Mr. John Smith | 65 years old | Male
Chief Complaint: Mr. Smith presents with shortness of breath and a chronic cough.
Medical History:
Chronic Obstructive Pulmonary Disease (COPD)
Hypertension
Type 2 Diabetes
History of smoking (quit 5 years ago)
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0800
Nurse's Note: Mr. Smith admitted to the medical-surgical unit. He reports an increase in shortness of breath and cough over the past week. Oxygen saturation at 90% on room air. Respiratory rate 24, heart rate 110, blood pressure 140/90. Auscultated wheezes and diminished breath sounds in the bases.
Vital Signs:
Blood Pressure: 140/90 mmHg
Heart Rate: 110 bpm
Respiratory Rate: 24 breaths per minute
Oxygen Saturation: 90%
1200
1600
Physician's Orders:
Oxygen therapy at 2 L/min via nasal cannula
Chest X-ray
Albuterol nebulizer every 4 hours as needed
Complete blood count (CBC)
Comprehensive metabolic panel (CMP)
Question 1: Why is oxygen therapy initiated for Mr. Smith, and what is the target oxygen saturation level?
Question 2: What is the purpose of ordering a chest X-ray in Mr. Smith's case??
Question 3: Why is prednisone prescribed for Mr. Smith, and what is the expected therapeutic effect?
Answers to Questions Below
Answers
Question 1: Why is oxygen therapy initiated for Mr. Smith, and what is the target oxygen saturation level?
Oxygen therapy is initiated to improve oxygenation in patients with COPD exacerbation. The target oxygen saturation level is typically 88-92% for COPD patients to avoid the risk of hyperoxia-induced respiratory depression.
Question 2: What is the purpose of ordering a chest X-ray in Mr. Smith's case?
The chest X-ray is ordered to assess for any acute changes in lung parenchyma, such as pneumonia or pneumothorax, which could contribute to Mr. Smith's worsening respiratory symptoms.
Question 3: Why is prednisone prescribed for Mr. Smith, and what is the expected therapeutic effect?
Prednisone is prescribed to reduce inflammation in the airways and improve respiratory symptoms in COPD exacerbations. It helps to decrease airway inflammation and bronchoconstriction, leading to improved breathing.
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