Problem
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, atrial fibrillation, and sleep apnea. 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), rivaroxaban (Xarelto) 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. You auscultate decreased breath sounds, expiratory wheezes, and coarse crackles in both lower lobes anteriorly and posteriorly.
His vital signs (VS) are 155/84, HR 110, T 37.4C, RR 30, and Spo2 88%.
Assessment findings this morning:
1) Increased fatigue over the past 3 days
2) Alert and oriented X 2-disoriented to place this morning
3) Tripod position
4) Dyspnea
5) Fatigue
6) Accessory muscle use
7) Breath sounds diminished to bases bilaterally
8) Productive cough with yellow blood-tinges sputum-difficulty expectorating
9) Expiratory wheeze bilaterally
10) Barrel chest
11) Skin is pale, hot and dry
12) Strong peripheral pulses
13) Intermittent chills
14) Fingernails are yellow with clubbing present
I. List and describe two diagnostic tests that would confirm a diagnosis of COPD?
II. With the diagnosis of COPD and a history of HTN, what cardiac condition is this patient at risk for developing? Explain the pathophysiology of the condition and its relevance to COPD.
III. Explain the significance of the respiratory assessment findings of a) tripod position b) fatigue c) wheezing?