• Angela is a 69 year old lady who was born in England and moved to Australia when she was 14 with her family. She is married and lives with her 74 year old husband, and has three daughters who live close by, and has seven grandchildren that she helps care for when her daughters work.
  Angela has a 24 pack per year history of smoking and has been diagnosed with Chronic Obstructive Pulmonary Disease, with an FEV1/FVC ratio of 52%. She quit smoking 6 years ago, but her husband continues to smoke. Her inhalers for COPD include Symbicort 400/12mcg (Budesonide and Eformetorol) and Spiriva 18mcg (tiotropium Bromide). She uses salbutamol via inhaler as required.

Angela worked as a cleaner for many years and has some arthritic changes related to the wear and tear secondary to this work. She takes paracetamol only to manage this. Angela is compliant with all medications and efforts to manage her COPD and arthritis.

On a routine visit with her GP, Angela was noted to be hypertensive with a BP of 164/96. She has been commenced on an angiotensin converting enzyme inhibitor, perindopril arginine, 2.5mg daily, to be reviewed in 4 weeks. Her weight has increased from 64kg to 72kg in the 3 months since her last review and she reports increased discomfort when mobilising, particularly from her spine. This is limiting her ability to exercise and she is now finding she is increasingly breathless when walking any distance, and is finding caring for the grandchildren more difficult.

Case Study for Part B

Angela has presented to her GP with increasing shortness of breath, increased sputum production, which has changed to dark yellow with green staining. She has been feeling unwell for several days and delayed seeking any intervention as her daughter was away and she has had 3 grandchildren staying. Her SaO2 is 84% on room air, temperature 38.4 C, she is significantly dyspnoeic, struggling to say more than 5 words without a breath. Her pulse is 104bpm and her BP remains elevated at 162/102mmHg. Angela admits she has not been diligent in taking her medication for this as she has heard friends say this medication gave them a cough and she was worried about it impacting on her COPD.

The GP has admitted her to hospital for IV antibiotics and oral prednisolone, salbutamol and atrovent nebulisers and oxygen therapy to maintain SpO2 above 92%. Angela is quite upset at being hospitalised as she feels it will inconvenience her family and leave her daughters struggling for childcare.
 This part of the assessment task requires you to develop a nursing care plan for the patient in the provided case study.  In order to do this, you will need to consider the role of the interdisciplinary team and registered nurse in the management of this patient. 

In addition to a brief introduction and conclusion, Part B of your report should include:

• A discussion of the guiding principles of health coaching, self-management, empowerment and advocacy in the collaborative management of the patient and her family, and how these can improve outcomes for them.
• 
  Develop a nursing care plan that contains three (3) nursing interventions that would be appropriate for the patient at this stage of her presentation.
• Each intervention must be supported by a rationale that explains how it is keeping with the guiding principles discussed in your report and/or how it is consistent with current best practice.
• 
  Discuss the role of the registered nurse in the acute medical ward in the management of this patient and her family. Provided an analysis of three (3) ways in which the registered nurse could collaborate with other members of the interdisciplinary team to co-ordinate the provision of holistic and comprehensive care to the patient and her family. This would include referrals to and involvement of care providers both in the acute and discharge settings for services that may be required when patient returns home.
  

Your report must adhere to academic writing conventions. Sub-headings may be used, but dot points and tables should not be included in your report.