Symptomatic management of patients suffering from chronic obstructive pulmonary disease is the best approach towards improving the quality of life and alleviating pain in these patients. In this study, thirty sources were analyzed. Results show that an advanced level skill of auscultation is one of the most vital skills in caring chronic obstructive pulmonary disease patients. Nurses with advanced level skills as per the GOLD standards for practice were found to be very useful in the management of exacerbations of chronic obstructive pulmonary disease. It is recommended that nurses and other health personnel caring for patients suffering from COPD be trained at advanced levels on the skill of auscultation. There is the need to emphasize that the skill of auscultation is not for doctors alone, but should be adopted by nurses too.

            Table of contents

Table of Contents

Abstract. 2

Introduction. 4

References. 14

Introduction

Chronic Obstructive Pulmonary Disease abbreviated as COPD is a syndrome of diseases that affect the respiratory system (Canadian Lung Association, 1969). In most of the circumstances, COPD consists of emphysema and chronic bronchitis. Exacerbations in COPD refer to deterioration of the condition. This paper evaluates critically the skill of respiratory auscultation in the detection of exacerbations in COPD. It is important to appreciate the signs of exacerbations in COPD before evaluating the skill of identifying them. The American Thoracic Society (2013) outlines various signs and symptoms that enable one to determine an exacerbation in COPD. Since this disease condition affects the respiratory system, breathlessness or shortness of breath is a major feature of COPD exacerbation. Noisy breathing including gurgling, wheezing, whistling and a rattling sound are present during the exacerbation.

Due to reduced oxygen supply, there is increased anxiety and the chest movements occur more quickly than usual. A severe or frequent cough which is dry is recorded. The skin and the nails may change color with the lips assuming a bluish tint. The patient loses appetite and has difficulty sleeping. The patient is unable to speak due to shortness of breath. Carbon dioxide may build up in the blood and cause headaches in the mornings. Heart complications may develop and lead to swelling of extremities.

Importance of Detecting Exacerbations COPD

Exacerbations in COPD should be detected early, and intervention made. Failure to detect them may lead to a fatal outcome especially in cases of shortness of breath. The skill of detecting COPD exacerbations is, therefore, very important in intervening during an exacerbation. From the symptoms of exacerbations in COPD as evaluated in this paper, shows that physical examination is almost sufficient in a patient are worsening condition in COPD. Since physical examination applies the use of the senses of the body, it is the best method to detect a worsening COPD and intervene. The skills of the health practitioners especially the nurses are of hand in managing COPD.

The indicators outlined by the Global Initiative for Obstructive Lung Disease (GOLD) (2013) warrant a skilled nurse or health practitioner to save a life in COPD. This is because, apart from detecting the obvious signs that bring about exacerbations, it is important to be able to detect comorbidities and to interpret spirometry results. Auscultation is a very vital skill in such cases because the results of auscultation keep on changing as the condition of the patient change. Due to the complications brought about by COPD and the possibility of comorbidities, symptomatic assessment is regarded the best way to intervene in a patient who is suffering from COPD (GOLD, 2013). In symptomatic assessment, auscultation plays a very big role; therefore, it is important that the health personnel caring for a COPD patient be completely skilled in auscultation.

Comorbidities during COPD are a major risk for complication of the patient. Having the skill of identifying comorbidities is one of the greatest ways of saving lives in COPD patients. Heart disease is outlined as a major comorbidity in COPD (GOLD, 2013). Detecting the condition of the heart or diagnosing heart disease cannot be done without the skill of auscultation. This explains why the skill of auscultation is very vital in caring for patients with COPD.

Pathology in the lungs will affect the sounds produced by the heart. Breath sounds too are compromised in such a situation. Physicians rely on the skill of auscultation to determine pathology in the lungs. Therefore, health care personnel caring for a patient with COPD will need to have advanced in the skill of auscultation.

Skill in auscultation

Although physical examination is relatively poor in detecting mild to moderate COPD, the physical signs of severe exacerbations in COPD are very specific and easy to detect (Mosenifar, 2013). The specificity of physical signs will make it easy for a nurse who is skilled in auscultation to detect them easily than one who is not. For example, to detect elevated jugular pulse in severe COPD will demand a skill in auscultation in the health care personnel caring for the patient. According to Mosenifar (2013), breath sounds are diffusely decreased during exacerbations in COPD. To detect such diffusely decreased breath sounds, one will need the skill of auscultation. This explains why the skill is considered vital in personnel caring for COPD patients.

A report by the Global Initiative for Obstructive Lung Disease (GOLD) (2006) emphasizes that COPD is characterized by airflow limitation in the heart and the effect of comorbidities. Further, this report observes that people living in areas with few medical facilities are affected the most. Going by this, it is important that the few personnel available in these areas be fully conversant with the skill of auscultation, in order to save lives in these places. The process of inflammation also brings about lung parenchyma damage and this causes lung pathology. Physical examination in detecting lung pathology will rely on auscultation.

The effectiveness of physical examination and in particular, auscultation is emphasized by Lindsay (2013) of the Ontario Lung Association. It is observed that auscultation has not and cannot be replaced by x-rays and ultrasound in the examination of the chest. Auscultation has remained to play a major role in the examination of the chest in the advent of new technology. With this in mind, it is vital that nurses caring for patients with exacerbations of COPD be very conversant with auscultation. Lindsay (2013) observes that the skill of auscultation is non-invasive thus, better than invasive techniques in the examination of the patient. This is very important in monitoring patients with exacerbations of COPD since examinations will be done frequently. Further, the skill of auscultation is totally innocuous and is cheap besides its nature of being easy to carry out. Skilled professionals will execute this skill better than a quack. It is important to advance the skill in nurses caring for patients with exacerbations of COPD in order to improve outcomes in such patients.

Although the stethoscope has not been rated, it remains the best conduit for transmission and interpretation of sound between the patient’s chest and the physician’s ears (Hans, Steve & Wodicka, 1997). The stethoscope has made auscultation one of the best skills to detect abnormalities of the chest. Among these abnormalities is the air flow obstruction that occurs during exacerbations of COPD. This is why health care personnel caring for a COPD patient, will require the skill of auscultation, that is at an advanced stage.

There are factors that have been known to affect the skill of auscultation. Among them are the psychoacoustic phenomena and the response of the stethoscope to the pathophysiology in the patient (Hans et al, 1997). This affects the understanding of bilateral asymmetry of sounds as heard by the physician and the real pathology in the patient’s chest. Advanced skill in auscultation is, therefore, needed in order to make correct interpretations in such cases. Nurses and other health trained at lower levels willnot be in a position to notice and interpret these fine details and observations. Emphasis should be put to the nurse’s curriculum and training to ensure that as many nurses as possible gain the advanced skill in auscultation. Chronic care stings and nursing homes are likely to experience the clients suffering from COPD in large numbers. It is important to reinforce training of the health personnel in these places to impart advanced auscultation skills in them for the benefit of the patints.

The value of chest X-ray is minimal in the diagnoses of COPD. Computed Tomography scans can be used, but these too are not very useful in diagnosing COPD (Kinnula & Helin, 2013). The detection of exacerbations thus becomes the best method to detect the severity and to determine the grading of COPD. Subjective symptoms which include recurrent exacerbations are, therefore, useful in determining to what extent is the COPD. The skilled nurse with expertise in auscultation will be best suited in detecting these subjective symptoms. In the administration of therapy, the skill of auscultation is needed to monitor the effectiveness of therapy. For example when administering oxygen, one needs to listen to air flow using a stethoscope to note whether the therapy has been effective.

Home treatment of COPD proves better that hospital treatment (Stevenson, 2007). This is because the nature of COPD is chronic. Establishing a home based hospital will spare the client the stigma that is usually experienced by patients in hospital. The logistics of establishing such an arrangement and caring for the patient at home will only be possible with the availability of skilled personnel. Further, the personnel cannot care for these patients if they lack the skill of auscultation since physical examination is key in identifying exacerbations.

For effective care of patients of COPD, there is a need to incorporate the skill of auscultation among the routine duties of the nurse (Barnes, Gardiner & Duff, 2007). It has been noted that nurses have not been practicing the skill of auscultation with the seriousness with which they practice the taking of vital signs. This is directly linked to the outcome of care in COPD patients. Barnes et al (2007) observe that auscultation is a vital aspect of chest assessment. There is need; thus, to train more nurses on the effective use of stethoscopes to improve outcomes in care of patients with exacerbations of COPD.

Flapping tremors and exertional breathlessness are some of the features of exacerbations in COPD (Chawla, n.d). Detection of such tremors will require the expertise of a well skilled nurse in auscultation. This brings the necessity that is emphasized in training nurses at an advanced level in the alleviating suffering in COPD.

The American Thoracic Society (2005) documents chronic obstructive pulmonary disease as one of the most common diagnosis that is refereed for home care. Caring for patients with COPD at home can prove difficult if the caregiver is not competent in the skill of auscultation. This is because symptomatic assessment is a major guide for interventions in a patient of COPD. It is, therefore, important that this home caregiver be pampered with the advanced skills of auscultation in order to give effective care to this patient.

History and physical assessment form the differential diagnosis of chronic obstructive pulmonary disease (American Lung Association, 1987). The skill of auscultation makes the major informative step in detecting exacerbations in COPD. Nurses or health care personnel without this skill will thus provide poor results in caring for patients with COPD. The lung over inflation and the wheezes characteristic of exacerbations of COPD can only be detected by skilled personnel.

The Thoracic Society of Australia and New Zealand (2002) agrees that confusion in the diagnosis of COPD has existed over time due to its correlation to Asthma. This has contributed to COPD being considered incurable over a long period of time. It is evident that outcomes can be improved with comprehensive patient assessment and detection of exacerbations in COP D. This has called for the development of new protocols and a renewed interest in training health care personnel who deal with the treatment of patients with COPD. Auscultation is a major concern in this kind of training due to its vitality in physical examination and in the detection of exacerbations of COPD.

Boyars and Karnath (2002) expresses the view that, although new technology has tried to challenge the stethoscope, it remains the most efficient device to a physician. The stethoscope is used in auscultation. With this fact, auscultation remains the principal method of determining the effect of the disease in the lungs. The skill of differentiating between normal and abnormal breath sounds in auscultation is the most useful in exacerbations of COPD.

The GOLD executive summary (2007) outline some of the goals of management in COPD as preventing and managing exacerbations, relieving symptoms, improve health status, improve exercise tolerance, and prevent complications. All these roles are performed by a multidisciplinary team, and nurses play a great role. Meeting these goals require the skill of auscultation especially in the monitoring. The person implementing the measures to meet the goals thus should be trained in auscultation for them to be effective in managing COPD.

Among the skills set by the curriculum for the SIU School of Medicine (2009) for the understanding and management of chronic obstructive pulmonary disease, is being able to distinguish between pleural fluid and areas of lung consolidation. The curriculum also involves the skill of differentiating the different pathological breath sound. This skill is possible only to a person who has the skill of auscultation.

The Department of Veteran affairs (2007) recognizes respiratory physical assessment as the leeway for the management of chronic obstructive pulmonary disease. Respiratory physical assessment depends on the skills of auscultation, palpation, percussion and inspection in order to bring about results. For a health care personnel or a nurse to do comprehensive physical assessment, one has to master the skill of auscultation. It is then that they will be in a position to detect exacerbations of COPD.

In cases of misdiagnosis and suspicion of COPD, physical examination can be used to provide a differential diagnosis (EB MEDICINE, 2013). This physical examination will depend on the auscultation to bring about the distinguishing features of COPD from other illnesses of the chest. This is yet another reason why the skill auscultation needs to be emphasized in order to manage with effectiveness the exacerbations of COPD. Detection of wheezes and crackles too will depend on the skill of auscultation (Geeky Medics, 2012).

It has been noted overtime that physicians worldwide have been writing prescriptions for respiratory infections than for any other infection in the human body (Mclvor, 2009). This is contributed by failure to distinguish the symptoms of the chest to come up with a differential diagnosis. The application of the skill of auscultation in detecting exacerbations of COPD has made sure that physicians do not blindly prescribe antibiotics in COPD.

Auscultation has been found to be the best skill in monitoring treatment, and therapy, in COPD. Lisarc et al (2000) employed the skill of auscultation in testing the effectiveness of anti-inflammatory properties of fenspiride, a drug used in the treatment of respiratory inflammation. In every patient, they administered the drug, the used auscultation to determine the changes in the lungs. Auscultation was also employed by Zuin et al (n.d) when experimenting of the efficacy of n-acetyl cysteine. The tolerability of this drug too was determined by monitoring the changes in exacerbations that took place in the patients who were given this dose and comparing with the placebo results.

Advanced technology has aided auscultation in the diagnosis of pneumonia in people with COPD. Morillo, Leon and Moreno (2012) assert that self-auscultation that is electronically supported aid in the diagnosis of pneumonia in patients suffering from COPD. This auscultation is specifically performed at the area of supra-sternal notch. This is a method that is cost-effective and can be of use in areas where facilities are constrained. Its help in the advancement of telemedicine is immense, and it depends on the skill of auscultation.

The reason that airflow limitation is very severe in COPD patients demands a high skill in auscultation. This is because air flow limitation makes auscultation difficult (Moore & Mackintosh, 1999). However, personnel who are highly skilled in auscultation will be able to detect wheezes that are relatively high-pitched through the chest.

Differentiating between the severities of the triad of the COPD is vital in planning care (Monash University, 2013). The skill of auscultation will be of use in bringing about this difference. These exacerbations are most of the time brought about by asthma, acute bronchitis and emphysema. Since the approaches of treating the three are different, using the skill of auscultation to determine which is more severe will help to manage the exacerbations with effectiveness.

Auscultation of the heart to detect the signs of cor purmonale in exacerbations of COPD is a useful feature (American Thoracic Association, 2013b). Signs like the split of the second sound are noticed when auscultation is carried out professionally. Murmurs of tricuspid or pulmonary insufficiency are also noticed.

Corbridge (2012) observes that, it is the skill of auscultation, which is able to tell about breath sounds that are highly diminished. Due to the airway obstruction following COPD, breath sounds are hard to detect. It is through the skill of auscultation that detection of these breath sounds is made possible. Thomson et al (2002) argue that auscultation has helped to detect new abnormalities in patients suffering from COPD. This is in comparison to chest x-rays which have not been very useful in detecting exacerbations and deterioration in COPD. American Society of Registered Nurses (2008) recognizes the need for application of advanced skill of auscultation in the Intensive Care Unit (ICU). This is because of the critical nature of patients in the unit. Auscultation is noninvasive and is not harmful in any sense. Using the skill in the ICU will see many patients prevented from undergoing the pain they experience during invasive procedures.

The skill of auscultation has gone far in saving lives of patients with exacerbations of COPD. The symptoms that signify the deterioration of the patient’s condition in COPD are detectable using the skill of auscultation. The skill has a wide application in caring for patients with respiratory disease. It is, therefore, recommendable that an advanced practice emphasizes auscultation in training health personnel especially those who will deal with caring for COPD patients.

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