NRP/555: Adult And Geriatric Management I Wk 8 Discussion – COPD
NRP/555: Adult And Geriatric Management I Wk 8 Discussion – COPD
See attached and below. Wk 8 DQ Respones 1 & 2 Instructions NRP/555: Adult And Geriatric Management I Wk 8 Discussion – COPD • Post 1 reply to each of the following discussion responses from classmates or your faculty member. Be constructive and professional. • Each reply must be minimum of 175 words each. • Each response must have at least 1 scholarly peer reviewed reference or textbook listed below under references. • Must cite and list references in APA 7th edition format. Wk 8 DQ Response 1. Please reply as instructed above. Early diagnosis of COPD is essential for lifestyle changes including smoking cessation and symptom control (Dunphy et al., 2019). When a patient is diagnosed in the later stages smoking cessation is vital slow the rate of declining lung function and should be discussed in depth with the patient (Dunphy et al., 2019). NRP/555: Adult And Geriatric Management I Wk 8 Discussion – COPD. This patient has been diagnosed with severe COPD which is a Grade C and the patient should be managed according to the most current guidelines. Dunphy et al. (2019) explain that the 2017 GOLD Guidelines suggest a long-acting muscarinic antagonist (LAMA, or if exacerbations continue, switch the patient to LAMA + LABA or LABA + ICS. Since this patient was diagnosed with severe COPD, he should be seen by his provider monthly and then annually once stable (Dunphy et al., 2019). If the patient meets the criteria, he may also need to be put on home oxygen (Dunphy et al., 2019). The patient qualifies for home oxygen if they (1) have a resting oxygen saturation less than 88%, or a PaO2 of 55 mm Hg or less or an oxygen saturation below 88% and (2) a PaO2 of 55 to 59 mm Hg with congestive heart failure, edema, erythrocytosis or cor pulmonale (Dunphy et al., 2019). The patient’s O2 goal is 90% or greater which usually can be done with 1 to 2 L of oxygen per minute. Education is vital as it is with any newly diagnosed condition and the patient should be reevaluated with an ABG or oximetry at 1, 3, and 6 months and then annually (Dunphy et al., 2019).
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Reference Dunphy, L., Winland-Brown, J.E., Porter, B.O., & Thomas, D.J. (2019). Primary Care: The art and science of advanced practice nursing (5th ed.) Philadelphia: F.A. Davis. Wk 8 DQ Response 2. Please reply as instructed above. The GOLD standard stands for the Global Initiative for Chronic Obstructive Lung Disease. This standard helps providers to diagnose COPD and serves as a guideline for treatment options. COPD is defined as “COPD is a common, preventable and treatable disease that is characterized by persistent respiratory symptoms and airflow limitation that is due to airway and/or alveolar abnormalities usually caused by significant exposure to noxious particles or gases. ” (Morroq, 2018). More specifically, it is a combination or small airway disease and parenchymal destruction. NRP/555: Adult And Geriatric Management I Wk 8 Discussion – COPD. Bronchodilators are still the treatment of choice for COPD patients. For episodic symptoms a LABA or LAMA are recommended. For persistent symptoms and LABA & LAMA are recommended.In patients which exacerbation’s, LABA & LAMA or LABA & ICS are recommended. For future exacerbation’s, roflumilast or macrolides are recommended, specifically in smokers. The revisions made to the GOLD standards in 2017 are intended to simplify the process so providers can individualize treatment for patients. Success would be measured by a decrease in exacerbations. Reference Morrow, R. (2018, February). New GOLD standard in COPD guidelines. World of Irish Nursing and Midwifery, 26(1), . https://web.b.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=7&sid=ee145ac6-c115-4123-91c3-11b83d8cc923%40pdc-v-sessmgr03. NRP/555 Textbook Dunphy, L. (2019). Primary care: The art and science of advanced practice nursing (5th ed.). F.A. Davis. Original Discussion Questions to have the entire scenario or idea of DQ responses. Imagine you are examining a 65-year-old man who smokes 40 packs of cigarettes in a year. He complains of shortness of breath. Spirometry finds he has severe obstructive nonreversible lung disease. • Which treatments would you use after consulting the GOLD standards? Which would you do first? • How would you measure success? • How would you handle the situation if the patient does not have insurance? NRP/555: Adult And Geriatric Management I Wk 8 Discussion – COPD
