Assignment
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. Explain the pathophysiology and significance of the target O2 saturation of 88-92% in a patient with COPD.
II. You assess your patient and get the following Vital Signs. Explain the rationale for each of the VS findings below. Indicate whether they are normal or abnormal, indicate normal ranges, and explain your rationale for the change in VS. For normal ranges and indication of normal/abnormal VS, for explanation.
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T 37.4 C
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HR 110/bpm
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BP 155/84
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O2 sat 88%
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RR 30/min
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III. Why does the diagnosis of COPD increase risk for pneumonia for this client?
IV. List and describe two diagnostic tests that would confirm a diagnosis of COPD?
V. 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.
VI. Explain the significance of the respiratory assessment findings of (i) tripod position (ii) fatigue (iii) wheezing?
VII. Explain the significance of each of the findings.
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Lab test
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Findings
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Normal Findings
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Arterial Blood Gases (ABGs)
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pH 7.32
PaCO2 54
PaO2 62
HCO3- 24
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pH 7.35-7.45
PaCO2 35-45 mmHg
PaO2 80-100 mmHg
HCO3- 21-28 mmol/L
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Leukocytes (WBC)
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14.8
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3.5-12 x 109/L
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Hemoglobin (Hb)
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100
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120-160 g/L (F)
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Hematocrit (Hct)
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0.48
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0.37-0.47
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Sodium (Na+ )
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147
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135-145 mmol/L
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VIII. Explain the pathophysiology of obstructive sleep apnea (OSA) and the relevance to this case study.
IX. What assessment finding (list 1) suggests the possibility of delirium? Why is this important to know for nursing?