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?
KRISTELLE
Concepts Covered:
- Cardiac Disorders
- Cardiovascular
- Circulatory System
- Nervous System
- Skeletal System
- Emergency Care of the Cardiac Patient
- Shock
- Shock
- Disorders of the Posterior Pituitary Gland
- Endocrine
- Disorders of Pancreas
- Hematology
- Gastrointestinal
- Upper GI Disorders
- Liver & Gallbladder Disorders
- Newborn Complications
- Renal
- Respiratory
- Test Taking Strategies
- Note Taking
- Prefixes
- Suffixes
- Medication Administration
- Gastrointestinal Disorders
- Respiratory Disorders
- Respiratory System
- Urinary System
- Pregnancy Risks
- Labor Complications
- Hematologic Disorders
- Fundamentals of Emergency Nursing
- Factors Influencing Community Health
- Delegation
- Perioperative Nursing Roles
- Lower GI Disorders
- Emergency Care of the Neurological Patient
- Acute & Chronic Renal Disorders
- EENT Disorders
- Central Nervous System Disorders – Brain
- Documentation and Communication
- Preoperative Nursing
- Disorders of the Adrenal Gland
- Disorders of the Thyroid & Parathyroid Glands
- Endocrine System
- Legal and Ethical Issues
- Adult
- Basics of NCLEX
- Communication
- Understanding Society
- Immunological Disorders
- Substance Abuse Disorders
- Studying
- Fetal Development
- Terminology
- Cognitive Disorders
- Musculoskeletal Trauma
- Intraoperative Nursing
- Tissues and Glands
- Vascular Disorders
- Eating Disorders
- Microbiology
- Male Reproductive Disorders
- Sexually Transmitted Infections
- Infectious Respiratory Disorder
- Anxiety Disorders
- Depressive Disorders
- Oncology Disorders
- Personality Disorders
- Psychotic Disorders
- Trauma-Stress Disorders
- Respiratory Emergencies
- Noninfectious Respiratory Disorder
- Basics of Chemistry
- Neurologic and Cognitive Disorders
- Integumentary Disorders
- Newborn Care
- Basics of Mathematics
- Statistics
- Emergency Care of the Trauma Patient
- Hematologic System
- Hematologic Disorders
- Developmental Considerations
- Digestive System
- Behavior
- Postpartum Care
- Basic
- Integumentary Disorders
- Metabolism
- Cardiovascular Disorders
- Concepts of Population Health
- Musculoskeletal Disorders
- EENT Disorders
- Basics of Human Biology
- Postoperative Nursing
- Urinary Disorders
- Neurological Emergencies
- Prenatal Concepts
- Disorders of Thermoregulation
- Community Health Overview
- Neurological Trauma
- Renal Disorders
- Concepts of Mental Health
- Childhood Growth and Development
- Prenatal and Neonatal Growth and Development
- Postpartum Complications
- Concepts of Pharmacology
- Integumentary Important Points
- Emotions and Motivation
- Health & Stress
- Multisystem
- Proteins
- Renal and Urinary Disorders
- Developmental Theories
- Reproductive System
- Endocrine and Metabolic Disorders
- Musculoskeletal Disorders
- Adulthood Growth and Development
- Psychological Emergencies
- Growth & Development
- Female Reproductive Disorders
- Basics of Sociology
- Neurological
- Intelligence and Language
- Labor and Delivery
- Reading
- Oncologic Disorders
- Bipolar Disorders
- Med Term Basic
- Peripheral Nervous System Disorders
- Infectious Disease Disorders
- Muscular System
- Central Nervous System Disorders – Spinal Cord
- Learning Pharmacology
- Prioritization
- Somatoform Disorders
- Writing
- Pediatric
- Emergency Care of the Respiratory Patient
- Sensory System
- State of Consciousness