...struggle to breathe. COPD applies to a group of lung diseases .it can be a combination of Emphysema, Bronchitis, and some time in non-reversible asthma. The two primary COPD conditions are chronic Bronchitis and Emphysema. These diseases distress different parts of the lungs, but both cause difficulty breathing. Emphysema gradually destructs the air alveoli in the lungs. Alveoli provide oxygen to the bloodstream. Over the period, Emphysema deteriorates the alveoli and finishes the elasticity of pulmonary airways. As a consequence,...
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...Chronic Obstructive Pulmonary Disease (COPD; Emphysema) Pathophysiology Abakyereba Kwansemah June 4, 2014 Abstract 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 tiredness. His vital signs (VS) are 162/84, 124, 36, 102° F, SaO2 88%. Admitting diagnosis is chronic emphysema with acute exacerbation. Admitting orders includes: diet as tolerated; out of bed with assistance; oxygen (O2) to maintain SaO2 of 90%; maintenance IV of D5W at 50 ml/hr.; intake and output (I&O); arterial blood gases (ABGs) in AM; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q24h; prednisone 60 mg/day PO; doxycycline 100 mg PO q12h x10 days, azithromycin 500 mg IV piggyback (IVPB) q24h x2 days then 500 mg PO x 7 days; theophylline 300 mg PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 ml) in 3 ml normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h;...
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...Current diagnosis COPD/Emphysema. Patient XX was diagnosed with COPD in 2009. COPD is a progressive disease with presence of airflow obstruction, which may be cause by chronic bronchitis or emphysema. Emphysema is a pathological condition caused by the destruction of alveolar walls and a consequent permanent enlargement of the alveolar sacs. According to the National Institute of Health (NIH), a diagnosis of COPD is made based on the patient’s signs and symptoms, medical and family history, and results of diagnostic tests. Common signs and symptoms of COPD include cough, dyspnea, wheezing, and chest tightness. Most patients are older than 50 years. They present with major complaints of severe dyspnea and require the use of accessory muscles...
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...Shift Summary: During this shift, I cared for a patient with idiopathic pancreatitis. This was the first patient I assessed, because the patient was intubated and had two chest tubes. The patient also had a Zassi tube in place; this was my first encounter with a fecal diversion device. Later in the shift, I discovered an opening in the indwelling urinary catheter line. I discontinued the catheter to prevent further urinary leakage and the transmission of bacteria. My other patient was admitted for a COPD exacerbation. This patient was stable all shift. I provided teaching to both the patient and her family, and call the family to update them on which room she would be transferring to. I gave the patient report to the floor nurse over the phone and helped transport the patient. I feel that I did well educating and communicating with the patients and their families. I also feel that I did better giving report. I could still improve on my time management skills....
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...Chronic obstructive pulmonary disease (COPD) is an umbrella term for people with chronic bronchitis, emphysema, or both. With COPD the airflow to the lungs is restricted (obstructed). COPD is usually caused by smoking. Symptoms include cough and breathlessness. The most important treatment is to stop smoking. Inhalers are commonly used to ease symptoms. Other treatments such as steroids, antibiotics, oxygen, and mucus-thinning (mucolytic) medicines are sometimes prescribed in more severe cases, or during a flare-up (exacerbation) of symptoms Chronic obstructive pulmonary disease (COPD) is a general term which includes the conditions chronic bronchitis and emphysema. COPD is the preferred term. • Chronic means persistent. • Bronchitis is inflammation of the bronchi (the airways of the lungs). • Emphysema is damage to the smaller airways and air sacs (alveoli) of the lungs. • Pulmonary means 'affecting the lungs'. Chronic bronchitis or emphysema can cause obstruction (narrowing) of the airways. Chronic bronchitis and emphysema commonly occur together. The term COPD is used to describe airflow obstruction due to chronic bronchitis. Furthermore COPD is an ongoing and a terminal disease that can have effect on patient daily living (Blackler et al. 2007). In this project, the topic chosen is Developing Self management plans to help people with COPD to control their condition. The key intervention innovating on is the development of COPD care checklist. This is due to how patients...
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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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...COPD COPD is a term used for Chronic obstructive pulmonary disease. This is an “obstructive disease”, meaning that airflow coming out of the lungs during exhalation is blocked. The blockage of airflow with COPD ,makes it very difficult for a person to breathe. Over time, COPD get progressively worse because doctors have not yet found a cure. COPD affects more Than 5% of the adult population, and is a major cause of morbidity and mortality in the United States and worldwide. 4 With COPD, a person will usually have two main medical conditions that limit airflow. These conditions are known as emphysema and chronic obstructive bronchitis. Emphysema causes the elasticity of the lung tissue to be lost. The alveolar walls between air sacs in the lung are damaged, and this causes them to lose their shape and become flimsy. Over time, this damage destroys the walls, leading to fewer, larger air sacs, rather than many, smaller air sacs like that of a normal lung. When this happens, the amount of surface available for gas exchange inside the lung is drastically reduced. With chronic bronchitis, the lining of the airways is constantly irritated and inflamed. This condition causes the lining to thicken, and leads to a lot of thick mucus production forming in the airways, making it harder to breathe. With destruction of the lung parenchymal, and narrowing of the small airways, air becomes trapped due to the inability of the airways to remain open during expiration...
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...In this case-study, the concept map outlines the presentation of RT, a 62-year-old female to the Emergency Department (ED) with complaints of dyspnea, cough, and a low-grade fever. RT’s past medical history includes risk factors for infection that includes: COPD, hypertension, diabetes mellitus type 2 that is controlled by diet, non-compliance with medications, and past refusal of immunizations for the flu and pneumonia. RT’s lab work, chest x-ray, and vital signs are indicative of community acquired pneumonia. RT is treated with broad-spectrum antibiotic and admitted for inpatient care. In the United States, it is estimated that 500,000 patients present to the ED with sepsis. Half of those patients have early sepsis and do not require intensive care. Many time the symptoms of sepsis are so subtle that are underrecognized and undertreated in the ED (Bruce, Maiden, Fedullo, & Kim, 2015, p. 130). In this case-study, RT symptoms of early sepsis are not recognized in the ED, and she is admitted to an inpatient unit....
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...CASE STUDY 29-Emphysema Scenario 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 (PHM) of hypertension (HTN), which has been well controlled by enalapril (Vasotec) for the past 6 years, and a diagnosis (Dx) of pneumonia yearly for the past 3 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 when he tells you that he has been a 2-pack-per-day smoker for 38 years. He complains of (C/O) sleeping poorly and lately feels tired most of the time. His vital signs (VS) are 162/84, 124, 36, 102 F, SaO2 88%. His admitting diagnosis is chronic emphysema with an acute exacerbation, etiology to be determined. His admitting orders are as follows: diet as tolerated; out of bed with assistance; oxygen to maintain SaO2 of 90%; maintenance IV of D5W at 50mL/hr; intake and output (I & O); arterial blood gasses (ABGs) in am; CBC with differential, basic metabolic panel (BMP), and theophylline (Theo-Dur) level on admission; chest x-ray (CXR) q 24h; prednisone 60mg/day PO; doxycycline 100 mg PO q 12h x 10 days, PO bid; heparin 5000 units SC q12h; albuterol 2.5 mg (0.5 mL) in 3 mL normal saline (NS) and ipratropium 500 mg by nebulizer q4-6h; enalapril 10 mg PO q am. 1. Explain the pathophysiology of emphysema. 2. Are D.Z.’s VS and SaO2 appropriate...
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...would like to do or see materialize in the future and the reason for that materialization. As leaders, in the healthcare industry, we all have visions that we would like to implement in order to improve the healthcare system we work and live in. “Nurses are central to the mission of promoting optimal levels of health and functional status. Information needs are constant and evolving; health professionals must be responsive and ready with facts and resources”, (Fetter, 1997). Nurses are not only patient caretakers but we are educators, as well. Therefore, one of my visions is for nurses to take on a more active role as a patient educator in efforts to prevent exacerbation, hospitalization and re-hospitalization. As a result of introducing this vision, patients will have a) improved quality of life, b) decreased exacerbation, hospitalization and re-hospitalization, c) increased knowledge and understanding of their disease, d) improved dignity and self esteem, and e) patients will have more autonomy in their care. In order for one to implement ones vision, there are many key concepts that need to be considered and put into place which should incorporate the importance and the impact these concepts will have on the vision. Communicating to patients about the specific disease, diagnosis and the risks involved. Patients need to be educated on the diagnosis, why they are at risk, what factors constitute risk, why are particular patients more at risk and how can risk be minimized...
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...settings such as, in critical nursing, psychiatric nursing, gerontological nursing, and for teaching purposes. In the United States, “the model is used to guide practice with clients with acute and chronic health problems” (Parker &ump; Smith, 2010, p. 192). As further explained by Parker and Smith (2010), the client system is the core: a person, individual, or community and the core interact with the flexible lines of defense, the normal lines of defense, and the lines of resistance. The client system is constantly affected by internal and external stressors. The goal of nurses in applying the Neuman System Model is, “to maximizing the quality of life lived, maintaining the highest level of independence possible, and preventing exacerbations of the on-going illness” (Ebersole, Hess, Touhy, Jett, and Luggen, 2008, p. 258). Mrs. J is a 79-year-old African-American female client, who lives with her husband in a wheelchair accessible home. She has always been a home maker, enjoys cooking the family meals, and raising the grandchildren. Mrs. J is a mother of three children with great family support and loves the outdoors. She has multiple medical conditions: adult onset diabetes, moderate obesity, indigestion, hypertension,...
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...1. What is an obstructive lung disorder? COPD- preventable and treatable disease state characterized by chronic airflow limitation that is not fully reversible. The airflow limitation is usually progressive and associated with an abnormal inflammatory response of the lungs to noxious particles or gases, primarily caused by cigarette smoking. 2. What should the nurse consider when giving oxygen to the patient with an obstructive lung disorder and why? -02 has an irritating effect in mucous membranes and dries secretions, therefore it is important that a high liter of flow of 02 delivering 35-50% be humidified when administered. - Periodic reevaluations are necessary for the patient who using chronic supplemental O2 -Most patients with COPD can tolerate 2 L/min via cannula -Access patients nares and ears for skin breakdown and may need to pad cannula where its sits on the ears -Watch for complications -Periodically check o2 delivery device to ensure that the prescribed concentration is being delivered -Monitor the effectives of 02 therapy( pulse ox, ABG’s) to evaluate patient response to therapy -Observe for signs of o2-induced hypoventilation because this occurs with carbon dioxide nacrosis -Position to minimize respirator efforts ( HOB elevate and provide overbed table for patient to lean on) -The person with COPD who retains CO2 should be treated with low rates of 02 with careful monitoring of ABG’s to avoid hypercarbia. 3. What are nursing management issues...
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...Danielle Wilkinson Alternate Clinical Assignment 01/27/2014 Case Study #1 Episode I 1. List five common environmental triggers for asthma and give at least one specific example for each. Five common environmental triggers for asthma are exercise, allergens, odors, weather, and food. Exercise induced asthma is common in young children and adolescents. The airways in the lungs become narrowed during strenuous exercise. There are many different types of allergens that induce asthma like dust mites, pollen from tress, mold, and pet dander. Odors that can trigger asthma are cigarette smoke, some kinds of perfume, cleaning products, and smoke from burning wood. Weather can trigger asthma by a sudden change in temperature, extreme hot or cold temperatures, and humidity. Foods may also trigger asthma in some by eggs, milk, peanuts, wheat, and soy. 2. Describe the impact of asthma (e.g., morbidity, mortality, economic impact, groups disproportionately affected) on the U.S. population. Asthma affects approximately 16 million Americans, with 2million emergency department visits, and 4,000 deaths a year. Low socioeconomic status impacts Americans with asthma because they may not be able to afford the medication that is prescribed. The more persistent asthma is to an individual, the more damaging occurs in the lungs. The airways begin to undergo remodeling which includes persistent changes in airway structure. The airways begin to become narrower because the epithelial...
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...corticosteroids Leukotriene antagonists are less effective than corticosteroids and thus less preferred. The prevalence of asthma has increased significantly since the 1970s. As of 2009, 300 million people were affected worldwide. In 2009 asthma caused 250,000 deaths globally. Despite this, with proper control of asthma with step down therapy, prognosis is generally good. Reaction: Suggestion: Chronic obstructive pulmonary disease (COPD), also known as chronic obstructive lung disease (COLD), chronic obstructive airway disease (COAD), chronic airflow limitation (CAL) and chronic obstructive respiratory disease (CORD), refers to chronic bronchitis and emphysema, a pair of commonly co-existing diseases of the lungs in which the airways become narrowed. This leads to a limitation of the flow of air to and from the lungs causing shortness of breath. In clinical practice, COPD is defined by its characteristically low airflow on lung function tests. In contrast to asthma, this limitation is poorly reversible and usually gets progressively worse over time. COPD is caused by noxious particles or gas, most commonly from tobacco smoking, which triggers an abnormal inflammatory response in the lung. The inflammatory response in the larger airways is known as chronic bronchitis, which is diagnosed clinically when people regularly cough up sputum. In the alveoli, the inflammatory...
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...Karim Hall Bronchitis Florida Technical College Abstract Bronchitis is one of the top 10 conditions for which most patients seek medical care for. Some physicians show considerable variability in describing the signs and symptoms when it is necessary to its diagnosis. A cough is also a most common symptom bringing patients to the primary care physician’s office, and bronchitis is usually the diagnosis in these patients. However, studies have indicated that many physicians treat bronchitis with antibiotics. These drugs have generally shown to become ineffective in patients with complicated bronchitis. A patient satisfaction with their treatment of bronchitis is related to the quality of the physician-patient interaction rather than to the prescription of an antibiotic. Bronchitis Bronchitis is an inflammation of the membrane that lines the air passages, or, bronchial tubes, of the lungs and results in the narrowing of these air passages. This disorder may be of either an acute or chronic type. Irritation of mucus-producing glands within the membrane results in the production of excess bronchial secretions. The main symptoms of bronchitis are cough and increased expectoration of sputum, with or without associated wheezing and shortness of breath. Men are more of a target to bronchitis then most women, men out numbering them 10 to 1 for reasons that are unclear. Acute bronchitis is a self-limited infection of the lower respiratory tract causing inflammation of the bronchi...
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