zhang et al., 2021). The move is essential since it will help improve symptoms and ensure that the client records positive health experiences (McGowan, Kramer and Teitelbaum, 2019). With this intervention in place, the patient will start to recover within the targeted 48 hours, thereby helping deliver the above SMART goal (Cravo et al., 2022). In terms of rationale, this intervention revolves around nurses’ ability to understand and respond to health problems associated with various chronic conditions (Marcelin et al., 2019). The second learning objective focuses on the ability to describe evidence-based practices and interventions for responding to behavioral distress proactively. The provision of proper treatment will be in accordance with this class’s aim and help address the recorded behavioral problems, thereby ensuring that positive health outcomes are eventually recorded.
Managing Complications
The process of managing complications is a form of intervention informed by the problems the patient is presently going through. He remains anxious and at times incapable to express his views and feelings about his worsening condition. With such issues, the nurse and other involved professionals will monitor the patient’s cognitive changes during the 48 hours period (Lenferink, van der Palen and Effing, 2018). Any behavioral issues or impairments in memory should be treated using the right drugs (Helvaci and Metin, 2020). This is an evidence-based practice needed to treat and manage the complications of COPD.
The nurse needs to understand that COPD is usually associated with additional diseases of the pulmonary system and that can worsen his shortness of breath. Tracey should be aware that the patient is at a higher risk of developing pneumonia and influenza (Saleem et al., 2019). As a professional, it could be necessary to secure the right drugs for such complications (Giovannoni, 2017). Throughout the intervention process, continuous monitoring would be essential to reduce challenges and eventually help improve the overall quality of the patient’s life (Gilliss, Pan and Davis, 2019). With proper interventions aimed at addressing the patient’s shortness of breath, it is agreeable that positive mental, cognitive, and behavioral outcomes will be recorded (Williams, 2018). In line with the third learning outcome, the nurse will recognize that care needs to be provided across the lifespan, identify emerging physical and behavioral health needs, and mental experiences, and eventually, provide personalized medical care. The rationale behind this choice of intervention is that it is evidence-based and resonates with acute exacerbation and shortness of breath associated with COPD.
Communication Strategy
Since the patient is anxious about his medical condition, the nurse should begin by ensuring that Tracey is part of the process. The involved individuals will begin by showing the patient where he is coming from and how positive health results are possible (Lin, Wu, and Hsu, 2019). During the identification of each intervention, the nurse should use written materials and charts detailing the best approaches (Yadav et al., 2020). The professional will consider simple language, speak charismatically, and encourage Tracey to make timely interpretations when necessary (Yearby, 2018). The nurse needs to ask questions and encourage the patient to be involved. During the process, the nurse should consider the patient’s cultural attributes that should help deliver culturally competent interventions (Ding et al., 2018). Once the client’s involvement is assured, the nurse will find it possible to engage the patient, introduce the management initiatives, and eventually support the delivery of the outlined SMART goal. When done effectively, the professional will shed more light regarding the existing health policies and guide the patient’s family to be part of the process. The strategy will also allow the patient and Tracy to be involved in accordance with the fourth learning outcome. Using proper communication strategies, it will be possible to provide personalized care and evaluate the recorded outcomes.
Conclusion
The formulated SMART goal is what will guide the interventions to ensure that the patient recovers from his shortness of breath in 4 days. With a proper communication approach, the individual will be willing to embrace the use of oxygen therapy, be involved in strategies that can improve his airways, and take the required medications (Ding et al., 2018). In conclusion, the proposed plan is evidence-based and capable of improving the patient’s life experience.
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