Running head: SENIOR HEALTH PROMOTION 1

Senior Health Promotion Project

Jennifer Salmon

Bon Secours Memorial College of Nursing

Tamera Krukiel, RN, MSN, ANP-BC, PMHNP-BC

NUR 4113

November 12, 2017

I pledge…
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Senior Health Promotion

The person interviewed for his project is an 81-year-old female with a pretty insignificant

medic al history. She is a retired insurance adjuster who lives in a single-family home with her

husband of 63 years. The patient is a smoker who smokes “about a half a pack a day.” Her

husband is a non-smoker and she states that she has smoked for as long as she can remember.

The amount she smokes has changed over the years but is currently around half a pack a day.

Overall, the patient feels like she is in good health. She has a family history of heart

disease, diabetes glaucoma and Chronic Obstructive Pulmonary Disease (COPD). Her current

medical conditions include venous stasis disease and COPD. She admits to having some

breathing issues from time to time; she describes this as a “flemy” cough that happens every now

and then. She has seen a pulmonologist for this issue and reports having a bronchoscopy to clear

out the mucus. This medical condition coupled with her COPD is the focus of this paper and

teaching plan.

A goal of Healthy People 2020 is to “improve the health, function, and quality of life of

older adult” (Health People). One of the focuses of this goal is to improve the management of

chronic conditions to improve quality of life and help older adults maintain their independence

while managing these conditions. A big focus of this is prevention and long-term care. Ensuring

that older adults know the steps, and take them, to preventing complications with illnesses and

training more health care providers to treat older adults and their conditions will go a long way in

helping older adults live longer, more fulfilling lives.

After interviewing this patient and discussing her health conditions and goals, the focus

of education and interventions was focused around her COPD and her struggle with increased

mucus production. The diagnosis of Ineffective Airway Clearance was identified by both myself
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and the patient as an important focus for education and changes in behavior to increase the health

quality of the patient. This focus is important for the patient because she struggles to feel as if

she breathes well enough and increased congestion is a source of concern and frustration for her.

Short term and long-term goals were discussed with the client and collaboratively, we

decided on a few. The short terms goals of being able to verbalize and understanding of what

causes the disease and being able to describe two ways that she can help alleviate the symptoms

and improve her airway were set with a goal of being attained by the last meeting. Looking

forward to long term goals, it was decided upon that the patient would increase her water intake

in an effort to thin secretions. This is a pretty hefty goal for her as her main source of fluid is diet

coke. She drinks it throughout the day without much water consumption. Another goal of

learning how to cough effectively to expel sputum was set. Lastly, the patient and I discussed her

cigarette smoking and how that affects her breathing and increases mucus production. The goal

for the patient is to cut down (or quit) how much she smokes. We both understand that this is not

a process that happens overnight so the goal of eliminating 3-5 cigarettes out of the day was set.

The outcomes for these goals rely on patient self-reporting. This lends itself to some false

reporting based on how the client feels she should report. We also utilized reporting from her

husband related to her water intake and coughing. It is hard to ask someone else to basically

count the amount if cigarettes someone smokes so that goal is based strictly on self-reporting.

Two weeks elapsed between our meetings and the patient was asked to keep track of how much

water she drank, if she felt she was able to cough in a way that helped clear her congestion and to

record how much she smoked a day during those two weeks. During our next meeting, we

discussed what she had recorded and I spoke with her husband to get his opinion on how things

went during those two weeks.

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Based on the results on the interview and information provided by the patient after the

two-week reporting time, a plan was developed around what COPD is and the things that she

could do to help with the symptoms she was experiencing. Schub and Heering (2017) note that

there are four steps in the management of a patient with COPD: “assess and monitor for COPD,

reduce risk factors, manage stable COPD, and manage exacerbations of COPD.” Some patients

require the use of bronchodilators as an avenue to manage their COPD. Although this patient has

been on inhaled therapy before, she is not utilizing that form of pharmacotherapy.

According to Engelke (2017), ‘increased patient knowledge about COPD and self-care

can enhance the patient’s ability to cope with the challenges of this disease.” He notes that it is

important to assess the patient’s learning style and readiness for education before proceeding

with education. It is important to consider the things that are important to the patient when

developing your teaching plan in order to create and environment for the greatest amount of

compliance. In an effort to understand the client’s learning style, a learning assessment was done

and the education for this topic was tailored around those preferences.

Although the patient learns by listening, watching, and reading, it was decided that visual

aids and short pamphlets would be most appropriate for this education. The education plan

developed with the patient focused on how to reduce symptoms and things that she could easily

do to help herself breathe a little easier with reduced mucus production. I thought it was

important to review what COPD was and the pathophysiology of the disease. I used terms that

were understandable for the patient as well as an image sheet depicting how the lungs of a

patient with COPD work. This is attached in the appendix in Table 1.

The second topic discussed was how to change her diet to eliminate foods that cause an

increase in mucus production and incorporate those that help eliminate mucus. The client was on
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board with trying to increase her water intake to help thin secretions but is a very picky eater and

some of the suggested items on the handout (Table 2 did not appeal to her at all. Of the options

provided on the handout, the patient decided that she would be able to incorporate pineapple and

green vegetables in to her diet, along with increased water consumption, to help reduce the

amount of mucus she produced.

The last topic, and quite possibly the most important, that was discussed was the affect

smoking has on her COPD and how increased smoking can exacerbate the condition. The patient

is an 81-year-old who has been smoking her whole life. It is unrealistic to think that she will stop

smoking completely. The focus of my education to her was how much an affect smoking has on

not only her COPD but the increased mucus production and how cutting back can positively

impact both and slow lung function loss.

The patient verbalized an understanding of how her smoking affects her breathing but

states that “the doctor says other than my COPD, my lungs are fine.” We discussed this idea and

how although her lungs are “fine” every time she smokes she is irritating her lungs and the

response of the lungs to irritation is mucus production. She verbalized that she understood this

and she was going to try and cut back by 3-5 cigarettes a day to see if that helped her issues.

All of the teaching aids used included pictures and words. This aligned well with how the

client likes to learn and also provided a hand help item the patient could refer back to should she

desire. The goals of the education were patient driven and focused on topics that the client

identified as areas of interest and comfortability. It was important to identify her readiness to

learn and what her priorities were and that her priorities and what was taught were in alignment

(Engelke, 2017). If the education and tasks did not fit in to her daily life, she would be less likely

to incorporate them thusly not improving her condition.

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After evaluation of the education and patient goals, it can be determined that the patient

goals were met. The patient reported incorporating two to three glasses of water in to her daily

routine and that for “most of the days” she cut back on her smoking by 3-4 cigarettes. She is able

to verbalize what her condition is and how certain factors affect it and can make it worse. She

also stated that she knew what she could do in order to help alleviate some of her symptoms. The

patient reported being able to productively cough “a few times” and expel some mucus that had

built up.

All of the goals relied on self-reporting so it is possible that the information reported was

not accurate. This could have been influenced by the patient’s desire to provide the outcomes

expected by the nurse or it is possible she didn’t want to disappoint. This patient is my

grandmother so I fully intend on continuing to follow up with her on how she’s doing to see if

this was only a short time change or if it is something she will continue to incorporate. She

reports that she wants to continue to incorporate the changes she made and her husband is very

involved and willing to help hold her accountable to the things she said she would do.

The outcomes identified by the nurse and the patient revolved mostly around primary

prevention. Although the patient already has COPD, which at this point cannot be prevented,

education was provided around ways to prevent increased mucous production and reduce the

severity of COPD exacerbations. The client understands that her COPD is not going to go away

but there are things she can do to help make it a little less severe at times.

I do believe that this patient education was successful and that the client sincerely wants

to continue to implement the changes she’s made in order to help her condition. She was

receptive and engaged during the educational time and was asking questions and writing things

down. I do believe that this may become challenging for her in the weeks to come. Her brother
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just passed away and she is in a heightened state of stress. She reports that “when she is stressed

she smokes more.” I do not believe any regression in changes implemented would be a result of

the educational plan developed but a result of life circumstances and habits. She has been doing

things a certain way for a very long time and those things can be hard to change.

Overall, I feel this process went very well. It was a little hard to remove myself from the

role of granddaughter and put myself in the role of nurse/teacher simply because my

grandmother and I are so close. I did find this to be an extremely educational experience both for

myself and for her. I haven’t really been in the role of teacher during my time in nursing school

and having the opportunity to take that role with someone I was comfortable with was a positive.
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References

COPD Foundation | Take Action Today. Breathe Better Tomorrow. (n.d.). Retrieved November

12, 2017, from https://www.copdfoundation.org/

Engelke, Z. M. (2017). Patient Education: Teaching the Patient with Chronic Obstructive

Pulmonary Disease (COPD). CINAHL Nursing Guide,

Healthy People 2020 [Internet]. Washington, DC: U.S. Department of Health and Human

Services, Office of Disease Prevention and Health Promotion November 9, 2017.

Available from: https://www.healthypeople.gov/2020/topics-objectives/topic/older-adults

Schub, T. B., & Heering, H. C. (2017). Case Management: Patients with Chronic Obstructive

Pulmonary Disease. CINAHL Nursing Guide,

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Appendix

Table 1
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Table 2
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Table 3
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Table 4