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Atsuto is an 80-year-old Japanese man who has lived in Australia for 25 years. He speaks limited English and lives with his wife and two sons. Both sons were born in Australia and attend university. Atsuto used to work at the Sydney Fish Market until his retirement some 10 years ago. Since then he has kept busy with his small garden in the inner suburb of Sydney. His enjoyments in life are talking with his sons, gardening and sitting on the front veranda smoking cigarettes. He does not drink alcohol but does smoke about one and a half packets of cigarettes a day and has done so since he was 17.He was diagnosed with emphysema when he was 62 caused by his smoking. His father died from lung cancer when he was 45 years old and his mother died from coronary artery disease 15 years ago. Both of his brothers also have coronary artery disease and chronic obstructive pulmonary disease (COPD). Atsuto was diagnosed about 20 years ago with hypertension and 8 years ago with COPD. His current medications are: • Quinapril 40 mg b.d. • Frusemide 20 mg b.d. • Atorvastatin 10 mg b.d. • Salbutamol 200 mcg every 4 hours when required. • ​​​​​​​​​​​​​​Prednisolone 20mg b.d Atsuto has lately been experiencing a persistent cough throughout the day. This cough is producing large amounts of tenacious green sputum. He has also been experiencing increased breathlessness, which he has been noticing as he tries to work in the garden. His wife notices that his appetite is not what it used to be and that his clothes no longer fit very well. He is looking thinner than previously. Atsuto’s sons notice this too and encourage him to go to the doctor. The oldest son, Kabuto, volunteers to go with him to act as a translator. Atsuto, his wife and Kabuto go to the doctor. Kabuto is able to translate for the doctor. They tell the doctor that Atsuto has been getting increasingly out of breath. He can’t work as fast as he used to. His cough has been getting worse and producing more sputum. On examination the doctor finds the following: • BP 155/80 • Pulse 100 • Respiration 28​​​​​​​• SP02 94% • Temperature 37.8°C • Auscultation of the chest: widespread expiratory wheeze with reduced air entry on both sides The GP has recommended Atsuto be admitted to a respiratory ward for further assessment, CXR and continued management. Atsuto was taken to hospital by his son where he has been admitted for the past 24hrs. Following a CXR Atsuto has been diagnosed with exacerbation of COPD caused by left lower lobe pneumonia. Question 1 Discuss in detail the pathophysiology of an infective exacerbation of COPD. How is this related this to Atsuto’s current condition as described above? What evidence exists to show that his condition is well managed or not well managed? Explain your rationale. Support your discussion with evidence from literature Question 2 Why is a patient with COPD at greater risk of a respiratory tract infection? Describe the pathophysiology of Atsuto’s breathlessness – include in your answer why an infective exacerbation of COPD would cause breathlessness. You should refer to pathophysiology, epidemiology (the Australian and global context) and justify your discussion with evidence from relevant literature. Question 3 Describe your priority nursing interventions for Atsuto in detail and give and explanation for why each intervention is a priority. Identify 3 priority nursing assessments you will undertake for this patient and describe why these are important How will you plan this care? Include priorities of care and argue why these are important alongside long and short term goals Identify 3 priority nursing referrals that you will make for this patient Analyse how you will evaluate the effectiveness of the interventions and include what you would expect to see and why. Use your core texts and peer reviewed journal articles form the last 5 years to support your argument. Question 4 In this section, students are required to examine the pathophysiology behind the disease process for which the patient is on oxygen. Outline why the patient in this case study is being administered oxygen. What evidence exists to show this is effective? Compare BiPAP to CPAP and discuss which would be of more benefit to Atsuto in his current condition. Explain your rationale. Use your core text books and research from the last 5 years to reinforce your work. References Please list in APA format all references used. Please note the indents used in APA are not transferable to PebblePad and it is therefore acceptable to not have an indent.
SCIENCE
HEALTH SCIENCE
NURSING
NUR 356

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