- Read the SOAP notes constructed by your course colleagues.
- Review the ‘P’s posted by your peers from your advanced practice nursing role perspective (Family Nurse Practitioner). From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their ‘P’.
- Post a response individually to each of them that expresses your advanced practice nursing role perspective of their ‘P’.
Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse practitioner did your peer develop a ‘P’ that aligns with Evidence Based Practice/CPG guidelines and/or the foundational basic sciences, etc.? Please be sure to validate your opinions and ideas with citations and references in APA format. 150 word minimum.
COLLEAGUE #1 RESPONSE (Pa.Ta.)
Subjective: 89-year-old male who has a history of smoking 2 packs of cigarettes a day for 69 years. He is in your office for a general health evaluation. He quit smoking cold turkey when he was 78 years old. He reports ongoing challenges with ‘belching’ but other than that he conveys that he is feeling pretty good. He is on no routine medications. He reports a cough, particularly in the mornings with productive for thick clear to white sputum and indicates that he gets SOB more easily than he used to.
Objective: Patient has pursed lip while breathing. At times he has a faint ‘whistling’ sound associated with his respiratory effort. His breath sounds are coarse and diminished in the lower lobes bilaterally.
Assessment: Patient is suffering from Chronic Obstructive Pulmonary Disease as evidenced by his history of smoking 2 packs of cigarettes daily for 69 years, morning chronic cough with productive thick sputum, SOB, pursing lips while breathing, wheezing sound with his respiratory efforts and coarse diminished lung sounds.
Therapeutics: Unfortunately, COPD is an irreversible condition, but it can be treated to reduce symptoms and risks of exacerbations, nondrug therapy include energy conservation, stopping smoking (patient stopped smoking at age 78) and avoiding environmental irritants (Arcangelo et al., 2017). The first thing to do to figure out what would be the best pharmacological management for this patient is to categorize the patient according to the GOLD system for grading COPD into a group (A-D, depending on patients risks, symptoms and severity of airflow limitation) a spirometry is required for the diagnosis (Arcangelo et al., 2017). Once the patient is placed in a group the proper drug combination can be prescribed. The drug options are short acting beta2-adregernic agonist (like Albuterol inhaler), long acting beta2-agonist (like Arformoterol nebulizer), short-acting anticholinergics (like Ipratropium Bromide), long-acting anticholinergics (like Tiotropium Bromide), oral corticosteroids, methylxanthines (like Theophylline extended release), phosphodiesterase 4 inhibitors (like Roflumilast), there is also a combination of beta2-agonist and anticholinergic and a combination of beta2-agonist and corticosteroids (Arcangelo et al., 2017). Additional therapies for patients with moderate to severe COPD include oxygen therapy (only during activities or while sleeping or all the time, can extend life and improve life) and pulmonary rehabilitation (will combine education, exercise training, nutrition advice and counseling) (Mayo Clinic, 2020).
Educational: Patient needs to be educated to avoid outdoor exercise when pollution levels are high or when temperatures are extreme; also, patients need to know they need to be physically active since medications together with improving tolerance to exercise and overall health can improve quality of life and reduce symptoms (Arcangelo et al., 2017). The patient needs extensive education regarding the prescribed meds to treat their COPD including indication, doses, how they work, side effects and how they are delivered. Is important for the patient to know he needs to avoid medications that suppress the respiratory system like antihistamines and cough suppressants, therefore before starting any OTC, new prescription, or CAM they need to consult first with their healthcare provider (Arcangelo et al., 2017). Patient needs to be educated on how to manage acute exacerbations since delaying treatment can lead to lung failure and patient may need additional medications like antibiotics (Mayo Clinic, 2020). Patient should get their annual flu vaccine as well. Patient should be aware that his years of smoking caused his COPD therefore he should understand that he can’t smoke again.
Consultation/Collaboration: Patient should be referred to a pulmonologist who can do more extensive pulmonary function tests on the patient and can monitor his COPD in collaboration with the patients PCP. Patient should also be referred to a pulmonary rehabilitation program since they can help the patient with multiple things like needed education, exercise, nutrition, counseling and can improve the patient’s quality of life (Mayo Clinic, 2020).
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2017). Pharmacotherapeutics for advanced practice (4th ed.). Wolters Kluwer Health.
Mayo Clinic. (2020, April 15). COPD. https://www.mayoclinic.org/diseases-conditions/copd/diagnosis-treatment/drc-20353685 (Links to an external site.)
COLLEAGUE #2 RESPONSE (Em.Bri.)
89 year old man in clinic for general health evaluation. States ongoing belching, but reports feeling “pretty good”. States no routine medications. Reports quitting smoking at age 78. Reports morning coughing with thick clear to white sputum, with reported SOB more frequent than previously.
Pursed lip breathing noted with faint “whistling” sound in respirations. Coarse to diminished in lower lobes bilaterally
Assessment: Patient appears showing signs and symptoms of COPD based on breathing, reported SOB, lung sounds, coughing with sputum, and history of long-term smoking. These symptoms do not indicate that the patient is in a COPD exacerbation or crisis based on assessment findings (Bickley, L. S., 2020).
Therapeutics: The gold standard for COPD patients is to recommend smoking cessation, lifestyle changes, energy conservation, and avoidance of pollutants and irritants (Arcangelo, et al., 2017). Drugs used to treat this condition include beta2-adrenergic agonists, anticholinergics, corticosteroids, methylxanthines, and phosphodiesterase 4 inhibitors (Arcangelo, et al., 2017). This patient should be scheduled for a PFT to see the level of function and the level of disease process, and based on the group and risk, then medication can be determined.
Education: Since the patient has already made the step to quit smoking, education regarding smoking cessation will not be necessary. The patient should be educated on the irreversible nature of COPD, the symptoms of an exacerbation, and how to take medication when prescribed. He should also receive education regarding regular exercise based on activity tolerance, avoiding smoky or polluted areas, and eating a heart healthy diet to reduce cardiovascular disease (Arcangelo, et al., 2017).
Consultation: I would recommend that this patient be scheduled for a PFT and consultation with a pulmonologist to further discuss the patient’s possible disease process and recommended treatment plan.
Bickley, L. S. (2020). Bates’ Guide To Physical Examination and History Taking (13th Edition). Wolters Kluwer Health. https://ambassadored.vitalsource.com/books/9781975109943 (Links to an external site.)
Arcangelo, V. P., Peterson, A. M., Wilbur, V., & Reinhold, J. A. (2016). Pharmacotherapeutics for Advanced Practice (4th Edition). Wolters Kluwer Health. https://ambassadored.vitalsource.com/books/9781496374066
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