COPD Case Study
Chamberlain College of Nursing
NR 324: Adult Health I
NR 324: Adult Health I
COPD Case Study
COPD Case Study
... [Show More]
Chamberlain College of Nursing
NR 324: Adult Health I
COPD Case Study
JS, a 72 year old, African American female, presents to the emergency room with chief complains of shortness of breath, cough and increasing purulent sputum production over the past 4-5 days. Her symptoms have increased over the past week, which include fatigue, restlessness, nausea, vomiting and headache. She currently smokes one pack a day and has been smoking since past 10 years. Her family history consist of both parents who are smokers, father was diagnosed with COPD and mother died due to lung cancer at age 60. Her past medical history consists of urinary tract infection, obstructive sleep apnea, depression, chronic obstructive pulmonary disease, and restless leg syndrome. Her current medical history consists of restless leg syndrome, sleep apnea and chronic obstructive pulmonary disorder. She is admitted to the clinic for recurrent episode of respiratory tract infection; COPD and to treat restless leg syndrome.
Upon admission, her arterial blood gases were drawn and the results include; PaO2: 42 mmHg; PaCO2: 65 mmHg; pH: 7.27 and SpO2: 84%. The results show respiratory acidosis, which is linked with COPD due to increase in CO2 . The normal results for ABGs include pH: 7.35-7.45, PaCO2: 35-45, HCO3: 22-26, PaO2: 80-100 and SpO2: 95-100%. Other test includes chest x-ray.
Physiological Nursing Diagnosis
Ineffective Airway Clearance related to chronic obstructive pulmonary disease evidenced by dyspnea and difficulty vocalizing.
Short term goal: Patient will be able to show how to effectively use deep breathing and coughing exercises within four days.
Long term goal: Patient will be able to describe ways to maintain an open airway by discharge.
Nursing Interventions: Auscultate breath sounds. Assess and monitor respiratory rate. Note presence and degree of dyspnea. Assist client to maintain a comfortable position to facilitate breathing by elevating the head of bed, leaning on over bed table, or sitting on edge of bed.
Encourage and assist with abdominal or pursed lip breathing exercises.
Rationale statements: Some degree of bronchospasm is present with obstruction in airway and may or may not be manifested in adventitious breath sounds, such as scattered, moist crackles (bronchitis), faint sounds, with expiratory wheezes (emphysema), or absent breath sound (severe asthma). Tachypnea is usually present to some degree and may be pronounced on admission, during stress, or during concurrent acute infectious process. Respirations may be shallow and rapid, with prolonged expiration in comparison to inspiration. Respiratory dysfunction is variable depending on the underlying process. Elevation of the head of the bed facilitates respiratory function using gravity. Supporting arms and legs with table, pillows, and so on helps reduce muscle fatigue and can aid in chest expansion. Provides patient with some means to cope with and control dyspnea and reduce air trapping.
Evaluative statements: Patient has no adventitious breath sounds on auscultation of lungs.
Patient has better airway clearance than they did when they came into the hospital due to comfortable position. Patient has a decrease in dyspnea due to pursed lip breathing exercises. Potential Patient Education: Teach patient about disease process, prognosis, and therapeutic regimen. Teach patient about risk factors that should be avoid. Teach patient coping suggestions such as breathing techniques, proper positioning, and how to take rest in between activities.
Psychosocial Nursing Diagnosis for COPD
Anxiety related to exacerbation of symptoms AEB shortness of breath, cough and increasing purulent sputum production over the past 4-5 days.
Short term goals: Patient will learn how to control future exacerbations related to anxiety.
Long term goals: Patient will reduce anxiety by staying healthy and quit smoking.
Nursing Actions and Rationales:
Assess client for signs and symptoms of fear and anxiety. Recognize signs such as tenseness, shakiness, restlessness, diaphoresis, elevated blood pressure, tachycardia, and self-focused behaviors. Feelings of breathlessness can provoke panic, which can make this patient feel more anxious. Encourage patient to enroll into a smoking cessation clinic. Give patient literature and brochures on options that are available for her. Do not leave patient alone during period of acute respiratory distress. Implement measures to reduce fear and maintain a calm, supportive, confident manner when interacting with patient. Teach patient how to perform actions to improve respiratory status in order to reduce dyspnea. Teach patient how to purse lip breath. Patient will perform actions and breathing techniques to decrease the feeling of feeling suffocated. Advice patient to pace activities, take frequent rests, use assistive devices, and break activities into smaller tasks to help reduce dyspnea development. Teach patient how to eat little and often, particularly if eating increases the sensation of breathlessness. Patient will be taught to recognize exacerbations and to seek help early to reduce the need for hospital admission.
Evaluation: Patient experienced a reduction in anxiety as evidence by: Verbalizing of feeling less anxious. Patient experienced usual sleep pattern, relaxed facial expression, and body movements. Patient’s vital signs stabilized over time. Patient enrolled in a smoking cessation program. Patient developed an exercise program to help reduce stress. Patient agreed to wear a transdermal nicotine patch per doctor’s advice.
References
Doenges, M., & Moorhouse, M. (2014). Nursing care plans: Guidelines for individualizing client care across the life span (9th ed.). Philadelphia, PA: F. A. Davis Company.
Pickstock, S. (2014). Managing and preventing acute exacerbations of COPD in the community. Journal Of Community Nursing, 29(3), 39-44. [Show Less]