568952

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George Allen

568952

George Allen

68 years old

Male

Attending

Dr. David Carter

Insurance

Medicare

Emergency Contact

Mary Allen (Wife), XXX-555-7890

Chief Complaint

“I've been feeling short of breath for the past few weeks, and I can't seem to catch my breath, especially when walking or doing anything physical.”

Medical History

- Chronic Obstructive Pulmonary Disease (COPD): Diagnosed 7 years ago
- Smoking History: 40 pack-years (quit 3 years ago)
- Hypertension
- Hyperlipidemia
- Seasonal Allergies
- History of Pneumonia: Hospitalized 2 years ago

Allergies

Sulfa drugs (rash and itching)

1600

Patient appears in moderate respiratory distress, with labored breathing and pursed-lip breathing. Skin is slightly pale, and accessory muscle use is noted. Patient reports dyspnea, worse with exertion. Breath sounds diminished bilaterally with expiratory wheezes.
Patient placed on oxygen via nasal cannula at 2 L/min to maintain SpO2 > 90%. IV access established for medication administration.

1600

Suspected Diagnosis: Emphysema exacerbation, secondary to COPD. The patient presents with a 2-week history of increasing dyspnea, decreased exercise tolerance, and persistent cough with scant sputum production. Given his long history of smoking and previous COPD diagnosis, the symptoms are likely related to a worsening of his emphysema. Plan includes supportive care, bronchodilators, corticosteroids, and evaluation of respiratory status.

Question 1

What does the ABG indicate about the patient’s respiratory status?

The ABG shows respiratory acidosis with elevated PaCO2, indicating impaired gas exchange due to emphysema

Question 2

Why was the combination of albuterol and ipratropium prescribed?

Albuterol/Ipratropium Use: This combination therapy helps open airways, relieving acute symptoms and supporting better airflow in obstructive lung conditions.

Scroll to see what happens next

George Allen

68 years old

Male

Attending

Dr. David Carter

Insurance

Medicare

Emergency Contact

Mary Allen (Wife), XXX-555-7890

Chief Complaint

“I've been feeling short of breath for the past few weeks, and I can't seem to catch my breath, especially when walking or doing anything physical.”

Medical History

Allergies

Sulfa drugs (rash and itching)

0800 (Day2)

Patient is alert and cooperative. Reports less shortness of breath. Mobilization limited due to dyspnea with exertion. Continued diminished breath sounds with wheezing on auscultation. Encouraged use of incentive spirometer to improve lung function.

Provided education on breathing techniques (pursed-lip breathing) and energy conservation. Administered bronchodilator treatment.

Question 3

Why is it important to taper the dose of corticosteroids?

Steroid Tapering: Gradual reduction of corticosteroids prevents adrenal crisis by allowing natural cortisol production to resume.

Question 4

What is the purpose of adding a long-acting beta-agonist (LABA) to this patient’s medication regimen?

LABA in COPD: LABAs provide sustained bronchodilation, helping prevent symptom recurrence and supporting long-term management of COPD.

George Allen

68 years old

Male

Attending

Dr. David Carter

Insurance

Medicare

Emergency Contact

Mary Allen (Wife), XXX-555-7890

Chief Complaint

“I've been feeling short of breath for the past few weeks, and I can't seem to catch my breath, especially when walking or doing anything physical.”

Medical History

Allergies

Sulfa drugs (rash and itching)

1000 (Day 5)

Patient is in good spirits and demonstrates improved breathing with pursed-lip technique. No new complaints of dyspnea, and cough is less frequent. Reviewed proper inhaler use, importance of medication adherence, and smoking cessation strategies with patient and wife.

Final set of vitals recorded, discharge paperwork completed, and patient educated on recognizing signs of exacerbation and when to seek medical help.

Question 5

Why is patient education on inhaler use important before discharge?

Inhaler Education: Ensures that the patient is using the device correctly for optimal therapeutic effect and symptom relief.

Question 6

What are key signs of a COPD exacerbation that the patient should be educated to recognize?

COPD Exacerbation Signs: Early recognition and treatment of worsening symptoms can prevent hospital readmission and further complications.

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