Community nurses often have people with chronic respiratory disease on their caseloads and among the vital skills needed to manage this group is the measurement of resting oxygen saturation by pulse oximetry, which can help the nurse decide whether or not to refer the patient onto a specialist oxygen service for assessment. Many elderly patients also have a diagnosis of chronic lung disease and will be receiving long-term oxygen therapy. Pulse oximetry is helpful in assessing whether the prescribed oxygen flow rate is correct for the individual — this may change over time if the patient’s condition deteriorates. This article examines the latest techniques and equipment in home oxygen therapy and the author pays particular attention to pulse oximeters, which are an affordable clinical assessment tool and can easily be added to the equipment already used by community nurses.
Chronic obstructive pulmonary disease (COPD) is a condition commonly seen in the community, with symptoms including breathlessness, chronic cough and wheezing. There is much that community nurses can do to support COPD patients through an acute exacerbation (AECOPD) and to optimise their care when stable. Community nurses can take an active role in providing advocacy for the patient and ensuring that their professional knowledge is updated to provide admission and a key area for COPD is a leading cause of hospital admission and a key area for service development in the community. Investment in education and clinical leadership in community nursing is vital to prepare the workforce to deal with the needs of people with COPD in the future.
Interstitial lung disease is a wide-ranging category of respiratory illness that includes many different lung conditions, such as interstitial pneumonia, idiopathic pulmonary fibrosis, non-specific interstitial pneumonitis and hypersensitivity pneumonitis. All interstitial lung diseases affect the interstitium, a delicate network of tissue that extends throughout the lungs and which supports the microscopic air sacs within the lungs (alveoli). Unfortunately, some forms of interstitial lung disease have a very poor prognosis, therefore it is important that community nurses are aware of the signs and symptoms of interstitial lung disease so that prompt referral, assessment and treatment can be started.
The first part of this two-part series on breathlessness (JCN 28(5): 83–90) looked at the emotional and physical distress and social isolation caused by the condition for both patients and their families, as well as examining the assessment of the condition. Refractory breathlessness, i.e. that which persists even when measures to optimise the underlying condition have been implemented, is one of the most distressing symptoms experienced by patients with advanced life-limiting illnesses. This, the second part of the series, looks at how community nurses can successfully manage patients, including lifestyle changes, self-management, psychological therapy and pharmacology.
The relationship between smoking and respiratory disease has long been established and smoking is recognised as a risk factor for chronic obstructive pulmonary disease (COPD) (Fletcher and Peto, 1977), lung cancer (Doll et al, 2004) and interstitial lung diseases (Bradley et al, 2008), as well as contributing to the symptoms of asthma (Siroux et al, 2000). However, when working with patients who have lived with their disease for some time, or who may feel it is too late to benefit from change, it is important to do more than simply reiterate the risks. The link between continued smoking, progression of respiratory disease, exacerbation of the condition and the detrimental effects of continued smoking on the efficacy of some treatments should also be communicated. This article looks at the risks of smoking, as well as providing guidance for community nurses on how to bring up the topic with their patients in a non-confrontational manner.
Chronic obstructive pulmonary disease (COPD) is a serious, long-term and irreversible disease, which obstructs airflow to the lungs due to inflammation of the air passages and lung tissue damage. The most debilitating and frightening symptom is breathlessness, which can affect an individual's ability to walk, exercise, work, socialise, sleep and eat, thus having a major impact on all activities of daily living. This article aims to provide an overview of COPD to facilitate a general understanding of the disease, assist community nurses with early identification for prompt
detection and highlight the pathways and management options available. Due to its complexity, COPD can be challenging for both patients and healthcare professionals, thus the earlier it is diagnosed and management plans started, the sooner its progression can be slowed and any impact reduced.
Chronic obstructive pulmonary disease (COPD) is the term given to progressive airflow obstructive conditions, namely emphysema and chronic bronchitis. The disease is not reversible, but its progression can be slowed with the correct treatment and management. Within our organisation, we realised that if district nursing teams worked inter-professionally, exacerbations of COPD could be reduced simply by assessment of inhaler technique whilst making home visits. This article, a previous entry to the JCN Writing Awards, presents the a review of the literature undertaken prior to changing practice.
Annette Bades, BSc (Hons) Adult Nursing, District Nursing Sister, Lancashire Care NHS Trust
Amira Obeid outlines the management of a seven year old girl who presented in general practice with a history of night cough, wheezing and a tight chest.
Jacinta Meighan-Davies and Helen Parnell discuss the rising incidence of allergic asthma in the UK and the challenges this poses for community nurses and patients.
Lin McGraw gives an overview of cystic fibrosis its symptoms and diagnosis as well as some aspects of care available in the community.
