Case history of Mr. George Williamson.George Williamson is a 72 year old man who is a lifelong smoker. 10 years ago, George was diagnosed with COPD however he has continued to smoke with this diagnosis. George has been prescribed Salbutamol; a short acting bronchodilator (SAB) to use on a PRN basis as well as an inhaled steroid which he is supposed to use twice a day.
Today you are seeing George and his granddaughter (who is his primary carer) in the respiratory outpatient’s clinic.George’s granddaughter reports that she doesn’t think that George is using his SAB inhaler correctly and often forgets to take his steroid inhaler. She says that he is too stubborn to listen to any advice on the matter. She also comments that his exercise tolerance is decreasing, and he now spends almost all of his time lying in a reclining chair at home. She is worried that his sedentary lifestyle and lack of movement may cause other health issues.
On examination, George’s wheeze is audible without use of a stethoscope. His Spo2 is 93% on room air. He is pursed lip breathing and leans forward in his chair. His spirometry results show and FEV1 of 36%. In clinic 6 months ago, his FEV1 was 42% and his Spo2 remains stable since his last clinic visit. His blood pressure is 125/60 with a pulse rate of 84. He states that his bowels feel “blocked up” and he can’t be bothered going out or doing jobs round the house anymore. He wants to know “when will this all go away and I’ll be better?”
For this essay, Review your chosen case. Using the clinical reasoning cycle you are required to assess, plan, implement and evaluate your care for the patient. After identifying the relevant assessment data you must identify two current or potential problems for your patient. For each problem identified, list two nursing interventions (collaborative/independent) linking to your research of the literature. One intervention must be nursing initiated. In collaborative interventions, you must focus on the role of the nurse. Include a one to two-line rationale for each intervention. Evaluation of the effectiveness of your interventions is essential.
Essay should cover the points below:
• Introduction: State an overview of the patient’s condition and identify TWO actual or potential nursing problems.
• For each of your identified problems: Briefly explain how it relates to the patient’s assessment data. You must demonstrate your understanding of the relevant pathophysiology to explain the link between the problem and the patient’s signs and symptoms. Identify TWO interventions to address each problem. Justify the interventions you will implement