Question

L.K. is a 35-year-old male, who recently moved here from Hungary.  He works as a mason, smokes 2 packs of cigarettes a day, drinks a six pack a night, and denies any past medical history.  He presents today, in the clinic with SOB and chest pain.  

1) As the nurse first meeting him, what do you suspect is happening to L.K., and why?

2) What would you anticipate the next course of action to be?  

3) What medications would you expect the doctor to order?

4) What tests?  

5) What should you, as his nurse educate him about the medications he may be getting?  

Answer 1

1. Chronic obstructive pulmonary disease is very common in smokers and alcoholics. It is an obstructive pulmonary disease characterised by cough, shortness of breath, chest tightness, wheezes. The patient’s symptoms and history of smoking and alcohol is suggestive of COPD

2. The next course of action will be thorough objective and subjective assessment of patient. The patient will be assessed for :

- cough : productive or non productive

- sputum analysis

- adventitious breath sounds

- respiratory rate, pulse rate, heart rate and BP

- cyanosis and clubbing

- symmetry of chest

3. Medications include bronchodilators, short and long acting beta 2 agonists like salbutamol, terbutaline and tiotropium. Corticosteroids and antibiotics

4. Tests include :

- spirometry and pulsoximetry

- chest xray, CT scan of lungs

- complete blood count

- sputum analysis

- ECG and ECHO to rule out any cardiac condition

5. Nursing interventions include educating patient about proper and timely administration of prescribed drugs, monitoring of vital parameters. Teach patient the correct way to use inhalers. Encourage patient to quit smoking and alcohol.