Critique Article of Chronic Respiratory Disease
In the article “Physical Examination of the Adult Patient with Chronic Respiratory Disease” Miller, Owens and Silverman (2015) discuss the nurses’ role in the diagnosis and management of COPD (chronic obstructive pulmonary disease). Miller, Owens and Silverman (2015) contend that nurses additionally play a critical role in early detection of any signs of the disease’s exacerbation. Assessment of the respiratory system, contends Miller, Owens and Silverman (2015), is part of the nurses routine care, although COPD patients’ assessment presents unique challenges. The focus of the paper however, is on nursing assessment of COPD. The authors focus on the assessment of COPD, with reference to the Dyspnea rating scale, which rate the COPD from grade one to five, five being a chronic stage of the disease (Miller, Owens & Silverman, 2015). Using the scale, Miller, Owens and Silverman (2015) contend, it is possible for a nurse to produce a quantitative dyspnea score within a few seconds. The article further indicates the need and importance of conducting anxiety and depression screening during COPD assessment given the high risk of development of psychological comorbidities from the aversive effects of dyspnea.
In their review of COPD, Miller, Owens and Silverman (2015) have included a number of elements in their review. These include the pathophysiology of COPD, nursing assessment of COPD and the nursing implications of the assessment. In looking at the pathophysiology of COPD, Miller, Owens and Silverman (2015) inform that COPD has an association with impaired pulmonary gas exchange and trapping as a result of inflammatory injury to the intrathoracic airways, lung parenchyma and pulmonary vasculature. This assessment of the pathophysiology of COPD is similar to Brashier and Kodgule’s assessment, who inform, “pulmonary capillary apoptosis in histological feature such as emphysema and physiological feature such as decreased surface area of alveoli for gaseous exchange and ventilation- circulation mismatch” (p. 18). The article additionally gives the different COPD phenotypes and their exacerbators, classifications that are vital in the identification of the different phenotypes of the disease.
In the assessment of the patient for COPD, Miller, Owens and Silverman (2015) enthuse that the first process is inspection, whose purpose is to determine the presence of any respiratory dynamics. This involves the inspection of organs including the mouth, nasal cavities, throat, chest wall and abdomen. Palpation of the thorax is the second process assessment, whose purpose is to confirm any suspicion of abnormalities by touch. Checking for enlarged lymph nodes, thoracic malformations and intercostal masses enlargement helps in determining any abnormalities. Percussion and auscultation are the final processes. Percussion involves the production of audible sounds and vibration, which assist in determining any possibility of air, fluid or solid filling of lung tissues. Auscultation on the other hand, has three components of listening to the sound of air during normal breathing, additional sound and the manner of transmission of spoken words through chest walls.
Providing the assessment process is a great step for nurses as provided by the authors as it allows nurses to perform the assessment procedurally, and get a deeper knowledge of the need and reason for performing the assessment in the given order. The procedures provided are therefore valid in the nursing practice, and indeed provide a guideline to nurses in performing the assessment procedure.
From the assessment review provided by Miller, Owens and Silverman (2015), it is conclusive to say that thorough assessment is important in providing valuable comprehension of the progression of the disease. Even more is that proper assessment helps in promoting positive patient outcomes, in addition to improving patient outcomes. Moreover, the assessment procedure has great implications to nursing practice. Through the frequent monitoring of patients, nurses can recognize any initial changes in the patient, and therefore help in taking the appropriate action. This improves nursing care and patient outcomes (Brashier & Kodgule, 2012). Laying out the procedure for assessment helps in reminding nurses the correct chronology for performing assessments. Moreover, regardless of the fact that nurses learn the procedures at assessment labs, and that carrying out the procedures may not be practical, knowing the procedures is important. This is especially in cases of abnormalities in the COPD patients, wherein palpation and percussion are effective in providing comprehensive information for nursing care.
Miller, Owens and Silverman (2015) offer incisive insights on the procedure for COPD assessment. However, there is no information on the funding of the review, although the affiliation of the authors is indicated. Additionally, the review does not include any declared conflicting interest by any individuals or organization. It is probable, therefore, that the review is a purely academic endeavor by the authors, although it has implications for nursing practice.
The article presents important insights into the procedures for assessment and examination of patients with chronic respiratory disease. By providing the pathophysiology of COPD, the article helps not only nurses, but readers as well to understand the workings of COPD, and the resulting effect on the respiratory system. Moreover, the article provides the different phenotypes and exacerbators of COPD (Miller, Owens & Silverman, 2015), allowing the nurses to differentiate among the three and therefore provide the requisite care for the patient.
Perhaps the biggest strength of the review lies on the nursing assessment procedure that it provides complete with the correct chronology of performing the assessment. Even more is its inclusion of the dyspnea rating scale is invaluable to nurses in diagnosis of COPD and administering the appropriate care to the patient.
On the other hand, the pathophysiology is brief and does not provide in depth information on the working of the diseases. Additionally, while it has been instrumental in providing assessment procedures, the article does not capture the diagnosis and treatment of COPD.
From its onset, the article set out to review the basic components of a respiratory assessment with consideration for COPD patient. The article successfully achieved this and provided even more information. By starting with inspection to auscultation, the article successfully reviews all the components of COPD patient assessment, with detailed information on handling the different grades of patients as indicated by the dyspnea rating scale.
The article provides important insights into the assessment of patients with COPD. The procedure in the article, although impractical under normal circumstances, can help promote positive patient outcome and improve nursing care. The inclusion of the dyspnea rating scale is especially important for nurses in determining the level of progression of the disease, and therefore provides the necessary care to the patient. From the article, using the dyspnea rating scale as the base in assessment is advisable as the baseline for initial examination for nurses. Moreover, the article had highlighted the relation between COPD and anxiety. In nursing practice, especially in the assessment of OCPD, it is important for nurses to monitor anxiety and depression among patients, and if possible address their occurrence among the patients.
Brashier, B., B. & Kodgule, R. (2012). Risk factors and pathophysiology of chronic obstructive pulmonary disease (COPD). Supplement to JAPI, 60, 17-21
Miller, S., Owens, L. & Silverman, E. (2015). Physical examination of the adult patient with chronic respiratory disease. Medsurg Nursing, 24(3), 195-198