Nursing care of Chronic Obstructive Pulmonary Disease patient with Diabetes Mellitus type 2, Chronic Kidney Disease Stage 3 & Hypertension: A Case Study

Abstract

This study was a case study to take care of a COPD patient with DM, CKD stage 3 and HT. This patient was a patient receiving services at the outpatient department (OPD) of Bang Kla Hospital from October 20, 2023 to March 15, 2024. The tools were used to collect data consisted of: 1) data recording form collecting data of outpatient medical records and database on services provided at the COPD OPD 2) Assessment tool of the functional health pattern developed by Gordon and 3) Nursing record forms of the COPD OPD. The data were collected by interviewing the patient and her family caregivers and reviewing documents. The data were analyzed by using comparative content analysis with theories, concepts, and nursing principles for patients with these diseases. Data analysis used comparative content analysis with theories, concepts, nursing process and nursing principles for patients with these diseases.

Study findings: The case study was a COPD patient with DM, CKD stage 3 & HT who was an 84 year old Thai woman. She came to receive services at the hospital according to the doctor's appointment along with having slight difficulty breathing and coughing with the sound of sputum in the throat. Results of the initial assessment found that she was good conscious, appeared slightly tired, found wheezing at both lungs, BP=178/66 mmHg. In addition, it was found that the patient had been hospitalized for exacerbation 2 times in the past two years. So, the nurse developed a nursing care plan (NCP) for this patient following the step of nursing process. The top three priority of nursing diagnosis were 1) Breathing pattern ineffective related to bronchospasm and airway clearance ineffective 2) Risk for unstable blood glucose related to poor adherence to diabetes management and deficient knowledge of diabetes or treatment and 3) Potential complication: Uremia secondary to ineffective renal function and ineffective health self-management. The nurse implemented NCP into practice in caring for this patient according to patient's problems and needs and evaluated results of nursing care with 3visits during 147 days of caring for the patient. Nursing evaluation found that all problems of the patient were achieved the goal. The patient did not need to be hospitalized due to continuous care planning based on the D-METHOD principle. This principle focused on health literacy of the patient and her caregiver, and they must be able to manage the patient’s health condition through diet control, exercise appropriately and administer medication according to the treatment plan to regulator the symptoms of the disease. So, the nurses need to have knowledge and understanding about the disease, pathological of each disease, medical treatment and having skills to enhance the capacity of patients and their caregivers to be able to effectively self -health management to control symptoms of the disease. Moreover, the nurses requirement to identify patients’ problems and needs in order to plan the NCP effectively for patients safety, no complications, and having doing well in their life.