BSN, RN
Robert "Bob" Thompson
MRN:
Room Number:
524
Isolation:
Code Status:
Weight:
142 lbs
Height:
5'10"
Robert "Bob" Thompson
68 y/o
Male
Provider:
Dr. James Wilson, MD
Allergies:
Penicillin (rash)
Emergency Contact:
Susan Thompson (Wife) | 555-XXX-4321
Insurance:
Medicare
Chief Complaint
"I can't catch my breath. My rescue inhaler isn't helping like it usually does. Been coughing more and the mucus is darker than usual."
Medical History
- Emphysema (diagnosed 10 years ago)
- COPD
- Hypertension
- Coronary Artery Disease
- Osteoarthritis
- History of pneumonia (2 years ago)
Home Medications
- Spiriva Handihaler 18mcg inhaled daily
- Symbicort 160/4.5mcg 2 puffs BID
- ProAir HFA 90mcg 2 puffs q4h PRN
- Lisinopril 20mg PO daily
- Aspirin 81mg PO daily
- Atorvastatin 40mg PO daily
Based on the ABG results, what type of acid-base imbalance does this patient have, and what is its relationship to his emphysema?
ABG Analysis:
The patient has respiratory acidosis with partial compensation. This is evident from:
Low pH (7.32): Indicates acidosis.
High PaCO2 (52 mmHg): Indicates respiratory cause (hypercapnia).
Elevated HCO3 (28 mEq/L): Suggests the kidneys are partially compensating by retaining bicarbonate. In emphysema, damaged alveoli reduce the ability to exhale carbon dioxide, leading to its buildup in the blood, causing acidosis.
What are the key assessments the nurse should perform to monitor for worsening respiratory status?
Key respiratory assessments:
Respiratory Rate: Watch for increasing rate or signs of labored breathing.
Oxygen Saturation (SpO2): Ensure it stays between 88-92% as prescribed.
Work of Breathing: Monitor for increased use of accessory muscles or tripod positioning.
Mental Status: Look for confusion or drowsiness, which may indicate worsening hypercapnia or hypoxemia.
Sputum Production: Note changes in color, consistency, or amount, which may suggest infection.
Vital Signs: Monitor for tachycardia or hypertension, which can indicate stress on the cardiovascular system due to hypoxemia.
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Robert "Bob" Thompson
68 y/o
Male
Provider:
Dr. James Wilson, MD
Allergies:
Penicillin (rash)
Emergency Contact:
Susan Thompson (Wife) | 555-XXX-4321
Insurance:
Medicare
Chief Complaint
"I can't catch my breath. My rescue inhaler isn't helping like it usually does. Been coughing more and the mucus is darker than usual."
Medical History
- Emphysema (diagnosed 10 years ago)
- COPD
- Hypertension
- Coronary Artery Disease
- Osteoarthritis
- History of pneumonia (2 years ago)
Home Medications
- Spiriva Handihaler 18mcg inhaled daily
- Symbicort 160/4.5mcg 2 puffs BID
- ProAir HFA 90mcg 2 puffs q4h PRN
- Lisinopril 20mg PO daily
- Aspirin 81mg PO daily
- Atorvastatin 40mg PO daily
What breathing techniques and positions should the nurse teach this patient to help manage dyspnea?
Breathing techniques and positions:
Pursed-Lip Breathing: Inhale slowly through the nose for 2 counts, then exhale through pursed lips for 4 counts. This helps reduce air trapping and improve oxygenation.
Diaphragmatic Breathing: Place a hand on the abdomen and focus on deep, belly breathing to strengthen the diaphragm and reduce the work of breathing.
High Fowler’s Position: Sitting upright or slightly leaning forward with arms supported on a table (tripod position) opens the airways and eases breathing.
Energy Conservation Techniques: Encourage rest between activities and pacing daily tasks to avoid overexertion.
What criteria would need to be met for this patient to be safely discharged home?
Discharge criteria:
Stable Respiratory Status: SpO2 consistently above 88% on prescribed oxygen.
Improved Symptoms: Reduced dyspnea, productive cough with lighter sputum, and less work of breathing.
Effective Inhaler Use: Patient demonstrates proper inhaler technique.
Ambulation and Self-Care: Able to walk short distances with minimal assistance and manage daily activities.
Education Completed: Understanding of medication regimen, breathing techniques, and follow-up care.
Support System: Confirmation that the patient has a caregiver (e.g., wife) to assist at home if needed.
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Robert "Bob" Thompson
68 y/o
Male
Provider:
Dr. James Wilson, MD
Allergies:
Penicillin (rash)
Emergency Contact:
Susan Thompson (Wife) | 555-XXX-4321
Insurance:
Medicare
Chief Complaint
"I can't catch my breath. My rescue inhaler isn't helping like it usually does. Been coughing more and the mucus is darker than usual."
Medical History
- Emphysema (diagnosed 10 years ago)
- COPD
- Hypertension
- Coronary Artery Disease
- Osteoarthritis
- History of pneumonia (2 years ago)
Home Medications
- Spiriva Handihaler 18mcg inhaled daily
- Symbicort 160/4.5mcg 2 puffs BID
- ProAir HFA 90mcg 2 puffs q4h PRN
- Lisinopril 20mg PO daily
- Aspirin 81mg PO daily
- Atorvastatin 40mg PO daily
What key elements should be included in the discharge teaching plan for preventing future exacerbations?
Discharge teaching elements:
Medication Adherence: Emphasize taking inhalers, steroids, and other prescribed medications as directed.
Proper Inhaler Technique: Demonstrate and practice how to use inhalers effectively.
Smoking Cessation: Reinforce the importance of avoiding all tobacco products and offer resources for support.
Infection Prevention: Encourage hand hygiene, avoiding sick contacts, and receiving recommended vaccines (e.g., flu, pneumonia).
Breathing Techniques: Teach and practice pursed-lip and diaphragmatic breathing.
Energy Conservation: Plan activities to avoid fatigue and allow for rest periods.
Environmental Modifications: Avoid triggers like smoke, strong odors, and air pollution.
Follow-Up Care: Stress the importance of attending follow-up appointments and pulmonary rehabilitation.
What warning signs should the patient be taught to monitor for at home?
Warning signs to monitor:
Increased Shortness of Breath: If breathing becomes more difficult than usual, even with prescribed treatments.
Changes in Sputum: If it becomes darker, thicker, or has blood.
Fever or Chills: Signs of a possible infection.
Fatigue or Weakness: Beyond the usual levels.
Chest Pain: Unexplained or severe.
Confusion or Drowsiness: Signs of worsening respiratory failure or hypercapnia.
Oxygen Saturation Drops: SpO2 below the prescribed range, even with oxygen therapy.
Decreased Appetite or Weight Loss: Indicating worsening health or malnutrition.
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