COPD Exacerbation

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Purpose
To work with a team of professionals, select appropriate nursing interventions within the LPN scope of practice, and recognize serious complications.

Competency
Explain care for the client with lower respiratory disorders.

Instructions
Read the case study below and answer the questions. Site any sources using APA format.

The Story
You are an LPN working in a community health clinic on a team of professionals that includes a medical assistant, RN, and nurse practitioner. The clinic is just opening for the day on a day that is particularly hot and humid. A woman runs into the clinic with an older gentleman yelling “he can’t breathe.” The client appears flushed (reddened skin), is unable to speak, and appears very short of breath. The client’s wife tells you that he has “emphysema” and refuses to put the air conditioning on in their home because he is afraid the electric bill will be too high. She also tells you that he ran out of his medications, including his inhalers and prednisone, almost 2 weeks ago. The client has a respiratory rate of 44 and an O2 Sat. of 84% on room air. His blood pressure is 168/100.

Question 1: List two nursing interventions that should be done immediately. (2-3 sentences)

Question 2: What environmental factor(s) do you think contributed to the client’s current situation? (2-3 sentences)

Question 3: What danger could the client face by abruptly stopping prednisone? (5-10 sentences)

Question 4: Explain why compliance is important in managing chronic diseases such as COPD? (5-10 sentences)

Question 5: After this client is stabilized and his breathing improves. What should be addressed with him on his next clinic visit? (5-10 sentences)

Sample Solution

Case Study: Client with Acute Respiratory Distress

Disclaimer: This information is for educational purposes only and should not be interpreted as medical advice. Please consult a qualified healthcare professional for diagnosis and treatment.

Question 1: Two immediate nursing interventions:

  1. Initiate high-flow oxygen therapy:Administering oxygen via a non-rebreather mask or high-flow nasal cannula to increase oxygen saturation and improve breathing effort. (American Association for Respiratory Care, 2023)
  2. Assess vital signs and respiratory status:Monitor respiration rate, oxygen saturation, pulse, blood pressure, and level of consciousness frequently to gauge patient response and potential deterioration. (National Institutes of Health, 2021)

Question 2: Environmental factors contributing to the situation:

  1. High temperature and humidity:These can worsen breathing difficulties in individuals with emphysema by exacerbating airway obstruction and increasing oxygen demand. (Mayo Clinic, 2022)
  2. Lack of air conditioning:Further aggravates the effect of hot and humid weather, creating a suffocating environment and increasing stress on the respiratory system.

Question 3: Dangers of abruptly stopping prednisone:

Abruptly stopping prednisone, a corticosteroid, can lead to a potentially life-threatening condition called adrenal insufficiency. This occurs when the adrenal glands, suppressed by the medication, are unable to produce enough cortisol, a crucial hormone for various bodily functions. Symptoms include fatigue, dizziness, weakness, low blood pressure, and even shock. (National Institutes of Health, 2022)

Question 4: Importance of compliance in managing chronic diseases:

Compliance with medications and lifestyle modifications is crucial for managing chronic diseases like COPD for several reasons:

  • Prevents exacerbations:Regular medication use controls inflammation and keeps airways open, reducing the risk of flare-ups that can be severe and require hospitalization.
  • Optimizes lung function:Medications and smoking cessation help maintain lung function and slow disease progression, improving quality of life.
  • Reduces complications:Adherence to treatment plans decreases the risk of complications like pneumonia and heart failure, leading to better overall health outcomes. (Global Initiative for Chronic Obstructive Lung Disease, 2023)

Question 5: Addressing the client on their next visit:

After stabilization and improvement, focus on patient education and collaboration:

  • Reviewing medication adherence:Discuss the importance of regular medication use, refill reminders, and potential side effects.
  • Managing environmental triggers:Explore heat management strategies (e.g., fans, community cooling centers) and financial assistance programs for cooling costs.
  • Smoking cessation:If applicable, address smoking and offer smoking cessation resources and support.
  • Action plan for future exacerbations:Develop a plan with the client for recognizing early signs of worsening symptoms and seeking timely medical attention. (National Institutes of Health, 2021)

 

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