A case of COPD

Case Study:
Mrs Helena Neumann a 67-year-old woman with a history of COPD presents with 3 days of worsening dyspnoea and increased frequency of coughing. Her cough is now productive of green, purulent sputum. She has had intermittent, low-grade fever of 37.8°C for the past 3 days and her appetite is poor. She has required increased use of rescue bronchodilator therapy in addition to her maintenance medications to control symptoms.
Mrs Neumann is a widow; she has 2 daughters one in the United States and the other in the United Kingdom, they visit her annually at separate times.
Medical history:
The patient has a 100-pack-year history of smoking (40 cigarettes per day for 50 years), hypertension and hypercholesterolemia
Salbutamol MDI PRN, Seretide MDI 250/25 2 puffs twice daily , Atrovent 1 puff twice daily, Captopril 12.5mg twice daily, Lipitor 20mg nocte. (Seretide hasn’t been re-filled for some time).
No allergies.
Assessment findings in the emergency department:
• Moderate work of breathing, RR30, Sp02 84% on room air, diminished breath sounds and cough with green sputum
• BP 140/90, HR 110 – reg. 12 lead ECG: no acute changes
• Chest x-ray – hyperinflation, consolidation in both bases
• Temperature 37.8°C
• Cachectic and very anxious and agitated
• Barrel chest, tripod positioning
Medications administered in the ED:
• Salbutamol 2.5mg via nebuliser
• Ipratropium 500 micrograms via nebuliser
• Prednisolone 30 mg orally
• 1 – 2 Litres of 02 delivered via N/Prong
Clearly and succinctly states purpose and introduces the topic
Discuss the pathophysiology of Chronic Obstructive Pulmonary disease (COPD). The pathophysiology of COPD is clearly discussed.
Describe the clinical manifestations of COPD including factors that influence disease development and progression. Clinical manifestations of COPD discussion is evidence based and relates to the patient in the case study.
Discuss two (2) nursing interventions that may be beneficial for Mrs. Neumann, and justify your recommendations with evidence based rationales. Discussion of two (2) nursing interventions which may benefit this patient are evidence based.
Critically explain why Short-acting bronchodilators nebulised e.g. Salbutamol 2.5mg & Ipratropium 500 micrograms and systemic glucocorticoids oral prednisolone 30-40 mg are the first line treatment for acute exacerbation of COPD?  Critically explains the medications used to treat acute exacerbations of COPD

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