Case Studies, Oxygenation and Perfusion
1. You are a nurse caring for your newest admission, a 68-year-old retired teacher who has a 50 pack-year history of smoking, which resulted in emphysema. She attends exercise classes at her local gym seeking to maximize her oxygenation. Recently, the patient has begun to contemplate the use of portable oxygen to decrease her workload to breathe. (Learning Objectives 4, 5, and 7)
a. What respiratory accommodations would you expect to observe in your patient due to her COPD?
b. How do the effects of emphysema increase respiratory workload?
c. As her condition becomes chronic, what effects would you expect to develop?
d. Considering her medical history, for which illnesses is she at greater risk?
e. Describe the lung sounds you would anticipate auscultating.
f. How would your patient’s COPD impact her dietary needs?
g. Outline measures that would promote your patient’s comfort.
h. Why would it be helpful to encourage adequate fluid intake?
i. What exhalation technique would be helpful to your patient? What are its benefits?
j. How could abdominal breathing assist your patient in oxygenation?
k. Why is it important to monitor oxygen flow rate in patients with COPD?
2. Your patient is a 75-year-old man who immigrated to the United States from Russia as an adult and has limited English skills. He has a history of diabetes, cardiovascular disease, and a severe stroke that impaired his ability to speak and swallow. He has a well-healed tracheostomy tube, but requires frequent suctioning due to thick secretions. (Learning Objectives 6 and 8)
a. List possible nursing diagnoses for this patient’s respiratory status.
b. What are possible nursing interventions that could address this patient’s respiratory care concerns?
c. Discuss desired outcomes for this patient.
Sample Solution
Case Studies, Oxygenation and Perfusion
Chronic Obstructive Pulmonary Disease (COPD) slowly damages the lungs and affects how you breathe. In COPD, the airways of the lungs (bronchial tubes) become inflamed and narrowed. They tend to collapse when you breathe out and can become clogged with mucus. Emphysema is a type of COPD. Smoking is the most common cause of emphysema. In people with emphysema, the air sacs in the lungs (alveoli) are damaged. The damage to the alveoli and airways makes it harder to exchange carbon dioxide and oxygen during each breath. Decreased levels of oxygen in the blood and increased levels of carbon dioxide cause the breathing muscles to contract harder and faster.
