copd case study

Chronic Obstructive Pulmonary Disease

RN Case in a Box

Mr. Huffington, a 68 year old African American man presents to the Emergency Department at the local community hospital with a fever, cough, worsening dyspnea, fatigue, swelling of bilateral feet and ankles, and thick yellowish-brownish sputum. Your client has brought a friend to the ED who states, “My friend is experiencing some confusion and is coughing more than usual and has shortness of breath and can’t walk very far”. Your client appears very anxious and is sitting on the stretcher leaning forward. Your client looks uncomfortable and has labored breathing. Your client has visited their general practitioner with similar symptoms two or three times a year in the last three years.

Your client has recently been in contact with a co-worker who had a cold or maybe the flu. Your client has not received any vaccines this year. Your client has been taking Tylenol for their fever and Motrin for their sore throat, body aches and pains.

Client History: Smoker for 40 years/2 packs a day and quit 2 years ago. Client diagnosed with COPD at that time. Your client has a history of hypertension and anxiety. NKDA. Medication regimen includes:

–Lisinopril 20 mg bid

–Metoprolol 50 mg bid

–Spironolactone 25 mg qd

–Furosemide 40 mg qd

–Salmeterol/fluticasone 50/500 dry powdered inhaler (DPI) one puff inhaled bid

–Tiotropium DPI one cap qd

–Diazepam 2 mg bid

–Albuterol/ipratropium metered dose inhaler (MDI) or solution for nebulization every 6 hours prn

–Levalbuterol MDI two puffs every 4 to 6 hours prn

–Home oxygen – 2LNC

Your client’s vital signs are:

BP: 168/92

RR: 28/min

HR: 120

Pulse Ox: 88% on 2LNC

Temperature: 38.2 C

Upon examination, the chest shows mild intercostal retractions seen around the anterolateral costal margins. Wheezes and rhonchi are heard bilaterally, with diminished breath sounds in the lower lobes.

Questions

1.What is the potential cause for your client coming to the ED?

2.What medications is your client likely to be given specific to the admitting diagnosis? What side effects and adverse reactions will you monitor for with each of Mr. Huffington’s medications?

3.What diagnostic tests/labs will be ordered in the ED?

4.What nursing interventions will be implemented in the ED or on the floor?

5.Your client asks “When will I be able to come off the oxygen and medications and be normal again?” As the nurse, what is your response?

6.Complete the client teaching plan and nursing care plan for your client:

Client/Family Teaching Project

From your experience today, select a topic you could teach to one

of the clients or family members and complete the following:

Client’s Medical Diagnosis: Client’s Age: Client’s Initials:
Teaching Topic:
Use Bloom’s Taxonomy terminology to write 3 objectives for the teaching session: (See Bloom’s Taxonomy handout at end of packet)
Would client or family member be motivated to learn about this topic?
What factors would influence client’s or family member’s ability to learn?	Estimated educational level:
	Estimated socioeconomic status:
	Cultural background: Discuss cultural considerations to consider:
Would client/family member have support from others? Who?
What would be the best teaching strategy or strategies to use for this topic? Discuss how you could facilitate. (one on one, group, discussion, written, verbal, demonstration, return demonstration, etc.)	.
What environment/setting would be needed for teaching this topic?	Where would the session take place?
	What seating is needed?
	What lighting is needed?
	What would make the room comfortable? (temperature of room, other factors)
What do you estimate to be the length of the teaching session or sessions?
What teaching aids would be used? (video, handouts, pamphlets, etc.?)
How would you determine if the client/family member learned the information?
References (List 2) using APA format:

Bloom’s Taxonomy

(Examples used to state instructional objectives from low to high levels of learning)

1.0 Knowledge	2.0 Comprehension	3.0 Application
define memorize repeat record list recall name relate cite state	restate discuss describe recognize explain express identify locate report review	translate interpret apply employ demonstrate dramatize practice illustrate operate schedule sketch
4.0 Analysis	5.0 Synthesis	6.0 Evaluation
distinguish analyze differentiate appraise calculate compare contract criticize diagram inspect debate inventory question relate solve examine	compose plan propose design formulate collect construct create design set up organize manage prepare	judge appraise evaluate rate revise score select choose assess estimate measure

Complete 3 Nursing Diagnoses for client(s) seen: (In addition to educational needs)

Problem (Use NANDA terminology)

Etiology R/T _____ 2° _________ (medical dx)

(S) AEB: (Subjective & Objective Signs/Symptoms)

Outcome/Short Term Goal

Interventions (State 3)

Rationale (Cite reference and page number)

Evaluation (How would you determine if the client improved or made progress?)

Problem (Use NANDA terminology)

Etiology R/T _____ 2° _________ (medical dx)

(S) AEB: (Subjective & Objective Signs/Symptoms)

Outcome/Short Term Goal

Interventions (State 3)

Rationale (Cite reference and page number)

Evaluation (How would you determine if the client improved or made progress?)

Problem (Use NANDA terminology)

Etiology R/T _____ 2° _________ (medical dx)

(S) AEB: (Subjective & Objective Signs/Symptoms)

Outcome/Short Term Goal

Interventions (State 3)

Rationale (Cite reference and page number)

Evaluation (How would you determine if the client improved or made progress?)