Case Study 29 COPD Exacerbation
D.Z., a 68-year-old man, is admitted at 1600 to a 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 a cachectic man who is
experiencing difficulty breathing at rest. D.Z. seems irritable and anxious; he complains of sleeping
poorly and states that lately he feels tired most of the time. He reports cough productive of thick
yellow- green sputum. You auscultate decreased breath sounds, expiratory wheezes, and coarse
crackles in both lower lobes anteriorly and posteriorly. His vital signs (VS) are 162/84, 124, 36, 102° F
(38.9° C), and Spo2 88%.
1. Are D.Z.'s VS and Spo2 acceptable? If not, explain why.
D.Z’s VS show hypertension, tachycardia, and tachypnea. All his VS are abnormal because his
body is trying to compensate for the lungs since they are having trouble oxygenating the
tissues. In addition, the oxygen saturation is low indicating not enough oxygen is going to the
tissues. All of these symptoms are consistent with the exacerbation.
2. Describe a plan for implementing these physician's orders.
Administer oxygen via nasal cannula to get 02 above 90 and put the pt on continuous ECG
monitoring and call lab for CBC, ABG, sputum culture and PFT.
3. What is the primary nursing goal at this time?
To improve respiratory status and gas
exchange
4. Based on this priority, identify three independent nursing actions you would implement.
Place patient on oxygen via nasal cannula, elevate the patient’s HOB, have patient use pursed lip
and deep breathing exercises
D.Z., a 68-year-old man, is admitted at 1600 to a 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 a cachectic man who is
experiencing difficulty breathing at rest. D.Z. seems irritable and anxious; he complains of sleeping
poorly and states that lately he feels tired most of the time. He reports cough productive of thick
yellow- green sputum. You auscultate decreased breath sounds, expiratory wheezes, and coarse
crackles in both lower lobes anteriorly and posteriorly. His vital signs (VS) are 162/84, 124, 36, 102° F
(38.9° C), and Spo2 88%.
1. Are D.Z.'s VS and Spo2 acceptable? If not, explain why.
D.Z’s VS show hypertension, tachycardia, and tachypnea. All his VS are abnormal because his
body is trying to compensate for the lungs since they are having trouble oxygenating the
tissues. In addition, the oxygen saturation is low indicating not enough oxygen is going to the
tissues. All of these symptoms are consistent with the exacerbation.
2. Describe a plan for implementing these physician's orders.
Administer oxygen via nasal cannula to get 02 above 90 and put the pt on continuous ECG
monitoring and call lab for CBC, ABG, sputum culture and PFT.
3. What is the primary nursing goal at this time?
To improve respiratory status and gas
exchange
4. Based on this priority, identify three independent nursing actions you would implement.
Place patient on oxygen via nasal cannula, elevate the patient’s HOB, have patient use pursed lip
and deep breathing exercises
