These interventions and additional interventions are discussed during nursing and medical treatments for the disease process. It works by inhibiting acetylcholine at receptor sites of bronchial smooth muscle, resulting in decreased cGMP and bronchodilation. By Keith Rischer March 27, 2018 February 1st, 2019 No Comments. Patient is dyspneic with diminished lung sounds in the bases and diffuse rhonchi and some faint, expiratory wheezing. 04.37 Chronic Obstructive Pulmonary Disease (COPD) Case Study (60 min) 04.45 Preeclampsia (45 min) 04.11 Emergent Delivery (OB) (30 min) This will include: diagnosis, assessment and care planning of the patient, treatment of the disease, prevention of … A chest x-ray showed an increased AP diameter, flattening of the diaphragm, and decreased lung markings. hospital for 3 days with an acute COPD exacerbation and will be discharged tomorrow. Store at room temperature in a light resistant container. Albuterol has the same method of action as Salmeterol, acting on ßâ‚‚ pulmonary receptors by increasing cAMP which relaxes bronchial smooth muscle. Combination therapy with long-acting inhaled anticholinergics or corticosteroids and ßâ‚‚-agonist are indicated for any patient with a FEV₁ less than 60% of the expected value. 12th Feb 2020 This risk factor includes passive smoking since the patient is exposed to environmental tobacco smoke due to her husband’s smoking in the home. He has 10-year history of hypertension. The patient’s white blood cell count is elevated which is indicative of an infection. His current antihypertensive regimen includes hydrochlorothiazide … 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. (Lewis, Bucher, Heitkemper, & Harding, 2017). The patient’s hemoglobin level is also increased. He is alert and oriented, but … The patient has a 61 pack-year history (number of packs smoked per day multiplied by number of years smoked) and still currently smokes “to calm her nerves”. Data Collection History of Present Adult inhale content of 1 cap/day (18 mcg) using HandiHaler inhalation device or 2 INH (spray) 2.5 mcg each daily. VAT Registration No: 842417633. View Notes - Unfolding Case Study Pneumonia-COPD Case Study (with answers)(3)(1)(1)(1)(1) (1).docx from NURSING 13 at Riverside City College. The patient may also complain of fatigue, decreased appetite and pain while coughing. Both of these medications are indicated for COPD, though Albuterol is short acting (SABA) and specifically targets acute bronchospasm. The patient is a married housewife with a 1 pack a day smoking history from age 15. Hypoxemia and hypercapnia may result from decreased gas exchange. ... Case Study … (Skidmore-Roth, 2017)  By combining these bronchodilators, DuoNeb “improves their effect and decreases the risk of adverse effects” (Lewis, Bucher, Heitkemper, & Harding, 2017). Monitor the effectiveness of this therapy via ABGs and pulse oximetry to evaluate the patient response to therapy. (Lewis, Bucher, Heitkemper, & Harding, 2017) The patient also has a low PaOâ‚‚ and low oxygen saturation. 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. All work is written to order. The result of the culture will also determine if antibiotics are necessary and what type of antibiotic is appropriate for treatment. In COPD, the airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. If increased Oâ‚‚ therapy of more than 35-50% is ordered, use a humidification or nebulization device to prevent drying secretions and mucous membranes. This diagnostic value determines the medication treatment. COPD/Pneumonia SKINNY Reasoning Case Study Presentation. Bailey, P., Colella, T., & Mossey, S. (2004). CNS depression, paresthesia, chest pain, increased heart rate, dry mouth, blurred vision, glaucoma, vomiting, abdominal pain, constipation, dyspepsia, urinary difficulty, rash, angioedema, cough, upper RTI, candidiasis, flulike syndrome. (Bailey, Colella, & Mossey, 2004) Another study suggested an intervention called COPD-Guidance, Research on an Illness Perception (COPD-GRIP), a questionnaire, so that the nurse may assess the patient’s illness perception. Start studying COPD Case Study. The patient also uses supplemental oxygen via nasal cannula to increase her PaOâ‚‚ and oxygen saturation levels. If patient appears resistant to total cessation of smoking, use the “5 R’s” (relevance, risks, rewards, roadblocks, and repetition) to motivate the patient to quit smoking. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization. Drug-drug interactions with oral contraceptives, estrogens, diuretics, St. John’s wart. Dose range, route, adverse effects, patient education, implementation, and assessment for these medications are located in table 2 in the appendix. If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! This is most likely due to the chronic, inadequate oxygenation the patient faces due to her disease process. (Lewis, Bucher, Heitkemper, & Harding, 2017). Booker, R. (2005, 09 09). Chronic obstructive pulmonary disease is “characterized by chronic inflammation of the airways, lung parenchyma (respiratory bronchioles and alveoli), and pulmonary blood vessels [with] not fully reversible airflow limitation during exhalation” (Lewis, Bucher, Heitkemper, & Harding, 2017). 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. It has the same method of action as Tiotropium, inhibiting acetylcholine at receptor sites on bronchial smooth muscle, resulting in decreased cGMP and bronchodilation. Digital Edition: Diagnosis and management of COPD: a case study 04 May, 2020. Respiratory acidosis is caused by a build-up of COâ‚‚, resulting in increased carbonic acid in the blood. Air becomes trapped in the lungs which creates gas exchange abnormalities, and an increased volume of residual air, making passive expiration arduous. The patient is also on supplemental oxygen via nasal cannula at 3L/min and IV fluids of normal saline at 80 mL/hr. DuoNeb is a combination of ipratropium and albuterol. Rinse mouth after use. Title: Case 27 – COPD with Respiratory Failure. (Lewis, Bucher, Heitkemper, & Harding, 2017), COPD is a progressive disease and clinical manifestations develop slowly. If this patient was producing sputum it would need to be collected and cultured and antibiotics would be prescribed, if appropriate. Learn vocabulary, terms, and more with flashcards, games, and other study tools. Do not use a spacer. The patient’s major risk factor is smoking. Infection is the … The patient may also alter their activities to avoid dyspnea, eventually having to modify their activities of daily living. Copyright © 2003 - 2021 - NursingAnswers.net is a trading name of All Answers Ltd, a company registered in England and Wales. Chronic obstructive pulmonary disease (COPD) is a group of common chronic … Amnah al-lail 2. Pulmonary function testing showed significant restrictive lung disease that was thought to be secondary to the patient’s chronic obstructive pulmonary disease (COPD). Search. The patient is a 76-year-old female with a history of chronic obstructive pulmonary disease (COPD). Oxygen therapy is also recognized as a primary treatment. Notify provider if >4 inhalations are needed. Severe ATT deficiency leads to premature bullous emphysema in the lungs” (Lewis, Bucher, Heitkemper, & Harding, 2017). Additional nursing interventions to increase these abnormal lab values are patient positioning and pursed-lip breathing. If anemia does occur in patients with COPD, it could … The patient states that she, “only smokes a little to calm her nerves” though her husband still continues to smoke in the home. • COPD is incredibly common; estimates vary but likely > 6% population • COPD is the fourth leading cause of death (since 1994). Learn vocabulary, terms, and more with flashcards, games, and other study tools. 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). Avoid OTC medications. Chronic obstructive pulmonary disease (COPD) is a progressive disease state characterized by airflow limitation that is not fully reversible. 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. 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. This preview shows page 1 - 2 out of 3 pages. This will also increase the patient’s FEV₁ level. A chest x-ray would be a reasonable … Recommend the patient to a pulmonary rehabilitation clinic and/or a support group to promote smoking cessation. 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. This LABA increases levels of cAMP, which relaxes pulmonary smooth muscle. The patient’s pH is low at 7.25 which indicates acidosis. Chronic obstructive pulmonary diseases (COPD) Adult Case Study Explain the role of smoking in the pathogenesis of COPD. This case study explains the symptoms, causes, pathophysiology, diagnosis and management of chronic … Albuterol (Proventil) is a ßâ‚‚-adrenergic agonist, bronchodilator, and sympathomimetic. Auscultate breath sounds, noting areas of decreased or absent breath sounds and adventitious sounds to obtain ongoing data on patient’s response to therapy. COPD case presentation by Amnah AlLail 1. If the patient is having trouble expectorating, teach and promote airway clearance techniques such as huff coughing to loosen secretions and promote expectoration. Registered office: Venture House, Cross Street, Arnold, Nottingham, Nottinghamshire, NG5 7PJ. This will reveal if the cause of the exacerbation is an infection and whether it is bacterial or viral. Question four Patients with an exacerbation of COPD usually present with increased sputum production, a change in sputum color compared with baseline, cough and/or worsening dyspnea. Start studying COPD case study answers. If patient is able to expectorate sputum, assess and monitor sputum volume and purulence to detect possible infection. The patient’s HCO₃⁻ should also be monitored to observe renal compensation and to monitor for decompensation and metabolic alkalosis. These are all physical manifestations of COPD as aforementioned in the pathophysiology of COPD. Applied Nursing Research, 33, 85-92. (Lewis, Bucher, Heitkemper, & Harding, 2017), Risk factors for COPD include exposure to noxious particles, especially cigarette smoke. The patient’s symptoms include patient report that she feels, “anxious, more fatigued than usual with a very poor appetite”, as well as increasing dyspnea described as “really bad now, I can’t breathe”. Recommend a “diet high in calories and protein, moderate in carbohydrate, and moderate to high in fat” (Lewis, Bucher, Heitkemper, & Harding, 2017). If this complication were to occur, it is most frequently treated by inserting a chest tube with drainage. Suggest the patient rest at least 30 minutes before eating and break up meals into five or six small meals a day to conserve energy. 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). Study for free with our range of nursing lectures! Michael Nastase Date 09/29/20 Asthma and COPD Case Study Answers Asthma 1. The patient uses Serevent Diskus DPI (50 mcg/inhalation), 1 puff twice a day. Registered Data Controller No: Z1821391. The patient is tachypneic with a respiratory rate of 34-38 and tachycardic with a pulse rate of 118-124. Use the “5 A’s” (ask, advise, assess, assist and arrange) to assess patient willingness to quit smoking. (Bailey, Colella, & Mossey, 2004) However, this study also indicated that the nurses believed anxiety to be the cause of the breathlessness, not that difficulty breathing caused anxiety. This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Adult inhale 50 mcg (1 inhalation as dry powder) every 12 hours. Avoid getting aerosol in eyes. (Lewis, Bucher, Heitkemper, & Harding, 2017), Once the exacerbation has subsided, nursing interventions would focus on patient teaching. All of these signs and symptoms are manifestations of the patient’s inadequate oxygenation due to an exacerbation of her COPD. The genetic risk factor for COPD is a deficiency of α– Antitrypsin (ATT). The patient should also use spirometry to measure their FEV₁/FVC ratio to monitor the effects of the medications. “The primary causes of [COPD] exacerbations are bacterial or viral infections” (Lewis, Bucher, Heitkemper, & Harding, 2017). Estimated to be the third leading cause of death by 2020. This is because studies have shown that smoking cessation changes the clinical course of COPD by preserving lung function. Chronic cough can cause excess mucus production. The patient’s FEV₁ was 40% of expected value. Outline Patient presentation COPD assessment according to GOLD 2017 Pharmaceutical care plan Smoking cessation Newly approved drugs for COPD … (Lewis, Bucher, Heitkemper, & Harding, 2017) Chronic inflammation causes structural deviations in the lungs which leads to airflow limitation and obstruction. Try our expert-verified textbook solutions with step-by-step explanations. 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