Question

CLIENT PROFILE

Mr. Cohen is a 75-year-old male admitted with an exacerbation of chronic obstructive pulmonary disease (emphysema). He has been keeping the head of the bed up for most of the day and night to facilitate his breathing which has resulted in lower back pain. Acetaminophen was not effective in reducing his pain, so the health care provider has prescribed oxycodone/acetaminophen one to two tablets PO every four to six hours as needed for pain. Mr. Cohen is on 2 liters of oxygen by nasal cannula. He can receive respiratory treatments of albuterol every six hours as needed. Mr. Cohen needs someone to walk beside him when he ambulates because he has an unsteady gait and often needs to stop to catch his breath.

CASE STUDY

The nurse enters the room and finds Mr. Cohen hunched over his bedside table watching television. He says this position helps his breathing. His lung sounds are clear but diminished bilaterally. Capillary refill is four second and slight clubbing of his fingers is noted. His oxygen saturation is being assessed every two hours to monitor hypoxia. Each assessment reveals oxygen saturation at rest of 90% to 94% on 2 liters of oxygen by nasal cannula.

After breakfast, Mr. Cohen complains of lower back pain that caused him increased discomfort while ambulating to the bathroom. He describes the pain as a dull ache and rates a 6 on a 0-10 scale. He requests two Percocet tablets. The nurse assesses Mr. Cohen’s vital signs (BP 150/78, HR 90, RR 26) and gives the Percocet as prescribed. Forty-five minutes later, Mr. Cohen states the Percocet has helped relieve his back pain to a 2 on a 0-10 pain scale and he would like to take a walk in the hall. The nurse checks his oxygen saturation before they leave his room, and it is 92%. Using a portable oxygen tank, the nurse walks with Mr. Cohen from his room to the nurse’s station (approximately 60 feet). Mr. Cohen stops to rest at the nurse’s station because he is short of breath. His oxygen saturation at the nurse’s station is 86%. After a few deep breaths and rest, his oxygen saturation rises to 91%. Mr. Cohen walks back to his room where he sits in his recliner to wait for lunch. His oxygen saturation is initially 87% when he returns and then 91% after a few minutes of rest. Expiratory wheezes are heard bilaterally when the nurse assesses his lung sounds. While Mr. Cohen waits for lunch to arrive, the nurse calls respiratory therapy to give Mr. Cohen his albuterol treatment. The respiratory treatment and rest relieves his acute shortness of breath. Is oxygen saturation is now 93%, and his lung sounds are clear but diminished bilaterally.

QUESTIONS

1.       Briefly define chronic obstructive pulmonary disease (COPD). What pathophysiology is occurring in the lungs of a client with emphysema?

2.       What are the five signs and symptoms of respiratory distress the nurse may observe in a client with COPD?

3.       List five nonpharmacological interventions that the nurse could implement to help decrease Mr. Cohen’s difficulty breathing.

4.       Should the nurse be concerned about the adverse effects of respiratory depression and hypotension when giving oxycodone/acetaminophen to Mr.
Cohen? Why or why not?

5.       Mr. Cohen will be returning home with oxygen. List at least five safety considerations the nurse should include in discharge teaching regarding the use of oxygen in the home.

Answer 1