COPD Case Study – Flashcards

Chronic obstructive pulmonary disease (COPD) is a group of common chronic respiratory disorders, such as chronic bronchitis, emphysema, and chronic asthma, which are characterized by progressive tissue degeneration and obstruction in the airways of the lungs. Emphysema occurs when the air sacs (alveoli) at the end of the smallest air passages (bronchioles) in the lungs are gradually destroyed, which leads to large, permanently over-inflated alveolar air spaces.

Dyspnea on exertion, hyperventilation with prolonged expiratory phase, use of accessory muscles, coughing and expiratory wheezes. respiratory rate greater than client's baseline, dyspnea on exertion or at rest, labored speech, nasal flaring, cyanosis, chest pain, pursed lip breathing

Patient will have a pink complexion, he will be in a tripod sitting position, hyperinflation leading to a "barrel chest", clubbing of the fingers, diminished breath sounds, and hyperresonance upon percussion. clubbing of fingers, peripheral cyanosis, jugular vein distention, anorexia and weight loss

Mr. Cohen's oxygen saturation readings are normal for a patient with COPD. Patients with COPD do not reveal O2 saturations of 95% or greater. It is normal for Mr. Cohen's O2 sat to be between 90-94% on oxygen. He has dyspnea on exertion, which is why his O2 saturation drops when he walks to the nurse's station (and returning to the room) and it increases once he is at rest. It is also normal for it to rise after a nebulizer treatment because it opens up the airways.

Acute pain can cause an individual's respiratory rate and blood pressure to increase because of the activation of the sympathetic nervous system. It also causes the heart rate to increase. The SNS causes blood vessels to constrict, thus raising the blood pressure.

Assist patient into the tripod position Relaxation techniques to decrease the work of breathing Encourage/teach pursed lip breathing Small, frequent feedings (avoid compromising respiratory effort Encourage ambulation (as tolerated) to prevent build up of secretions small frequent meals, distraction, rest periods, smoking cessation, emotional support, fan for air circulation, relaxation technique

Measure respiratory rate Patients subjective SOB Assess characteristic of sputum and if cough is productive Measure O2 saturation Able to demonstrate pursed lip breathing, relaxation and coughing techniques

Adding oxygen won't necessarily help Mr. Cohen, because his main problem is getting rid of CO2. This is why COPD patients are taught to breathe out with pursed lips. This way they can prolong their exhale and get rid of more CO2. Another reason why the nurse did not increase the level of O2 is because if there is too much O2 being administered the patient loses the need/desire to breathe, doing so would only worsen his hypoxia. this is not true for all patients with COPD- patients with hypoxemia and respiratory failure need oxygen

Have to keep in mind his culture-Judaism and what his nonpharmological pain management activities are. A nurse must keep in mind of the Sabbath and that he may not want to do any "work" from Friday sundown to Saturday sundown Patients diet of kosher food should be kept in mind

This Patient would likely benefit from relaxation techniques. This may include meditation or guided imagery to help divert his attention from his pain. Mr. Cohen may also benefit from alternative forms of medicine, such as acupuncture or reiki.

Pain should be measured primarily through subjective means, such as the pain scale and Mr. Cohen's self-report. They can also be measured through objective signs, such as a rise in blood pressure and heart rate, guarding, grimacing, positioning, affect, and behaviors, such as Mr. Cohen isolating himself from others and inactivity.

Yes, there is a risk for respiratory depression that can compromise his already fragile respiratory status. Given his COPD, his lungs are already having a difficult time keeping up with oxygen demands as evidenced by his shortness of breath, depressing his respiratory rate can further exacerbate this problem. The patient already has an unsteady gait and requires assistance, so the dizziness that comes with hypotension would make him even more of a fall risk. The risk of these potentially harmful side effects are even higher given his age and slowed drug metabolism.

- Activity intolerance related to imbalance between oxygen supply and demand - Ineffective airway clearance related to increased mucus and bronchoconstriction - Ineffective self-health management related to inability to meet increase oxygen demand and dyspnea on exertion. - Impaired gas exchange r/t ventilation-perfusion imbalance, risk for falls, impaired physical mobility

Don't smoke while using oxygen tank; Keep tank at least 15 feet away from matches, candles, gas stove, or other source of flame; Place no smoking signs on doors Notify local fire department and electric company of oxygen use in home Keep oxygen tank 5 feet away from television, radio, and other appliances Keep tank away from direct sunlight When traveling in car place oxygen tank on floor behind front seat.

An "advance directive" is a legal document to provide your directions or preferences concerning your health care and/or to appoint someone to act on your behalf when you are unable to. A "living will" is a document that may state your wishes regarding any kind of health care you may receive. A "health care representative" is a person whom you authorize in writing to make any and all health care decisions on your behalf including the decision whether to withhold or withdraw life support systems. A "conservator of the person" is someone appointed by the Probate Court when the Court finds that a person is incapable of caring for himself/herself including the inability to make decisions about his or her medical care. People who can be your representative or conservator include: your physician administrators, and employees of the facility For completion of the forms a person must have a notary and witness, they do not always need a lawyer

Nurses can articulate the benefits of advance directives; however, nurses generally lack the knowledge and training to conduct such discussions Providing EOL care that is appropriate, compassionate, and in accordance with the patient's wishes is an essential component of the nurse's role Inform an administrator or risk manager of the conflict. It is also helpful to bring in a social worker to explore the conflict Ethics committee might meet with the family and key members of the healthcare team