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NURSING INTERVENTIONS TO PREVENT POST-OPERATIVE COMPLICATIONS IN COPD PATIENTS.
Term Paper ID:29917
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Discusses a number of stratgies & intervention nurses can employ to prevent complications after surgery for Chronic Obstructive Pulmonary Disease (COPD),... More...
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Paper Abstract:
Discusses a number of strategies & interventions nurses can employ to prevent complications ater surgery for Chronic Obstructive Pulmonary Disease (COPD). Description of COPD including prevelance, conditions, symptoms. Sociodemographics & medical profile. Risks. COPD education. Examines nursing interventions including exercises & weight loss program.; psychosocial support. Value of physical assessment data. Nursing applications.
Paper Introduction:
NURSING INTERVENTIONS TO PREVENT POSTOPERATIVE COMPLICATIONS IN COPD PATIENTS
Introduction
Madison, and Irwin (1998) define Chronic Obstructive Pulmonary Disease (COPD) as a sort of umbrella term that refers to a large group of lung diseases which can interfere with normal breathing. In their discussion of the various illnesses that are associated with the condition, COPD Support (2001), notes that there are three basic conditions which COPD patients can suffer from: emphysema (the progressive destruction of the grape-like sacs that exchange oxygen in the air for carbon dioxide); chronic bronchitis; and chronic asthma. Not all patients have all three conditions, although a few do.
In a report issued by the National Institutes of Health
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Topics covered in the paper include: COPD education, exercises ofupper and lower extremities, breathing exercises, and psychosocial support.The paper ends with the development of conclusions based on the reviewedresearch and personal consideration of how the writer might use thisinformation as part of nursing practice. Palestra, 16(4), 39-47. Further, this intervention canactually improve the patient's exercise performance which, in turn, allowsthe patient to optimize the benefits of any exercise program in which he orshe is currently enrolled. Whitsel (2 ) recommends that patients be given lots ofencouragement to remain in the program. Lewis (2 ) also recommends that any pulmonary rehabilitationprogram include a physical component such as exercise and also both apsychosocial component (e.g., support groups, individual counseling) and aneducational component in which patients learn facts about their conditionand how to manage it. Thus they can be considered interdependentinterventions which may or may not require a physician's order but are theresult of the health care providers involved with the care of the client. They also engaged in psychosocial interventions consisting of offeringpatients' ongoing support and encouragement. Interventions were found togreatly reduce the risk of complications when compared with a group ofpatients who did not receive this program. Based on assessment data and in consultation with relevant healthpersonnel, those interventions most likely to reduce the patient's risk ofpost-operative complications would be selected. Nursing diagnoses provide the basis for selection of nursing interventions to achieve outcomes for which the nurse is accountable (p. According to Madison and Irwin (1998),there are several interventions which will reduce the risk of acuteexacerbations following surgery as well as just generally reduce the riskof any complications arising that are related to COPD. The NationalInstitutes of Health also state that the most common causes of COPD, whilenot fully understood, include: smoking, air pollution, occupationalexposures (especially if combined with cigarette smoking) and heredity. Madison, J. Conclusions Based on the reviewed literature, the first conclusion that can beformulated is that prior to the selection of one or more nursinginterventions for the prevention of post-operative complications in COPDpatients, there should be a thorough assessment of the patient's physicalstatus and that this intervention should include pyschosocial informationsuch as gender and ethnicity as part of the assessment of physicalvariables. As to the sociodemographic and medical profile of these patients,extensive evaluation of a given patient is required in order to become acandidate for one of these procedures, which are performed only in majormedical centers. Lewis does note that of all the exercisesavailable to COPD patients, the most important of these is aerobic trainingthat includes lots of exercise of the arms and legs. About COPD. Patient Care, 34(1 ),6 -74. These interventions include: (1) Chest physiotherapy (CPT) which is a means of clearing the lungsof accumulated mucus. As people lostweight, they experienced greater gains in exercise capacity and enduranceperformance. National Institutes of Health. Glaspole, Gabbay, Smith, Rabinov and Snell (2 ) report that forsevere, far-advanced COPD disease, some patients may benefit from dramaticand very expensive therapy such as surgical lung volume reduction or evenlung transplantation. Document available at: www.nursingworld.org Gravil, J. Nursing. NURSING INTERVENTIONS TO PREVENT POSTOPERATIVE COMPLICATIONS IN COPD PATIENTS Introduction Madison, and Irwin (1998) define Chronic Obstructive PulmonaryDisease (COPD) as a sort of umbrella term that refers to a large group oflung diseases which can interfere with normal breathing. Symptoms of COPD are said to include: shortness of breath; cough andsputum (occurring for many years before the development of shortness ofbreath; frequent respiratory infections: cyanosis, abnormal lung songs,swelling of the feet and heart failure (National Institutes of Health,2 1). & Irwin, R. (September 3 , 1998). Regarding these interventions, itcan also be concluded that the literature emphasized that most of theseinterventions be accompanied by ongoing monitoring and assessment ofpatients' progress using a good variety of outcome measures as only in thisway will nurses be able to document patient success or lack thereof.Further, such data will provide nurses with information relevant to whetherany given patient should be kept in a particular program of intervention orstarted on another intervention that would be more beneficial. In theirdiscussion of the various illnesses that are associated with the condition,COPD Support (2 1), notes that there are three basic conditions which COPDpatients can suffer from: emphysema (the progressive destruction of thegrape-like sacs that exchange oxygen in the air for carbon dioxide);chronic bronchitis; and chronic asthma. Clark also recommends thatonce this exercise training is started, nurses must continue to monitor thepatient on a variety of outcome measures such as skeletal muscle adaptationand so forth in order to make sure that gains are being made. (2 1). Gordon, M. The categories proposed by Gordon which would be used in theassessment of COPD patients are the categories of: nutritional/metabolicprocesses; elimination processes; activity and exercises processes;cognitive/perceptual processes; sleep/rest processes; self-perception/self-concept processes; role/relational processes; sexuality/reproductiveprocesses; coping and stress tolerance; and values and beliefs. al (1998) had nurses conductan ongoing assessment and monitoring of their COPD patients' progress usingspirometry and oxygen saturation in the home health care setting. (1998). (1997). In this regard, Gavil, Al-Rawas, Cotton, Flanigan, Irwin andStevenson (1998) discuss interventions nurses used in the home health caresetting with COPD patients. (1998). M. Specifically, in a study of 13 patients enrolled in a 12-weekcomprehensive pulmonary rehabilitation program that included a weight losscomponent, Whitsel (2 ) found several positive outcomes. Nursing Interventions In terms of interventions to prevent post-operative complications inCOPD patients, the first step that must be taken is a complete assessmentof the patient. It is recommendedthat all of the suggested interventions by undertaken as part of anintensive and dependent management processes in which nurses essentiallywork under doctors and follow their orders. H., Al-Rawas, O.A., Cotton, M. I.(2 ). Specifically, in their study, Gravil et. Annals of Thoracic Surgery, 69(6), 1711-1716. Another risk is the amount of anesthetic timerequired with longer times being associated with greater risk. Document available:www.springnet.com. A second conclusion of the study is that there are severalinterventions from which nurses can select for their patients and that thepatient need not be restricted to any one particular type of intervention.Rather, a comprehensive intervention program is likely to be optimallyeffective. S. Lancet, 348(9 35), 1111-1112. Body weight and other factors affecting successin pulmonary rehabilitation for individuals with emphysema and chronicbronchitis. Nursing nomenclature andclassification system development. Inaddition, nurses engaged in psychoeducational interventions in which theyprovided patients with information about COPD and how to live well with it. Clearly, one post-operative complication that should be prevented isthe possibility of acute exacerbations of patients' conditions which canlead to respiratory deterioration. North American Nursing Diagnosis Association, 1997-1998. Glaspole et. (2) Supplemental Oxygen Therapy which can be given through a gascylinder or an oxygen concentrator. Physical measuresconducted to determine who may fit selection criteria include assessmentsof arterial blood gases, prednisolone use, pulmonary function tests, 6-minute walk test, and anesthetic time. Not all patients have all threeconditions, although a few do. Whitsel, L. In a report issued by the National Institutes of Health (2 1), it isestimated that approximately 13.5 million Americans have COPD, and that itis now the fourth leading cause of death in the United States. COPD Support, Inc. Caring for a patient with COPD: How to helphim breathe once the damage is done. Glaspole, I. J. It was, however, noted that such a program is vulnerable to drop outin large numbers. Hanson, M. D. Predictors of perioperative morbidity and mortality in lung volumereduction surgery. As to what interventions are available to nurses, examination of theliterature indicates that nurses should consider: chest physiotherapy,supplemental oxygen therapy, providing patients with information about COPDand its management, providing patients with support groups and other formsof relevant psychosocial counseling, pulmonary rehabilitation, long-termoxygen therapy, and weight loss programs. What Gordon (1998) proposed was a way at looking at diagnosticassessment that includes developmental, cultural, gender and illness-related considerations in the process of examining physical variables andtheir impact. They also decreased their need for oxygen titration at restand experienced decreased breathlessness at higher workloads. This assessment is most likely best accomplished by usingGordon's (1998) Function Health Pattern classification for assessmentdeveloped for The North American Nursing Diagnosis Association (NANDA).What Gordon (1998) observed is that a diagnosis is a conceptual model forinterpreting a set of observations in order to provide organization forunderstanding these observations as they relate to diagnosis of any kind.In this regard, NANDA (1997) states that a nursing diagnosis is: a clinical judgment about individual, family, or community responses to actual or potential health problems/life processes. What is COPD?. Restrictive selectioncriteria are also used for those having lung transplantation with thesecriteria sometimes varying from medical center to medical center. Home treatment of exacerbations of chronicobstructive pulmonary disease by an acute respiratory assessment service.Lancet, 351(9119), 1853-1855. While neither of these procedures cures COPD, eachmay be helpful for a small select group of patients with life-threateningstages of the disease. It is said to be the comprehensive program that trulymaximizes positive outcomes. Lancet, 352(9126), 467-474. These interventionscover a wide range of exercises such as aerobic training, multi-gymexercise programs, and isolated peripheral muscle training. 1). She also calls upon nurses not torule even severely compromised patients out of pulmonary rehabilitationprograms as her findings suggest that the program can considerably andpositively impact upon the progression of their disease. The most common COPD patient is an older male who smokes and whosuffers from a degree of both bronchitis and emphysema (Hanson, 1997). However, as to which exercises are best for a given COPD patient,Clark (1996) states that assessment of the patient's current physicalstatus (e.g., of his nutritional status, skeletal muscle functioning) aswell as his/her psychosocial status is needed. N., Gabbay, E., Smith, J. (2 ). Thesecomplications, according to Lewis (2 ) include: pneumonia, rightventricular heart failure, and respiratory failure. While these interventions were done dependentlyas the result of doctor's orders, they can also be done independentlywithout a physician's order. Documentavailable:/www.nhlbi.nih.gov/ health/public/lung/other/copd/copd_toc.htm. Article available: www.copd-support.org. M., Flanigan, U., Irwin, A.& Stevenson, R. It is here recommended that the assessment be conducted usingGordon's (1998) Function Health Pattern classification for assessmentdeveloped for The North American Nursing Diagnosis Association (NANDA). Optimal treatment for COPD. (2 1). Philadelphia:Author. It is alsonoted that existing research on exercise training for samples of COPDpatients have shown that the interventions are strongly contributive to theprevention of deteriorating nutritional status, impaired muscle function,and depressed psychosocial functioning. A key question that can beasked here is: What are the major nursing interventions recommended forpreventing complications in COPD patients? Lewis, L. One of these is said to be body weight. Chronic obstructive pulmonarydisease. References Clark, C.J. (2 ). Is pulmonary rehabilitation effective forpatients with COPD. However, Whitsel (2 ) points out that if the interventionis to be maximally effective, there are certain additional factors to whichnurses must attend. (1998). Lewis (2 ) recommends a variety of interdependent interventionsthat can be used to prevent complications in post-operative COPD patients.The first of these is long-term oxygen therapy that Lewis states has beenestablished to reverse secondary polycythemia and alleviate right heartfailure resulting from cor pulmonale. Nursing World: Online Journal of Issuesin Nursing. Further, such programs should include a weightloss component; such a component being an interdependent intervention whicha nurse can provide under a doctor's order or can undertaken independently. Clark (1996) presents an analysis of several nursing interventionswhich help post-operative COPD patients achieve significant improvement inpulmonary capacity. al (2 ) state that selection criteria are derived inan attempt to reduce the risk of post-operative complications. As can be seen from the foregoing literature, exercise is often arecommended intervention for preventing post-operative complications inCOPD patients. & Snell, G. S. (1997).NANDA nursing diagnoses: Definitions and classification. In particular, Clark recommends "exercise training"consisting of a series of interdependent interventions. The recommendation for a weight loss component is based on solidfindings. The risk of postoperative complications leading to mortality andmorbidity in patients who, otherwise, might have lived as the result ofsurgery makes it imperative for nurses to have a thorough understanding ofinterventions associated with preventing postoperative complications inCOPD and provides the justification for this paper's focus on a discussionof these interventions. Psychoeducational and psychosocial interventions can also operate toreduce post-operative complications of COPD patients as anxiety anddepression often accompany the condition, making the patients' life notonly difficult but operating to depress patient compliance with managementefforts. A., Rabinov, M. Whitsel (2 ) reports that any exercise intervention for COPDpatients must assess whether body weight is a factor in exercise capacityand variance in outcomes. With respect to lung volume reduction surgery, the currentselection criteria are very restrictive; only 2 -4 percent of COPDpatients considered have qualified in the past. It uses gravity and physical therapy to help move thesecretions out of the lungs and stimulate coughing. As age increases, the authorsreport, so does the risk of complications with people over 65 beingespecially vulnerable. Commonly, CPT involvesclapping with the cupped hand on the chest wall, the use of vibration(accomplished either with the hand or with mechanical vibrators), deepbreathing exercises, and exercises related to helping the patientaccomplish an adequate cough.
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