NR 601 WEEK 2 COPD CASE STUDY PART 2 Primary Care o
the Maturing and Aged Family (Susan Brown)
Week 2: COPD Case Study: Part 2
NR-601 Primary Care of the Maturing and Aged Family
Susan Brown
January 2020
Primary diagnosis:
1. Chronic Obstructive Pulmonary Disease (COPD)
Pertinent positives to support the diagnosis of COPD include: Spirometry results pre-
bronchodilator FEV1/FV ratio 0.52 and a post-bronchodilator FEV1/FV 0.52. A FEV1/FVC ratio
of less than 0.7 constitutes a diagnosis of COPD in symptomatic patients (GOLD, 2019). J.D. is
a former smoker with a 20 pack -year history, over the age of 40. Individuals that smoke or have
m
a history of smoking and are over the age of 40 are at an increased risk for COPD (Dunphy,
er as
Winland-Brown, Porter, & Thomas, 2019). Chronic cough with 6-month duration; that is
co
productive with white-yellowish phlegm and is worse in the morning. SOB upon activity and
eH w
relieved by rest. Symptoms of COPD include chronic cough, production of phlegm, and SOB,
o.
particularly upon exertion. The phlegm or mucus that is produced may be clear, white, yellow or
rs e
greenish in color (Rabe & Watz, 2017). Faint forced expiratory wheezes in bilateral bases could
ou urc
be heard on auscultation. In COPD wheezes and crackles in the bases of the lungs can be heard
upon auscultation (Rabe & Watz, 2017). O2 sat on RA 94%. Typically, normal O2sat readings
should be between 95-100% on RA (Hafem & Sharma, 2019).
o
aC s
2. ICD-10 (J44.9)
vi y re
3. Treatment plan:
ed d
ar stu
According to GOLD (2019), J.D. falls into group B; he is having symptoms and is at low risk for
exacerbations at this time. The initial step would be to place him on a long acting bronchodilator.
The first line therapy is a long-acting muscarine antagonists (LAMA) or long-acting beta-2-
is
agonist (LABA).
Th
Rx: Olodaterol inhaled MDI: 2.5mcg per actuation
Sig: 2 puffs inhaled every 24 hours
sh
Disp: #1 (one)
Refills: 5 (five) [ CITATION Epo19 \l 1033 ].
This study source was downloaded by 100000830034489 from CourseHero.com on 08-30-2021 00:41:20 GMT -05:00
https://www.coursehero.com/file/53536871/Susan-Case-study-2-draft6778docx/
, Additionally, it is recommended that patients with COPD have a short-acting bronchodilator or
rescue inhaler as needed (GOLD, 2019).
Rx: Albuterol inhaled MDI: 90mcg per actuation
Sig: 2 puffs inhaled every 4 to 6 as needed for shortness of breath or wheezing
Disp: #1 (one)
Refills: 5 (five) [ CITATION Epo19 \l 1033 ].
Additional tests/procedures:
Oxygen saturation (O2) monitoring:
m
er as
This is a way to noninvasively assess the arterial oxygen saturation and the potential need for
supplemental therapy with oxygen (GOLD, 2019). The target O2 sat for a patient with COPD is
co
eH w
88-92% (Lacasse, Tan, Maltias, & Krishan, 2018). Recommendations from GOLD (2019)
arterial or capillary blood gases should be drawn if O2 sats are below 92%.
o.
Alpha -1 antitrypsin level: rs e
ou urc
The World Health Organization has recommended that all patients with a diagnosis of COPD
should be screened for alpha-1 antitrypsin deficiency (GOLD, 2019).
o
Sleep study:
aC s
vi y re
Patients with COPD exhibit a common finding of obstructive sleep apnea. Identification of
obstructive sleep apnea can improve outcomes. Patients with COPD and OSA have an increased
risk of death, as well as hospitalizations (GOLD, 2019).
ed d
Exercise testing:
ar stu
According to GOLD (2019), exercise testing can provide valuable information for selection of
patients that are appropriate for rehabilitation.
is
Patient Education:
Th
All patients should be educated on the disease process and the progression of disease, as well as
how to identify the symptoms of an exacerbation and decompensation (GOLD, 2019)
Education on a realistic goal of disease management should be included. In treatment, the
sh
primary goal is symptom control and complication prevention. It is imperative to educate the
patient on the fact that COPD is an irreversible and progressive disease
Development of an action plan for acute exacerbations is beneficial in reducing hospital
admissions and improving quality of life
This study source was downloaded by 100000830034489 from CourseHero.com on 08-30-2021 00:41:20 GMT -05:00
https://www.coursehero.com/file/53536871/Susan-Case-study-2-draft6778docx/
the Maturing and Aged Family (Susan Brown)
Week 2: COPD Case Study: Part 2
NR-601 Primary Care of the Maturing and Aged Family
Susan Brown
January 2020
Primary diagnosis:
1. Chronic Obstructive Pulmonary Disease (COPD)
Pertinent positives to support the diagnosis of COPD include: Spirometry results pre-
bronchodilator FEV1/FV ratio 0.52 and a post-bronchodilator FEV1/FV 0.52. A FEV1/FVC ratio
of less than 0.7 constitutes a diagnosis of COPD in symptomatic patients (GOLD, 2019). J.D. is
a former smoker with a 20 pack -year history, over the age of 40. Individuals that smoke or have
m
a history of smoking and are over the age of 40 are at an increased risk for COPD (Dunphy,
er as
Winland-Brown, Porter, & Thomas, 2019). Chronic cough with 6-month duration; that is
co
productive with white-yellowish phlegm and is worse in the morning. SOB upon activity and
eH w
relieved by rest. Symptoms of COPD include chronic cough, production of phlegm, and SOB,
o.
particularly upon exertion. The phlegm or mucus that is produced may be clear, white, yellow or
rs e
greenish in color (Rabe & Watz, 2017). Faint forced expiratory wheezes in bilateral bases could
ou urc
be heard on auscultation. In COPD wheezes and crackles in the bases of the lungs can be heard
upon auscultation (Rabe & Watz, 2017). O2 sat on RA 94%. Typically, normal O2sat readings
should be between 95-100% on RA (Hafem & Sharma, 2019).
o
aC s
2. ICD-10 (J44.9)
vi y re
3. Treatment plan:
ed d
ar stu
According to GOLD (2019), J.D. falls into group B; he is having symptoms and is at low risk for
exacerbations at this time. The initial step would be to place him on a long acting bronchodilator.
The first line therapy is a long-acting muscarine antagonists (LAMA) or long-acting beta-2-
is
agonist (LABA).
Th
Rx: Olodaterol inhaled MDI: 2.5mcg per actuation
Sig: 2 puffs inhaled every 24 hours
sh
Disp: #1 (one)
Refills: 5 (five) [ CITATION Epo19 \l 1033 ].
This study source was downloaded by 100000830034489 from CourseHero.com on 08-30-2021 00:41:20 GMT -05:00
https://www.coursehero.com/file/53536871/Susan-Case-study-2-draft6778docx/
, Additionally, it is recommended that patients with COPD have a short-acting bronchodilator or
rescue inhaler as needed (GOLD, 2019).
Rx: Albuterol inhaled MDI: 90mcg per actuation
Sig: 2 puffs inhaled every 4 to 6 as needed for shortness of breath or wheezing
Disp: #1 (one)
Refills: 5 (five) [ CITATION Epo19 \l 1033 ].
Additional tests/procedures:
Oxygen saturation (O2) monitoring:
m
er as
This is a way to noninvasively assess the arterial oxygen saturation and the potential need for
supplemental therapy with oxygen (GOLD, 2019). The target O2 sat for a patient with COPD is
co
eH w
88-92% (Lacasse, Tan, Maltias, & Krishan, 2018). Recommendations from GOLD (2019)
arterial or capillary blood gases should be drawn if O2 sats are below 92%.
o.
Alpha -1 antitrypsin level: rs e
ou urc
The World Health Organization has recommended that all patients with a diagnosis of COPD
should be screened for alpha-1 antitrypsin deficiency (GOLD, 2019).
o
Sleep study:
aC s
vi y re
Patients with COPD exhibit a common finding of obstructive sleep apnea. Identification of
obstructive sleep apnea can improve outcomes. Patients with COPD and OSA have an increased
risk of death, as well as hospitalizations (GOLD, 2019).
ed d
Exercise testing:
ar stu
According to GOLD (2019), exercise testing can provide valuable information for selection of
patients that are appropriate for rehabilitation.
is
Patient Education:
Th
All patients should be educated on the disease process and the progression of disease, as well as
how to identify the symptoms of an exacerbation and decompensation (GOLD, 2019)
Education on a realistic goal of disease management should be included. In treatment, the
sh
primary goal is symptom control and complication prevention. It is imperative to educate the
patient on the fact that COPD is an irreversible and progressive disease
Development of an action plan for acute exacerbations is beneficial in reducing hospital
admissions and improving quality of life
This study source was downloaded by 100000830034489 from CourseHero.com on 08-30-2021 00:41:20 GMT -05:00
https://www.coursehero.com/file/53536871/Susan-Case-study-2-draft6778docx/
