Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Included In This Lesson
Study Tools For Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min)
Outline
Mr. Whaley is a 65-year-old man with a history of COPD who presents to his primary care provider’s (PCP) office complaining of a productive cough off and on for 2 years and shortness of breath for the last 3 days. He reports that he has had several chest colds in the last few years, but this time it won’t go away. His wife says he has been feverish for a few days, but doesn’t have a specific temperature to report. He reports smoking a pack of cigarettes a day for 25 years plus the occasional cigar.
What nursing assessments should be performed at this time for Mr. Whaley?
Upon further assessment, Mr. Whaley has crackles throughout the lower lobes of his lungs, with occasional expiratory wheezes throughout the lung fields. His vital signs are as follows:
BP 142/86 mmHg HR 102 bpm
RR 32 bpm Temp 38.8°C
SpO2 86% on room air
The nurse locates a portable oxygen tank and places the patient on 2 lpm oxygen via nasal cannula. Based on these findings, Mr. Whaley’s PCP decides to call an ambulance to send Mr. Whaley to the Emergency Department (ED). While waiting for the ambulance, the nurse repeats the SpO2 and finds Mr. Whaley’s SpO2 is only 89%. She increases his oxygen to 4 lpm, rechecks and notes an SpO2 of 95%. The ambulance crew arrives, the nurse reports to them that the patient was short of breath and hypoxic, but sats are now 95% and he is resting. Per EMS, he is alert and oriented x 3.
What is going on with Mr. Whaley, physiologically?
What would you have done differently? Why?
Upon arrival to the ED, the RN finds Mr. Whaley is somnolent and difficult to arouse. He takes a set of vital signs and finds the following:
BP 138/78 mmHg HR 96 bpm
RR 16 bpm Temp 38.4°C
SpO2 96% on 4 lpm nasal cannula
What is the possible cause of Mr. Whaley’s somnolence?
What orders do you expect from the ED provider?
The provider writes the following orders:
Keep sats 88-92%
CXR
Labs: ABG, CBC, BMP
Insert peripheral IV
Albuterol nebulizer 2.5mg
Budesonide-formoterol 160/4.5 mcg
The nurse immediately removes the supplemental oxygen from Mr. Whaley and attempts to stimulate him awake. Mr. Whaley is still quite drowsy, but is able to awake long enough to state his full name. The nurse inserts a peripheral IV and draws the CBC and BMP, while the Respiratory Therapist (RT) draws an arterial blood gas (ABG). Blood gas results are as follows:
pH 7.30
pCO2 58 mmHg
HCO3– 30 mEq/L
pO2 50 mmHg
SaO2 92%
Mr. Whaley’s chest x-ray shows consolidation in bilateral lower lobes.
Interpret the ABG. Explain.
Which medication should be administered first? Why?
Mr. Whaley’s condition improves after a bronchodilator and corticosteroid breathing treatment. His SpO2 remains 90% on room air and his shortness of breath has significantly decreased. He is still running a fever of 38.3°C. The ED provider orders broad spectrum antibiotics for a likely pneumonia, which may have caused this COPD exacerbation. The provider also orders two inhalers for Mr. Whaley, one bronchodilator and one corticosteroid. Satisfied with his quick improvement, the provider decides it is safe for Mr. Whaley to recover at home with proper instructions for his medications and follow up from his PCP.
What are priority discharge teaching topics for Mr. Whaley?
Care plan
Concepts Covered:
- Basics of NCLEX
- Test Taking Strategies
- Integumentary Disorders
- Postoperative Nursing
- Musculoskeletal Disorders
- Musculoskeletal Trauma
- Emergency Care of the Trauma Patient
- Shock
- Acute & Chronic Renal Disorders
- Vascular Disorders
- Communication
- Perioperative Nursing Roles
- Hematologic Disorders
- Disorders of the Thyroid & Parathyroid Glands
- Cardiac Disorders
- Emergency Care of the Cardiac Patient
- Disorders of the Posterior Pituitary Gland
- Male Reproductive Disorders
- Infectious Disease Disorders
- Infectious Respiratory Disorder
- Intraoperative Nursing
- Medication Administration
- Urinary Disorders
- Urinary System
- Upper GI Disorders
- Preoperative Nursing
- Lower GI Disorders
- Neurological Trauma
- Neurological Emergencies
- Noninfectious Respiratory Disorder
- Respiratory System
- Oncology Disorders
- Respiratory Emergencies
- Immunological Disorders
- Central Nervous System Disorders – Brain
- Renal Disorders
- EENT Disorders
- Emergency Care of the Neurological Patient
- EENT Disorders
- Liver & Gallbladder Disorders
- Shock
- Studying
- Disorders of Pancreas
- Respiratory
- Emergency Care of the Respiratory Patient
- Legal and Ethical Issues
- Documentation and Communication
- Fundamentals of Emergency Nursing
- Female Reproductive Disorders
- Sexually Transmitted Infections
- Peripheral Nervous System Disorders
- Microbiology
- Central Nervous System Disorders – Spinal Cord
- Integumentary Disorders
- Disorders of Thermoregulation
- Neurologic and Cognitive Disorders
- Renal and Urinary Disorders
- Disorders of the Adrenal Gland
- Respiratory Disorders
- Nervous System
- Integumentary Important Points
- Tissues and Glands
- Delegation
- Factors Influencing Community Health
- Multisystem
- Cardiovascular
- Circulatory System
- Newborn Complications
- Gastrointestinal Disorders
- Cognitive Disorders
- Neurological
- Gastrointestinal
- Endocrine