COPD Case Study
Patient and History:
D.Z. a 65 year old man is admitted to a medical floor for exacerbation of his chronic obstructive pulmonary disease (COPD). He has a past medical history of HTN, which has been well controlled by enalapril for the past six years and a diagnosis of pneumonia for the three years. He appears as a cachectic man who is experiencing difficulty breathing at rest. He reports a cough productive of thick yellow green sputum. DZ seems irritable and anxious when he tells you that he has been a 2 pack a day smoker for 38 years. He complains of sleeping poorly and lately feels tired most of the time.
His vital signs:
BP 162/84 P 124 R 36 T 102. F SaO2 88% room air.
Admitting diagnosis: Exacerbation of COPD etiology to be determined.
His admission orders:
Diet as tol, OOB with assistance, O2 to maintain sats >90% , IV D5W @ 50 ml/hr , Strict I/O, ABGs in am, CBC with diff. BMP, Theophylline level on admission, CXR q 24 hrs,
• Prednisone 60 mg PO q Day
• Doxycycline 100 mg PO q 12 hr x 10 days
• Azithromycin 500 mg IVPB q 24 hr x 2 days then 500 mg PO x 7days
• Theophylline 300 mg PO BID
• Heparin SQ 5000 units BID
• Albuterol 2.5 mg/3 ml NS and Atrovent 500 mg by nebs Q 4-6 hrs
• Enalapril 10mg PO q am
8. Identify three expected outcomes of D.Z’s treatment.
You notice a box of dark chocolate on D.Zs over the bed table. He tells you that he wakes at night and eats 4-5 pieces of dark chocolate. Several of your COPD patients have identified their craving for dark chocolate in the past.
10. What would you do to address dietary and nutritional needs with DZ and his wife?
11. List six educational topics that you need to explore with DZ.