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?
Rina’s NCLEX Study Plan 2026
Concepts Covered:
- Endocrine System
- Studying
- Urinary System
- Tissues and Glands
- Nervous System
- Circulatory System
- Medication Administration
- Hematologic System
- Skeletal System
- Digestive System
- Respiratory System
- Emergency Care of the Cardiac Patient
- Reproductive System
- Endocrine and Metabolic Disorders
- Basics of Human Biology
- Muscular System
- Sensory System
- Communication
- Legal and Ethical Issues
- Basics of NCLEX
- Prenatal Concepts
- Prioritization
- Fundamentals of Emergency Nursing
- Documentation and Communication
- Delegation
- Community Health Overview
- Factors Influencing Community Health
- Concepts of Mental Health
- Test Taking Strategies
- Note Taking
- Substance Abuse Disorders
- Behavior
- Concepts of Population Health
- Concepts of Pharmacology
- Health & Stress
- Labor and Delivery
- Gastrointestinal Disorders
- Microbiology
- Depressive Disorders
- Postpartum Care
- Emergency Care of the Trauma Patient
- Emotions and Motivation
- Growth & Development
- Intelligence and Language
- Psychological Disorders
- State of Consciousness
- Respiratory Disorders
- EENT Disorders
- Infectious Disease Disorders
- Integumentary Disorders
- Neurologic and Cognitive Disorders
- Hematologic Disorders
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Renal and Urinary Disorders
- Oncologic Disorders
- Anxiety Disorders
- Cognitive Disorders
- Eating Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Bipolar Disorders
- Developmental Considerations
- Psychological Emergencies
- Somatoform Disorders
- Perioperative Nursing Roles
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- Central Nervous System Disorders – Brain
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- Shock
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- Newborn Complications
- Disorders of Thermoregulation
- Neurological Trauma
- Integumentary Important Points
- Multisystem
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- Prefixes
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- Terminology
- Proteins
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- Med Term Basic
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- Basics of Mathematics
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- Pregnancy Risks
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- Understanding Society
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- Adulthood Growth and Development
- Learning Pharmacology