Illness in older people

Answer

Illness in Older People

Case Summary

            E.T. is a 72-year-old non-Indigenous Australian male who was presented with chest tightness and shortness of breath, which were link to exacerbation of chronic obstructive pulmonary disease (COPD). Smoking was identified as the main cause of COPD exacerbation. In addition, E.T. has a history of peripheral artery disease (PAD). Continued smoking with a history of COPD may have contributed to the damage of the vascular beds of the lower limbs, which may have resulted in development of PAD (Brusselle et al., 2016). The scope of this paper includes identification of care priorities, nursing interventions, and evaluation strategies.

Care Priorities

One of Top Care Priorities for E.T. is Smoking Cessation

This is because smoking is a predominant risk factor for COPD and PAD. In addition, smoking can also lead to exacerbation of COPD, with associated symptoms such as respiratory impairment and airway limitation (Terzikhan et al., 2018). It has also been established that smoking cessation would result in reduced risk of COPD exacerbation and improve prognosis of COPD. Besides, smoking cessation would result in improved quality of life, reduced mortality risk, reduced risk of hospitalization, reduced risk of airway obstruction, and delayed rate of decline of lung function (Bollmeier & Hartmann, 2020). On the other hand, smoking cessation would also improve PAD recovery and reduce the risk of development of symptoms such as non-healing leg ulcers, intermittent claudication, leg pain at rest, and gangrene (Terzikhan et al., 2018).

Another Care Priority is the need for Review of Current COPD Treatment Plan

            The main rationale is that use of salbutamol alone seems inadequate in managing COPD. COPD has exacerbated regardless of treatment. Exacerbation is an indication of possible treatment failure. Exacerbations of COPD are not considered as random events but tend to occur during a high-risk period. Since exacerbation of COPD is a recurring event, then future instances may be worse and debilitating to the patient. In worst case scenarios, exacerbations may be life threatening and increase the risk of mortality (Bollmeier & Hartmann, 2020).

Monitoring and Evaluation of Treatment Outcomes

            Under new treatment plan, E.T. should be monitored and evaluated frequently for prognosis of COPD and PAD. Frequency of COPD exacerbation and hospitalization should be put into consideration (Bollmeier & Hartmann, 2020). Besides, E.T. should be monitored for PAD and evaluated for possible treatment options. E.T. ought to be monitored on whether he has actually quit smoking since smoking cessation will help reduce the risk of future COPD exacerbations (Bollmeier & Hartmann, 2020). E.T. will be educated on how to take the prescribed me

Nursing Interventions

Nicotine Replacement Therapy

Smoking cessation is one of the care priorities for E.T., but in case he finds it difficult to stop smoking nicotine replacement therapy should be initiated. This may be initiated if the patient finds it difficult to stop smoking. But first four-counselling sessions aimed at helping him to stop smoking before consideration of nicotine replacement therapy. Nicotine replacement medications such as varenicline and bupropion increase the success rate for smoking cessation attempts (Flowers, 2017).

A New Treatment Plan for COPD

Since salbutamol has been established inadequate in managing COPD, E.T. need to be prescribed in but fluticasone and roflumilast should be prescribed to improve COPD treatment outcomes. Combination of fluticasone and rofllumilast would result in greater improvement of lung function (Bollmeier & Hartmann, 2020). E.T. will be educated on how to take the prescribed medications. He will have to spray fluticasone into his nostrils twice a day; that is, in the morning and in the evening (MedlinePlus, 2020). Initial dosage of roflumilast is 250 mcg PO once in a day for 4 weeks (Drugs.com, 2020). 

Patient Education to Improve Outcomes of Treatment

            Monitoring and evaluation would help identify patient education needs so as to improve treatment outcomes. The patient needs to be educated on pathophysiology, prognosis, and management of both COPD and PAD. In addition, he needs to be educated on dosage and frequency of usage of both fluticasone and roflumilast. Adverse effects of each should as well be included in this plan. Fluticasone may cause side effects such as diarrhoea, headache, vomiting, dizziness, bloody mucus, and stingy, dryness, irritation, or burning in the nose (MedlinePlus, 2020). Besides, the patient needs to be advised and his informal caregivers to be alert about worsening of side effects such as anxiety, depression, insomnia, mood changes, mood changes, and suicidal thoughts. He should seek medical attention if such symptoms are detected (Drugs.com, 2020).

Evaluation Strategies

Evaluating whether E.T. has Ceased Smoking

            Evaluation of smoking cessation will be executed using an appropriate smoking cessation smartphone application. The app will facilitate real-time monitoring and evaluation of smoking cessation. E.T. will set his smoking quit date in the app and work towards achievement of it. Besides, it allows for the patient to self-monitor smoking cessation achievements, identify smoking triggers, and self-report his achievements to healthcare providers (Luscher et al., 2019). 

Follow-up and Monitoring for Frequency of COPD Exacerbations and Association-Hospitalizations

            Follow-up will focus on evaluating the patient for medication adherence. On the other hand, the patient should be advised to report instances COPD exacerbations. Healthcare providers should also record and analyse the frequency of hospitalization due to COPD exacerbations. These will inform on whether therapeutic plan is effective or not.