Chronic Obstructive Pulmonary Disease

A 68 year old male presented to the emergency department at 0800 hours via ambulance after experiencing chest discomfort and intermittent palpitations since 0500 hours. Prior to presentation, the patient stated he

D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years. He has had pneumonia yearly for the past 3 years, and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is an acute

Chronic Obstructive Pulmonary Disease also known as COPD, is one of the third leading cause of death in the United States (National Heart Lung and Blood Institute [NHLBI], 2013a). According to the Centers for Disease Control and Prevention (CDC) (2015) approximately 15 million Americans are affected by COPD, with a morbidity rate of 6.8 million. Data from the CDC from 2011 states that 6.3% of the U.S population suffer from this disease; Florida has the COPD prevalence rate of 7.1% with the highest percentage going to Kentucky with a rate 9.3% as summarized by the COPD foundation (2015). CDC calculated the cost of having COPD as $32.1 billion in 2010 and they expect it to rise to $49 billion by 2020, all for a disease that could be prevented. Additionally CDC has stated the mortality rate has decreased in men in the United States from 57.0 per 100,000 to 47.6 per 100,000 from 1999 to 2010. However, regarding the rate for women, there has not been much change during the same time period. The rate shifted from 35.3 per 100,000 to 36.4 per 100,000 (CDC, 2014).

Physical Examination: General: The patient is an alert, oriented male appearing his stated age. He appears to be in moderate distress. Vital signs: blood pressure 132/78 and pulse 68 and regular. Temperature is 38.56 oC (101.4 oF). HEENT:Normocephalic, atraumatic. Pupils were equal, round, and reactive to light. Ears are clear. Throat is normal. Neck: The neck is supple with no carotid bruits. Lungs: The lungs are clear to auscultation and percussion. Heart: Regular rate and rhythm. Abdomen:Bowel sounds are normal. There is rebound tenderness with maximal discomfort on palpation in the right lower quadrant. Extremities: No clubbing, cyanosis, or edema.

R.W. appears with progressive difficulty getting his breath while doing simple tasks, and also having difficulty doing any manual work, complains of a cough, fatigue, and weight loss, and has been treated for three respiratory infections a year for the past 3 years. On physical examination, CNP notice clubbing of his fingers, use accessory muscles for respiration, wheezing in the lungs, and hyperresonance on percussion of the lungs, and also pulmonary function studies show an FEV1 of 58%. These all symptoms and history represented here most strongly indicate the probability of chronic obstructive pulmonary disease (COPD). COPD is a respiratory disease categorized by chronic airway inflammation, a decrease in lung function over time, and gradual damage in quality of life (Booker, 2014).

Another Consultation Report dated 12/06/2016, indicated that the claimant presented with exacerbation of COPD, acute bronchitis, and pseudomonas aeruginosa. The CT scan of the chest revealed bilateral lower lobe atelectatic changes, fibrosis, and a small 1 cm left lower lobe nodular density. A pulmonary consultation was recommended. His blood pressure was 142/79 mmHg. The physical examination revealed bilateral decreased breath sounds and scattered wheezes. His glucose was 189. DuoNeb, IV Solu-Medrol, and IV antibiotics were prescribed.

States that it started 3 days back and uses oxygen at home. States that he is a former smoker and laying on his back feels better. Also says he has a list of medication, more than 20. Pt has a history of COPD, CHF, DM,morbid obesity, HTN, HLM, hypothyroid, and sleep apnea. Has no accessory muscle use. CC is shortness of breath. Assessment is that there is no deformities or trauma of the head or neck area. Chest shows no signs of deformities or trauma. The abdominal area is tender and warm to the touch. Pelvis and back was not assessed. The upper and lower extremities show signs of low circulation and swelling. PMS=4. I helped with placing the BP cuff on the left arm and attaching it to the monitor. First vitals were recorded. O2 was given by the Nurse and then Albuterol by nebulizer. After 30 minutes, I assisted the Nurse and other hospital workers in moving the PT to a bigger bed. Second set of vitals were recorded. After becoming stable the Pt was moved up to the floor.

Patient “DD” is a 56-year-old woman who was admitted to a nearby hospital for respiratory failure. With the only previous medical history being chronic bronchitis, she was diagnosed upon admission with COPD, anemia, hypoxia, moderate anxiety, and dyspnea.

“The patient is Adam Rudd, a 78 y/o white male with a history of hypertension. He has been diagnosed with hypertension past 15 years and is on anti-hypertensive medications and aspirin. He is very weak and short of breath. He is accompanied with his longtime friend Jennifer, who reports that Rudd was looking very weak and was complaining of severe headache and blurred vision before coming to the hospital. He is 5’9” and weighs 270 lb. Vital signs recorded were: oral temperature 98.20 F, BP 224/120 mm Hg with a heart rate of 102 beats/minute and respiration of 24 breaths per minute. The pulse oximetry reading was 94% on room air. He is complaining of severe headache and blurred vision. Rudd said that he did not take his antihypertensive medication or aspirin since he ran out of pills. He has not been taking his medication for past 15 days. He reports no known allergies to any medications or other substances.”

c. 34 years old male who complained of shortness of breath. He was obese and had a history of COPD. He was on two liters nasal cannula. After admitting at the ER, he was tranfered to med-surge floor for further evaluation.

All over the world, chronic obstructive pulmonary disease (COPD) is a very significant and prevalent cause of morbidity and mortality, and it is increasing with time (Hurd, 2000; Pauwels, 2000; Petty, 2000). Due to the factor of COPD being an underdiagnosed and undertreated disease, the epidemiology (Pauwels, Rabe, 2004) is about 60 to 85 % with mild or moderate COPD remaining undiagnosed (Miravitlles et al., 2009; Hvidsten et al., 2010).

“Teaching patients about promoting, maintaining, and restoring their health is a required nursing skill that most often results in a positive outcome, enhancing the patient 's quality of life” (Lewis et al., 2014, p.52). The intent of this analysis is to educate patients with chronic obstructive pulmonary disease on means that can enhance their quality of life and avert the progression of their disease. More specifically, it will focus on the aspect of teaching Mrs. N, a patient, how to effectively handle certain symptoms experienced with techniques like pursed-lip breathing and also, to upsurge the client’s awareness on preventative measures to abate the possibility of acute exacerbations. Mrs. N is a 100-years-old woman of Canadian and Arabic background. In mid-September, she was rushed to the hospital after experiencing worsening dyspnea and a fever. The doctors deduced a diagnosis of pneumonia and therefore, she was transferred to the medical unit at the Lakeshore hospital in order to be treated with intravenous antibiotics. Mrs. N has a past medical history of chronic obstructive pulmonary disease, hypertension, anemia, deep vein thrombosis and mixed dementia. Mrs. N is a retired widow with two daughters, who come and visit her on a daily basis at the hospital and encourage her to mobilize and eat because she has an extremely poor appetite on most days. She’s well cared for by a team of care workers in the nursing home where she lives and her daughters and

Ineffective breathing pattern related to decreased oxygen saturation, poor tissue perfusion, obesity, decreased air entry to bases of both lungs, gout and arthritic pain, decreased cardiac output, disease process of COPD, and stress as evidenced by shortness of breath, BMI > 30 abnormal breathing patterns (rapid, shallow breathing), abnormal skin colour (slightly purplish), excessive diaphoresis, nasal flaring and use of accessory muscles, statement of joint pain, oxygen saturations of 85-95% 2L NP, immobility 95% of the day, and adventitious sounds throughout lungs (crackles) secondary to CHF, hypertension, pain caused by gout and arthritis, and obesity

A: Janie is a 60 year old Female with PMH of A-Fib, COPD, Hypothyroidism, HTN, Lung Cancer and recently diagnosed Pulmonary Embolism. Janie presents to ER for evaluation on SOB, cough with greenish sputum, sore thoart, hoarseness and generalized weakness. Janie lives at home with her husband, use to smoke ½ pack per week, but quit many years ago, denies alcohol or drugs. Family history is non-contributory. Allergies: NKDA. Differential diagnosis includes worsening Lung Ca, PE, COPD and CHF. Janie uses home O2 at 4 L/NC. V/S: T=98.7, HR=89, R=16, B/P=132/56, O2 sats=100% on 4L/NC, Pain=6/10. Labs: WBC=7.6, H&H=8.5/27, Na=141, Troponin=0.08/0.06, BNP=495, INR=4.2, UA=3+ protein, 1+ blood and 6-10 RBC. CXR: Impression:1). COPD with nonspecific coarsening of the basilar interstitium. 2). Mild cardiomegaly with borderline cardiac compensation. 3). Right

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.