Required Uniform Assignment: Case Study Presentation
Bmsafiri
Samplepowerpoint.pptxCOPD
Team Members:
Adewale Okanlawon
Fatimoh Olateju
Uchenna Orji
Tracie Pemberton
Marlene Rosales
COPD
“Chronic obstructive pulmonary disease, or COPD, refers to a group of diseases that cause airflow blockage and breathing related problems. It includes emphysema and chronic bronchitis.” (CDC, 2018)
As you can see on the left lung presented here, the bronchioles are filled with mucous. This causes the ‘crackles’ that are heard upon auscultation of the lungs.
Biographics
Name: Ana Jones
Gender: Female
Ethnicity: Hispanic/Latino
Age: 56 years old
Ht/Wgt: 5’2, 152 lbs (69.09 Kg)
Admitting Doctor: Dr. Snow, MD direct admission
Medical Diagnosis: COPD Exacerbation with possible Lung Infection
Code: Full
Diet: Low Sugar
Activity as tolerated
Our patient has a history of Diabetes, admits to poor diet and lack of physical activity. Patient states has a history of elevated cholesterol levels and hypertension. Patient experienced an MI 3 years previous. Patient does not smoke or drink alcohol and does not use illegal substances.
Chief Complaint
Patient presents with:
Chief complaint: “I can’t catch my breath and I am burning up”
fever
shortness of breath
uncontrolled chills
extreme fatigue
low/no appetite
cough with greenish mucous
chest pain when coughing 6/10 on scale
As always, ABC is top priority, so have patient on supplemental oxygen and will now proceed with examination
Biographics Continued
Past Health History:
Diabetes
Hypertension
COPD
MI (3 years previous)
Social:
Patient brought in by her husband. Married 30 years, 2 adult aged children, housewife.
Husband states “he is very worried about his wife as she doesnt seem to be able to breath at all”. Husband informed us their daughter and sick grandbaby had been visiting last week.
Biographics Continued
Current Medication:
Metformin
Hydralazine
Nebivolol
Albuterol
Fluticasone
Metoprolol
Patient is currently on Metformin for blood glucose control, Hydralazine and Nebivolol for control of hypertension, Albuterol and Fluticasone for COPD and Metoprolol for MI
Physician Orders
Administer oxygen via nose cannula and titrate to 98% O2 saturation, 2L/m
Start IV, with 0.9 Saline
Respiratory - breathing evaluation and treatment
Sputum Test (stat)
Ct Scan
Labs:
Full CBC
ABG
Cholesterol Panel
V/S q 4 hours
Administer: Levofloxacin 750 mg IV , Tylenol 650 Mg PO, fever greater than 101.,
Call with Lab report
Nurses Notes: Keep patient elevated at 45% to facilitate breathing, advise client to call for assistance when needs to use use the restroom. Sputum test MUST be done before administering Levofloxacin. CT Scan is to check for any inflammation or fluid in the lobes of the lungs. We will be expecting to see an elevated WBC. Physician is suspecting streptococcus pneumococcus This would be supported by the S/S of dyspnea, cough with sputum and activity intolerance.
Vital Signs
Temperature: 103.6 F
RR: 29 (high)
BP: 140/89
HR: 102 bpm
SP02: 92%
Skin is flushed and diaphoretic
Client is in obvious distress with SOB, client has visible chills and says “I am worried about my condition and my husband’s anxiety over this situation isn’t helping. This is overwhelming!”
Focused Physical Examination
Respiratory: Crackles bilaterally. Diminished sounds lower lobe anteriorly and posteriorly. Diffuse inspiratory and expiratory wheezing bilaterally anterior and posterior. Accessory muscles used for breathing
Cardiovascular: Heart sounds present and normal anteriorly and posteriorly, capillary refill less than 3 seconds bilaterally
Neurological: Patient present and aware x4
HEENT: Head normal cephalic, pupils round reactive to light, mild cyanosis noted to lips with dry mucous membranes
GI/GU: Normal bowel sounds
Dietary History: regular diet with poor control of blood glucose
Integumentary: Skin warm, flushed and diaphoretic
Musculoskeletal: normal tonicity and strength x5 bilaterally
Psychological/Family - Support: Pt lives at home with husband
Laboratory Test Ordered w/rationale
Sputum Culture, Gram Positive Stain - tests for streptococcus pneumococcus or other gram positive (bacterial infections)
Full CBC - Checking for increased WBC to indicate infection and determine type of infection and link condition to possible pathogens
ESR - determine inflammation rate in body
CRP - determine inflammation rate in body
Blood Culture - detect bacteria in blood
Cholesterol Panel - pt has history of hypertension and currently has elevated blood pressure. Need to determine current cause.
Sputum Culture ordered before administration of antibiotics
Full CBC to check counts of RBC, White Blood Cells,
ESR 0 erythrocyte sedimentation rate and C-Reactive Protein to measure for inflammation
Blood Culture to detect for bacteria in the blood
Results of Test Ordered
Significant Findings
CT Scan: Lower lobes inflamed bilaterally, fluid filled sacs bilaterally representing alveolar edema
Sputum, GRAM positive came back with a positive result for streptococcus pneumococcus
ABG reflects Respiratory Acidosis
WBC is elevated
LDL is elevated
Dr Snow called with report of findings
Dr Snow was given the full report and ordered we proceed with his orders as prescribed. He will return in 4 hours to check on his patient.
Health Care Team Members & Role
Primary care physician - a primary care physician role is to prescribe medications that can help make breathing easier, such as prednisolone, albuterol, and antibiotics. They also the first healthcare provider that is first seen. They come up with a diagnosis based on signs and symptoms the patients presents.
Pulmonologist - a pulmonologist is a one who specializes in overall anatomy and physiology of the lungs. The role a pulmonologist plays in the case of a COPD patient is to create an individualized plan of treatment of the diagnosis. They also perform a procedure known as a bronchoscopy, the goal of this procedure is to have an internal look into the lungs to see the COPD damage and to make breathing easier.
Respiratory therapist- a respiratory therapist role is to help exercise and train the lungs to expand and recoil during inspiration and expirations.
Dietician- a dieticians role is to help suggest diets that will help the patient lose weight , such diets would be low carb diets, or low fats diets.
Thoracic surgeon - thoracic surgeons role is to perform lung surgery. Such surgeries are lung volume reduction or lung transplant.
Psychiatrist- COPD is a severe medical condition and it can cause the patient to fall into depression and face anxiety.
Image: Getty Images/Image Source
Each care provider plays a major role in the care for a patient who has COPD, they work together to make sure that the ultimate treatment for COPD is achieved.
List of Medications
Treatments & Procedures
List of Medications
Albuterol
Prednisolone
Revefenacin
Tiotropium
Olodaterol
Roflumilast
Treatment & Procedures
COPD can be treated with either or all of the following:
Oxygen therapy - O2 therapy is needed if oxygen levels begin to deplete, oxygen can be administered through a simple mask or a nasal cannula.
Surgery - surgery is typically the last option and often reserved unless the COPD is severely advanced. Such procedures include bullectomy, lung transplant and lung volume reduction.
Medication - oral steroids, bronchodilators can be administered by the physician to help relax and widen the muscles of the airways, so that breathing can be less stressful. ,
Image Source: Nurse.org
The common medications administered for COPD are albuterol, prednisolon, revefenacin, tiotropium, olodaterol and roflumilast. These medications are oral steroids, long and short-lasting bronchodilators and their indication is to help alleviate the discomfort while breathing and makes breathing much easier and bearable. COPD can be treated by placing the patient on oxygen therapy through a simple mask or cannula to help administer oxygen when oxygen levels are depleting. Surgical procedure such as lung transplant, bullectomy and lung volume reduction are surgical procedures that will help make breathing comfortable.
Dietary Prescriptions
People who suffer from COPD usually have low body mass, decrease in lean body mass and overall weight loss. Therefore it is imperative that their diet should include foods that are high in fiber, such as seeds, nuts, vegetable, fruits. Proteins are necessary to help maintain a strong and healthy respiratory muscles. Avoid foods that cause bloating and high in sodium, as it can make breathing uncomfortable and sodium retain water in the body.
Fluid intake should be taken before meals as it can help reduce pressure and feeling of being full before meals are consumed.. A good posture should be maintained as it helps reduce the risk of aspiration and promotes proper breathing and swallowing.
Image: Getty Images/Image Source
COPD patients diet is tailored to their health, they are advised to incorporate foods that are high in fiber and proteins to help them gain healthy weight, as COPD patients have low body mass, decreased lean body mass and overall weight loss. It is advised that COPD patients do not drink fluids before having meals as it prevents them from becoming full and they have the desire to eat. Foods high in sodium should be monitored because we don’t want them to have edema which makes breathing difficult. low body mass, decrease in lean body mass and overall weight loss. have low body mass, decrease in lean body mass and overall weight loss. have low body mass, decrease in lean body mass and overall weight loss.
Nursing Plans of Care - Physiological Nursing Diagnosis
Priority Nursing Diagnosis - Impaired gas exchange, as evidenced by SOB, reduced tolerance for activity, abnormal ABG values, dyspnea and abnormal breath sounds upon auscultation of lungs
Short term goal - Demonstrate improved ventilation and adequate oxygenation of tissues by ABGs within patients normal range and be free of symptoms of respiratory distress (Vera, 2019)
Long term goal - Participate in treatment regimen within level of ability
Patient is positive for infection, but airway clearance, breathing and cardiovascular are always top priority, as such the priority nursing diagnosis is in regards to dyspnea, shortness of breath and low O2 saturation.
Nursing Plans of Care - Physiological Nursing Diagnosis
Interventions with rationale
Auscultate breath sounds, noting areas of decreased airflow and adventitious sounds
Breath sounds may be faint, monitor for airflow and areas of consolidation. Wheezing can indicate retained secretions and crackles may indicate interstitial fluid
Monitor V/S, O2 saturation (titrate oxygen to maintain 98%) and monitor ABGs
We are monitoring for tachycardia, dysrhythmias, changes in BP, changes in O2 saturation so we can maintain proper levels with supplemental oxygen, and ABGs to monitor PH levels and PaCo2 levels (respiratory acidosis)
Elevate head of the bed to ease the workload on the lungs and encourage deep slow breathing with periods of pursed-lip breathing.
Improvement in oxygen delivery when upright and decreased airway collapse.
When auscultating, we want to follow this with an assessment of respiratory rate, use of accessory muscles and ability to speak and converse. This will help evaluate respiratory distress.
When monitoring O2 sat, if levels drop, immediately call PCP and recommend change in oxygen delivery.
Nursing Plans of Care - Physiological Nursing Diagnosis
Interventions with rationale
Auscultate breath sounds, noted improved breath sounds, lungs clear to auscultation bilaterally
O2 saturation returned to 99% on room air, PH return to 7.38 and supplemental oxygen is no longer needed
After intervention the patient is now able to breath without use of accessory muscles, take a deep breath without coughing and sleep prone
Statements after Interventions
Nursing Plans of Care - Physiological Nursing Diagnosis
Interventions with rationale
Instruct patient on importance of secretions, expectorate instead of swallowing.
This will prevent ingestion of bacteria and will facilitate a visual representation of changes in infection condition as color, odor and amount of sputum can be tracked
Demonstrate and encourage good hand hygiene, limit visitors while immune system is compromised and institute isolation precautions
The goal is to limit the spread of germs, limit reinfection of patient by others and help client prevent future infections
Preventing reinfection in the future, limiting additional introduction of pathogens to patient while compromised and preventing spread of current infection to others is a primary concern and this is best handled by proper hand washing and limitation of exposure to others.
Nursing Plans of Care - Physiological Nursing Diagnosis
Interventions with rationale
Quantity of secretions diminished and then were clear. Sputum went from green to clear and now mucous membranes are moist and clear.
Patient and her husband are able to perform good hand washing and have repeated back to me the importance of hand hygiene and avoiding situations with evidence of possible contamination.
Statements after intervention
Nursing Plans of Care - Psychosocial Nursing Diagnosis
Priority Nursing Diagnosis:
Stress overload r/t coping with chronic illness AEB patient states “I am worried about my condition and my husband’s anxiety over this situation isn’t helping. This is overwhelming!”, patient reports extreme fatigue, patient has HR 102 bpm and 29 breaths/minute.
Short term goal: Patient will identify stressors that can be controlled and those that cannot
by the end of the shift.
Long term goal: Patient will identify one successful behavior change to reduce or eliminate that will increase successful stress management
Marlene
Nursing Plans of Care - Psychosocial Nursing Diagnosis (Cont’d)
Interventions and Rationales
The nurse will assist to recognize patient’s thoughts, feelings, actions, and physiologic responses
Self-awareness can help the patient reframe and reinterpret their experiences
The nurse will teach the patient how to decrease heart rate, respirations, and feelings of stress (engage in a diversional activity, use of guided imagery, teach to use mini-relaxation breathing techniques)
Faced with overwhelming multiple stressors, the patient can be assisted to differentiate which stressors can be modified or eliminated
The nurse will encourage the patient to discuss stresses with spouse and children
Discussing stress with loved ones can help them understand her feelings and emotions and can aid in building a stronger connection so that she has someone to turn to in times of stress
The nurse will ask the patient to list one or two changes they would like to make in the next week
In a person who is already overwhelmed, small changes in lifestyle may have a higher chance for success, will increase confidence, and reduce chances of future exacerbations
The nurse will assist to set realistic goals to achieve a more balanced health-promoting lifestyle (What is most important? What aspects of your life would you like to change the most?)
Setting realistic goals will increase confidence and success
Marlene
Nursing Plans of Care - Psychosocial Nursing Diagnosis (Cont’d)
Evaluative Statements
Patient was able to recognize her thoughts, feelings, actions, and physiologic responses.
Patient demonstrated techniques to reduced heart rate, respirations, and feelings of stress using distraction and controlled breathing techniques.
Patient discussed stresses with her spouse and children. She states “I feel better than I can talk to my family about what I’m feeling and I know I can count on them when I need someone to talk to.”
The patient identified one lifestyle change that she would like to make in the next week. She states, “I will walk one to two blocks each day.”
The patient was able to set realistic goals for herself. She states “I need to improve my diet, so I will eat at least one vegetable a day.”
Patient/Family Teaching Goals
Physiological Teaching:
Educate patient the importance deep breathing and controlled coughing.
This reduces fatigue usually associated with forceful coughing and uncontrolled breathing
Educate the patient on the importance of pursed lip breathing.
Pursed lip breathing helps with slow expiration, helps prevent collapse of small airways, and control rate of respirations
Educate the patient on the importance daily controlled exercise regimens.
It is important that the patient participates in controlled exercises throughout the day. This can help strengthen upper and lower extremities, increase patient activity tolerance level, and help manage stress.
Adewale
Patient/Family Teaching Goals
Psychosocial Teaching:
Encourage the patient to take some time to meditate throughout the day.
This will help identify anything current stressors that may be affecting the patient and also help reduce the patient's stress and anxiety.
Educate the patients family, especially the husband, on the importance of making the home environment a stress free area.
This will help with patients anxiety and improve overall patient outcomes.
Educate the patient on the importance of getting a good night's rest.
It is important for adults to get 7-9 hours of sleep. This will also help with the patient’s stress and relieve anxiety.
Adewale
References
CDC - COPD Home Page - Chronic Obstructive Pulmonary Disease (COPD). (2018, June 06). Retrieved November 25, 2020, from https://www.cdc.gov/copd/index.html
COPD: Who's on Your Medical Care Team? (2019, August 19). Retrieved November 29, 2020, from https://www.webmd.com/lung/copd-medical-care-team
Nutrition and COPD - Dietary Considerations for Better Breathing. (n.d.). Retrieved November 29, 2020, from https://www.todaysdietitian.com/newarchives/td_020909p54.shtml
Vera, M., By, -, Vera, M., & Matt Vera is a registered nurse with a bachelor of science in nursing since 2009 and is currently working as a full-time writer and editor for Nurseslabs. During his time as a student. (2019, September 28). 7 Chronic Obstructive Pulmonary Disease (COPD) Nursing Care Plans. Retrieved November 25, 2020, from https://nurseslabs.com/chronic-obstructive-pulmonary-disease-copd-nursing-care-plans/2/
References (Continued)
Carpenito, L. J. (2017). Nursing diagnosis: application to clinical practice. 15th edition. Philadelphia, PA: Wolters Kluwer.
