National Guidelines to consider when Treating a Client with COPD.
The discussion focus on the case of a 56-year-old white man. The client has been smoking for the last 40 years. He complains of a significant decline in the functioning of the lungs. His skin is pale, dyspneic, and he appears almost listless. He can’t sleep on the bed, making him lie on the recliner. He states that he does not have the energy to do anything, including eating. Nonetheless, the provided information is shallow to guide the healthcare provider during treatment process necessitating for more subjective and objective data.National Guidelines to consider when Treating a Client with COPD.
Additional Subjective Data
The client would share more details to enhance the diagnosis and treatment processes. First, the client would be asked whether he is experiencing shortness of breath and difficulty in breathing particularly when engaging in physical activities. Also, the client would be asked about any incident of wheezing and tightness in the chest.According to Sarkar et al. (2019), chronic obstructive pulmonary disease (COPD) is characterized by wheezes due to the vibration caused by the narrowed airway walls.Details of any chronic cough accompanied by the production of sputum will be gathered. The client would also share details about frequent cases of respiratory infections. Finally, the client would share the history of such symptoms among his family members. According to the Kaiser Foundation Health Plan of Washington. (2020), prolonged cigarette smoking, severe respiratory illnesses, the history of emphysema in the family, progressive shortness of breath, and long-term cough with or without mucus are the major risk factors of COPD.National Guidelines to consider when Treating a Client with COPD.
Additional Objective Data
More objective data would also be assessed. First, the clinician would evaluate the general appearance of the patient for cyanosis, respiratory distress, tachypnea, peripheral edema, and elevated jugular venous pulse (JVP). The lungs would also be inspected for hyperinflation. According to Sarkar et al. (2019), the deformation of the chest into a barrel-shape is a significant symptom of COPD. Besides, the percussion of the lung would be assessed for hyperresonance. The final assessment of the lung would entail auscultation to check prolonged expiration, diffusely declined breath sound and any other additional sounds such as coarse crackles with inspiration. Another assessment involves checking for any signs of backing up of the blood in the veins of the neck. Such situation might portray a heart condition. Abdominal palpation that involves tapping or pressing of the abdomen is also recommendable. More assessment would be conducted on the fingers and lips of the client to check any blue tint on the skin. Additionally, the fingers would be assessed for any swelling and bulging outward of the nails. Final evaluation for swelling would be conducted on the client’s legs and feet to rule out any case of edema.National Guidelines to consider when Treating a Client with COPD.
National Guidelines to consider when Treating a Client with COPD
The diagnosis and management of COPDrequire adherence to the set of national guidelines. Additionally, it aims at the follow-up of individuals diagnosed with COPD and the management of exacerbations associated with the condition. The latest guideline on COPDwas published by the National Institute for Health and Care Excellence (NICE) in 2010(NICE, 2020). The guidelines would be observed when dealing with cases of COPD in individuals aged 16 years and above. The guidance focuses on assisting persons with COPD to be diagnosed earlier, thus enhancing the success of the administered treatment. The successful treatment plan would, in turn, minimize symptoms associated with the condition, thus improving the overall quality of life.National Guidelines to consider when Treating a Client with COPD.
Spirometrywill be ordered to confirm the suspected COPD. This test is recommendable for all smokers aged 45 years and above. The test is particularly recommendable among individuals experiencing shortness of breath, wheezing, coughing, or persistent production of sputum.Forced vital capacity (FVC) and FEV1 are among the significant spirometric features of COPD(Mapel et al., 2015). FEV1 indicates the volume of air, which a client can breathe out in one second after a full inspiration. On the other hand, the FVC represents a total maximum volume of air that can be exhaled by an individual following a full inspiration. Less than 0.7 postbronchodilator FEV1/FVC ratios are attributed to less than 80 percent in the predicted FEV1 value. This value indicates a limitation in airflow, thus confirming COPD.
In addition to spirometry, other tests such aschest radiography are recommendable for this client. The test will specifically indicate any nodules in the lungs or fibrotic change.A complete blood count would also be recommendable to rule out cases of polycythemiaor anaemia. Finally, pulse oximetry at rest accompanied by exertion is recommended to assess for hypoxemia. Additionally, this test will evaluate the requirement for supplemental oxygen.National Guidelines to consider when Treating a Client with COPD.
Is there a need for a Consult?
As a primary care physician, it would be recommendable to consult a pulmonologist during diagnosis and treatment of this client.Pulmonologists complete an extra two to three years during their medical training. During this period, they specialize in the prevention, diagnosis, and treatment of various conditions that affect the lungs and entire respiratory systems such as asthma and pneumonia. Therefore, involving a pulmonologist during diagnosis and treatment process will enhance the overall patient outcomes and experience.
Medical and Nursing Diagnoses
The suspected COPD will be ruled out through both medical and nursing diagnosis. The nursing diagnosis will involve assessing various symptoms, including chronic cough, exertional breathlessness, frequent production of sputum, wheezing, and frequent respiratory infections. According to NICE Guideline(2019), the manifestation of these symptoms among smoker and ex-smoker aged 35 years and above portrays COPD. On the other hand, a medical diagnosis will involve various tests, including chest X-ray,sputum culture, and echocardiogram. Chest X-ray will evaluate any deformation of the chest while sputum culture will assess the production of sputum. An echocardiogramwill evaluate the possibility of pulmonary hypertension or cardiac disease. CT scan will also be conducted to testing if the presented symptoms are in line with spirometric impairment.National Guidelines to consider when Treating a Client with COPD.
Ethical considerations will be adhered to during the treatment of this client. The first ethical consideration is the principle of autonomy that states that the client should be granted the right to self-determination. Nonmaleficence is the second ethical principle, which should be considered. It states that the client should not be exposed to any form of harm. The principle of beneficence should also be considered. It states that the treatment should contribute to the well-being of the client. The practitioner should also adhere to the principle of justice, thus treating the client withfairness. The principle of fidelity is the last one, which should be considered. It states that the professional should be faithful and committed to the assigned responsibilities during the treatment process.National Guidelines to consider when Treating a Client with COPD.
Plan of Care
The recommended plan of care involves medical, nursing, and complementary therapies. The medical care entails inhaled and oral treatment. Inhaled treatment will includethe use of
devices such as inhalers to improve the overall functioning of the lungs. On the other hand, oral surgery will be considered if the inhaled treatment will not be effective in managing the presented symptoms of COPD. It will involve the use of various medications, including long-term oral corticosteroids, theophylline, and mucolytics. Long-term oral corticosteroids will be administered following an exacerbation. However, the dosage will be kept low to limit side effects. Theophylline will be considered if symptoms persist. According to NICE Guideline (2019), theophylline is recommendable if symptoms persist, and inhaled therapy is not an option. Mucolytics will be considered in the event of productive cough. Nursing therapy will involve educating the patient to avoid risk factors, specifically smoking. Finally, oxygen therapy will be recommended for this client. Long-term oxygen therapy is suitable for patients whose FEV1 is less than 30%.National Guidelines to consider when Treating a Client with COPD.
The Consideration of Healthy People 2020’s Objectives
The objectives of Healthy People 2020should be considered when dealing with this client. Specifically, the clinician should consider the aim of preventing diseases from improving the overall high-quality. This objective will be achieved by preventing the recurrence of this condition in the future by encouraging the client to stop smoking.National Guidelines to consider when Treating a Client with COPD.
The Utilization of Circle of Caring
Attaining optimum health result will require the engagement of other specialists and family members during the diagnosis and treatment of the client. First, pulmonologistswouldenhance the management of the presented symptoms since they are experienced in diagnosing and treating lung and respiratory conditions. Counsellors would also improve health results by educating the client dangers associated with smoking. Finally, optimal health will be achieved by involving the client and his family members in the treatment process. Doing so will motivate them to work towards the success of the administered treatment plan.National Guidelines to consider when Treating a Client with COPD.
Additional Patient Teaching
The required patient teaching, in this case, is about the risk factors associated with this condition. Specifically, the client should be educated that his smoking habit is increasing the risk of COPD. Therefore, quitting smoking will minimize the risk of COPD.
Recommendable Billing Codes for COPD
The recommendable billing code forCOPD is emphysema and chronic bronchitis. J44 is used to code for confirmed COPD. J44.0 is used to code for COPD accompanied by an acute lower respiratory infection(Drella, 2017).COPD with (acute) exacerbation is coded using J44.1. Finally, code J44.9 is used for unspecified COPD. Therefore, code J44.9 is the most suitable for this client since his COPD is unspecified.
In conclusion, suspected cases of COPD can be ruled out through subjective and objective data and diagnostic tests. However, it is recommendable to involve other specialists, especially pulmonologists, to achieve optimal health results.National Guidelines to consider when Treating a Client with COPD.
Drella, M. (2017). How to Code for COPD (Chronic Obstructive Pulmonary Disease). Outsource Strategies International. https://www.outsourcestrategies.com/blog/how-to-code-for-chronic-obstructive-pulmonary-disease.html
Kaiser Foundation Health Plan of Washington. (2020). History and Physical Exam for COPD: Exam Overview. Kaiser Permanente. https://wa.kaiserpermanente.org/kbase/topic.jhtml?docId=hw165182
Mapel, D. W., Dalal, A. A., Johnson, P., Becker, L., & Hunter, A. G. (2015). A clinical study of COPD severity assessment by primary care physicians and their patients compared with spirometry. The American Journal of Medicine, 128(6), 629-637.
NICE Guideline. (2019). Management of COPD (NICE Guideline): Summary of NICE guidance on COPD treatment. Mims. https://www.mims.co.uk/management-copd-nice-guideline/respiratory-system/article/882159
NICE. (2020). Chronic obstructive pulmonary disease in over 16s: diagnosis and management. National Institute for Health and Care Institute. https://www.nice.org.uk/guidance/ng115
Sarkar, M., Bhardwaz, R., Madabhavi, I., & Modi, M. (2019). Physical signs in patients with chronic obstructive pulmonary disease. Lung India: Official Organ of Indian Chest Society, 36(1), 38.
National Guidelines to consider when Treating a Client with COPD.