Question

PART 1 MEDICAL-SURGICAL CASES CASE STUDY 29 Case Study 29 e mokay Clasworoup - . Doto Mar. 3.20 Group Members Scenario DZ, a 68-year-old man, is admitted at 1600 to a medical floor with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD). His other past medical history includes hypertension and type 2 diabetes. He has had pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. His current medications include enalapril (Vasotec), hydrochlorothiazide (HCTZ), metformin (Glucophage), and fluticasone/salmeterol (Advair). He appears a cachectic man who is experiencing dif- ficulty breathing at rest. DZ. seems irritable and anxious; he complains of sleeping poorly and states that Lately he feels tired most of the time. He reports cough productive of thick yellow-green sputum. You aus. cultate decreased breath sounds, expiratory wheezes, and coarse crackles in both lower lobes anteriorly and posteriorly. His vital signs (VS) are 162/84, 124, 36, 102°F (38.9°C), and Spo, 88%. Chart View Physician's Orders Diet as tolerated Out of bed with assistance Oxygen (O) to maintain Spo, of 90% IV of D5W at 50 mL/hr ECG monitoring Arterial blood gases (ABGS) in AM CBC with differential now Basic metabolic panel (BMP) now Chest x-ray (CXR) daily Sputum culture Albuterol 2.5mg plus ipratropium 250 mcg nebulizer treatment STAT 1. Are D.Z's VS and Spo, acceptable? If not, explain why. These findings are expected for COPD ex acabation but not appropriate. The body is compensating for lack of o2 and is ouer stressed Copyright 2016 by Morbine, an impre

Answer 1

1. Yes , the findings are acceptable in COPD exacerbation patients . Due to exacerbation the HR, RR and BP are increased above normal . Temperature is above normal due to infection . SPO2 - is below 90 because patients with COPD are no longer sensitive to high levels of carbon dioxide; therefore, their primary drive to breathe becomes hypoxia. High-flow oxygen therapy "fixes" hypoxemia, thereby taking away the secondary drive to breathe in the client with COPD.