Running head: CASE STUDY 1

Case Study

Student's Name

Institutional Affiliation
Case Study 2

Introduction
Chronic Obstructive Pulmonary Disease (COPD) refers to the prominent contributor to the
global causes of death which is five percent where Ninety percent of death takes place in middle-
income or low regions. Due to the important contribution of coordinated care for COPD, various
approaches have been identified that incorporate nurses (Schmid-Mohler, 2020). While COPD is
not permanently treatable, there are adequate ways like oxygen therapy and prescribed
antibiotics and bronchodilators, by which its complications can be delayed. The role of the
nurses to identify COPD, and promote reductions in complications is paramount. The following
case study reviews a patient with COPD and explores recommendations according to evidence-
based practices (EBPs). Furthermore, the theoretical frameworks for the delivery of nursing care
are explored.

Part A)
A sixty-year-old female named Jenny is identified in this case who showed herself at the clinical
center after the symptoms were seen from Chronic Obstructive Pulmonary Disease (COPD). The
patient had earlier visited the emergency room and was discharged once stabilized after which
she presented for a follow-up. The patient had started witnessing symptoms 3 days before the
acute exacerbation of her symptoms. The symptoms included shortness of breath that aggravated
while walking. The patient had been experiencing acute exacerbations at least twice every year
for the last 2 years. The patient has been using BiPAP ventilator support when going to bed.
There were no associated symptoms within the respiratory, gastrointestinal or cardiovascular
system. She also reports difficulty in breathing. Additionally, she also complains of generalized
fatigue. She has not left her bed unless to go bathroom as she fears her shortness of breath will
intensify. 

She has been a smoker with 30 pack-years histories but she stopped 5 years ago ever since being
diagnosed with COPD. She has a history of allergies since she was a child. She is currently
taking Fluticasone Furoate and Vilanterol inhaler daily, Hydralazine 50 mg thrice daily, and
Ipratropium Bromide as well as Albuterol sulfate combination every 4 hours. Other medications
that she is taking includes oral aspirin 75 mg once daily and oral Rosuvastatin 20 mg daily. She
had been diagnosed with acute-on-chronic COPD exacerbation at the emergency room and was
Case Study 3

stabilized within 2 days of admission. On further probing, her husband reported that she had
been increasingly non-compliant towards her medications. Additionally, she had not been
mobilizing out of fear that she would have shortness of breath. Her initial laboratory tests
demonstrated hypoxemia on arterial blood gas (ABG) and hypercapnia. Her sputum culture
reported Streptococcus pneumonia during the emergency room visit for which she was treated
with intravenous antibiotics. The patient was referred to her physician due to non-compliance
and lack of awareness of the disease mechanisms. 

Inside the context of this case, the Chronic Care Model (CCM) provides a robust framework to
enhance healthcare among patients with long-standing illnesses. This framework provides
adequate insight into various conditions such as COPD, diabetes mellitus (DM), and other
diseases that have a chronic yet life-debilitating prognosis. The model takes into considering
various stakeholders including patients, healthcare professionals, and the healthcare
infrastructure. Within the CCM, the nursing staff, as well as advanced nursing practitioners, are
also identified as important contributors to the care of patients (Fiandt, 2006). As COPD and
other chronic diseases deplete healthcare resources, consideration to treat the exacerbations is
targeted with limited attention to providing patient education to prevent these. Consequently, it is
important to use a multidisciplinary approach to manage COPD patients. By the CCM, the
participation of nurses, as well as other healthcare providers such as physiotherapists, is also
observed to improve cost-effectiveness. The contribution of nurses towards COPD management
is to address and promote self-care among patients (De Godoy, Nogueira & Godoy, 2016). Two
prominent areas focus for COPD that are also relevant for nurse-led approaches are self-
management as well as coordination (Schmid-Mohler et al., 2020). In the context of the UK, the
burden of COPD is well observed with the health care system and the society which consist of
819.42 pounds per single patient. In addition to this, the health care staff even failed to identify
the disease as a burden as it is misdiagnosed and un-treated (Keating, 2011). Thus, the planned
and formulated interventions are especially significant which reduce a COPD exacerbation and
considered one of the most common reasons for emergency room visits and contributors to the
financial burden within healthcare. Patients at risk of acute exacerbations can be securely and
effectively treated at home with the help of respiratory nurses (Ram, 2004). Steady and
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subsequent follow-ups after exacerbations from which nurse visits to fortify educational and
therapeutic amenability verified to stabilize COPD patients.

Part B)
COPD therapy aims to minimize the ongoing symptomatology and consequently improving the
long-term outcomes. However, COPD contains many risks of aggravation later such as
exacerbations, or mortality. The practice of COPD Evidence based on the symptoms presented in
a single patient have demonstrated that there is a variation on how to categorize COPD owing to
the wide range of pulmonary tests and lab tests (Corhay, 2014). To confirm the diagnosis of
COPD, the gold standard remains spirometry. In the case of the female presented in the given
case study, she needs to get improved non-pharmacological interventions in COPD which have
great potential. For instance, smoking leads to the decline of lungs function. Thus, she should not
be present as active nor passive smokers. Consequently, smoking cessation is shown to improve
lung function. Additionally, if she has not been vaccinated then, vaccinations including influenza
and pneumococcal have been shown to reduce the burden of respiratory infections. Another non-
pharmacological approach is incorporating pulmonary rehabilitation (Ospina, 2018). There have
been various benefits of rehabilitation including improvement in exercise tolerance, thereby
improving the quality of life for elderly patients. Besides, pulmonary rehabilitation has been
revealed to reduce the number of hospitalizations. Long-acting bronchodilators, inhaled
corticosteroids are the therapies that can cure the symptoms of COPD. In the case of acute
exacerbations, the treatment with bronchodilators, systemic steroids, and antibiotics has been
observed to improve patient outcomes (Hanson, 2020).

Physiological care and support are needed for effective recovery. People who are the victim of
COPD feel insecure and lost their hope for speed recovery (Rosa, 2018). The communication
between the emergency room, hospital staff, and primary care physician seems to be patchy.
Additionally, the patients are always under the assumption that their health information is with
their primary care physicians. Consequently, evidence-based practices under the qualitative
multiple case studies among the COPD patients recommend and ensure continuity of care,
especially for patients with COPD. According to Waibel (2015) there is a critical need to ensure
that COPD patients can maintain continuity of care. This continuity of care for COPD patients is
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relevant across community settings as well. Patients frequently present to the hospital due to
acute exacerbation. Therefore, the mortality rates among patients with COPD are high, especially
with severe disease. Most commonly, Wallace (2009) outlined that exacerbation is due to
infections where other contributors include cardiovascular or other pulmonary conditions such as
heart failure or pneumothorax. The endorsement to assess the chest through x-ray and ensuring
an arterial blood gas is obtained. Oxygen support is critical for patients who have an acute
exacerbation of COPD. In such cases, a venturi mask may be considered. It is important not
allow the oxygen saturation to be reduced below Ninety percent (Hanson, 2020). 

Part C)
The self-efficacy theory presented by Bandura has great significance for the management of
chronic diseases. The theory originated from the social cognitive theory developed in the 1970s
explains the outcomes of psychological procedures that may impact the behavior of individuals
under specific conditions (Bandura, 1977). The self-efficacy theory identifies the capabilities and
processes of people to comprehend their beliefs, emotions, and processes that impact their
behavior. The theory of self-efficacy is particularly relevant for patients with noncompliance
issues. The theory was a product of observation. Essentially, Bandura started observing human
actions, thereby developing the theory through modeling. The theory identifies the importance of
psychosocial settings to promote self-efficacy. Within the theory, various concepts require
further elaboration. The human or personal agency is identified to be deliberate and what is
conveyed to others. This agency continues to evolve throughout life. The human or personal
agency changes according to perceptions of self-efficacy. The agency is also impacted when the
environment may be created or imposed. Another concept includes expectations in self-efficacy.
Self-efficacy is identified as a belief that individuals may have critical condition in order to
promote ability to do a task. In the nursing field, self-efficacy is defined as the patients being
self-encourage in personal care. The positive belief and manners towards self-care enhance the
well-being of the patients. These beliefs are important as they promote competence for humans.
Self-efficacy is known to contribute to the behaviors of humans (Bandura, 1997). 

After adopting the theory of self-efficacy for patient survival among a group of COPD patients,
findings suggest that self-efficacy is a prominent marker of the 5-year survival rate among
Case Study 6

patients (Kaplan, 1994). Similarly, another study used the framework of Bandura's self-efficacy
theory to understand the relevance of providing educational interventions. Insight from the study
demonstrates that the application of the educational program, using the self-efficacy theory, can
be helpful to improve the immediate and long-term outcomes of COPD patients (Kasikci, 2011).
The self-efficacy theory also promotes the improvement in the quality of life of COPD patients.
The QOL is a measure that is directly related to respiratory function. Therefore, an increase in
physical health will also lead to an improvement in QOL. Using self-efficacy measures, recent
evidence demonstrates the relevance of self-efficacy theories within the COPD care of patients
(Kohler, Fish & Greene, 2002).  The disease management of COPD consists of self-management
education (SME) that further promotes self-efficacy among patients. With the lack of uniformity
across the studies, the self-efficacy outcomes from these programs remain inconclusive.
However, the self-efficacy theory, combined with patient-centered care, is suspected to improve
the self-efficacy outcomes for patients with COPD (Stellefson, 2012). 

Various scales have incorporated the self-efficacy theory to assess its correlation with COPD
outcomes (Wigal, 1991). Customarily, the nursing case can be described in a holistic way to deal
with diseases. In COPD, nurses partook in non-pharmacological approaches to diminish
symptoms and improve patients ' satisfaction, for example, stopping smoking, increasing
exercise, and lung rehabilitation. The rising burden of chronic diseases has prompted the
advancement of more complete and multimodal approaches, combining a few of the theories of
conventional nursing with instructive and mentoring interventions to improve self-efficacy and
long-term outcomes. Nurses have reliably exhibited a positive commitment to the delivery of
home-care and early discharge for COPD patients (Otuwa, 2018). Under these projects, patients
with intense intensifications are thought about at home by a specific respiratory nurse with the
help of a multidisciplinary clinic group. 

Part D)
Since COPD and other ongoing long-term illnesses place an unreasonable burden on healthcare
resources, the attention is frequently delivered to treating acute illnesses instead of more viable
and practical approaches to prevent these exacerbations. For instance, COPD treatment is
frequently observed to cater to the management of AE-COPD, while no contributions are made
Case Study 7

to instruct patients or wellbeing frameworks on the prevention of exacerbations. Thus, in absence

of contribution in the awareness among the patients in developing the frameworks for the
wellbeing and reducing the risk of poor prognosis, promoting "ideal" care for COPD fails. In this
manner, a coordinated multidisciplinary approach is required for the prevention of COPD
exacerbations (Adams et al., 2007). Three components of self-management including
educational, behavioral, and motivational have been identified to reduce AECOPD. Self-
administration strategies for implementation are often targeted in community settings to imbibe a
positive effect on the patients' everyday lives and to control tension on healthcare infrastructures.
Some nurse-led self-administration programs have promoted helpful effects regarding
diminished impromptu specialist visits, diminished patient stress, and expanded self-efficacy;
however, there is a lack of adequate EBPs to reach firm determinations about the clinical or cost-
viability of these programs (Baker, 2017). 

The recorded evidence of COPD in the health sectors showed that the rising incidence and
burden of chronic illnesses have prompted the rise of more proactive and coordinated ways to
deal with these patients across the healthcare sector (Epping, 2004). A significant consideration
for these approaches is the self-involvement of patients for their health. Regardless of certain
challenges in identifying the advantages of chronic illness self-management programs, articles
report a few advantages, and all feature the significance of healthcare workers in supporting
these practices. Within the primary sector, community nurses are adequately equipped to help
these patients, however, a change of nursing practice should happen. The primary focus during
the clinical appointment is geared toward meeting the behavioral, motivational, and educational
requirements of patients (Robinson et al., 2008). Other self-administration methodologies, for
example, giving data about diet and exercise, promoting confidence, and encouraging open
discussion, have gained less insight. During the clinical appointments, respiratory nurses may
also address and focus on these self-administration techniques (Verbrugge, 2013). 

Nursing in COPD is progressively significant and portrayed by the continuity of care. Nurses are
associated with COPD management at all stages, from prevention to end-of-life care including
patients ' homes, family practice, and healthcare settings. In the case of the given scenario, 65
years of female, need to be regularly assessed with vital function which is new models of care
Case Study 8

dependent on various sorts of telemedicine support (Kowitlawakul, 2011). Likewise, treatment

for the case is important to consider which pharmacological and non-pharmacological treatment
is suitable. The administration of short-acting beta-agonist is viewed as a first-line treatment.
However, another choice may also be an anti-cholinergic. The selection of the medication is also
impacted by the underlying diseases of the patients. Evidence demonstrates that there is no
adequate benefit of incorporating a second bronchodilator for the patients (Agusti et al., 2012).
Steroids have been shown to improve the health outcomes for patients with severe exacerbations.
As the underlying pathophysiology of COPD identifies compromised lung function, it is
important to continually change the antibiotics being received. For instance, the newest
generations of antibiotic therapy are expected to improve the outcomes for the patients.
Noninvasive positive-pressure ventilation is considered when the patients are ominous which
needs the support of respiratory. There has not been any role for the mucolytic agents or any
pulmonary rehabilitation in acute settings (Jones et al., 2009). However, pulmonary
rehabilitation may be done during the intermediate stages when COPD is not exacerbated. While
there is limited insight into the nursing roles within the management of COPD according to
evidence-based practices, various studies have examined the feasibility and effectiveness with
promising results (Fletcher, 2013).

Nurse-led consultations and management of chronic care are significant intercessions that allow
nurses to give, enhance or extend the care given by doctors. According to Healery (2016)
discussions led by experienced nurses in the 65 years old, Jenny needs regularly incorporate
inspections that generally are conducted by doctors, such as physical assessment of patients,
diagnosis, and, in nations like the UK, recommending prescriptions. Nurse-led interventions are
expected to help patients adapt to their condition and improve their satisfaction. They incorporate
patient instruction, guided self-administration, smoking cessation, and lung recovery programs.
Over the previous decade, the function of nurses in the management of respiratory illnesses has
expanded. A 2006 review portraying nurse-led COPD centers in the UK indicated that a huge
number of nurses suggested pharmacological and non-pharmacological mediations as well as
gave subsequent consideration autonomously and confirmed spirometry analysis (Bourbeau,
2006). 
Case Study 9

While there is no cure for COPD, it is pertinent to improve the quality of life of the patients. The
nurses have critical roles in managing patients that require continued care. Additionally, the
nurses may help by educating the patient to use the correct inhaler technique as it is necessary to
assess the technique (Fletcher, 2013). In case the patient is unable to inhale properly, the nurse
may offer pressurized metered-dose inhalers as these are easier to use. As in the case of the
patient, the use of oxygen therapy is necessary as in the advanced case of the patient. However, it
is important to monitor for arterial blood-gas. These insights must be offered to the patient
during the consultation. Finally, the pulmonary rehabilitation for the patient is important as she
has not been assembling adequately. Pulmonary rehabilitation may also be provided by a nurse
and it may improve the quality of life of the patient (Agusti et al., 2010). To maintain compliance
with the medications, nurses should provide insight to the patient regarding self-management.
The patient will only be able to improve her health if she remains obedient and starts getting her
pulmonary rehabilitation.
Case Study 10

Conclusion
The case study reviewed the outcomes of a middle-aged patient with COPD. The analysis
provided an overview of potential contemporary health issues that the patient had presented with.
Additionally, the evidence-based practices were explored to provide insight into the condition of
the patient. The theoretical underpinnings of nursing care were also reviewed. The final section
identified evidence-based practices relevant to the patient in the case study. The practices were
identified based on the specific requirements of the patient and the literature was reviewed to
present recent findings.
Case Study 11

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