5.2.4: FRAME 4- Generate Solutions

CORRECT Answer

Question Type: Highlight Text

Scoring: +/-

NCSBN Item Type and Scoring: https://www.ncsbn.org/public-files/p...main_stage.pdf

After applying oxygen via nasal cannula, using his albuterol and nebulizer, Stanley’s vital signs are BP 142/80 mmHg, T 98.6 F (37 C.), P 80 beats/minute, RR 20 breaths/minute, oxygen saturation 88%. Stanley appears less anxious. Stanley states it is difficult for him to eat. He does not feel hungry and has noticed his clothes fit more loosely. Stanley 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. Stanley says he sleeps better in the recliner chair. Stanley states, “sometimes it is hard to breathe when I go for my walk”. Stanley has smoked since he was 16 years old, quit for a little bit....but, states he “enjoys smoking” because it “takes the edge off.”

RATIONALE

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 headache may be because of headache-related sleep disturbances. Headaches related to COPD may be attributed to airway constriction. Therefore, the client with COPD who is 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).

FOCUSED GUIDE

Differentiation of COPD, bronchitis, emphysema, and asthma are important in creating hypotheses and generating solutions for a plan of care and treatment. Mosenifar (2022) published the Venn diagram below and describes signs and symptoms for differential diagnoses, considerations for pulmonary rehabilitation, and indications for admissions. This is an excellent resource to facilitate classroom discussion.

The Venn diagram below outlines chronic obstructive pulmonary disease (COPD). Chronic obstructive lung disease is a disorder in which subsets of clients may have dominant features of chronic bronchitis, emphysema, or asthma. The result is airflow obstruction that is not fully reversible (Mosenifar, 2022).

Nutritional support for clients with COPD results in malnutrition or, specifically, undernutrition. Malnutrition refers to deficiencies, excesses, or imbalances in a person’s consumption of energy and/or nutrients. Malnutrition includes undernutrition. Undernutrition includes four sub-forms: wasting, stunting, underweight, and deficiencies in vitamins and minerals. Undernutrition makes individuals more vulnerable to disease and death, especially in children (World Health Organization, 2023a).

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).

A third SDOH domain addressed in this case study is Social and Community Context. The goal for this domain is to increase social and community support. For Stanley, social and community context includes access to an adequate amount of healthy food sources, sidewalks in good repair for safe ambulation, and cost-effective modes of public transportation. The SDOH domain, Social and Community Context, identifies interventions to help people get the social and community support they need, which 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 the limited access to healthy food and food insecurity.