Respiratory Case Study
D.Z is a 62-year-old man, admitted at 1600 to a medical floor with a diagnosis of acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD). His past medical history includes hypertension and types 2 diabetes. He has had pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. His current medications include enalapril (Vasotec), hydrochlorothiazide (HCTZ), metformin (Glucophage), and fluticasone/salmeterol (Advair). He appears anxious and has difficulty breathing at rest. D. Z seems irritable and anxious; he C/O of sleeping poorly and states that lately, he feels tired most of the time. He reports a productive cough with thick yellow-green sputum. You auscultate decreased breath sounds, expiratory wheezes, and coarse crackles in both bilateral anterior and posterior lower lobes. His vital signs are 162/84, 124, 36, 102 degrees, and SPO2 88%.
Doctor’s orders:
Diet as tolerated
Out of bed with assistance
Oxygen to keep SPO2 above 90%
D5W at 50ml/hr.
ECG monitoring
Arterial Blood Gases (ABG) in the AM
CBC with differential now
BMP now
CXR daily
Sputum culture
Albuterol 2.5mg and ipratropium 250mcg nebulizer treatment STAT
Questions:
- What is COPD?
- What are the signs and symptoms of COPD?
- How is COPD treated?
- Is there any other order you will anticipate from the doctor?
- Explain some of the teaching points you would like to address with this patient?
- State 2 nursing diagnoses.
