Med Surg Case Study #19: Chronic Obstructive Pulmonary Disease

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

Nurse's Note: Mr. Smith's shortness of breath has improved with oxygen therapy. Chest X-ray ordered and completed. Albuterol nebulizer administered, and he reports feeling more comfortable. Respiratory rate 18, heart rate 90, blood pressure 130/80.

Vital Signs

• Blood Pressure: 130/80 mmHg

• Heart Rate: 90 bpm

• Respiratory Rate: 18 breaths per minute

• Oxygen Saturation: 94%

1600

Nurse's Note: Mr. Smith reports mild improvement in his symptoms. Chest X-ray showed no acute changes. Albuterol nebulizer administered as scheduled. Respiratory rate 20, heart rate 95, blood pressure 135/85.

Vital Signs:

• Blood Pressure: 135/85 mmHg

• Heart Rate: 95 bpm

• Respiratory Rate: 20 breaths per minute

• Oxygen Saturation: 92%

Physician's Orders:

1. Oxygen therapy at 2 L/min via nasal cannula

2. Chest X-ray

3. Albuterol nebulizer every 4 hours as needed

4. Complete blood count (CBC)

5. 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

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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.