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If you need assistance with writing your nursing essay, our professional nursing essay writing service is here to help! Rock active learning as an educator or if you are a student, use this written case study with fully developed answer … This preview shows page 1 - 2 out of 3 pages. Data Collection History of Present COPD Case Study Patient and History: D.Z. Signs observed upon assessment include the patient being pale and restless, sitting in a tripod position using pursed-lip breathing and accessory muscles during respiration. It is not used for acute exacerbations. Patient is dyspneic with diminished lung sounds in the bases and diffuse rhonchi and some faint, expiratory wheezing. This LABA increases levels of cAMP, which relaxes pulmonary smooth muscle. No, B.T.’s vital signs are not acceptable and are abnormal. Her blood oxygen level is chronically low which is compensated by her body increasing the amount of red blood cells in an attempt to carry more oxygen. COPD-intuition or template: nurses’ stories of acute exacerbations of chronic obstructive pulmonary disease. • COPD is incredibly common; estimates vary but likely > 6% population • COPD is the fourth leading cause of death (since 1994). This medication has drug-drug interactions with CPY3A4 inhibitors, aerosol bronchodilators, tricylics, MAOI’s and ß-blockers. 12th Feb 2020 It works by inhibiting acetylcholine at receptor sites of bronchial smooth muscle, resulting in decreased cGMP and bronchodilation. COPD/Pneumonia SKINNY Reasoning Case Study Presentation. If the patient is producing sputum, a sample should be collected and cultured. Her blood pressure is borderline hypotensive at 100/54. Recommend a “diet high in calories and protein, moderate in carbohydrate, and moderate to high in fat” (Lewis, Bucher, Heitkemper, & Harding, 2017). (Lewis, Bucher, Heitkemper, & Harding, 2017). Radiography is also used to monitor for complications. The patient was also prescribed DuoNeb solution (500 mcg ipratropium and 2500 mcg albuterol in 3-mL) via nebulizer STAT and every 6 hours. CASE STUDY 2 COPD Case Study Case Mr. H.B is a 68-year-old African American widower. The increased carbonic acid dissociates, resulting in increased H⁺ which is the cause of the patient’s decreased pH. Solu-medrol’s anti-inflammatory process works by suppressing the migration of fibroblasts and leukocytes, decreasing capillary permeability and lysosomal stabilization. Medication therapy did not significantly differ in that short-acting bronchodilators were recommended as first line therapy to treat breathlessness though antibiotics were also recommended “in exacerbations that are characterized by an increase in sputum purulence” (Booker, 2005). Assess for co-morbidities such as osteoporosis, cardiovascular disease or psychologic problems to ensure patient comprehension and safe management of disease. Lewis, S., Bucher, L., Heitkemper, M., & Harding, M. (2017). (Lewis, Bucher, Heitkemper, & Harding, 2017), Once the exacerbation has subsided, nursing interventions would focus on patient teaching. Respiratory function and paradoxical bronchospasm. Chronic cough can cause excess mucus production. Early signs include chronic cough, usually with sputum production and dyspnea, especially upon exertion. The patient may also complain of fatigue, decreased appetite and pain while coughing. This treatment is appropriate due to the rationale; the antibiotic is indicated if the exacerbation is in response to infection. He has a past medical history of … Chronic obstructive pulmonary disease (COPD) is a group of common chronic … The patient has a 61 pack-year history (number of packs smoked per day multiplied by number of years smoked) and still currently smokes “to calm her nerves”. The patient’s pH is low at 7.25 which indicates acidosis. Booker, R. (2005, 09 09). His … (Skidmore-Roth, 2017)  By combining these bronchodilators, DuoNeb “improves their effect and decreases the risk of adverse effects” (Lewis, Bucher, Heitkemper, & Harding, 2017). Bailey, P., Colella, T., & Mossey, S. (2004). As the disease process progresses, functional residual capacity is increased and air trapping causes chest hyperextension and the patient may become barrel chested and the diaphragm may flatten. (Bailey, Colella, & Mossey, 2004) Another study suggested an intervention called COPD-Guidance, Research on an Illness Perception (COPD-GRIP), a questionnaire, so that the nurse may assess the patient’s illness perception. Adult inhale content of 1 cap/day (18 mcg) using HandiHaler inhalation device or 2 INH (spray) 2.5 mcg each daily. This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. In COPD, the airflow limitation is both progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases. The patient’s gender is also a risk factor due to the belief that “women may be more susceptible to the adverse effects of smoking” (Lewis, Bucher, Heitkemper, & Harding, 2017). This preview shows page 1 - 2 out of 3 pages. Recommend the patient to a pulmonary rehabilitation clinic and/or a support group to promote smoking cessation. (Lewis, Bucher, Heitkemper, & Harding, 2017), Risk factors for COPD include exposure to noxious particles, especially cigarette smoke. Low levels of ATT can be detected by a blood test. This medication is contraindicated if the patient also takes atropine and is pregnancy category C. This medication is not for immediate relief of breathing problems. This will reveal if the cause of the exacerbation is an infection and whether it is bacterial or viral. (Lewis, Bucher, Heitkemper, & Harding, 2017) Possible symptoms include the patient complaining “of not being able to take a deep breath, heaviness in the chest, gasping, increased effort to breathe and air hunger” (Lewis, Bucher, Heitkemper, & Harding, 2017). Applied Nursing Research, 33, 85-92. Position the patient to minimize respiratory efforts: elevate the head of the bed, have patient sit in high fowlers and provide an overbed table for the patient to lean on, in order to promote chest expansion and effective breathing and save energy. Monitor the effectiveness of this therapy via ABGs and pulse oximetry to evaluate the patient response to therapy. Late in COPD, pulmonary hypertension may occur as a result of thickening of the vascular smooth muscle. This LAMA is used for long-term treatment and once-daily maintenance of bronchospasm associated with COPD. A bit more about Jim: Medical history: COPD… The patient’s major risk factor is smoking. This risk factor includes passive smoking since the patient is exposed to environmental tobacco smoke due to her husband’s smoking in the home. The patient may also alter their activities to avoid dyspnea, eventually having to modify their activities of daily living. Before admission, had 7 days of exceptional shortness of breath and increased volume, Had increased salbutamol use at home to five or six times a day for dyspnea, Had three or four bouts of exacerbations of COPD in the past year that she treated at, Thirty pack-year history of smoking; smokes half a pack per day now to “clear out lungs”, Cannot climb one flight of stairs without stopping; walks down the flat driveway 10 yards, Awakens 2-3 times per night coughing and short of breath, Weight 58.5kg (129lbs); height 1.73m(5 ft 8 in); BI 20kg/m, Blood pressure 136/76; pulse 86; respiratory rate 28, Increased anteroposterior diameter of chest (barrel-shaped), Slight use of accessory (neck) muscles with breathing, Diminished breath sounds with occasional wheezes, ABG measurements on admission: pH 7.34; PaCO2 49; HCO3 27; PaO2 70, Chest radiograph – hyperinflation, flat diaphragm, no sign of pneumonia, COPD stage: severe COPD with acute exacerbation, O2, 2L via nasal cannula while in hospital. 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