Chronic Obstructive Pulmonary Disease Essay Discussion Paper
Greg, age 20, is an African-American male who comes to the ED complaining “I can’t get my breath.” His friend Jamie, who has brought him to the hospital. Nurse Jackie, the triage nurse, quickly escorts them both to a nearby room, where she assesses Greg. She finds his breathing is labored with audible wheezing and notes that he can speak only in short sentences.
Realizing he needs immediate evaluation and treatment, Nurse Jackie positions him in high Fowler’s position. His vital signs are temperature 98.7°, blood pressure 190/88 mm Hg, pulse 122 beats/minute, and respiratory rate 32 breaths/minute. His oxygen saturation is 88%. Nurse Jackie administers oxygen 2 L per nasal cannula and places Greg on a cardiac monitor, which reveals sinus tachycardia. Then she contacts the ED physician.
On arrival, the physician auscultates Greg’s lungs and finds bilaterally diminished lung sounds with expiratory wheezing in the upper and lower fields. He orders an increase in supplemental O2 to 3 L to attain an O2 sat of 93%. As ordered, Nurse Jackie obtains an arterial blood gas sample, chest X-ray, and electrocardiogram. ABG results show a pH of 6.85, partial pressure of arterial oxygen of 62 mm Hg, bicarbonate level of 26 mEq/L, and a partial pressure of arterial carbon dioxide of 48 mm Hg.
- Based on the ABG, what does the result tell you about the patient? How did you come up with this conclusion? Explain your answer. (2 points)
- What medication would you anticipate the ED physician to order? How do these medications help your patient? Name two drug classification that the ED physician would order for this patient. Explain your answer. (3 points)
- What would be a NANDA for this patient? What is your goal (SMART)? (2 points)
Greg was diagnosed with new onset asthma. Greg was getting discharged with inhalers.
- Based on your answer to question #2, what would you include in your patient teaching? Provide three patient teaching that you would include and the rationale. (3 points)
Case Study B:
The patient is a 60-year-old white female presenting to the emergency department with acute onset shortness of breath. Symptoms began approximately 2 days before and had progressively worsened with no associated, aggravating, or relieving factors noted. She had similar symptoms approximately 1 year ago with an acute, chronic obstructive pulmonary disease (COPD) exacerbation requiring hospitalization.
1) How would you explain COPD to the patient? In your own words. (2 points)
2) What is your short-term goal (WITHIN YOUR SHIFT)? Long-term goal (HOME)? Why? Explain both answers. (2 points)
3) Provide two nursing diagnosis you would use for this patient. PRIORITIZE. Include goals for your Nursing Diagnosis. (4 points)
4) Provide two diagnostic tests you would perform for this patient and why. (1 point)
5) What patient/family teaching would you provide the patient before discharge? (1 point)
- The ABG result shows that the patient is in respiratory acidosis, which is a condition that occurs when the lungs cannot remove enough carbon dioxide from the body, leading to an increase in carbon dioxide and a decrease in blood pH. The pH value of 6.85 is below the normal range of 7.35-7.45, indicating acidosis. The partial pressure of arterial oxygen (PaO2) of 62 mm Hg is also below the normal range, indicating hypoxemia. The bicarbonate level of 26 mEq/L is within the normal range, indicating that the kidneys are compensating for the respiratory acidosis.
- The ED physician would likely order bronchodilators, such as albuterol or ipratropium, to help relieve the patient’s bronchospasm and improve airflow to the lungs. These medications work by relaxing the smooth muscles of the airways and widening them, allowing more air to flow through. The physician may also order systemic corticosteroids, such as prednisone, to reduce airway inflammation and swelling. These medications help by suppressing the immune response that causes inflammation in the airways.
- A NANDA for this patient could be “Impaired gas exchange related to bronchospasm and hypoxemia as evidenced by diminished lung sounds and low oxygen saturation.” The goal would be to improve gas exchange and increase oxygen saturation to at least 95% on room air. This goal is SMART because it is specific, measurable, achievable, relevant, and time-bound.
- Patient teaching for inhaler use would include the proper technique for using the inhaler, such as shaking the canister, exhaling completely, and timing the inhalation with the actuation of the inhaler. The patient should also be taught to clean the inhaler regularly and to keep track of the number of doses remaining in the canister. Additionally, the patient should be advised to seek medical attention immediately if their symptoms worsen or if they experience any adverse effects from the medication.
- Chronic obstructive pulmonary disease (COPD) is a lung disease that makes it hard to breathe. It’s a term that includes chronic bronchitis and emphysema. COPD causes damage to the lungs that makes it hard to get enough oxygen in and to breathe out carbon dioxide. COPD is usually caused by long-term exposure to irritants, such as cigarette smoke or air pollution.
- The short-term goal within the shift is to stabilize the patient’s breathing and oxygenation status. This includes administering supplemental oxygen, bronchodilators, and corticosteroids as needed to improve airflow and reduce inflammation. The long-term goal is to manage the patient’s COPD to prevent future exacerbations and slow the progression of the disease. This may include smoking cessation, pulmonary rehabilitation, and medication management.
- Two nursing diagnoses for this patient may be:
- Impaired Gas Exchange related to decreased lung function as evidenced by shortness of breath and decreased oxygen saturation. The goal for this nursing diagnosis would be to improve oxygenation status and maintain adequate oxygen saturation levels.
- Ineffective Airway Clearance related to increased mucus production and inflammation as evidenced by audible wheezing and cough. The goal for this nursing diagnosis would be to improve airway clearance and reduce the risk of respiratory distress.
- Chest X-ray: to assess for any abnormalities in lung structure or function, such as emphysema or pneumonia.
- Pulmonary function tests: to measure lung function, including lung capacity, airflow, and gas exchange. This can help diagnose COPD and monitor disease progression.
- Smoking cessation: to reduce further damage to the lungs and prevent future exacerbations.
- Proper medication use: to ensure the patient is using their inhalers or other medications correctly and getting the most benefit from them.
- Signs and symptoms of exacerbation: to help the patient recognize when their symptoms are worsening and seek treatment early.