Mr. W is an 80-year-old man admitted to the ICU for exacerbation of COPD. He has a history of smoking and his symptoms include increased sputum production, decreased appetite, difficulty sleeping, and increased shortness of breath. Examination finds diminished breath sounds and lab results show abnormalities consistent with respiratory compromise. He is started on antibiotics, bronchodilators, and mechanical ventilation due to worsening oxygenation and is successfully weaned after 6 days. Nursing priorities include maintaining airway patency, facilitating gas exchange, enhancing nutrition, preventing complications, and providing education.
Mr. W is an 80-year-old man admitted to the ICU for exacerbation of COPD. He has a history of smoking and his symptoms include increased sputum production, decreased appetite, difficulty sleeping, and increased shortness of breath. Examination finds diminished breath sounds and lab results show abnormalities consistent with respiratory compromise. He is started on antibiotics, bronchodilators, and mechanical ventilation due to worsening oxygenation and is successfully weaned after 6 days. Nursing priorities include maintaining airway patency, facilitating gas exchange, enhancing nutrition, preventing complications, and providing education.
Mr. W is an 80-year-old man admitted to the ICU for exacerbation of COPD. He has a history of smoking and his symptoms include increased sputum production, decreased appetite, difficulty sleeping, and increased shortness of breath. Examination finds diminished breath sounds and lab results show abnormalities consistent with respiratory compromise. He is started on antibiotics, bronchodilators, and mechanical ventilation due to worsening oxygenation and is successfully weaned after 6 days. Nursing priorities include maintaining airway patency, facilitating gas exchange, enhancing nutrition, preventing complications, and providing education.
Mr. W is an 80-year-old man admitted to the ICU for exacerbation of COPD. He has a history of smoking and his symptoms include increased sputum production, decreased appetite, difficulty sleeping, and increased shortness of breath. Examination finds diminished breath sounds and lab results show abnormalities consistent with respiratory compromise. He is started on antibiotics, bronchodilators, and mechanical ventilation due to worsening oxygenation and is successfully weaned after 6 days. Nursing priorities include maintaining airway patency, facilitating gas exchange, enhancing nutrition, preventing complications, and providing education.
Case Scenario: Mr. W is an 80-year-old retired truck driver admitted to medical ICU for exacerbation of his COPD. He lives his wife, who is 78 years old. Mr. W continues to smoke one to two packs of cigarettes per day, as he has done since the age of 15. Over the past week, Mrs. W has noticed a decrease in Mr. W’s activity level and attention span. He has a productive cough of thick tenacious sputum, averaging 1 cup per day. Over the past week the sputum has become yellow. His appetite has decreased, and he has difficulty sleeping at night, often awakening and gasping for breath. Mr. W is having increasing difficulty in bathing and dressing. Physical examination reveals a thin man with weight of 138 lbs. He had a barrel chest and his accessory muscles of respiration to breathe. Auscultation of the chest reveals diminished breath sounds with scattered coarse crackles bilaterally and no wheezes, Mr. W’s blood pressure is 138/68 mm Hg , his pulse is 92 beats /min. and his respiratory rate is 35 breaths / min. His oral temperature is 38.3C (101F).
Laboratory tests show ABG measurement to be pH of 7.40, PaCo2 of 41 mmHg, PaO2
of 55 mmHg,
SaO2 of 90%(normal 95%) and bicarbonate (HC03) of 28. Mr. W has a white cell count of 12,000. Sputum cultures reveal Haemophilus influenza. A diagnosis of H. influenza pneumonia is made. Because of increasing shortness of breath and decreasing oxygenation, Mr. W is intubated and placed on mechanical ventilation according to the couple’s wishes. Intravenous antibiotic therapy
Levofloxacin
is started, and bronchodilator therapy is initiated to reduce airway resistance and
promote pulmonary hygiene. Mr. W remained on mechanical ventilation for 6 days until he is successfully weaned and transferred to the medical division.
Sympatho/ parasympatholytic
bronchodilators are: beta-2 adrenergic agonists, such as salbutamol, salmeterol,
formoterol and vilanterol. anticholinergics, such as ipratropium, tiotropium, aclidinium and glycopyrronium. theophylline.
Nursing Priorities 1. Maintain airway patency. 2. Assist with measures to facilitate gas exchange. 3. Enhance nutritional intake. 4. Prevent complications, slow progression of condition. 5. Provide information about disease process/prognosis and treatment regimen.
Nursing Interventions Patient and family teaching is an important nursing intervention to enhance self- management in patients with any chronic pulmonary disorder.
To achieve airway clearance:
• The nurse must appropriately administer bronchodilators and corticosteroids and
become alert for potential side effects. • Direct or controlled coughing. The nurse instructs the patient in direct or controlled coughing, which is more effective and reduces fatigue associated with undirected forceful coughing. To improve breathing pattern: • Inspiratory muscle training. This may help improve the breathing pattern. • Diaphragmatic breathing. Diaphragmatic breathing reduces respiratory rate, increases alveolar ventilation, and sometimes helps expel as much air as possible during expiration. Pursed lip breathing. Pursed lip breathing helps slow expiration, prevents collapse of • small airways, and control the rate and depth of respiration. To improve activity intolerance:
• Manage daily activities. Daily activities must be paced throughout the day and support devices can be also used to decrease energy expenditure. • Exercise training. Exercise training can help strengthen muscles of the upper and lower extremities and improve exercise tolerance and endurance. To monitor and manage potential complications:
• Monitor cognitive changes. The nurse should monitor for cognitive changes such as personality and behavior changes and memory impairment. • Monitor pulse oximetry values. Pulse oximetry values are used to assess the patient’s need for oxygen and administer supplemental oxygen as prescribed. • Prevent infection. The nurse should encourage the patient to be immunized against influenza and S. pneumonia because the patient is prone to respiratory infection.
Demonstrate effective coughing and deep-breathing
Helps maximize ventilation. techniques.
Keep environmental pollution to a minimum such as
Precipitators of an allergic type of dust, smoke, and feather pillows, according to the respiratory reactions individual situation.
Assist the patient to assume a position of comfort Elevation of the head of the bed (elevate the head of the bed, have patient lean on an facilitates respiratory function by use of overbed table or sit on edge of the bed). gravity;
Auscultate breath sounds. Note adventitious breath Some degree of bronchospasm is present sounds (wheezes, crackles, rhonchi). with obstructions in the airway Keep environmental pollution to a minimum such as Precipitators of an allergic type of dust, smoke, and feather pillows, according to the respiratory reactions that can trigger or individual situation. exacerbate the onset of an acute episode.
ncrease fluid intake to 3000 mL per day within cardiac
Hydration helps decrease the viscosity of tolerance. Provide warm or tepid liquids. Recommend secretions, facilitating expectoration the intake of fluids between, instead of during, meals.
Suctioning clear secretions that obstruct
Suction secretions as needed. the airway therefore improves oxygenation.
More aggressive measures to maintain
Administer bronchodilators if prescribed. airway patency.
Instant Download for Test Bank for Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition, Linda Anne Silvestri, 2024 Full Chapters in PDF
Instant Download for Test Bank for Saunders Comprehensive Review for the NCLEX-RN Examination, 7th Edition, Linda Anne Silvestri, 2024 Full Chapters in PDF
