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Scenario CASE 29 COPD Exacerbation Med Sug Cases D. Z., a 68-year-old man, is admitted at 1600 to a medical floor with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD).$19.99
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Scenario CASE 29 COPD Exacerbation Med Sug Cases D. Z., a 68-year-old man, is admitted at 1600 to a medical floor with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD).
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Scenario CASE 29 COPD Exacerbation Med Sug Cases
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Scenario CASE 29 COPD Exacerbation Med Sug Cases
Scenario CASE 29 COPD Exacerbation Med Sug Cases
D. Z., a 68-year-old man, is admitted at 1600 to a medical floor with a diagnosis of acute exacerbation
of chronic obstructive pulmonary disease (COPD).
D. Z., a 68-year-old man, is admitted at 1600 to a medical floor with a diagnosis of acute exacerbation
of chronic obstructive pulmonary disease (COPD). His other past medical history includes hypertension and
type 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 a cachectic man who is experiencing difficulty
breathing at rest. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately he
feels tired most of the time. He reports cough productive of thick yellow-green sputum. You auscultate
decreased breath sounds, expiratory wheezes, and coarse crackles in both lower lobes anteriorly and
posteriorly. His vital signs (VS) are 162/84, 124, 36, 102° F (38.9° C), and Sp O2 88%.
Physician's Orders
Diet as tolerated
Out of bed with assistance
Oxygen (O 2) to maintain SpO2 of 90%
IV of D5W at 50 mL/hr
ECG monitoring
Arterial blood gases (ABGs) in AM
CBC with differential now
Basic metabolic panel (BMP) now
Chest x-ray (CXR) daily
Sputum culture
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
1.
D.Z vitals are not appropriate, he is hypertensive at 162/84 mmHg ,tachycardic at 124 bpm, and tachypneic
of 36, SpO2 88% is low, the pt has orders for O2 to maintain SpO2 of 90%> and has a fever of 102 F. Most
concerning for me are D.Z. RR of 36, pt's SpO2 needs to be closely monitored. A RR of 36 is very close to
needing assisted ventilation for efficient gas exchange (Ex. BiPAP) An infection process may be thhe under
cause of D.Z. symptomatology.
2. Describe a plan for implementing these physician's orders.
After administering the albuterol treatment, provide the patient with 3L-5L oxygen through nasal cannula f
oxygen saturation. Once the patients O2 sat is stable then I would place the 5 leads EKG electrodes (tele
collect the sputum culture, and hang the D5W. Then I would draw blood for the CBC and BMP, and ABG a
the AM Lastly, I would make sure the chest xray is ordered daily for the patient.
, 3. Patient maintains optimal gas exchange as evidenced by usual mental status, unlabored
respirations at 12-20 per minute, What is the primary nursing goal at this time? oximetry
results within normal range SpO290%>, blood gases within normal range, and baseline HR for
pt. Patient will maintain clear lung fields and remains free of signs of respiratory distress.
4. Based on this priority, identify three independent nursing actions you would implement.
1. Initiate the Albuterol nebulizer treatment
2. Continue administering O2 to the patient vis nasal cannula after the treatment
3. Recheck vitals and reassess the patient.
5. Identify three expected outcomes for D.Z. as a result of your interventions.
1. DZ’s Spo2 level will be 90% or higher
2. The patient’s respirations will slow down and become unlabored
3. When the patient has a decrease in their anxiety level, the vital signs will return to normal limits
Medication Administration Record
Methylprednisolone (Solu-Medrol) 125 mg IVP every 8 hours
Azithromycin (Zithromax) 500 mg IVPB q24h × 2 days then 500 mg PO× 7 days
Fluticasone/salmeterol (Advair) 100/50 mcg 2 puffs twice daily
Heparin 4000 units subcut every 12 hours
Enalapril (Vasotec) 10 mg PO daily
Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment every 6 hours
Metformin (Glucophage) 500 mg PO twice daily
6. Indicate the expected outcome for D.Z. that is associated with each medication he is
receiving.
Methylprednisolone (Solu-Medrol) – stress of inflammatory and immune responses inautoimmune disord
reactions and neoplasms Azithromycin
Azithromycin (Zithromax) – resolution of the signs and symptoms of infection
Fluticasone/salmeterol (Advair) – treat air flow blockage and reduce the worsening of COPD
Heparin – prolonged PTT without signs of hemorrhage, prevent DVTs
Enalapril (Vasotec) – decrease BP and decrease development of heart failure.
Albuterol / ipratropium – prevention or relief of bronchospasm
Metformin (Glucophage) – control blood glucose levels
•
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