Question

Case Study: COPD

Please complete below.

CASE STUDY THE PATIENT WITH COPD 

Use a separate sheet of paper to answer the questions in this Case Study. Answer guidelines for this Case Study are available on your Evolve website at http:/levolve. elsevier.com/Iggy/ in the "Prepare for Class" folder.

The 72 -year-old patient is being evaluated in his home by the home health nurse. He was admitted to the hospital for an exacerbation of his COPD and discharged 2 days ago. He states, "I feel a little more out of breath today than I usually do, but I am breathing better than I was when I went to the hospital." He is thin with a barrel-shaped chest. He is slow moving and slightly stooped. He demonstrates rapid, shallow respirations at \(30 / \mathrm{min}\). He currently denies chest pain, but he reports feeling exhausted.

1. List at least eight questions the nurse could ask to evaluate this patient's current condition.

2. Describe how the nurse uses the following assessment tools to determine the severity of the dyspnea:

a. Visual Analog Dyspnea Scale

b. Peak expiratory flowmeter

c. Pulse oximetry (assume availability of portable unit)

3. Identify four or five common nursing diagnoses for patients with COPD.

4. Identify at least eight teaching points to help this patient conserve energy.

5. The patient tells the nurse that he has heard about pulmonary rehabilitation. He is not sure why his doctor did not suggest this for him, but he wonders if it is a possibility.

a. What is pulmonary rehabilitation?

b. Describe a typical simple rehabilitation plan.

6. Prepare and practice a dialogue for calling the physician to make an inquiry if pulmonary rehabilitation is appropriate for this patient.

Answer 1

Question no 1) Does patient position affect breathing?

• Do you routinely use oxygen?
• Do you have dyspnea with routine activity? Or chronic coughing?
• Do you smoke
• Are you taking medication routinely
• Do you have wheezing while exhaling
• Which time does difficulty in breathing occur
• Do you feel shortness of breath?
• Do you feel any improvement in your condition?

Question no 2)

A) using a dyspnea scale the subject is instructed to give a qualification of his dyspnea placing a horizontal or vertical line ,usually 100mm in length.Exersice is conducted and patient can give a rating of dyspnea at different levels

B)

The nurse can check your peak flow using these basic steps

• Move the marker to the bottom of the numbered scale.
• Stand up straight.
• Take a deep breath. Fill your lungs all the way.
• Ask to hold breath while you place the mouthpiece in mouth, between your teeth. Close your lips around it.
• Blow out as hard and fast as you can in a single blow. first burst of air is the most important. So blowing for a longer time will not affect your result.
• Write down the number you get.
• Move the marker back to the bottom and repeat all these steps 2 more times. The highest of the 3 numbers is your peak flow number. it is written down in log chart.
• And by this values dyspnea can be measured

C)usinga pulse oximetry

A blood oxygen level lower than 89% means there may not be enough oxygen in blood to meet body's needs. This could be used to asses any v/ q mismatch

Question no 3)

Nursing diagnosis

1. Ineffective Airway Clearance
2. Impaired Gas Exchange
3. Ineffective Breathing Pattern
4. Imbalanced Nutrition: Less Than Body Requirements
5. Risk for Infection
6. Deficient Knowledge
7. Activity Intolerance

Question no 4)

• Simplify tasks and set realistic goals. Don't think you have to do things the same way you've always done them.
• Plan activities (chores, exercise, and recreation) ahead of time. Space out your activities throughout the day. Do not schedule too many things to do in one day. Do the things that take more energy when you are feeling your best.
• If needed, rest before and after activities.
• If you become tired during an activity, stop and rest. You might need to finish it on another day or when you feel less tired.
• Do not plan activities right after a meal. Rest 20 to 30 minutes after each meal.
• Ask for help. Divide tasks among family and friends.
• Get a good night's sleep and elevate your head when sleeping. Be careful not to nap too much during the day or you might not be able to sleep at night.
• Do all of your grooming (shaving, drying your hair, etc.) while sitting.
• If needed, use devices and tools that assist you such as a walker, shower chair, hand-held shower head, bedside commode, or long-handled tools for dressing (such as a dressing stick, shoe horn, or sock donner).
• Wear clothes that have zippers and buttons in the front so you don't have to reach behind

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