4.2.4: FRAME 4- Generate Solutions
- Page ID
- 90017
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The nurse comes for their weekly visit with Stanley. Upon arrival, Stanley is sitting at the kitchen table, he is short of breath and appears tired. Stanley states, “I just took my albuterol. I get so short of breath when I come back from my truck.”
QUESTION: Highlight Text
Scoring Rule: +/-
After reviewing the intake information from the home health, highlight the findings that are most concerning in the nurses note.
“After applying oxygen via nasal cannula, using his albuterol and nebulizer, vital signs were obtained. BP 142/80 mmHg, T 98.6 F (37 C.), P 80 beats/minute, RR 20 breaths/minute, Sp02 88%. Client appears less anxious. Client states it is difficult for him to eat. He does not feel hungry and has noticed his clothes fit more loosely. Client states he does not sleep well in his bed at night because he feels restless when he lies down and often wakes with a headache and shortness of breath and has recently been sleeping better in the recliner chair. Client states “sometimes it is hard to breathe when I go for my walk.” Client has smoked since he was 16 years old, quit for many years and started smoking again after the death of his brother 7 years ago...but, states he “enjoys smoking” because it “takes the edge off.”
Putting It All Together
DEBRIEF
COPD is a progressive lung disease characterized by dyspnea, frequent coughing or wheezing, chest tightness, chronic cough (that may be productive), frequent respiratory infections, lack of energy, and weight loss. The nurse recognized that it is difficult for Stanley to eat and that he does not feel hungry. Eating small frequent meals may be more tolerable for Stanley. Nutritional supplements may also help with caloric intake. Monitoring Stanley’s weight and observing trends will allow for earlier intervention of cachexia.
COPD morning headaches may be due to a buildup of carbon dioxide during sleep. The association between COPD and migraine or severe headaches may be because of headache-related sleep disturbances. Headaches related to COPD may be attributed to airway constriction. Therefore, a client with COPD experiencing morning headaches should be evaluated for sleep apnea (Minen et al., 2019).
Undernutrition is characterized by decreased body weight in clients with COPD and has been recognized as a poor prognostic factor (Rawal et al., 2015). Reduced food intake among COPD clients affects their muscle strength, which may potentially lead to worsened respiratory function and is also associated with low physical activity, which reduces skeletal muscle mass and bone tissue (Christensen et al., 2022). Undernutrition challenges the individual as well as the community, as it is associated with depression, reduced physical ability, longer hospitalizations and rehabilitation, reduced quality of life, poorer response to treatment, and increased mortality (Christensen et al., 2022).
RECOGNIZING SOCIAL DETERMINANTS OF HEALTH (SDOH)
Social and Community Context is a third SDOH domain addressed in this case study. The goal for this domain is to increase social and community support. For Stanley, social and community context includes access to adequate healthy food sources, sidewalks in good repair for safe ambulation, and cost-effective modes of public transportation. The SDOH domain, Social and Community Context, identify interventions to help people get the social and community support they need are critical for improving health and well-being.
Referrals to local community food resources such as food banks or food pantries, free meal options at shelter services, local churches, community education and outreach programs, farmers markets, and cooperative grocery stores are options. Additional resources include government programs such as WIC and SNAP. Keep in mind, access to public transportation to get to these resources contributes to limited access to healthy food and food insecurity.
What Do You Think About?
- Describe the pathogenesis of COPD.
- Differentiate COPD, bronchitis, emphysema, and asthma.
- Compare and contrast undernutrition and malnutrition?
- Identify sources in your local community for individuals who are food insecure.