Northern Arizona UniversityNUR 347Critical review Scenario COPD-A Fib-PNA

Critical review Scenario #1 D.Z. is a 68 year old man admitted at 1600 to the medical floor with a diagnosis of acute exacerbation of chronic obstructive pulmonary disease (COPD). His other past medical history includes hypertension and Type 2 Diabetes. He has had Pneumonia yearly for the past 3 years and has been a two-pack-a-day smoker for 38 years. His current medications include enalapril (Vasotec), hydrochlorothiazide (HCTZ), metformin (Glucophage), and fluticasone/salmeterol (Advair). He appears emaciated and is experiencing difficulty breathing at rest. D.Z. seems irritable and anxious and is complaining of sleeping poorly- “Lately I just feel tired most of the time”. He reports a productive cough, thick yellow-green sputum, and upon auscultation you note diminished breath sounds throughout, expiratory wheezes and coarse crackles in both lower lobes anteriorly and posteriorly. Vitals signs are: 162/84, HR 124, RR 36, and temp 102 F, 88% on room air. Physician’s Orders: Diet as tolerated Out of bed with assistance Oxygen per nasal cannula to keep O2 sats at 90% IV of D5W 50mL/Hr Telemetry Monitoring Arterial Blood Gas in AM (ABG) CBC with diff and BMP now Chest x-ray (cxr) daily in AM, do one now STAT Sputum culture Albuterol 2.5mg + Ipratropium 250mcg nebulizer STAT