Review the case study scenario below and the client's family history and medical profile information from unit 1.
Next, write a 6-8 analysis of the client (including title and reference) according to the assignment specifications, outline, and grading rubric.
Case Study 2 Scenario:
Client, William Collins, arrived to the emergency room for an exacerbation of Chronic Obstructive Pulmonary Disease (COPD). The emergency department nurse enters the triage room to find Mr. Collins sitting at the side of the bed leaning forward with both arms on the bedside tray. He complains he is having shortness of breath that he is unable to control with his usual medications. His son is with him at the bedside because his wife is unable to come with him due to dialysis.
Case Study Analysis
The case study analysis should include the following sections with responses and rationales for all the prompts.
Introduction (3-5)
Provide an overview of the pathophysiology of the disease exhibited by the client. Include:
What additional assessment findings would you look for?
What lab abnormalities would you expect to see?
What diagnostics would you anticipate the healthcare team ordering?
Provide a rationale for your answers.
Implications for Self-Care (2 paragraphs)
Consider Maslow’s hierarchy of needs and describe where the client falls in that hierarchy and how this will impact care and healing.
How does this disease process impact the client’s and/or their care provider’s ability to care for themselves?
Patient Education Strategy (2-3 paragraphs)
Identify 3-5 appropriate nursing interventions and teaching points for your client based on the pathophysiology and assessment findings.
Describe the educational strategies that should be incorporated when building a plan of care for your client.
Support with rationale.
Interdisciplinary Collaboration (2-3 paragraphs)
Identify 2-4 interdisciplinary team members who need to be included in the care of the client. Include rationale.
Consider the care the client will need while inpatient and upon discharge.
Consider nutrition, community services, and financial implications.
Full Answer Section
Pathophysiology
COPD is caused by inflammation and narrowing of the airways in the lungs. This inflammation can be caused by a variety of factors, including cigarette smoking, air pollution, and dust. The inflammation damages the air sacs (alveoli) in the lungs, making it difficult to breathe. The inflammation also narrows the airways, making it difficult for air to flow in and out of the lungs.
Assessment Findings
In addition to the shortness of breath that Mr. Collins is experiencing, other assessment findings that I would look for include:
- Respiratory rate: A normal respiratory rate is 12-20 breaths per minute. A respiratory rate above 20 breaths per minute is considered tachypnea, which is a sign of respiratory distress.
- Oxygen saturation: A normal oxygen saturation is 95-100%. An oxygen saturation below 90% is considered hypoxemia, which is a sign of low oxygen levels in the blood.
- Use of accessory muscles: Accessory muscles are muscles in the neck and shoulders that help to breathe. When someone is having difficulty breathing, they may start to use their accessory muscles to help them breathe. This is a sign of respiratory distress.
- Wheezing: Wheezing is a high-pitched whistling sound that occurs when the airways are narrowed.
- Crackles: Crackles are popping sounds that occur in the lungs when there is fluid or inflammation in the airways.
Lab Abnormalities
The following lab abnormalities may be seen in patients with COPD:
- Arterial blood gas (ABG): An ABG is a test that measures the oxygen and carbon dioxide levels in the blood. Patients with COPD may have low oxygen levels and high carbon dioxide levels.
- Complete blood count (CBC): A CBC is a test that measures the different types of blood cells in the blood. Patients with COPD may have an elevated white blood cell count, which is a sign of inflammation.
- Chest X-ray: A chest X-ray may show hyperinflation of the lungs, which is a sign of COPD.
Diagnostics
The following diagnostics may be ordered for Mr. Collins:
- Arterial blood gas (ABG): To measure his oxygen and carbon dioxide levels.
- Complete blood count (CBC): To measure his white blood cell count.
- Chest X-ray: To look for signs of hyperinflation.
- Pulmonary function tests (PFTs): PFTs measure how well the lungs are working. They can be used to diagnose COPD and to monitor the progression of the disease.
Rationale
I would look for the assessment findings and order the diagnostics listed above because they can help me to assess Mr. Collins' respiratory status, identify any underlying causes of his exacerbation, and develop a treatment plan.
Implications for Self-Care
COPD is a chronic disease that cannot be cured, but it can be managed. There are a number of things that Mr. Collins can do to manage his COPD and to prevent exacerbations, including:
- Quitting smoking: Smoking is the leading cause of COPD. Quitting smoking is the best thing that Mr. Collins can do to improve his health and to prevent further damage to his lungs.
- Taking medications as prescribed: Mr. Collins has been prescribed medications to help control his COPD. It is important for him to take these medications as prescribed, even when he is feeling well.
- Avoiding triggers: There are a number of things that can trigger COPD exacerbations, such as cigarette smoke, air pollution, and dust. Mr. Collins should avoid these triggers as much as possible.
- Getting enough exercise: Exercise can help to improve lung function and to reduce symptoms of COPD. Mr. Collins should talk to his doctor about how much exercise is safe for him.
- Eating a healthy diet: Eating a healthy diet can help to improve overall health and well-being. Mr. Collins should focus on eating plenty of fruits, vegetables, and whole grains.