Question

Case Study  

M.B. is a 65-year-old male who is being admitted from the emergency department to the cardiopulmonary unit with an exacerbation of chronic obstructive pulmonary disease (COPD).  

M.B. has been using ipratropium (Atrovent) and albuterol (Proventil) metered-dose inhaler for control of his symptoms. His admission vital signs are as follows: blood pressure 158/86 mm Hg, heart rate 118 beat/min, respiratory rate 36 breaths/min, temperature 101.4° F (38.4° C), and SaO₂ 85%. He is 5 ft 10 in tall, weighs 180 lb, and has a marked barrel chest.

Discussion Questions

1. What classic manifestations indicate the patient had a COPD exacerbation?

2. What are some likely causes of her COPD?

3. What symptoms indicate the overuse of inhalers, and which drug would cause the symptoms described?

4. What is the only way H.M. can halt the progression of her lung disease?

5. Why would H.M. “feel full fast” when eating? What could you do to minimize this issue?

6.   Priority Decision: What are nursing priorities for discharge planning and teaching?

8.  Priority Decision: Based on the assessment data presented, what are your priority nursing diagnoses? Are there any collaborative problems?

Answer 1

M.B. is a 65 years old male , who is being shifted to cardiopulmonary unit from emergency department due to exacerbation of COPD .

On assessment his vital signs were:-

Blood pressure - 158/86mmhg

Temperature - 101.4 °F

Respiratory rate - 36bpm

Heart rate - 118bpm

SPO2 - 85%

His chest is barrel shaped

Weight of the patient is 180lbs= 180×0.45= 81kg

Height of the patient is 5foot 10 inches

1. The clinical manifestations that indicate that the patient had COPD excaberations are :-

- Tachypnea (increased respiratory rate=36bpm)

- Lower oxygen saturation level than normal (SPO2-85%) due to decreased gas exchange because of increased mucus production.

- Tachycardia ( heart rate more than normal = 118bpm to compensate the increased oxygen demand )

- High blood pressure ( 158/86mmhg)

- Barrel chest is the classical sign of COPD

2. Some likely causes of her COPD are :-

- overuse of ipratropium and albuterol metered dose inhalers

- lung infection as she has fever of 101.4°F

- overweight (81kg)

- age (over 40 years )

- genetics and hereditary

3. The symptoms that indicate overuse of inhalers are :-

- fast heart rate means tachycardia( 118bpm )

- increased rate of breathing (36bpm)

- higher blood pressure (158/86mmhg)

And it is caused by the overuse of albuterol . Albuterol is beta2-adrenergic agonist bronchodilators. It's side effects are :-

fast or irregular heart rate

chest pain

shakiness

nervousness

headache

nausea

vomiting

dizziness

sore throat

runny nose

Serious side effects include :-

tightening and swelling of the muscles around your airways

trouble breathing

wheezing

# Serious allergic reaction include:

hives

skin rash

swelling of your face, eyelids, lips, tongue, or throat

trouble swallowing

Stevenson's Johnson syndrome

shock (loss of blood pressure and consciousness)

heart problems include:

faster heart rate

higher blood pressure

4. The only way H.M. can halt the progression of her lung disease is by using the inhalers in the correct way . Nurse should explain her the proper usage of metered dose inhalers so that such complications can be avoided in future by overusing it . Nursing intervention about using inhalers :-

STEPs :-

Have your patient sit up straight.

Assess her ability to hold and manipulate the inhaler and depress the canister.

Insert the medication canister in the inhaler and remove the inhaler mouthpiece cover.

Have the patient shake the inhaler well and hold it with the canister upright 1 to 2 inches (2.5 to 5 cm) from her open mouth.

Advice her to take a deep breath and exhale slowly

Tilt her head back slightly and prepare to inhale slowly and deeply through her mouth. As soon as she starts breathing in, she should press down on the canister to release the medication ( number of puffs should be taken according to the prescription)

place her lips firmly around the mouthpiece to inhale (unless the medication is a steroid, which calls for the open-mouth technique)

Tell her to continue breathing in as the medication is released and to continue inhaling slowly and deeply for 3 to 5 seconds.

Tell her to hold breath for 8 to 10 seconds while the medication reaches deep into his airways, then exhale through pursed lips.

Teach her to repeat inhalations as directed, allowing 1 minute between puffs.

Have her replace the cap on the mouthpiece when she's finished.

Advice her to rinse mouth with water afterward.

Show her how to remove the medication canister and clean the inhaler in warm water.