Analysing factors associated with successful treatment.
Case Study Overview
This case study involves a patient named R.W, a 64-year-old Caucasian postal clerk who has smoked a pack of cigarettes a day for the past 35 years. He reports to his CNP in his family practice clinic. He presents with progressive difficulty getting his breath while doing simple tasks. He is having difficulty doing any manual work, but he has no symptoms when working behind his desk. He also reports a cough, fatigue, and weight loss. He has been treated for three respiratory infections a year for the past 3 years and feels like another one is developing now. On physical examination, you notice clubbing of his fingers, use of accessory muscles for respiration, wheezing in the lungs, and hyper resonance on percussion of the lungs. Pulmonary function studies show an FEV1 of 58%. Analysing factors associated with successful treatment.
ORDER HERE A PLAGIARISM-FREE PAPER HERE
Discussion
Diagnosis
The most likely diagnosis for R.W is Chronic Obstructive Pulmonary Disease (COPD). COPD is primarily characterized by a continuous limitation in the flow of air, and destruction of lung tissues. It is also associated with structural changes in the lungs that are a result of chronic inflammation from prolonged exposure to toxic gases and particles most specifically, cigarette smoking. The inflammation causes narrowing of the airways and a decrease in the lung recoil.Analysing factors associated with successful treatment.
Stage of Disease
Newsome et al., (2018) refer to the GOLD guidelines on the diagnosis and staging of COPD based on the level of obstruction in the flow of air as measured by spirometry, breathlessness, and symptoms. According to these guidelines, the stages of COPD are based on how decreased an individual’s FEV1 spirometry score. The CNP grades the COPD from grade I to grade IV. Grade I is mild COPD where the FEV1 value is 80% or more. Grade II is moderate COPD where the FEV1 value ranges between 50%-79% (O’Reilly, 2016). In stage III, the FEV 1 value ranges between 30%-49% and is deemed to be severe COPD. In the last stage, stage IV, the FEV1 value is less than 30% and deemed very severe. Therefore, since R.W has an FEV1 of 58% alongside his signs and symptoms, he has moderate COPD. Analysing factors associated with successful treatment.
Pharmacotherapeutics Treatment Goals
The pharmacological management of COPD is one of the most integral foundations of COPD management. The overall goal of COPD management is improving an individual’s quality of life (QoL) and functional status by improving symptoms, optimal lung function, and preventing the occurrence of exacerbations. This requires that a CNP should be able to recognize the impact that symptoms have on the life of a patient as part of patient-centered management (Patel et al., 2019). Therefore, for this patient, the main pharmacotherapeutics treatment goals are; relief and resolve of respiratory symptoms of cough, wheezing, and fatigue. He will also be able to perform manual work, simple tasks, and Activities of Daily Life (ADL) normally. His FEV1 will also increase from 58% to 80% and more. Analysing factors associated with successful treatment.
Prescription Drug Therapy
GOLD guidelines recommend that the pharmacological intervention of patients in GOLD group A (mild) should be managed with a short-acting beta2 agonist or a short-acting anticholinergic. Patients in GOLD group B should be managed with either a long-acting beta 2 (LABA) agonist or a long-acting anticholinergic (LAMA) as the first-line (Lee et al., 2013). Those in GOLD group C or D should be managed with combined therapy of an inhaled corticosteroid and a long-acting beta 2 agonist or a long acting anticholinergic. The guidelines further recommend that to increase the effectiveness of pharmacotherapy, CNPs should recommend smoking cessation for all patients with COPD who smoke (Patel et al., 2019). Analysing factors associated with successful treatment.
In comparison, guidelines by the American Thoracic Society (ATS) and the American College of Chest Physicians (ACCP) recommend that patients with an FEV1 of 60% to 80% should be managed with inhaled bronchodilators. Management for those with an FEV1 < 60% should include a long-acting beta2 agonist or a long-acting anticholinergic (Fernandes et al., 2017). Since R.W has an FEV1 of 58%, he should be managed with a long-acting beta2 agonist or a long-acting anticholinergic based on the ATS/ACCP guidelines (FEV1 &l
Order this paper