Referral For Copd And Dyspnea

This is a case study on a 76 year old man.Mr Alan Chari(pseudonym used to protect the identity of a patient),was admitted over night in my department.He is a divorcee who stays with son.He is a retired teacher and his son is permanently employed by a local company as an electrician.He is independent with activities of daily livings but is occasionally limited by his ill health.He used to be a heavy smoker .After realising the burden COPD has on general New Zealand population ,affecting about15% of the adult population over the age of 45 years according to asthmanz( 2010) ,l took this case study to gain in-depth understanding.

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

D.Z.is a 65-year-old man admitted to medical ward with an exacerbation of chronic obstructive pulmonary disease (COPD; emphysema). Past medical history (PMH) indicates hypertension (HTN), well managed with enalapril (Vasotec) past six years, diagnosis (Dx) of pneumonia yearly for the past three years. D.Z. appears cachectic with difficulty breathing at rest. Patient reports productive cough with thick yellow-green sputum. He seems anxious and irritable during subjective data collection. He states, he has been a 2-pack-a-day smoker for 38 years. He complains of (c/o) insomnia and

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).

According to the provider, the claimant's cough has been improved. His review of systems was positive for fatigue, malaise, sleep difficulty, shortness of breath, wheezes, and a cough. His blood pressure was 115/71 mmHg and his BMI was 30.35 kg/m2. The physical examination revealed wheezes. Clonazepam was prescribed for agitation. Atorvastatin, Nystatin, Citalopram, and a probiotic were prescribed. Continued use of Aspirin and a regular inhaler were suggested. Further, a follow-up visit with Endocrinology, Cardiology, and Pulmonology. As it relates to a spot in his lung, a repeat CT scan was recommended. The bronchial washes were negative for

A cousin of mine, Susan, approached me after her father received open heart surgery. Susan’s father, age 59, has been a chronic smoker since the age of 19. What went from two cigarettes a day quickly become two packs a day, with no end in sight. During July of 2015 he complained of feeling dizziness, shortness of breath,

HPI: Margaret Elliot is a 52-year-old Caucasian female that is presenting with shortness of breath that has recently worsen. Mrs. Elliot states that her problems began 20 years ago when she had bronchitis, which she consistently has 2-3 times a year. She said that her symptoms have been getting worse the last 2.5 month, but have severely worsen over the past three days. She states that it has been restricting her daily activities and has been troubling her while sleeping lying down. She states that her symptoms improve alittle when she takes her medications. She also states that her symptoms worsen when she tries to walk across the room

History of Present Illness: Mr. Magnuson is a very pleasant 77-year-old gentleman who was previously seen in this office by Elvira Aguila, MD for COPD and hypoxic respiratory failure. He is here today for routine followed up. He was last evaluated in January 2015. Since that time, he states that his dyspnea is worse. He feels that it is related to the weather. He does state that he works around the house, although he does have significant functional limitations because of shortness of breath. His wife also confirms that he is able to do less and less. He has a stable, minimal cough. He is using 4L of oxygen at night as well as, as needed throughout the day. He continues to smoke three to four cigarettes on

Chronic obstructive pulmonary disease (COPD) is a condition that refers to chronic airflow limitations and is a term associated with chronic bronchitis and emphysema (American Nurse Today, 2012). According to American Nurse Today, COPD is one of the leading causes of death and disability worldwide (ANA, 2012). As nurses, it is essential to provide appropriate education to patients with COPD on home oxygen to ensure quality of life and safety.

History of Present Illness: Ms. Babula is a very pleasant 76-year-old woman who was previously seen in this office by Elvira Aguila, MD for moderate COPD by pulmonary function testing in 2010. She is currently on monotherapy with Atrovent p.r.n. and she has not used her bronchodilators for quite some time. She does have some stable dyspnea on exertion, which does not limit any of her activities. She does take care of an 18-month-old child as well. She denies any cough, though she does feel that she has some chest congestion in the morning. She denies any chest pain or wheezing.

Rationale: L.J. exhibits symptoms of COPD that include shortness of breath and productive cough. He has a smoking history of 65-pack-year and smoking has been identified as the primary cause/trigger of the disease (Nagelmann et al., 2011).

History of Present Illness: Ms. Crouthamel is a very pleasant 76-year-old woman who I saw in April for a COPD and hypoxic respiratory failure. She has had stable symptoms of shortness of breath. She denies any significant cough. She does state that the humid weather can make breathing difficult at times. She remains active by participating in work in her garden on a daily basis. She is on supplemental oxygen 24 hours a day. She does also admit to occasional tobacco use.

Millions of individuals suffer and die from Chronic Obstructive Pulmonary Disease (COPD) each year in our nation. Currently, there is no cure for COPD; therefore, the most beneficial goal for these patients is to provide enhanced quality of life that includes limited admissions to the hospital setting and decreased exacerbations. Management of this disease process through proper patient education and multidisciplinary collaboration improves a COPD patient’s ability to maintain a healthier state of life as well as decrease their chance of a costly hospital readmission (Chamberlain, Lau, Siracuse, 2017).

Management is diverse, the objective is to relief from symptoms, delay progression, increase exercise tolerance and reduce mortality; this can be accomplished by preventing and treating complications (Nettina, 2013). Since smoking is so rampant in this patient, it is critical that the nurse translates the importance of smoking cessation to slow disease advancement and increase survival (Nettina, 2013). Another standard treatment of COPD is the use of inhaled bronchodilators that reduce dyspnea and bronchospasm (Nettina, 2013). Some of these medications are long acting, such as the anticholinergic Tiotropium or the beta adrenergic agonists Salmeterol, others are short acting, used before activity or when symptoms worsen; examples of such are Ipratropium, an anticholinergic, and the beta adrenergic agonists Albuterol (Nettina, 2013).The patient that has repeated exacerbations and is symptomatic with a FEV1 less than fifty percent is often prescribed inhaled corticosteroids (Nettina. 2013). Those experiencing an acute exacerbation are prescribed oral corticosteroids due to their anti-inflammatory attributes (Nettina, 2013). All of these inhaled medications require the nurse to provide extensive teaching on proper use of the types of inhalers, as well as, the importance of the taking as prescribed; this is also the case of the oral corticosteroid

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