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.