Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with ...

Nursing Care of Dyspnea: The 6th Vital Sign in Individuals with Chronic Obstructive Pulmonary Disease (COPD)Recommendation 3.1:Nurses will assess patients’ inhaler device technique to ensure accurate use. Nurses will coachpatients with sub-optimal technique in proper inhaler device technique. (Level of Evidence =1a)Discussion of Evidence:Coakley (2001) and Wright et al. (2002) suggest that the use of inhalers is widespread for conditions such asCOPD and yet many people have difficulties in mastering correct inhaler technique. The inhaled route isthe preferred route as it minimizes systemic availability and therefore minimizes side effects (Coakley, 2001;Wright et al., 2002). Elderly people have specific problems with inhaler use and require interventions aimedat improving their inhaler technique and minimizing waste of inhaled medication and therefore lack oftherapeutic effect. A systematic review of the literature showed that only 46-59% of patients used theirinhalers correctly (Cochrane, Bala, Downs, Mauskopf & Ben Joseph, 2000). Knowing this, nurses must be able todemonstrate correct inhaler technique, assess and optimize patient’s technique (Coakley, 2001; Wright et al.,2002). Frequent assessment of inhaler technique needs to become a regular activity of health promotion forall patients using these devices (Coakley, 2001).See Appendix M for a discussion of device technique.Recommendation 3.2:Nurses will be able to discuss the main categories of medications with their patients including:■■■■■■■Trade and generic namesIndicationsDosesSide effectsMode of administrationPharmacokineticsNursing considerations(Level of Evidence =IV)Discussion of Evidence:Education of individuals with COPD is aimed primarily at improving their coping skills to help them tocontrol their disease and live functional lives. It also leads to an increased understanding of the physicaland psychological changes produced by chronic illness and may lead to fewer admissions to hospitals aswell as reduced time in hospital (Clinical Epidemiology & Health Service Evaluation Unit, 1999). Educating the patientabout their medication is an important part of ensuring safe medication use (Cohen, 1999). Patients whoknow what their medication is for, how it should be taken, how it works, and what it looks like are in theposition to reduce the likelihood of medication error. Patient education and counselling about medicationsshould happen at all points of care (Cohen, 1999).See Appendix L for a list of COPD Medications.38