...Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease Chronic Obstructive Pulmonary Disease (COPD) is an irreversible debilitating disease of the airway that is currently the fourth leading cause of death in the United States and is rising. Chronic obstructive pulmonary disease is treatable but currently there is no known cure and it is a major cause of morbidity and mortality. COPD causes reduction in airflow during the ventilation cycle due to the loss of air way elasticity, narrowing of the airways, chronic airways inflammation and over active mucous production (Frace, 2008). Known risk factors for development of COPD include tobacco use (including second hand smoke), air pollution, dust and exposure to chemicals used in the production of coal, cotton and grain. There are many complications of COPD, the most common are pneumonia, pneumothorax, cor pulmonale, atelectasis, and in severe cases there maybe respiratory insufficiency and failure (Bare, Cheever, Hinkle, & Smeltzer, 2010). Nursing management for a patient with chronic obstructive pulmonary disease begins with assessment; gathering information from the patient including detailed medical history, present symptoms and evaluate findings of diagnostic tests. Symptoms vary with each patient, but may include chronic cough, clubbing of the fingers, chest tightness, weight loss, cyanosis, difficulty breathing with a higher rate of respirations and difficulty sleeping (Weber...
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...physical findings|||||pp 33-35, 35-45, 47, 151-153, 153-155, 155-156, 156-158, 158-163, 175-177| 3. Laboratory data e.g.,• CBC• electrolytes• coagulation studies• culture and sensitivities• sputum Gram stain|||||pp 45-47| 4. Pulmonary function results|||||pp 47, 151-153, 153-155, 155-156, 156-158, 158-163, 191-194, 194-196, 197| 5. Blood gas results|||||pp 47, 124-126, 126-127, 127-128, 151-153, 153-155, 156-158, 158-163| 6. Imaging studies e.g.,• radiograph• CT• MRI|||||pp 33-45, 47, 151-153, 175-177| 7. Monitoring data|||||| a. fluid balance|||||pp 139-140| b. pulmonary mechanics e.g., maximum inspiratory pressure, vitalcapacity|||||pp 47, 139, 191-194, 194-196| c. respiratory e.g.,• rate• tidal and minute volume• I:E|||||pp 47, 139, 191-194, 194-196| d. pulmonary compliance, airways resistance, work of breathing|||||pp 47, 137-139, 141-143| e. noninvasive e.g.,• pulse oximetry• VD/VT• capnography• transcutaneous O2 / CO2|||||pp 20-21, 47, 137-139, 167-172, 172-175| 8. Cardiac monitoring|||||pp 35-45, 158-163| a. ECG data results e.g., heart rate, rhythm|||||pp 35-45, 103-111, 158-163| b. hemodynamic monitoring results e.g.,• blood pressure• CVP• PA pressure• cardiac output / index|||||pp 35-45, 111-119, 158-163| 9. Maternal and perinatal / neonatal history and data • Apgar scores• gestational age• L / S ratio|||||pp 167-172, 172-175| B. Collect and Evaluate Additional Pertinent Clinical...
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...R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3- = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia. What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD? Interpret R.S.’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia? 1. Clinical findings that are likely in R.S. as a consequence of his COPD are chronic bronchitis and emphysema; these two diseases are related to COPD. He most likely to have a chronic cough that could last for over a year. R.S. will probably experience shortness of breath when he exhales and could develop hypoxemia, which is significantly low level of oxygen within the blood. Even though they both will suppress your breathing, these would differ from those of emphysematous COPD because they would experience antitrypsin deficiency, have smaller bronchioles, have a longer span of shortness of breath and...
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...admits him to a medical-surgical unit for further evaluation and treatment. Mr. Lewis has lab work drawn. His electrolytes are as follows: sodium 138 mEq/L, potassium 3.1 mEq/L (low), chloride 104 mEq/L, and magnesium 1.5 mEq/L (low). His arterial blood gas measurements are as follows: pH 7.48 (high), PaCO2 40 mm Hg, HCO3 29 (high). Jamie Taylor, a 22-year-old nursing student, is assigned to Mr. Lewis. She reviews Mr. Lewis’ medical record before going in to assess him. 1. After reviewing his chart and lab work, what fluid and electrolyte imbalances would Jamie determine? (Select all that Apply) A. Fluid volume deficit B. Hypokalemia C. Hypermagnesemia D. Hyperkalemia E. Hypomagnesemia 2. What acid-base imbalance is Mr. Lewis experiencing? A. Metabolic acidosis B. Respiratory acidosis C. Metabolic alkalosis D. Respiratory alkalosis 3. The hospitalist orders an IV of D5NS to run at 125 ml/hour. What type of fluid is this? Why would this type of fluid be ordered? A. Hypotonic B. Isotonic C. Hypertonic 4. Two hours after the IV is started, Mr. Lewis complains of pain at the insertion site. Jamie assesses the site and notes that it is cool to touch around the site and is edematous. She tries to obtain a blood return and does not get any return. This indicates...
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...Respiratory Therapy is a health profession that specializes in Cardio Pulmonary functions and health. Respiratory therapists help with prevention, assessing patients, treatment, diagnostic evaluation, education, and care. They treat patients from all ages, from babies to the elderly. The requirements in becoming a Respiratory Therapist are taking Human Anatomy, Chemistry, Pharmacology, Microbiology, and Mathematics at a high school or college level. To begin the Respiratory Therapy Program out of high school you have to have a C or better in Chemistry, Anatomy, Algebra 2 minimum, and English. If these courses were not taken in high school, they would need to be taken at the college level to complete the prerequisites to apply for the Respiratory Program. The Program Certification may be obtained with an Associate’s Degree. Having a Bachelor’s Degree in Respiratory Therapy show more knowledge about your profession and chances are better at achieving a job right out of college and working about anywhere. The reasons why someone would want to become a Respiratory Therapist is helping patients with Lung Disease, Heart Disease, and Neuromuscular Disorders to improve the patients quality of life. Respiratory Therapists are people-oriented, dependable, flexible, honest, compassionate, caring, and courteous. In addition, the successful Respiratory Therapist must be able to handle the physical and emotional outcomes of what can be a very stressful job. Last, the successful...
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...history of hypertension, which has been well controlled by Enalapril (Vasotec) for the past 6 years, 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 HR, 36 RR, 102 degrees F, Sao2 88%. His admitting diagnosis is an acute exacerbation of chronic emphysema. Chart View Physician’s OrdersDiet as toleratedOut of bed with assistanceOxygen (O2) to maintain Sao2 of 90%IV of D5W at 50 ml/hrECG monitoringArterial blood gases (ABGs) in AMCBC with differential nowBasic metabolic panel (BMP) nowChest x-ray (CXR) q 24 hrs. Sputum cultureAlbuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT | 1. Explain the pathophysiology of emphysema. Emphysema is characterized by destruction of the walls of the alveoli, with resulting enlargement of abnormal air spaces. Deficiency of a₁-antitrypsin contributes to the development in some individuals, especially when combined with exposure to cigarette smoke (Pearson, 1006). 2. Are D.Z.’s vital signs and Sao2 appropriate? If...
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...have to be long; you could even give me bullet-point answers to the questions listed below) that answers all of the questions posed after Case Study 1. I have included an easy second case study which, if you complete it, will be worth extra credit. Answers to the first Case Study are worth 25 points and responding to Case Study 1 is required work for the course. The extra credit, which is not required, will be worth a total of 10 points. Both are due at the beginning of class on Tuesday, March 10, 2015. Case 1 R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3- = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia. Discussion Questions 1. What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD? Chronic Obstructive Pulmonary Disease (COPD) is comprised primarily of two related diseases: Chronic Bronchitis and Emphysema. These are characterized by unexplained chronic productive cough for at least...
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...Case 1 R.S. has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH = 7.32, PaCO2 = 60 mm Hg, PaO2 = 50 mm Hg, HCO3- = 30 mEq/L. His hematocrit is 52% with normal red cell indices. He is using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray that R.S. has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia. Discussion Questions 1. What clinical findings are likely in R.S. as a consequence of his COPD? How would these differ from those of emphysematous COPD? Chronic Bronchitis and Emphysema are two clinical findings as a consequence of COPD. 2. Interpret R.S.’s laboratory results. How would his acid-base disorder be classified? Respiratory acidosis = PaCO2 > 40mmHg and it is caused by decreased in minute ventilation (hypoventilation). Respiratory acidosis is a condition that causes an excess of carbonic acid. Metabolic alkalosis = HCO3 > 24mEq/L and it is caused by acid loss or HCO3 retention. 3. What is the most likely cause of his polycythemia? COPD/chronic bronchitis. Chronic bronchitis/COPD results in chronic inflammation and swelling of the bronchial mucosa resulting in scarring as a consequence there is no proper oxygenation and a potential airway obstruction...
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...Acid-Base Imbalance Janet J Memoli Grand Canyon University NUR 641E September 30, 2015 Acid- Base Imbalance One of the basic concepts that new nurses need to learn is that homeostasis in the body is maintained by the acid base balance in the body. That concept is critical when looking at arterial blood gases. This can help guide the nurse to anticipate what the doctor will order and the education that she needs to give the patient and the family. This case study should help to illustrate the point. Case Study The case study that was given to us is a 22 year old woman who reports being “sick with the flu” She has been vomiting and having difficulty keeping food and drink down. In addition she has been taking antacids to calm down the nausea. After fainting at home she was driven to the local hospital where they have put in an IV. Her blood gas reveals the following: pH of 7.5, PaCO2 = 40 mm Hg, PaO2= 95 mm Hg, SaO2 = 97% and HCO3- = 32 meq/liter. Interpretation If you start with the basics on this case, the first thing to determine if it is an alkalosis or an acidosis. pH is 7.5 so the result is alkalosis. pH below the 7.35 is an acidosis and pH above the 7.45 is an alkalosis. There are two organ systems that primarily help with the acid base balance in the body and that is respiratory and renal. The renal system contributes to metabolic acidosis or alkalosis. When we look at the respiratory system we are looking at the PaCO2 which in...
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...difficulty managing his daily activities. For the past week the man has experienced increased dyspnea and cough and has been unable to care for himself. On observation, his personal hygiene appeared to have deteriorated. The man stated that he has been unable to get his breath or inhale deep enough to cough up secretions. He complained of mild nausea without abdominal pain or vomiting. His physician had given him an unknown oral antibiotic 3 days before this admission. The man was diagnosed with severe chronic bronchitis approximately 6 years ago and had an acute myocardial infarction 2 years ago. His pulmonary function studies 1 year before this admission showed severe airway obstruction and air trapping. He has a history of high blood pressure, congestive heart failure, chronic dyspnea on exertion, and chronic cough and he experienced two episodes of pneumonia within the last year. In recent months, according to a neighbor, he has become increasingly depressed. According to his daughter, his physical activity is minimal. He generally spends most of his days watching television, smoking, and napping. All his children, none of whom live in the immediate area, have tried to coax him to move to a boarding house environment, but he has adamantly refused. During his last admission, the advantages of pulmonary rehabilitation were discussed with him. The patient said that he had no need for pulmonary education, nor for the services of other agencies or organizations to...
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...Pulmonary Embolism Pulmonary embolism is an occlusion of the pulmonary artery or one or more of its branches by matter carried in the blood current. The matter is called “embolus”. Which is most commonly a blood clot; However, it maybe a fat particle, air, amniotic fluid, tumor or other tissue fragment, parasite, or foreign body. PE refers to pulmonary arterial occlusion by a blood clot (thromboembolism), unless it is qualified by other causes such as fat embolism, and air embolism. Pulmonary embolism result from clots formed in the veins of the calf, legs, and pelvis that can radiate to the lungs. Signs and symptoms of PE include: cardiac arrythmias, dyspnea, chest pain, tachycardia, dizziness/fainting, hemoptysis, coughing, anxiey, tachypnea, and pleuritic pain. Diagnosis is based on serum lab results, EKG, Spiral chest CT, Ultrasound, Chest xray, and Arterial blood gases. Subjective Data: Patient Profile and Medical History E. R. a 40 year old African American male presented to the Emergency room with a history of Hypertension, Pleurisy, and Pulmonary Embolism to Left shoulder post rotator cuff surgery times 4 years ago with treatment of Coumadin times 6 months. History of Vasectomy in 1999. Primary Diagnosis: Pulmonary Edema Recent Development and Current complaints: of low grade fever, SOB, Pleuritc left side chest pain, and nonproductive cough times 2 days. Objective Data: Physical Examination: B/P- 153/99 HR-108 Resp-22 Temperature- 100.3 orally ...
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...difficulty interpreting arterial blood gases (ABGs). Confusion often begins with trying to remember many random rules and lacking a standardized approach to ABGs. In addition, nurses often attempt to analyze too many components of the ABG at the same time. The result is often confusion and an incorrect diagnosis. Therefore, the “6 Easy Steps to ABG Analysis” were developed to provide nurses with an accurate and systematic method of easily interpreting arterial blood gases. The “6 Easy Steps to ABG Analysis” are listed below for easy reference, and will be explained in more detail in the sections that follow. Lastly, examples will be presented with a systematic review of pertinent findings. The 6 Easy Steps to ABG Analysis: 1. Is the pH normal? 2. Is the CO2 normal? 3. Is the HCO3 normal? 4. Match the CO2 or the HCO3 with the pH 5. Does the CO2 or the HCO3 go the opposite direction of the pH? 6. Are the pO2 and the O2 saturation normal? In order for our analysis to be effective, notes will have to be written next to the results on our lab slip. Alternately, the ABG results can be transcribed onto another paper for analysis (see example one below for the format). www.Ed4Nurses.com 1 6 Easy Steps to ABG Analysis ©2003-2009 Ed4Nurses, Inc. Step 1: Analyze the pH The first step in analyzing ABGs is to look at the pH. Normal blood pH is 7.4, plus or minus 0.05, forming the range 7.35 to 7.45. If blood pH falls below 7.35 it is acidic. If blood pH rises above 7.45, it is...
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...L.S. is brought to the emergency department for management of acute mushroom poisoning. Her respirations are slow and shallow, and she is non-responsive. She is admitted to the critical care unit to be closely monitored for the development of ventilatory failure and renal failure, which often accompany mushroom poisoning. Her urine output is decreased at about 20 ml/hr. Her laboratory values are: * Serum K+ = 5.7 mEq/L * Arterial blood gases (ABGs) * pH = 7.13 * PaCO2 = 56 mm Hg * PaO2 = 89 mm Hg * HCO3– = 18 mEq/L. Questions 1. What is the relationship between acid-base balance and serum potassium level? 2. What is the reason for L.S.’s low urine output? How should her fluids be managed? 3. Categorize and explain the probable cause of L.S.’s acid-base disorder. 4. Can L.S. compensate for her acid-base disorder? Why or why not? 5. How should her acid-base imbalance be medically managed? 1. Acid-base balance can influence the serum K+ levels detected in the blood. When a patient experiences hypokalemia, K+ is excreted from the cells and H+ takes its place creating an alkalotic state; K+ is processed out of the body via the kidneys and polyuria can be a clinical symptom. In the case of hyperkalemia, K+ is not properly processed by the kidneys as a result of renal failure; decreased urine output is a clinical symptom. 2. The reason for the patient’s low urine output is due to her acute renal failure. Since the kidneys are in...
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...Airway/Breathing (Oxygenation) Pneumonia/Chronic Obstructive Pulmonary Disease Clinical Reasoning Case Study STUDENT Worksheet JoAnn Walker, 84 years old Overview This case study incorporates a common presentation seen by the nurse in clinical practice: community acquired pneumonia with a history of COPD causing an acute exacerbation. Principles of spiritual care are also naturally situated in this scenario to provide rich discussion of “how to” practically incorporate this into the nurse’s practice. Concepts (in order of emphasis) I. Gas Exchange II. Infection III. Acid-Base Balance IV. Thermoregulation V. Clinical Judgment VI. Pain VII. Patient Education VIII. Communication IX. Collaboration I. Data Collection History of Present Problem: Pneumonia-COPD JoAnn Walker is an 84-year-old female who has had a productive cough of green phlegm 4 days ago that continues to persist. She was started 3 days ago on prednisone 60 mg po daily and azithromycin (Zithromax) 250 mg po x5 days by her clinic physician. Though she has had intermittent chills, she first noticed a fever last night of 102.0. She has had more difficulty breathing during the night and has been using her albuterol inhaler every 1-2 hours with no improvement. Therefore she called 9-1-1 and arrives at the emergency department (ED) by emergency medical services (EMS) where you are the nurse who will be responsible for her care. Personal/Social History: JoAnn was widowed...
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...Case Study Complete Case History The patient in this case study reports being ‘sick with flu’ for 8 days. She has been vomiting, and cannot keep any liquids or food down. She also reports that she has been using antacids to help calm the nausea. After fainting at home, she was taken to the local hospital, severely dehydrated. Upon looking at her arterial blood gas result, it would appear that this patient would be suffering from metabolic alkalosis. This patient’s pH is greater than 7.45 (normal: 7.35-7.45) and her bicarbonate (HCO3) is greater than 26 (normal 22-26). Blood gases indicate that case study patient is suffering from hypochloremic metabolic alkalosis. Focused Assessment The case study patient reports being “sick with flu” for eight days. She reports vomiting several times a day and taking more the recommended dose of antacids. She reports that she fainted today at home and came to the hospital. The case study patient reports that this all started approximately eight days ago. The case study patient also reported taking excess amounts of antacids. Ingesting large amounts of this medication can cause metabolic alkalosis. When antacids are taken in large doses, the ions are unable to bind, and therefor the bicarbonate is reabsorbed and causes alkalosis (Lehne, 2013). Renal and Respiratory systems response Hypochloremic Metabolic alkalosis occurs when there is an acid loss due to prolonged vomiting which causes a decrease in the extracellular...
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