Exacerbation of COPD etiology

COPD Case Study

Patient and History:

D.Z. a 65 yr old man is admitted to a medical floor for COPD exacerbation. PMH of HTN, controlled well by enalapril for the past 6 years as well as a recent diagnosis of pneumonia.  He appears cachectic and experiences dyspnea at rest.  He reports a productive cough of thick yellow green sputum.  D.Z. is experiencing irritability and anxiety.  He reports smoking 2 packs a day for 38 years. He complains of sleeping poorly and feeling tired most of the time.

Vital signs:

BP 162/84, P 124, RR 36, T 102.8F SaO2 88% Room air.

Admitting diagnosis: Exacerbation of COPD etiology to be determined.

Orders:

Diet as tolerated, Up with assistance, O2 to maintain sats greater than 90%, IV D5W @ 50 ml/hr, Strict I/O, ABG’s in AM, CBC with diff, BMP, Theophylline level on admission, CXR every 24 hours.

Medications:

Prednisone 60mg po daily

Doxycycline 100mg po every 12 hours for 10 days

Azithromycin 500 mg IVPB every 24 hours for 2 days then 500mg po for 7 days

Theophylline 300mg po BID

Heparin SQ 5000 Units BID

Albuterol 2.5mg/3ml NS and Atrovent 500mg by nebs every 4-6 hours

Enalapril 10mg po every am

Questions:

1. In 200 Words Explain the pathophysiology of COPD give clinical example of symptoms and pathophysiology associated with COPD.

2. What type of COPD do you feel this patient is experiencing provide explanation in 200 words minimum?

3. Are DZ’s VS and SO2 appropriate? If not explain why?

4. Identify 3 nursing diagnosis and interventions that can be implemented to improve oxygenation and explain how to determine effectiveness. 200 word minimum.

5. Explain the purpose of the following classes of drugs as they relate to COPD provide explanation and direction for each use.

Antibiotics

Bronchodilators

Anticholinergics

Corticosteroids