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Question: Discuss the Pathophysiology of COPD as it relates to the acute and Chronic Symptoms the Patient is Experiencing. Answer: Path physiology of COPD Chronic obstructive a pulmonary disease is major health care concern worldwide with greater portion of the population is affected. It is often characterized by symptoms like chronic bronchitis and emphysema. COPD is a medical condition which is characterized by inflammation, dysfunction and air way obstruction. It involves chronic inflammation of the air pathways, the lungs and blood vessels due to exposure of irritants such as tobacco smoke. The inflammation of the air way leads to narrowing of air path thus remodeling the airway. Factors which contribute to this include fibrosis, scar tissue build up after damage of the air ways and increased multiplication of epithelial cells beneath the air way, (Sohal,Ward,Danial, Wood Walters, 2013). The destruction of parenchyma is often linked to tissue elasticity capacity due to destruction of the components feeding the alveoli. The impacts of this collapse of during inhalation, disturbed air flow, air retention in the lungs and decreased lung carrying level. In smoking, the mucous glands get enlarged in the lining of the walls , this condition leads cell metaphase which is characterized by the healthy cells being changed over by the mucous secreting ones in the air pathway,(Shen, Wolkowicz, Kotova, Fan Timko, 2016). This leads to excess mucous in the pathways which in the long run they build up and blocks thus hindering airflow, (Eschenbacher, 2014). Patient s of COPD always present with variety of symptoms and signs of chronic bronchitis, destructed airway disease and emphysema. The common symptoms include cough, breathlessness and wheezing, (Hatipoglu Milstein, 2016). The accuracy of the information given in showing mild to moderate COPD is poor. Observations for severe disease state include tachypnea and respiratory disruption, cyanosis, peripheral enlargement and strain on respiratory muscles. Physical examination of the thorax shows elevated inflammation, wheezing, prolongs expiration, decreased breath sounds. There are unique characteristics which identify persistent diseases from and emerging disease such as emphysema. In chronic bronchitis the following features are observable, patients appear obese, common coughs, functioning of accessory muscles is observed and patients can portray signs of right heart failure. In emphysema the clinical signs portrayed include, thin patients with barrel chest, little expectoration, distant heart sounds, breathing assistance by use of lips and overall appearance is observed to be classical COPD signs. COPD diagnosis is formalized when the ratio of forced expiratory volume in a second over forced vital capacity is less than 70 %. Criteria assessment of severe obstruction of airflow is characterized with 4 stages; stage I (mild), stage II (moderate), stage III (severe), stage IV (very severe), (Pavord, Barnes, Dransfield, Locantore Pascoe, 2015). For clear confirmation of COPD, other tests can be done include, hematocrit, serum potassium level, sputum evaluations, electrocardiography, (Choudhury, Davey, Simpson, 2016). Management of acute COPD exacerbations Medical assessment of exacerbation entails medical history, examinations spirometry, blood gas measurement .personal health record should be used. With high impact publicity on dangers of smocking and cigarette abuse, COPD continues to ravage a significant portion of the population currently acute COPD is often characterized by chronic bronchitis, emphysema. Chronic bronchitis is characterized by excessive coughing and sputum increase in the patient, (Deslee et al., 2015) on the other hand emphysema is observed with dyspenia from destruction of lung cells and tissue, (Musso Gubler, 2015). Outpatient management for patients should be geared in increasing quality of life by preventing acute exacerbations and slowing down diseases progress. Providing care to the COPD patients is often a critical work which needs to be taken off with due diligence Chronic obstructive pulmonary disease in the acute phase is medically managed with oxygen for those patients with low oxygen levels, inhalation of anti cholinergic, administration of strong antibiotics and corticosteroids intake. Therapeutic of methylxanthine can be administered in patients who respond to other bronchodilators. Treatment of exacerbations is always done using treated with broad and stronger antibiotics such samoxcillin, trimethoprim, doxcycycline with more exacerbated patients, (Williams Bourdet, 2012). The management of COPD often includes non smocking therapy for patients like Bill who are chronic smokers. Cessation is of smocking is advised and oxygen support is needed as the case for Bill. Intake of drugs such as anticholinergics and corticosteroids provide short duration benefits to patients with chronic state disease. The corticosteroids taken will assist in decreasing airway activity and minimize health care activity for management of respiratory symptoms. Acu te exacerbations assist in reducing long term oxygen supply treatment. Having long duration of oxygen sessions helps to observe pulmonary function and rehabilitation. In care management influenza and pneumococcal vaccines so as to prevent further infections. Infections associated with exacerbations COPD have shown to be characterized with increased sputum and increased dyspenia. The most common causes of these exacerbations include streptococcus pneumonia, homophiles influenza, viruses, and pseudomonas species. Clinical monitoring of patients with COPD includes the utilization of post bronchodilator, pulse rate and timed walking from specified distances. Pharmacological therapy needs to be employed for patient Billy. Patients with this disease often signify poor respiration status, and infections often hamper the treatment. Antibiotic treatment is highly advised to fight off the infections. The treatment is analyzed on adjusting and addition of medication used during the stabilization phase, (Ross Hansel, 2014). The objective of therapy of prevention is to minimize hospitalization admission and prevention of respiratory failure and eventual death with the aim of recovery to quality health, (Richardson, 2016). Care involves treatment plans and use of corticosteroids, bronchodilators, antibiotics oxygen therapy and ventilator support. The chronic persistence of exacerbations is the most common factor that affects the overall care in COPD management. Prevention of exacerbations can be handled prior with the doctor fro a prevention plan to be developed. In management care, patient education should be focused and aim smoking cessation, influenza and pneumonia vaccinations (Young et al., 2014). Thus with patient Billy, minimizing the frequency and severity of acute exacerbations has been proved to reduce mortality associated with COPD. On discharge management care should be considered. Patient who have acute COPD exacerbations are prone to the following conditions, pneumonia, congestive heart failure, pneumothorax, pleural effusion and cardiac diseases. Treatment regimes are quite slow and close monitoring should be considered for them, (Young et al., 2014). Mortality is often the highest risks for these patients and observation of key clinical features are important in order to predict outcome, (Suzuki et al., 2014). Early prognosis and identification of exacerbation have shown to reduce recovery time. Upon discharge follow up schedule should be effectively planned for close monitoring for those who are at risk of recurrence of associated infections and implementing of a preventive plan. Minimizing frequency of acute exacerbations has shown to improve mortality avoidance associated with COPD. Management of acute exacerbation of COPD, at home, is important. With availability of therapies like oxygen support is key in delivering a home care based approach. Hospital care based approach is encountered with high costs; this means that cost is higher than hospital care. Hospital based is safe and provide effective care, and should be sued as an alternative in caring for the acute COPD phase patients. Home based care increase the patient satisfaction and reduces the overall medical monetary requirements. Home hospital schemes are safe and effective option for patients who prefer it. Benefits associated include patient satisfaction, improved quality of life, improved satisfaction and preference. In acceptance f hospital schemes, there are some components which play a key role in providing health care. Care provided at home should be effective and acceptable to the patient. With the availability of good communication system home based care can be implemented effectively while at h ome. Effective communication enables intervention for acute exacerbation of COPD. Studies that have been conducted have shown that home based interventions improve the functional and cognitive capability of the patient, (Norrie, Dziadekwich, Fernandes 2016 ). Outreach health care plan should be implemented. Home based uncourageous support, self care management. Outreach care program should be initiated to support the patient. The function of outreach program is to maintain health status and reduce hospital admissions of acute COPD patients. Shared care is extremely important in providing and planning of home based care. The objectivity of the program activity should include, improve on lung function, improved health related quality of life, reduced mortality and reduced health care costs, (Sunde et al., 2014). Support system framework The support needed by home based COPD patients include provision of non invasive pressure support ventilation, (Mullaney, Reilly Quinn, 2016). Several organizations shave volunteered in providing care to these patients especially those at home. They function as source of information and support system for patients. In planning care management, exercise is paramount in maintaining a healthy lifestyle to these patients and forms an important path in rehabilitation of COPD patients. Care plan should incorporate exercises as they reduce symptoms and other associated complications. Home based care for COPD has been studied and proven to improve the patients knowledge on the disease and improvement s on some aspects of quality life, (McDowell, McClean, FitzGibbon Fate, 2015). Care provided by adequate visits by community nurses have shown to improved care. Patients knowledge increases when this kind of knowledge is adopted. Intervention based care has shown to improve patients understanding on quality of care and quality of life, (Mullaney, Reilly Quinn, 2016). Home based care approach has shown to be effective on minimizing hospital admissions a providing home based therapy care. A nurse led intervention approach has shown to increase the patients knowledge but dont minimize hospital admission rates, however early interventions have shown to minimize hospital readmission process. Care management aims to focus its approach on chronic pain management, fatigue, exercise tolerance and depression incidences. Home based cares thus have shown to offer the needed help to patients and provide viable alternatives to patient. Effective communication of patients from the medical team in the hospital has shown to improve the quality of life for acute exacerbation of COPD and close monitoring of infection diseases, (Diaz, Salvador, Dan Randall, 2015). Designing of management strategies include immunization and ear ly treatment of infections forms the basis of care for COPD patients. Care plans need to be design along with management strategies, (Mullaney, Reilly Quinn, 2016). Severe state of COPD to patent Bill may cause severe impacts which include depression, anxiety, panic mode and social exclusion and co morbidities experience come into play. Studies have shown that acute COPD have effects on neuropsychological deficits among patients and an association with lower cognitive progress, (Mullaney, Reilly Quinn, 2016). As a support system, patients like Bill should be health care assistant from the family members at home for recovery and management of the diseases. The heath care delivery schedule for Bill should be reoriented in such a way that it provides effective care despite the disease stage. On improving the functional and psychological position of the mind, pulmonary rehabilitation should be initiated at home Support resource and education care plan Health delivery system appropriate should include multi approach team of the health care team for close follow-ups. Self management care like support for patients and families for improved and acquisition of skills and techniques to handle the state of health for patient Billi. Decision support offer should reflect proven based protocol and professional development plan. Clinical information system should form the key path in keeping track of progress record of the patients, (Kaptein, Fischer Scharloo, 2014). Disease management protocol criteria needed should follow the chronic care model. COPD management plans should in-cooperate physical exercise, self care management and structured follow ups for patients. Effective education should be geared towards complete smoking cessation; structured education plan should involve an action plan for self treatment and regular follow ups, (Smith et al., 2012). Education care models for Bill should be planned regularly and assessment of what he is doing should be done to assess effectiveness. Studies have shown that improving education and health care facilitation improves the outcomes and costs for the patient. The discharge care plan for patient Bill is that the immediate caregivers back at home should be involved in the planning process. Caregivers act as health care champion and provide emotional and psychological assistance to the patient. The discharge plan implemented should utilize effective strategies and maintenance of clinician and patient engagement is followed. Hence clinical follows up periodically should be initiated in taking care of the patients ill health References Sohal, S. S., Ward, C., Danial, W., Wood-Baker, R., Walters, E. H. (2013). Recent advances in understanding inflammation and remodeling in the airways in chronic obstructive pulmonary disease. Expert review of respiratory medicine, 7(3), 275-288. Shen, Y., Wolkowicz, M. J., Kotova, T., Fan, L., Timko, M. P. (2016). Transcriptome sequencing reveals e-cigarette vapor and mainstream-smoke from tobacco cigarettes activate different gene expression profiles in human bronchial epithelial cells. Scientific reports, 6, 23984. Ross, C. L., Hansel, T. T. (2014). New drug therapies for COPD. Clinics in chest medicine, 35(1), 219-239. 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