4.2.1: FRAME 1- Recognize Cues

Stanley is a 77-year-old male who was recently hospitalized for COPD exacerbation and pneumonia. After six days in the hospital, IV antibiotics, and oxygen therapy, Stanley was discharged from the hospital and referred to home health and pulmonary rehab. Due to the number of hospitalizations over the past six months, there is a concern about the client’s adherence to the medication regime. A home health nurse has been assigned as Stanley’s case manager and is reviewing client data and seeing Stanley for the first time today.

Recognize Cues

QUESTION: Multiple Response Select All That Apply

Scoring Rule: +/-

After reviewing the client’s information, select findings that negatively contribute to Stanley’s COPD symptoms? Select all that apply.

 Asthma

 Tobacco abuse

 Hypertension

 Poor adherence to medication regime

 History of ruptured aortic aneurysm

 Anxiety increased feelings of restlessness and perceived symptoms

Putting It All Together

DEBRIEF

Cigarette smoking is the leading cause of COPD. According to the American Lung Association (2023), approximately 75 percent of all COPD cases occur in people with a smoking history. When a cigarette burns, it creates more than 7,000 chemicals, and many are harmful. The chemicals in cigarette smoke weaken the lungs' defense against infections, cause constriction of the bronchial tubes, inflammation of the bronchioles, and destroy the alveoli, all of which are contributing factors to COPD.

Asthma and COPD are both chronic inflammatory lung diseases associated with significant morbidity and mortality. In both conditions, inflammation is associated with structural alterations at large and small airway levels. Both asthma and COPD are characterized by various degrees of airflow limitation, inflammation, and tissue remodeling (Kim & Rhee, 2010). This type of pathology is known as asthma-COPD overlap syndrome (Hikichi et al., 2018).

Breathing patterns in COPD clients result in shallow respirations. When this occurs, the brain can sometimes perceive there to be a stressful situation, even when there is not one. This can cause a stress response in the body, often referred to as anxiety. COPD clients should be encouraged to engage in psychotherapy, attend support groups, connect with spiritual communities, and talk with their healthcare providers to assist with the complex emotions that arise with the diagnosis of COPD (American Lung Association, 2023).

RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)

This case study focuses on an individual with COPD and addresses four of the five SDOH domains, Health Care Access and Quality, Neighborhood and Built Environment, Social and Community Context, and Economic Stability.

The first of the domains is Health Care Access and Quality. Stanley was recently hospitalized for a COPD exacerbation recording his sixth hospital admission in six months. Access to quality health care includes assessing if the client has health care insurance. According to Healthy People 2030, about 1 in 10 people in the United States do not have health insurance. Related objectives within the Health Care Access and Quality domain are to reduce the proportion of emergency department visits with longer wait times than recommended (AHS-09) and to increase the proportion of adults who get recommended evidence-based preventive health care (AHS-08). Prevention of exacerbations is a therapeutic goal for clients with COPD. Stanley’s scenario could factor into the population data objectives, reducing emergency department visits and receiving evidence-based preventive healthcare.

What Do You Think About?

1. How do other inhaled tobacco products, such as e-cigarettes and cigars, affect one’s risk of developing COPD?
2. What preventive services could be beneficial to Stanley?
3. Discuss health care quality and the possible association with Stanley’s recurrent hospitalizations for COPD exacerbations.