Question

Case study questions 1-7

COPD Case Study DZ, a 65-year-old man, is admitted to a medical floor for exacerbation of his COPD (emphysema). He has a past medical history of HTN, which has been well controlled with enalapril for the past 6 years, and has been diagnosed with pneumonia yearly for the past 3 years. He presents as a thin, poorly nourished man who is experiencing difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. He seems imitable and anxious when he tells you that he has been a 2 pack per day smoker for 38 years. He complains of sleeping poorly and lately feels very tired most of the time. His VS are BP 162/84, HR 124, RR 36, Temp 102, Sats 88% His admitting diagnosis is chronic emphysema with an acute exacerbation. His admitting orders: • Out of bed with assistance • Oxygen to maintain saturation at 90% • DSW at 50ml/hr maintenance fluids • ABG in the AM • CBC and BMP on admission • Chest x-ray every 24 hours • Prednisone 60 mg PO daily • Doxycycline 100mg PO BID for 10 days • Azithromycin 500mg IVPB daily for 2 days, then 500mg PO for 7 days • Theophylline 300 mg PO BID • Heparin 5000 units subQevery 12 hours • Albuterol 2.5mg in 3ml of normal saline and ipratropium 500 mg by nebulizer every 4-6 hours • Enalapril 10mg PO daily 1. Explain the pathophysiology of emphysema. 2. Are DZ'S VS and O2 sats appropriate for the diagnosis? If not, why? 3. Identify 3 measures you could try to improve oxygenation. 4. Explain the main purpose of the following classes of drugs: antibiotics, bronchodilators, and corticosteroids. 5. What are the two most common side effects of bronchodilators? 6. List 3 educational topics that you need to explore with DZ DZ's wife approaches you in the hallway and says, "I don't know what to do. My husband used to be so active before he retired 6 months ago. Since then he's lost 35lbs. He is afraid to take a bath and it takes him hours to dress. He has gone downhill so fast that it scares me. He is afraid to do anything for himself. He wants me in the room with him at all times. But, I have to keep working because his medical bills are draining all of our savings, and I have to be able to support myself when he's gone. You know, sometimes I go to work just to get away from the house and his constant demands. He calls me several times a day asking me to come home, but I can't come home. You may not think I'm much of a wife, but honestly, I don't want to come home anymore. I just don't know what to do." 7. How would you respond to her statement?

Answer 1

1 Pathophysiology of emphysema ; Emphysema is adisorder in which the alveolar walls are disstroyed. The destruction leads to permanent overdistention of the air spaces. Air passages are obstructed as a result of these changes rather than from mucus production, as in chronic bronchitis. theenzymes protease and elastes can attack and distroy the connective tissues of lungs. Em physema may result from a breakedown in the lungs normal defense mechanism aginst these enzymes.Diffcult expiration in emphysema is the result of destruction of the walls (septa) between the alveoli.partial airway colapse. and loss of elastic recoils. As the alveoli and the septa cooapse, pockets of air form between the alveolar space (blebs) and within the parenchyma( bullae). This process leads to increased ventilatory dead space from areas that do not participate in gas or blood exachange.

2 yes

3 measures to imprive oxygenation ;to administer low- flow oxygen therpy as need via nasal prongs or high-flow venturi mask 2 ,regular monitoring of Respiratory rate and pattern , pulse oximetry, abg and manifseation of hypoxia or hypocapnia 3 assist the client into high-fowlers position 4, administer beodhodilators if ordered and monitor the side effects.

4 purpose of Antibiotics ;to prevent bacterial infection

Bronchodilators; to dilate the airways and decrease the airflow resistance

Corticosteroids; to redduce the inflamatory component of the emphysema

5 Side effect of brochodilator ;increased heart rate and palpitation 2 Shaky feeling or nervous 3 muscle aches or cramps

6 educational topic; to taught how to administer oxygen and medication , what side effect to look for and how to manage them , lower body exrcise is commonly prescribed and upper body exercise also used in some case and about the self care and adherence. Needs of respiratory follow up , and include the hazards of infection and ways to decrease personal risk.

7 Approch her in in proper ways likes listen her problems and give good suggestions about how to managae an elderly clients and the importants of his needs and care.at the same time good rapport with family relations .