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Integrated nursing care about a person suffering from COPD disease


Task: Present evidence-based case study focusing on a person with a long term condition or acute illness, who is at risk of acute deterioration. Show how the understanding of psycho-social as well as physical symptoms contributes to individualised assessment and person-centred care.



COPD is a chronic health disease that disturbs the lungs and brings difficulties in breathing properly and which over time also affects the other body parts. It often occurs to a person who smokes adequately and this affects the health of the person massively.As per the reports, the third highest number of death in the global region is caused by COPD disease which accounts for 3.23 million deaths in a year. In the US many adults were diagnosed with COPD disease which accounts for nearly 14% in 2017. More than 80% of the population suffering from COPD face shortness in breath (Elflein, 2021). The chosen case study for the essay is a fictional case where a person is suffering from COPD disease and is severe condition. Chris Stevens a person with COPD disease taken in the essay is a fictional name and is not a real person.Psychological, emotional care etc. has to be provided to a patient for improving their health and reducing the level of anxiety and depression in the patient.In the essay pathophysiology, psychological, coping strategies, potential deterioration and appropriate nursing assessment is discussed.


Pathophysiology refers to the identification of irregular changes in the body functions because of the acute disease suffering by a patient. The pathophysiology of acute illness in a body of a patient recognises the three main effectors which include trauma, infection, and ischemia-reperfusion injury. The pathophysiology of acute illness is a generalised process that activates the coagulation systems and immune-inflammatory systems with the production of diffuse tissue and damage in organs (Arlati, 2018).COPD or Chronic obstructive pulmonary disease is a treatable disease which is caused by a progressive limitation of airflow and destruction of tissues. It is caused by prolonged contact with harmful gases and is mostly caused by smoking cigarettes.A person suffering from COPD experiences pain in their body as the lungs are affected and find difficulty breathing (Roland, 2018).There are main two conditions in COPD i.e. chronic bronchitis and emphysema which affects the different parts of the lungs and makes it difficult in breathing properly.As per the case of Chris Stevens the 70 years old male is suffering from COPD and is facing various health issues in his body. He suffered severe COPD 9 years ago according to his medical history and respiratory failures 2 years ago. From his medical history, it has also been identified that at the age of 45 years he used to take 1 packet of cigarettes a day which he stopped around 9 years ago after being diagnosed with COPD disease. A person with COPD disease over time gets worse and affects the many parts of the lungs which make it very difficult in breathing with acute pain in the chest.The effects of prolonged COPD are not limited to airways and lungs but with time it leads to bring various additional diseases which include heart disease, depression and osteoporosis. Exacerbation is one of the common types of COPD disease that affects the respiratory system with prolonged COPD infection in a patient (Califano, 2018). As per the medical report, Chris Stevens suffering from COPD finds difficulty in sleeping and has chest pain the medication provided to him is home oxygen, bronchodilators and oral steroids. Furthermore, he is also experiencing anxiety and depression which is a common symptoms that a person faces with prolonged COPD.A person with COPD may bring difficulties in breathing due to the development of mucus causing them to clog, refractory asthma, chronic bronchitis etc. which is very harmful.As per the medical report of Chris Stevens he use to smoke regularly or could be said he was a chain smoker due to which he developed COPD disease and other additional diseases (Wu, 2019).The other physiological change that occurs due to prolonged COPD is the development of hyperinflation which happens due to the expiratory flow restriction that is triggered by the lung's elastic recoil reduction and increase in airway struggle.It upsurgesthroughout physical exercises and acute exacerbation and has a vital negative impression on the respiratory muscles. A person with prolonged COPD faces Hoover’s chest sign which is the paradoxical inspiratory indrawing of the lateral rib cage (Sarkar et al., 2019).

Acute deterioration

Acute deterioration includes the physiological changes that occur in the mental state. A person living with prolonged COPD may face shortness of breath and pain in the chest which causes anxiety, depression and panic Attacks. Anxiety and depression are some of the comorbidities in COPD patients and their effects on mortality, quality of life and exacerbation rates are recognised (Miravitlles & Ribera, 2017).The common diseases of COPD are emphysema and chronic bronchitis. Bronchitis causes the irritation and contraction of respiratorypipes and emphysema gradually abolishes the air sacs in the lungs. A person experiencing COPD finds shortness of breathing and its symptoms include shortness of breath and intermittent coughing. Acute exacerbations, tightness and wheezing in the chest, weight loss, swelling of ankles cough without mucus etc. are also the symptoms of COPD disease (Pietrangelo, 2014).A person with COPD overtime experiences various challenges that affect their physical and mental health and proactively and timely management is imperative for reducing the worsening of the disease progression (Stellefson et al., 2019).As per the medical reports of Chris Stevens who is 70 years old with prolonged COPD has faced issues in sleeping, chest pain and depression and anxiety. Furthermore, it is evident that a person may deteriorate his health and the disease because of the underlying additional health issues he is facing. Chest pain, depression and anxiety and is admitted to the hospital because of COPD exacerbation the medications provided to him are home oxygen, bronchodilators and oral steroids which identify that he might deteriorate in his physical and mental well-being.Anxiety is often linked with clinical depression in COPD patients and this can have a high risk to suffer from comorbid clinical anxiety. As per the reports, COPD patients with anxiety varies from 2 to 80% and depression varies from 7% to 80% and is a health issue which can significantly deteriorate the disease of a patient (Tselebis et al., 2016). It has been identified from the medical reports that Chris Stevens the patient used to smoke 1 packet ofcigarettes in a day which is very harmful to the lungs and is also the main developer of COPD in human health. Anxiety-related conditions in COPD patient is generally linked with reduced purposeful ability and rehospitalisation. The research also identifies that the respiratory rate gets increase with anxiety resulting in low breathing pattern which worsens dyspnea in COPD patients. A patient with COPD may have various kinds of symptoms ranging from short terms depression or adjustment condition with depressed mood to dysthymia. A person with COPD and depression and anxiety has higher chances of getting hospitalisation and exacerbations and may face death (Yohannes et al., 2022).Therefore, Chris Stevens has anxiety and depression and he might deteriorate his physical health and mental well-being and is imperative to take care of his health issues from getting worse.

Assessment and care

Chronic obstructive pulmonary disease (COPD) is a prolongedillness that distresses the lungs and is mostly caused due to excessive smoking of cigarettes. Anxiety and depression are common issues that are with COPD patients.It has also been identified that the death rates from COPD are increasing due to the failure of the healthcare system in addressing the problem. Anxiety disorders in COPD patients are identified using established diagnostic criteria like DSMˆ43 or ICDˆ44 criteria while the symptoms are identified through formal psychological instruments like Hamilton Anxiety rating Scale.The diagnostic tools for depression in COPD patients are ICD-10ˆ44 and DSM-Vˆ79 which help in identifying the level of depression a patient is facing (Bandelow et al., 2017). A patient with COPD has a spectrum of symptoms which includes short-term depression or dysthymia to major depression.There are various tools that are used in identifying the status of depression and anxiety in patients with COPD.One of the widely used assessment tool is the distress thermometer which helps in identifying the performance of patients and the level of distress they have and in identifying the progress in their health issues.

Distress Thermometer

A distress thermometer is also one of the useful tools that are widely used by healthcare professionals to screen a person suffering from stress. It is a single tool that is used to assess the distress level of a COPD patient with a scale of 0(no distress) to 10(extreme distress) using a thermometer. It is one of the significant tools that are completed by a patient in quantifying the level of stress they experienced in the past week. The tool is used for people suffering from cancer to identify the level of stress they are experiencing and in providing effective medications and therapies based on the stress scale report (Geerse et al., 2019). It is evident that people suffering from COPD may face distress and according to his medical history, Chris Stevens is suffering from anxiety which affects his physical and mental health. Therefore, it is imperative for healthcare professionals to provide a Distress thermometer to measure the extent of distress a patient is facing. It is a simple screening scale tool which is easy to understand and scale the distress in patients. It can be completed within five minutes and can be used to reassure patients that the health care providers in interested in their mental well-being in all aspects. The implementation of a Distress thermometer allows healthcare professionals to take possible interventions for patients and improve their health. It has been identified as one of the most significant distress-warranting assessment tools for psychological services (Makuch et al., 2019).

Integrated psychological care

Anxiety and depression are key issues that COPD patient faces when they are going under certain treatment programs and this impacts their physical and mental state massively.The two integrated features are anxiety and depression which the patient Chris Stevens is facing in his health.

Emotional:Anxiety and depression also affect the emotional well-being of a patient suffering from COPD disease. A person suffering from COPD faces emotional health which includes feeling of fear and sadness and this impact the health outcomes of the patient. Furthermore, the emotional aspects affect the health of the patient and the nursing care. Health professionals have to work on taking different strategies for managing the emotional aspects of patients and improving their health.

Psychological: Anxiety and depression are some of the issues that are faced by COPD patients and psychological intervention helps in bringing improvement in their thinking and reducing anxiety and depression (Anlló et al., 2022).Anxiety and depression impact the psychological aspects of patients and may not be able to focus properly on their health improvement.COPD has a major impact on the psychological well-being of the affected people and has a high chance of anxiety and depression than other normal people (Pumar et al., 2014). The increasing anxiety and depression affect their mental health and their improvement in health gets decreased massively and this impacts the patient suffering from COPD.

Cognitive behavioural theory

Cognitive behavioural theory is one of the relevant that theory that suggests that emotions, behaviours, thoughts and body sensations are connected and this affects the way a person feels.It allows focusing on ways in which a patient conceptualises the health threats and the factors that serve as a barrier to treatment. Health behaviour theories play a significant role in planning and implementing health improvement programmes (Adefolalu, 2018). Anxiety and depression are some of the health issues that affect the emotional and psychological aspects of a person and nursing care.From the case study, it can be said that the patient was suffering from emotional and psychological aspects as he was facing anxiety and depression which is considered a barrier to the health improvement of apatient. As per the theory, it is essential that nursing care has to be changed for managing the health of the patient and various other therapies have to be implemented for their health improvement.


COPD is one of the significant health issues and is a major cause of mortality and morbidity in the global region.Coping strategies like medications which include Home oxygen, bronchodilators, and oral steroids are being provided to a patient for his recovery from the disease. Medication is one of the significant parts that are to be provided to a patient for their health recovery (Brien et al., 2016).According to the case study, Chris Stevens is a 70years old retired person and use to smoke 1 packet of cigarettes in a day which he topped 9 years ago. Furthermore, he also faced respiratory failure 2 years ago but is coping with the healthcare professionals to cure the disease. He consumes alcohol occasionally and has a wife and a daughter but has not disclosed his religion and sexuality which he may not be comfortable sharing. From the case study, it could be said that he is coping as he has stopped smoking and is working on getting better. Again due to the worsening of the COPD disease he is facing health issues and this has affected his mental and physical state. One of the greatest anxieties related to COPD is fear of death and suffocation which influences the coping capacity associated with the disease. However, fears, concerns and beliefs of patient related to the disease symptoms brings complications like prolonged stress and anxiety which further decreases the immune system. As per the case study, Chris Stevens was suffering from difficulty insleeping, anxiety and depression and chest pain and acute COPD exacerbations. The coping includes providingthem with emotional and psychological support to improve their health and reduce the extent of anxiety and depression in them. Therefore, it is imperative to provide effective coping to a patient for improving their health and bringing growth and changes in their mental and physical well-being.Fear, beliefs and concerns regarding health disease symptoms bring stress and weaken the immune system and bring cardiovascular disease and other diseases which can bring a person to death. It significantly influences their capacity to cope with symptoms linked with long-term disease. For the management of COPD adequate coping styles and strategies are required for improving the health of the patient. In COPD patients the coping styles and strategies are identified on the basis of the anxiety and depression levels that patients have (Stoilkova et al., 2013).From the case study, it can be identified that person left smoking as he got COPD disease and drinks alcohol occasionally and this affects their health massively.In COPD disease spirituality and religiosity are considered coping strategies which help in improving health. Religiosity defines the use of beliefs, faiths, values and practices and spirituality permeates the questions regarding the meaning of life and its real purpose (Nascimento et al., 2019).


COPD is one of the serious and chronic health issues which have affected many peoplein the global region. One of the main reason that people faces COPD health disease is because of adequate smoking which brings difficulties in breathing with acute chest pain. The disease over time gets worse and this leads to bringing other additional health issues which deteriorate the health of a patient. In the case study, it has been identified that a person with COPD has exacerbated issues and is facing sleeping difficulties, chest pain etc. which has to be treated properly. It is important that a patient with COPD has provided proper medications and other healthcare therapies which help in reducing anxiety and depression and an effective nursing care plan.Healthcare professionals and nurses with effective coping strategies and proper medications etc. can help in improving the health of the patient suffering from COPD disease.


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