This case study examines undergraduate nursing and midwifery programmes, focusing on curriculum design and professional development. It explores how these programmes prepare students with essential clinical skills and competencies.
This report utilizes the ISBAR framework for clinical handover and outlines the case of Ms. Lucille Ballute, a 35-year-old patient who was admitted to the general medical ward after experiencing breathlessness while exercising, fatigue, a productive cough, and difficulty in breathing for three days. A clinical evaluation done on admission showed a raised respiratory rate, audible wheezing, and oxygen desaturation. The history of the patient includes recently diagnosed chronic obstructive pulmonary disease (COPD), along with multifactorial comorbid impediments like obstructive sleep apnoea and chronic bronchitis. There is also documentation of a history of long-term smoking, which stopped a month before admission. The diagnostic examination showed pulmonary hyperinflation, leukocytosis, along with respiratory failure and other supporting evidence of severe respiratory disease, which mandates medical and nursing management.
This study seeks to investigate the diagnosis, nursing care, and multidisciplinary care needed for effective patient treatment outcomes. A systematic effort is made to determine two primary nursing issues using clinical assessment and pathophysiology. Appropriate nursing interventions are proposed with relevant discussion of the assessment stage, intervention stage, and medication stage. It focuses on the importance of interdisciplinary teamwork while detailing a multidisciplinary discharge plan. This case study broadens the understanding of complex respiratory problems in the nursing field by applying the nursing process and critical thinking skills.
To support academic growth, we provide reference documents and sample papers that help students understand assignment structure and presentation standards. Being a professional assignment help in UK, we focus on offering ethical guidance while maintaining plagiarism-free work. The Nursing And Midwifery Undergraduate Programs Case Study Sample serves as an example to explain formatting, observations, and discussion. These samples are intended only for study and reference use.
Ms Lucille Ballute was hospitalized and sought medical attention for breathing difficulties she endured for the past three days, alongside lightheadedness and coughing. During the assessment, she was noted to have increased respiration as well as a generalized weakness. It was also observed with other nurses that her oxygen saturation level, along with the oxygen saturation level, was lower than the required normal level. In addition, the client was also observed to have chronic coughs as a result of her COPD along with chronic bronchitis and also suffered from obstructive sleep apnea alongside high cholesterol and gastroesophageal reflux disease (Wu et al. 2024). Lucille did have a long history of smoking 25 cigarettes a day for 15 years, which she recently quit. This, alongside various other factors, caused her to aggravate her respiratory impairment. The results of the diagnostic tests showed lung hyperinflation and high white blood cell count.
The development of Chronic Obstructive Pulmonary Disease (COPD) involves lung injury that results from inflammation in the airways that impede airflow. Apart from COPD, mucous bronchitis also causes airway obstruction due to excessive production of mucus, resulting in recurrent infections of the respiratory tract. Prolonged years of smoking are one of the leading causes of COPD due to airway dilation and narrowing, excessive secretion of mucus, and other structural changes of the lung (Czarnecka-Chrebelska et al. 2023). These air flow limitations progress into difficulties in breathing, gas retention, and other complications due to the high chances of infection. Another contributing factor to lung and airway restriction is the presence of obstructive sleep apnoea, which helps in hoarding oxygen and enhances respiratory work overload.
Some of the findings noted upon examination point towards acute exacerbation of COPD, including hypoxaemia, wheezing, shortness of breath, and productive cough. Gas exchange showed clear impairment, as evidenced by respiratory acidosis with metabolic compensation from ABG analysis results (Tinawi, 2021). The presence of sputum with a rusty color indicated possible cases of bacterial infection that required other examinations alongside focused treatments.
From the clinical history, pathophysiology, and diagnosis data, two priority nursing problems have been detected: Ineffective gas exchange and Ineffective airway clearance. Both nursing diagnoses are very important to manage acute exacerbation of chronic obstructive pulmonary disease (COPD), together with the prevention of further respiratory complications.
Impaired Gas Exchange
There is impaired oxygen gas exchange because of the oxygen desaturation, tachypnoea, dyspnoea, and cyanosis. An ABG analyzer output shows that there is respiratory acidosis with some metabolic compensation, which proves that insufficient alveolar ventilation and gas exchange exist (Hassan & Elkhatieb, 2024). The uncontrolled chronic inflammation of bronchi with associated mucus hypersecretion and airflow obstruction seen in COPD results in an impaired ventilation-perfusion ratio, which decreases oxygenation and increases carbon dioxide retention. If untreated, hypoxia with hypercapnia will cause respiratory failure, which requires immediate assistance. To improve respiratory function and mitigate complications, ensure proper oxygenation without allowing for hypercapnia.
Ineffective Airway Clearance
A productive cough with thick and tenacious sputum, wheezing that can be heard, and an increased effort to breathe show airway clearance problems. Mucous chronic bronchitis as part of COPD is associated with overproduction of mucus and failure to clear the secretions, which leads to obstruction and higher chances of infection (Shah et al. 2023).
The presence of sputum, which has a rusty brown color, indicates a possible infection in the lungs, further aggravating the inflammation and causing more difficulty in secretion drainage. Also observed is the poor technique of using the inhaler, which may worsen the obstruction caused by the bronchodilator and aid in maintaining the obstruction of the airway. Proper airway clearance is important in adequate ventilation, prevention of atelectasis, and further damage to the lungs.
Both nursing problems are a priority in order to protect the airway and prevent complications, and ultimately enhance the patient’s condition.
4.1.1 Nursing Assessment and Rationale
To assess gas exchange, there is a need for constant measurement of oxygen saturation (SpO₂), respiration rate, ABGs and signs of hypoxia or hypercapnia. With pulse oximetry, oxygen saturation can be measured noninvasively, allowing for the careful titration of supplemental oxygen while avoiding the chance of inducing hypercapnia. An ABG assessment is important in determining the degree of hypoxaemia and hypercapnia with the acid-base derangement and gives a clue to the ventilation-perfusion mismatch and the level of respiratory support given (Karunarathna et al. 2024).
A complete respiratory assessment encompasses observing the patient's breathing through a pseudo-normal breathing pattern, checking for the presence of head bobbing or flaring, and listening to lung sounds for wheezes and or reduced air movement. Severe hypoxaemia may lead to the patient having confusion or agitation and may need immediate action and is associated with cyanosis of lips and fingertips (Stacy, 2022). Nocturnal oxygen desaturation should be ruled out given obstructive sleep apnoea in the absence of a personal continuous positive airway pressure (CPAP) device.
4.1.2 Nursing Intervention and Rationale
For individuals with impaired gas exchange, the primary treatment is oxygen therapy, which must be administered carefully to keep the SpO₂ within 88-92% as recommended by COPD management guidelines. Oxygen therapy is mostly administered through a nasal cannula at 1-2 L/min to reduce the risk of carbon dioxide retention without compromising oxygenation. There is a need for constant supervision to evaluate response and modify treatment if required. Oxygen positioning is essential for enhancing ventilation. The semi-Fowler’s position enhances lung expansion, reduces diaphragmatic pressure, and improves oxygenation (Purnamayanti et al. 2023). Promoting controlled active breathing, such as pursed-lip breathing, facilitates better alveolar ventilation while decreasing air-trapping, thus allowing better gas exchange. Teaching energy conservation methods like pacing and avoiding unnecessary exertion can reduce the risk of aggravated dyspnoea.
The use of supervised breathing and mobility exercises early on in the plan of pulmonary rehabilitation improves lung function and increases exercise tolerance. In some cases of profound respiratory distress, oxygenation improvement and respiratory workload relief may be achieved through non-invasive ventilation (NIV) support (Grieco et al. 2021). Cooperation between physiotherapists and respiratory specialists guarantees full respiratory support integration.
4.1.3 Medication Management Implications
The primary goal is to balance bronchodilation and airway inflammation while utilizing pharmacological management. Breathlessness is rapidly alleviated with bronchodilation from short-acting beta agonists (SABAs) such as salbutamol. The inflammation and exacerbation of the airway are controlled by the long-acting beta agonists (LABA) and inhaled corticosteroids (ICS), fluticasone/salmeterol, which also aids in the stability of the airways for a longer duration (Melani et al. 2024).
The efficacy of the medication is heavily reliant on the inhaler technique, which must be executed properly. Education on the administration of inhalers and spacers will optimize drug delivery to the lower airways. Appropriate use comes with monitoring adverse effects for medication, such as tachycardia with the use of beta-agonists or oral candidiasis with corticosteroids. In light of hypercholesterolaemia and combined with the atorvastatin use, liver function becomes essential to monitor for potential drug interactions (Knežević et al. 2024). Further, adherence to nicotine replacement therapy aids in the cessation of smoking, which improves the utilization of the respiratory system and lowers the rate of disease progression.
4.2.1 Nursing Assessment and Rationale
The effectiveness of sputum characteristics, breath sounds, cough, and the general effort put into respiration to evaluate clear airways. Persistent rust-colored secretions alongside tenacious thick sputum suggest an infection and require further investigation for possible culture sensitivity testing to determine the prospective pathogen and tailor antibiotic treatment accordingly.
Coarse crackles or wheezing while breathing signify an accumulation of secretions in certain lung areas, which can be detected by auscultation of the lungs (Singh, 2023). Also, the strength of the cough is evaluated since weak expiratory force can result in the retention of pulmonary secretions. One's hydration level needs to be tracked because too little fluid intake can thicken mucus, making it more difficult to clear the airways.
4.2.2 Nursing Intervention and Rationale
Effective coughing techniques like the huff cough proximal to nebuliser therapy help in the mobilisation of secretions and prevent mucus plugging. Nebulising oxygen or saline therapy helps in loosening thick sputum, facilitates expectoration and improves sputum clearance (Youssefnia et al. 2022). Out of the mentioned strategies, providing adequate oral fluid intake is the easiest way to promote hydration as long as the patient does not have specific medical conditions, and in this case, well-hydrated mucus is easy to expectorate.
Chest physiotherapy, such as percussion and postural drainage, may assist with the mobilisation of secretions while preventing atelectasis (Main et al. 2024). This aid is provided by a physiotherapist to optimize ventilation and enhance airway clearance. Some patients with excessive secretions may require suctioning to allow airflow through the trachea. Instructing patients on how to minimize exposure to smoke or allergens as a means to prevent airway inflammation is very important to limit the severity.
4.2.3 Medication Management Implications
Ipratropium and Salbutamol are bronchodilators that aid in the relaxation of smooth muscles of the bronchial region, in addition to improving mucociliary clearance. Steroids, such as budesonide and fluticasone, lead to a reduction in the inflammation of the airways and control the hypersecretion of mucus and excessive activity of the bronchi. If necessary, mucolytic agents promote easier clearance of the mucus by lowering its viscosity (Roe et al. 2025). If there is an established bacterial infection, then antibiotic treatment allows for adherence to guidelines to reduce the chances of developing antibiotic resistance. Oral thrush from inhaled corticoids and gastrointestinal changes from the ingestible antibiotics are considered side effects that will be managed to promote proper medication usage.
Given the previously mistaken use of inhalers, direct observation of the inhaler’s usage is crucial. Guided training of the inhaler leads to a better understanding of the correct inhaling techniques, which improves the overall respiratory management. This, along with optimizing non-pharmacological treatment, guarantees effective management of drug therapy. Effective nursing management of impaired gas exchange and ineffective airway clearance requires a multidisciplinary approach (Alsaedi et al. 2024).
Cross-disciplinary cooperation is necessary in discharge planning to achieve a comprehensive approach that meets the multifaceted chronic care requirements of patients with respiratory illnesses. Collaboration among healthcare providers improves the quality of care provided, which minimizes hospital readmissions and improves patients’ overall health. With the coexistence of chronic obstructive pulmonary disease (COPD), chronic bronchitis, and obstructive sleep apnea, there needs to be a coordinated discharge plan that assists in optimizing respiratory function while managing symptoms and lifestyle changes (Alford, 2021).
Integration of medical, nursing and allied health professionals promotes a more comprehensive approach that includes medication treatment, pulmonary rehabilitation, education on inhaler use and cessation of smoking. Furthermore, interdisciplinary care addresses anxiety and therapy compliance along with other lifestyle and sociocultural aspects to aid in recovery and lower the chances of relapses.
An RN is key to discharge planning, coordination of care and education, as well as compliance with prescription treatments. An important task is evaluating readiness to be discharged by confirming that symptoms are stabilised and support systems are adequate. Interventions aimed at self-care include education on disease processes, correct use of an inhaler, use of oxygen, and motivational breathing exercises (Henriques et al. 2024). The RN also takes the role of ensuring compliance with medications by explaining the prescribed medication, possible side effects and the need for adherence to the long-term therapy.
Considering the shift to vaping and the negative effects of smoking on breathing, smoking cessation education and enrolling patients in supportive programs are fundamental to discharge planning. The RN further assists with direction on early recognition of breathing exacerbation, such as increased dyspnea, changes in sputum, and low-grade fever, so that appropriate medical care can be provided promptly. Moreover, guaranteeing that patients have follow-up appointments with respiratory specialists, physiotherapists, and GPs improves continuity of care (Pagano et al. 2024). Including family and caregivers as co-workers on the plan, and in tackling the issues of home care, allows there to work together to provide further support to self-management.
Discharge planning is a multidisciplinary process including several professionals who all work towards a successful discharge.
|
Healthcare Professional |
Role in Discharge Planning |
|
Respiratory Physician |
Manages COPD long-term, adjusts medications, and monitors disease progression through follow-ups. |
|
Physiotherapist |
Provides pulmonary rehabilitation, breathing exercises, airway clearance techniques, and mobility support. |
|
Pharmacist |
Reviews medications, educates on inhaler use, and addresses potential drug interactions or side effects. |
|
Dietitian |
Assesses nutritional needs, offering dietary advice for respiratory health and weight management. |
|
Smoking Cessation Specialist |
Provides counselling, nicotine replacement therapy adjustments, and long-term cessation resources. |
|
General Practitioner (GP) |
Coordinates chronic disease management, primary care, and early intervention for exacerbations. |
|
Community Nurse |
Conducts home visits, reinforces education, and supports adherence to treatment to prevent readmission. |
The discharge plan incorporates an interdisciplinary approach that enhances continuity of care, improves respiratory function and establishes optimal long term health outcomes.
8 Years | MSc
6. Conclusion
In conclusion, statements were made for clinical presentation, nursing care and discharge planning of an admitted patient with exacerbation chronic respiratory disorder. Thus, case documentation of these disorders included chronic obstructive pulmonary disease (COPD) and chronic bronchitis. The pathophysiology of these disorders leading to dyspnoea, increased work of breathing and body weakness as well as pulmonary congestion, was described. Two nursing diagnoses, both impaired gas exchange and ineffective airway clearance, were given. Therefore, these situations were compounded and thus needed comprehensive measures that could remedy the patient’s condition.
However, nursing care was directed to the promotion of oxygenation and avoidance of possible complications through assessment, intervention, and management of medication. Another aspect was to collaborate with other professionals in the case, particularly with the other professionals who made up the round comprehensive discharge plan to ensure continuity in care of the respiratory therapy, physiotherapy, pharmacy and other professional services. The RN was best in terms of patient education as well as symptom monitoring, and care coordination. Integration of nursing care and discharge planning leads to improvement in recovery, decrease in readmission, and patient self-management for chronic respiratory illness.
References
1.0 Introduction: Mental Health& Wellbeing in Public Services Boost your academic performance with our top-quality...View and Download
Bronchiolitis in Infants: A Nursing Care Analysis The investigation will focus on pharmacological administration, taking into...View and Download
Gender Sexual and Reproductive Health Sexual health awareness proves to be a pivotal context; despite huge importance it is...View and Download
1.0 Introduction - AHS205 The Australian Healthcare System AHS205 The Australian Healthcare System within a Global Context...View and Download
Introduction The present report will focus on comparing and contrasting three organisations dealing in food and beverages...View and Download
Introduction: Impact of Mental Health Stigma on People With Schizophrenia in UK Enhance your grades with our...View and Download
Copyright 2026 @ Rapid Assignment Help Services
