Copd

COPD
Chronic Obstructive Pulmonary Disease (COPD) is a lung disease that makes it hard to breathe. COPD refers to two lung diseases, emphysema, and chronic bronchitis and is an obstruction to breathing that decreases air exchange in the lungs. Emphysema does not always coexist with chronic bronchitis. Asthma, Pulmonary Fibrosis, or Pulmonary Hypertension is not diagnosed as COPD.
Some people may think they simply have a "smoker's cough" or that breathlessness is just a part of getting older. It may be nothing serious or it may be an early symptom of COPD. A good idea is to get these symptoms checked out by a Physician. When a patient is diagnosed with COPD, they have already lost part of their lung function. If COPD is diagnosed and treated early better results will occur with this chronic disease. Healthy airways have elastic air sacs in the lungs, making it easy for air to move in and out quickly. Chronic inflammation can be caused by exposure to smoke and can cause the lungs to thicken and lose their elasticity. The airways cannot widen when more air is needed, and thick mucus forms. This typically causes coughing that may be associated with mucus, wheezing, shortness of breath, chest tightness, and other symptoms. The educational research for COPD included websites from the American Lung Association, National Institute of Aging, National Asthma Foundation, National Institute of Health, course material, and self-knowledge of COPD from years of critical care experience. COPD is also a personal morbidly that I live with every day, and had to relocate to a milder climate to prevent advancement of mild COPD.
The personal impact of COPD can be devastating. The lack of activity intolerance because of shortness of breath (SOB) can be in varying degrees depending on what stage the patient currently possesses, according to the American Lung Association (ALA) the four stages of COPD: * Stage One – Mild COPD * Chronic cough with some mucus production * 80% normal lung function * Stage Two – Moderate COPD * Chronic cough with copious mucus production * Shortness of breath with exercise * 50-79% lung function * Stage Three – Severe COPD * Fatigue and reduced ability to exercise * Severe flair-ups * Chronic cough with copious mucus production * 30-40% lung function * Stage Four – Very Severe COPD * Weight loss * Blue skin color of the lips, fingertips, and toes (called cyanosis) * Life-threatening flair-ups * Chronic cough with copious mucus production that is difficult to clear even with medications and cough * Lung function of less than 30% along with chronic respiratory failure with carbon dioxide retention
The personal impact upon the patient may depend on what stage of the disease is present. Stage One COPD symptoms included shortness of breaths, stop for a minute, and able to continue desired activity. This is the hardest stage to education because they do not feel a chronic disease is present because of lack of symptoms. COPD gets worse over time, and damage to lungs cannot be undone. Stage Four is end-stage COPD. Most end stage COPD patients are confined to a bed or wheelchair, oxygen on at all times, and still SOB at rest. Taking care of end-stage COPD patients and watching them die struggling to take their very last breath is tramautic for even the most seasoned nurse.
The social impact of COPD can depend on the stage present. Mild COPD may mean only occasional SOB periods but still can achieve most activities and interactions with society and social events. In, contrast, Stage Four COPD a patient could be on Hospice, confined to his bed or house with supplemental oxygen at all times rendering him unable to attend social events. With end stage COPD a patient cannot tolerate even the shortest visitation because of the inability to breath and talk. This leaves the patient even more isolated and depressed.
The financial aspect of COPD can be very costly to both employers and individuals. The following statists are from the ALA: * In 2008, $13.1 million U.S. adults were estimated to have COPD. However, close to 24 million more were under-diagnosed with COPD * Estimated 672,000 hospital discharges were reported in 2006 * 64% of hospital discharges were age 65 or older * 51% COPD patients say the disease limits their ability to work, etc. * In 2010, the cost to the nation for COPD was projected to be $49.9 billion, including $29.5 billion in direct health care expenditures, $8 billion in indirect morbidity costs and $12.4 billion in indirect mortality costs
COPD is a disease with progressive SOB episodes. The initial learning process of COPD should include extensive information about medications, Pulmonary Rehabilitation, nutrition, and health protection (vaccines). Also included in the educational process teaching method by Redman assess the patients’ readiness to learn an evaluation of the teaching process (Redman, 2007). 1. Assessment of need to learn 2. Assessment of motivation 3. Diagnostic statements and setting of objects with patient 4. Teaching-Learning 5. Evaluation and re-teaching if necessary
If these steps are not followed the patient teaching process will not be accomplished. The patient teaching education will not be effective leaving the patient virtually uneducated or even resistant to future education. In this situation the patient would not control symptoms and further advancement of COPD could occur.
COPD patient diagnosed decades ago recently complained of increasing frequent episodes of SOB with activity. I ask her if she had been doing her pursed-lipped breathing exercises when she became SOB. She stated that she had never heard of this procedure. A demonstration with exaggerated diaphragm breathing over the phone was performed and the patient joined the breathing demonstration. Then she performed the purse-lipped breathing exercise on her own as in a teach-back method of education. Follow-up completed by the Health Educator included mailing the patient education material with the process explained. The next communication with this same patient resulted with her explaining how much this purse-lipped breathing exercise has improved her quality of life. The patient also expressed much gratitude in taking the time to explain and teaching the process.
There are many educational therapy modes for patient education. The Health Belief Model and the Transtheortical methods describe motivation in educating the patient (Redman, 2007). If the patient is not motivated for learning the diagnosis teaching process will not occur and injury could occur because of lack of treatment modalities.
The Health Belief Model describes patients are not likely to take a health action plan until they are susceptible to the disease symptoms and when the benefits of action outweighs the barriers (Rosenstock, 1994). Patients are motivated to learn if experiencing a severe exacerbation of the symptoms. In patient educational practices the health belief model is used to assess if an individual holds these resistances to education and to direct teaching at missing skills of information. This model address different levels of disease with the same educational processes. It is always a panic when a COPD is very SOB and the stress of not able to breathe warrants treatment with medicine or oxygen, depending on the stage of the COPD. Most COPD patients are reluctant to use medication. Just passing by someone smoking, a stray dog or cat or unexpected physical exercise of chasing down a favorite pet can bring on unwanted COPD symptoms. Most restaurants, employers, and government buildings have no smoking policies or a designated smoking section.
The Transtheortical Method (Redman, 2007) describes motivation and has been successful in chronic condition education in various stages of a disease. This theory is different from the Health Belief Model as the Transtheortical Method can change motivation according to the level of the disease discussed and to use different process of educating a patient at different stages. In the earlier stages patients’ decisions to let COPD remain untreated are stronger than in later stages. In later stages of COPD actions and treatments are required to ease the mode of breathing. The Transtheortical Method insists an individual instructional strategy be matched to the current stage of the disease for individuals who are ready to actively participate in their disease process education.
COPD is a chronic disease patients can learn to self-manage with the proper education strategy, attitude, and access to health care. The key is early detection with life-long 2education.