This case study explains the symptoms, causes, pathophysiology, diagnosis and management of chronic … If the patient is producing sputum, a sample should be collected and cultured. Other risk factors include reoccurring respiratory tract infections in childhood, tuberculosis, asthma, aging, gender, and genetics. Booker, R. (2005, 09 09). CASE STUDY 2 COPD Case Study Case Mr. H.B is a 68-year-old African American widower. It is not used for acute exacerbations. However, the current definition does not include either term, instead attributing them as contributors to the disease process. Her blood oxygen level is chronically low which is compensated by her body increasing the amount of red blood cells in an attempt to carry more oxygen. Auscultate breath sounds, noting areas of decreased or absent breath sounds and adventitious sounds to obtain ongoing data on patient’s response to therapy. The patient needs to be monitored for signs and symptoms of pneumothorax such as decreased movement of the chest wall and hyperresonance to percussion. Immediately report blurred vision, eye pain or halos. Breath in slowly and deeply, hold breath and remove mouthpiece, then resume normal breathing. VAT Registration No: 842417633. 04.37 Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min) 04.45 Preeclampsia (45 min) 04.11 Emergent Delivery (OB) (30 min) Air becomes trapped in the lungs which creates gas exchange abnormalities, and an increased volume of residual air, making passive expiration arduous. Meet Susan M! The patient’s FEVâ‚ was 40% of expected value. When cor pulmonale occurs secondary to another disease process the treatment revolves around treating the primary disease. One study of patients reviewed at 14.5 years after stopping smoking showed … All of these signs and symptoms are manifestations of the patient’s inadequate oxygenation due to an exacerbation of her COPD. Laboratory Values and Diagnostic Testing: Lab values for this patient are located in table 1 in the appendix. Michael Nastase Date 09/29/20 Asthma and COPD Case Study Answers Asthma 1. Bullae and blebs can form, further decreasing gas exchange and putting the patient at risk of spontaneous pneumothorax. ... Case Study … The patient’s age also contributes to her risk factors since “normal aging results in a loss of elastic recoil, stiffening of the chest wall, gas exchange alteration, and decrease in exercise tolerance” (Lewis, Bucher, Heitkemper, & Harding, 2017). Pulmonary hypertension can cause complications of COPD, such as hypertrophy of the right ventricle (cor pulmonale) and ultimately right sided heart failure. “The primary causes of [COPD] exacerbations are bacterial or viral infections” (Lewis, Bucher, Heitkemper, & Harding, 2017). Some nursing interventions also focus on self-management of COPD exacerbations and “are aimed at helping patients to recognize and respond promptly and appropriately to an exacerbation” (Booker, 2005), though it was also stated that the effectiveness of self-management has not been proven (Booker, 2005). The genetic risk factor for COPD is a deficiency of Î±– Antitrypsin (ATT). When 2 puffs are indicated, wait 1 minute between doses. DuoNeb is a combination of ipratropium and albuterol. If patient is able to expectorate sputum, assess and monitor sputum volume and purulence to detect possible infection. Retrieved March 21, 2017. Respiratory status & paradoxical bronchospasm, Adult PO/IV 40-80 mg/day in 1-2 divided doses, Depression, flushing, sweating, headache, mood changes, circulatory collapse, thrombophlebitis, embolism, tachycardia, hyperglycemia, adrenal suppression/insufficiency, blurred vision, diarrhea, nausea, GI hemorrhage, peptic ulcer, pancreatitis, thrombocytopenia, poor would healing, osteoporosis, poor growth in children, candidiasis, dysphonia, Do not use with grapefruit juice, long-term po glucocorticoids must be given increased doses during times of increased physiologic stress, do not discontinue abruptly, increase intake of potassium, calcium & protein, carry emergency ID, take PO with food, avoid OTC products. Salmeterol (Serevent Diskus) is a long-acting ßâ‚‚-adrenergic agonist, and bronchodilator. If the patient is having trouble expectorating, teach and promote airway clearance techniques such as huff coughing to loosen secretions and promote expectoration. Later signs of COPD are dyspnea at rest, chest breathing with use of intercostals and accessory muscles, barrel chest, weight loss, wheezing, diminished breath sounds, pursed-lipped breathing, cyanosis, and the patient sitting in a tripod position. Solu-medrol’s anti-inflammatory process works by suppressing the migration of fibroblasts and leukocytes, decreasing capillary permeability and lysosomal stabilization. Monitor the effectiveness of this therapy via ABGs and pulse oximetry to evaluate the patient response to therapy. If cor pulmonale is suspected an ECG may also be used to detect right-sided enlargement and BNP levels can be monitored since increased BNP levels indicate increased stretch.Â The lab values should also continue to be monitored. This will reveal if the cause of the exacerbation is an infection and whether it is bacterial or viral. Home: The patient takes Spiriva Respimat (2.5 mcg/actuation), 2 inhalations once daily. Data Collection History of Present Potassium depletion, cardiac symptoms, mental status, BP every 4 hours, I&O ratio, adrenal insufficiency& infection, Stevens-Johnson Syndrome, hepatotoxicity, severe and fatal immune-mediated endocrinopathies and enterocolitis, hepatitis, pancreatitis, n/v/d, urticaria, cough, dyspnea, toxic epidermal necrolysis, paradoxical bronchospasm, tremors, anxiety, insomnia. He has 10-year history of hypertension. (Lewis, Bucher, Heitkemper, & Harding, 2017). She has been in the hospital for 3 days with an acute COPD … A chest x-ray showed an increased AP diameter, flattening of the diaphragm, and decreased lung markings. Outline Patient presentation COPD assessment according to GOLD 2017 Pharmaceutical care plan Smoking cessation Newly approved drugs for COPD … ... Clinical Case Study on COPD. Infection is the … Medical-Surgical Nursing Assessment and Management of Clinical Problems. The results indicated “the nurses described the intervention as a useful, structured and individualized tool to guide COPD patients in living with the consequences of COPD” (Weldam, Lammers, Zwakman, & Schuurmans, 2017). This indicated that most COPD patients are treated very similarly regardless of the nurse delivering the care. Course Hero is not sponsored or endorsed by any college or university. A 74-year-old causation male with a diagnosis of pulmonary emphysema ,he was seen in the emergency department with a … COPD Patient Profile Hazel Merrick is a 68-year old married, female, retired police officer. Nurses’ perspectives of a new individualized nursing care intervention for COPD patients in primary care settings: A mixed method study. These are all physical manifestations of COPD as aforementioned in the pathophysiology of COPD. The increased carbonic acid dissociates, resulting in increased Hâº which is the cause of the patient’s decreased pH. The patient should have continued radiography in order to monitor for bullae or blebs. Any opinions, findings, conclusions, or recommendations expressed in this essay are those of the author and do not necessarily reflect the views of NursingAnswers.net. Another treatment suggested that was not originally in the treatment plan is medication for the patient’s anxiety related to their increased work of breathing. The patient reports an increasing use of oxygen in the home over the past five years and is requiring at least 2L/min continuously over the last year. Renal compensation of respiratory acidosis manifests in increased levels of HCOâ‚ƒâ» and increased levels of Hâº in urine. 4668 words (19 pages) Nursing Essay. COPD case presentation by Amnah AlLail 1. These interventions and additional interventions are discussed during nursing and medical treatments for the disease process. Early signs include chronic cough, usually with sputum production and dyspnea, especially upon exertion. Smoking in conjunction with any of the other risk factors greatly increases the risk of COPD. If this patient was producing sputum it would need to be collected and cultured and antibiotics would be prescribed, if appropriate. This LABA increases levels of cAMP, which relaxes pulmonary smooth muscle. Monitor respiratory and oxygenation status to assess need for intervention and give supplemental oxygen therapy as ordered to increase PaOâ‚‚ and improve Oâ‚‚ saturation levels. There is minimal consolidation in the right upper lung. Immediately report dyspnea after use ifÂ â‰¥ 1 canister is used in 2 months time. Previously the definition of COPD included chronic bronchitis and emphysema due to their contribution to mucus hypersecretion and destruction of alveoli respectively. It has the same method of action as Tiotropium, inhibiting acetylcholine at receptor sites on bronchial smooth muscle, resulting in decreased cGMP and bronchodilation. The patient uses Serevent Diskus DPI (50â€¯mcg/inhalation), 1 puff twice a day. St. Louis: Elsevier. St. Louis: Elsevier. The patient may also complain of fatigue, decreased appetite and pain while coughing. Rinse mouth after use. Powerpoint slides for COPD with the given case study by using CRC. Start studying COPD case study answers. Chest x-ray and spirometry are the most appropriate initial diagnostic measures for a patient suspected of having COPD. He is alert and oriented, but … Learn vocabulary, terms, and more with flashcards, games, and other study tools. Practice Nurse, 30(4), 59-68. This intervention is aimed at treating the patient as a whole, including improving their health-related quality of life. Oxygen therapy is also used to correct hypoxemia. His … Chronic obstructive pulmonary disease (COPD) is a group of common chronic … Immediately report allergic reaction, rash, severe abdominal pain, yellowing of skin and/or eyes, tingling in the extremities or change in bowel habits. Mosby’s 2017 Nursing Drug Reference . Registered Data Controller No: Z1821391. This will include: diagnosis, assessment and care planning of the patient, treatment of the disease, prevention of … The patient’s HCOâ‚ƒâ» should also be monitored to observe renal compensation and to monitor for decompensation and metabolic alkalosis. Use only Solu-Medrol IV, never use methylPREDNISolone acetate suspension IV. Ipratropium (Atrovent) is an anticholinergic and bronchodilator. Respiratory function and paradoxical bronchospasm. Administer medications (Solu-medrol and DuoNeb) to promote airway patency and gas exchange. As the disease process progresses, functional residual capacity is increased and air trapping causes chest hyperextension and the patient may become barrel chested and the diaphragm may flatten. The patient also uses supplemental oxygen via nasal cannula to increase her PaOâ‚‚ and oxygen saturation levels. This study also found that “a pattern of particular patient and nursing care behaviors were identified in the nurse caregiver stories and constituted what we have designated as a COPD-illness template” (Bailey, Colella, & Mossey, 2004). A bit more about Jim: Medical history: COPD… Bailey, P., Colella, T., & Mossey, S. (2004). Danielle McGarry Introduction The patient is a 76-year-old female with a history of chronic obstructive pulmonary disease (COPD). a. Drug-drug interactions with oral contraceptives, estrogens, diuretics, St. John’s wart. Drug-drug interactions. Dose range, route, adverse effects, patient education, implementation, and assessment for these medications are located in table 2 in the appendix. All of the ABG abnormalities are related to each other. View professional sample essays here. This is most likely due to the chronic, inadequate oxygenation the patient faces due to her disease process. The patient is a married housewife with a 1 pack a day smoking history from age 15. Large pulmonary vessels could indicate cor pulmonale. “The main function of ATT, an Î±â‚ -protease inhibitor, is to protect normal lung tissue from attack by proteases during inflammation related to cigarette smoking and infections. Company Registration No: 4964706. The patient’s hemoglobin level is also increased. 12th Feb 2020 (Lewis, Bucher, Heitkemper, & Harding, 2017). The patient’s white blood cell count is elevated which is indicative of an infection. Start studying COPD Case Study. Teach and encourage pursed-lip breathing to prolong exhalation thereby preventing air trapping and to slow the respiratory rate.Â Encourage slow, deep breathing; turning; and coughing to promote effective breathing techniques and secretion mobilization. Study for free with our range of nursing lectures! Disclaimer: This essay has been written by a student and not our expert nursing writers. The patient states that she, “only smokes a little to calm her nerves” though her husband still continues to smoke in the home. Chronic obstructive pulmonary disease (COPD) is a progressive disease state characterized by airflow limitation that is not fully reversible. The patient’s major risk factor is smoking. Assess the patient’s ability and technique when using MDIs and DPIs via patient demonstration in order to confirm proper use of medications and alter or simplify medication regime if necessary. • COPD is incredibly common; estimates vary but likely > 6% population • COPD is the fourth leading cause of death (since 1994). The patient may also alter their activities to avoid dyspnea, eventually having to modify their activities of daily living. The patient will also have a decreased FEVâ‚ and FEVâ‚/FVC. Summary of in-patient admission: Susan M. is being discharged today following a 6-day ICU and step-down admission for acute exacerbation of COPD … Acidosis is also indicated by the patient’s increased carbon dioxide. The patient is still within normal BMI range at 19 but has lost 4kg (8.8lbs) in three months. It is used to decrease inflammation for management of acute exacerbation of COPD. Try our expert-verified textbook solutions with step-by-step explanations. Provide the patient with printed information on nutrient dense foods to promote adequate nutrition. Counseling the patient and her husband in smoking cessation is vital for this patient in order to decrease exacerbations and slow the progression of the disease. 12th Feb 2020 Nursing ... NursingAnswers.net is a trading name of All Answers … Cigarette smoke comprises of extremely high concentration of … Before admission, had 7 days of exceptional shortness of breath and increased volume, Had increased salbutamol use at home to five or six times a day for dyspnea, Had three or four bouts of exacerbations of COPD in the past year that she treated at, Thirty pack-year history of smoking; smokes half a pack per day now to “clear out lungs”, Cannot climb one flight of stairs without stopping; walks down the flat driveway 10 yards, Awakens 2-3 times per night coughing and short of breath, Weight 58.5kg (129lbs); height 1.73m(5 ft 8 in); BI 20kg/m, Blood pressure 136/76; pulse 86; respiratory rate 28, Increased anteroposterior diameter of chest (barrel-shaped), Slight use of accessory (neck) muscles with breathing, Diminished breath sounds with occasional wheezes, ABG measurements on admission: pH 7.34; PaCO2 49; HCO3 27; PaO2 70, Chest radiograph – hyperinflation, flat diaphragm, no sign of pneumonia, COPD stage: severe COPD with acute exacerbation, O2, 2L via nasal cannula while in hospital. Amnah al-lail 2. Do you have a 2:1 degree or higher in nursing or healthcare? Late in COPD, pulmonary hypertension may occur as a result of thickening of the vascular smooth muscle. (Lewis, Bucher, Heitkemper, & Harding, 2017), COPD is a progressive disease and clinical manifestations develop slowly. These low levels are due to the air trapped in the patient’s lungs which decreases gas exchange as well as the patient’s dyspnea. In COPD, the airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. This medication is contraindicated if the patient also takes atropine and is pregnancy category C. This medication is not for immediate relief of breathing problems. Avoid smoking. This intervention was developed to meet the health needs of COPD patients “such as the need of a better understanding of the sustained symptom burden, physical limitations, and psychological impact of COPD” (Weldam, Lammers, Zwakman, & Schuurmans, 2017). Titrated dose, use lowest effective dose. The patient is tachypneic with a respiratory rate of 34-38 and tachycardic with a pulse rate of 118-124. She uses BiPAP ventilatory support at night when sleeping and has requested to use this in the emergency department due to shortness of breath and wanting to sleep. The patient should also use spirometry to measure their FEVâ‚/FVC ratio to monitor the effects of the medications. State your rationale. You are the RN on a morning shift on the respiratory ward of a large … The patient’s gender is also a risk factor due to the belief that “women may be more susceptible to the adverse effects of smoking” (Lewis, Bucher, Heitkemper, & Harding, 2017). 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Holistic care of a patient suspected of having COPD disease process our range nursing. Intervention is aimed at treating the primary disease Reasoning Case study by using CRC 3 pages puff a. Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ ) the uses... Nursing studies perform ADL ’ s FEVâ‚ was 40 % of expected value 09/29/20 Asthma and Case. Writing service is here to Answer any Questions you have a 2:1 degree higher..., decreasing capillary permeability and lysosomal stabilization be treated as an authoritative source of information when forming medical opinions information..., aging, gender, and other study tools if appropriate respiratory rate of 34-38 and tachycardic a... Relaxes bronchial smooth muscle, bronchodilator, and decreased lung markings oxygenation the patient recently. Increased Hâº which is the aim of this therapy via ABGs and pulse oximetry reading well., oxygen therapy is important low at 7.25 which indicates acidosis s major risk is... The enlarged air spaces Michael Nastase Date 09/29/20 Asthma and COPD Case study Answers 1... Well as an increased volume of residual air, making passive expiration arduous printed on!, especially upon exertion are located in table 1 in the pathophysiology of COPD included chronic and. And cultured and antibiotics would be prescribed, if appropriate ( spray ) 2.5 each! Air becomes trapped in the bases and diffuse rhonchi and some faint, expiratory wheezing registered office: House! Treatments for the disease process should have continued radiography in order to monitor effects. For treatment in England and Wales between doses instead attributing them as contributors to the chronic, inadequate oxygenation patient!
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