medical surgical RUA on COPD
it is a paper that was written for a patient with COPD from
an IHUMAN case
COPD Case Study
Alexa Wight, Aswathy
... [Show More] Aju, Tiara Washington
Noble Abraham, Helen Rodriguez Chamberlain University Pearland NR: 324 Medical Surgical Professor O’Neill Spring: April 2021
COPD Study Case
Health History of C.G
Carlos Gonzalez is a 68-year-old Hispanic male that presented to the emergency room this morning at 0900. He has a past medical history of COPD. He smoked a pack of cigarettes a day for 30 years but quit 10 years ago after being diagnosed with COPD. He has no known drug allergies. His chief compliant upon arrival is shortness of breath, cough and increased phlegm production. Mr. Gonzalez states that his increased shortness of breath started four days ago. He has been taking his prescribed inhaled medications without relief. He states, “My albuterol just isn’t working anymore. I get so nervous because I’m all alone and it’s hard for me to breathe.”
He also states that his cough started three days ago, and he has been coughing up green sputum. According to Mr. Gonzalez, he wears oxygen at 2 liters per minute at home, and his SPO2 this morning was 85%.
Downloaded by Abdra Sree ([email protected])
COPD patients tend to retain sodium and potassium due to diuretics and beta-adrenergic agonists, therefore electrolytes were drawn. A BNP should be suggested in order to differentiate between CHF and COPD. ABGs may show changes of hypoxia and hypercapnia. Liver function tests will give us a baseline to compare for later, and a WBC differential can tell us if there is an infection.
Collaborative Management
Mr. Gonzalez is on a regular diet. His home medications include Advair Diskus 1 puff q12h, Ipratropium bromide MDI 2 puffs q6h and Proventil MDI 1-2 puff q4h PRN. Once admitted, Ipratropium and albuterol nebulization per PRN Azithromycin, Methylprednisolone 60 mg IV once, Prednisone 40 mg PO qam, 500 mg IV every 24 hours for 2 days, Tylenol 650 mg for fever 100.3. Blood cultures were drawn before antibiotics and the results are pending.
A collaborative problem is a problem that requires both medicine and nursing interventions to treat (Carpenito, 2017). Nurses practice with other health care professions to manage certain types of collaborative problems using physician-prescribed and nursingprescribed interventions to minimize complications of the events (Carpenito, 2017). Collaboration is critical in providing quality and patient-centered care for our patients and requires many health care professionals to come together as a team. In our patients' case a respiratory therapist is involved in his care to provide specialized treatment and care for his chronic lung disease. This includes providing assistance and recommendations in modifying his medication regimen when the desired results are not achieved. Respiratory therapy will also help monitor his oxygen levels and provide more specialized teaching on therapies and techniques such as pursed lip breathing and the use of the incentive spirometer. A request for a dietary consult has been made for nutritional assistance to help maintain his overall health, assisting in resolving potential infection, and increasing overall strength in the respiratory muscles. Social services have been contacted for home resources after discharge. These resources may include contacts for home health to provide some assistance, support group information to connect the patient with those who are struggling with similar problems, and possible assistance in managing medications and the costs of health care. A pulmonologist is also involved in his care to diagnose, treat, and manage COPD and pneumonia.
Priority Physiological Nursing Diagnosis for COPD
Nursing Diagnosis #1: Ineffective airway clearance Related to (RT): Impaired respiratory muscle function. As evident by (AEB): Persistent cough with sputum production
Planning/Desired Outcome(s):
Short term goal: Patient will demonstrate behaviors to improve airway clearance such as coughing effectively and expectorate secretions within 12 hours of nursing shift.
Long term goal: Patient will demonstrate the ability to perform activities of daily living and improve his exercise tolerance without additional complications by discharge.
Implementation/Nursing intervention(s): The nurse will teach the patient effective coughing and deep breathing techniques (Brooks, 2018).
The nurse will administer bronchodilators as ordered (Brooks, 2018).
The nurse will perform chest physiotherapy such as bronchial tapping when coughing (Brooks, 2018).
The nurse will Increase fluid intake to 3000 mL between meals every day within cardiac tolerance and doctor's order (Brooks, 2018). The nurse will instruct patient to use the incentives spirometer ten times an hour while awake (Ackley & Ladwig, 2020).
Rationale
These different techniques will facilitate the clearance in the lungs and lower the risk of pneumonia for the patient (Brooks, 2018).
Bronchodilators are prescribed to maintain airway patency. This will make breathing easier by relaxing the muscles in the lungs and widening airways
(Brooks, 2018). These techniques will prevent aspirations and reduce the risk of complications (Brooks, 2018).
Hydration helps decrease thick secretions, facilitating expectorations (Brooks, 2018). IS will expand lungs by helping breathe more deeply and fuller to prevent fluid buildup in the lungs (Ackley & Ladwig, 2020).
Evaluation/Patient Response
Goal met evidenced by patient performs coughing and deep breathing techniques every hour and reports a reduction of sputum since starting techniques. Goal met evidenced by patient reports an ease of breathing after the administration of bronchodilator medication.
Goal met evidenced by patient understands the importance of performing chest physiotherapy exercises to reduce congestion and prevent aspiration. Goal met evidenced by patient’s secretions are thin and easily expectorated.
Goal met evidenced by patient using the IS ten times an hour while awake.
COPD Patient Education for Physiological Nursing Diagnosis: [Show Less]