Question

Day 1, 1330. Jim Lawson is a 64-year-old Caucasian male admitted to the hospital medical floor for a respiratory infection. Jim, a 2 pack-a-day smoker, has a history of chronic obstructive pulmonary disease (COPD). He awakened in the morning with increased shortness of breath and coughing with the production of green-brown sputum. Vital signs are BP 144/88. P94, R 30, temperature 100.2 orally. Physicians orders include: ABG’s stat, sputum for C & S then begin Ampicillin 500 mg IV q 6 hours, IV d5W 100cc/hr, Theo Dur 1 bid, Albuterol 3 mg per nebulizer qid and prn acute dyspnea, o2 1.5L/min.

1 Relate this clinical data to the diagnosis of COPD. What other symptoms would the nurse expect the client to exhibit?

2. What are the benefits and risks of O2 therapy in a client with COPD?

3. Why was the O2 therapy limited to 1.5L/min?

Answer 1

1 Wheezing and chest tightness maybe present.The person with advanced COPD may experience weight loss and anorexia.Fatigue is a highly prevalent symptom that affects the patients activities of daily living .Haemoptysis may occur during respiratory tract infections.

2 Management of corpulmonale includes continious low-flow oxygen.Long-term oxygen therapy improves survival of hypoxaemic patients ,especially when used greater than 15 hours per day..It is frequently used in the treatment of COPD.Long term oxygen therapy improves survival,excercise capacity ,cognitive performance and sleep in hypoxaemic patients.it reduce the work of breathing,maintain the PaO2. The potential risks are it reduces COPD patients drive to breath resulting in CO2 narcosis.Pulmonary toxicity may result from prolonged exposure to a high level of Oxygen.Absorption Atelectasis and infection can be a major hazard of oxygen administration.

3 it is critical to start oxygen at low flow rates until ABG can be obtained.ABG are used as a guide to determine what FiO2 level is sufficient and can be tolerated.The patients mental status and vital signs should be assessed before starting oxygen therapy and frequently thereafter.ABG should be monitored frequently to evaluate the effectiveness of therapy and to guide the tapering of supplemental oxygen.