CASE STUDY – EMPHYSEMA
(adapted from Winningham, 2013 Critical Thinking Cases in Nursing)
Scenario
D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive
pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been
well controlled by enalapril (Vasotec) for the past 6 years, has had pneumonia yearly for the past 3 years,
and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing
difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems
irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time.
His vital signs (VS) are 162/84, 124, 36, 102 ° F, Sa O 2 88%. His admitting diagnosis is an acute
exacerbation of chronic emphysema. Vital Signs: BP 152/84, HR 124, RR 42, T 100.4F
Prescriber Orders
Diet as tolerated.
Out of bed with assistance
Oxygen (O 2 ) to maintain Sa O 2 of 90%.
Continuous ECG monitoring.
IV of D5W at 50 ml/hr
Arterial blood gases (ABGs) in AM.
Chest x-ray (CXR) q24h
CBC with differential, Basic metabolic panel (BMP), Sputum culture now
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Methylprednisolone (Solu-Medrol) 125 mg IVP q8h
Doxycycline (Doryx) 100 mg PO q12h × 10 days
Azithromycin (Zithromax) 500 mg IVPB q24h × 2 days then 500 mg PO × 7 days
Fluticasone/salmeterol (Advair) 100/50 mcg 2 puffs bid
Heparin 4000 units subcut q12h
Enalapril (Vasotec) 10 mg PO q AM
Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment q6h
1. Are D.Z.'s vital signs and Sa o 2 appropriate? If not, explain why.
D.Z.’s vital signs are not appropriate. D.Z. is hypertensive, with increased heart rate, respiratory rate and
temperature.
2. What is your plan (in priority order) for implementing these physician's orders?
This study source was downloaded by 100000901307859 from CourseHero.com on 10-15-2025 22:38:23 GMT -05:00
https://www.coursehero.com/file/27067011/Emphysema-case-studydocx/
(adapted from Winningham, 2013 Critical Thinking Cases in Nursing)
Scenario
D.Z., a 65-year-old man, is admitted to a medical floor for exacerbation of his chronic obstructive
pulmonary disease (COPD; emphysema). He has a past medical history of hypertension, which has been
well controlled by enalapril (Vasotec) for the past 6 years, has had pneumonia yearly for the past 3 years,
and has been a 2-pack-a-day smoker for 38 years. He appears as a cachectic man who is experiencing
difficulty breathing at rest. He reports cough productive of thick yellow-green sputum. D.Z. seems
irritable and anxious; he complains of sleeping poorly and states that lately feels tired most of the time.
His vital signs (VS) are 162/84, 124, 36, 102 ° F, Sa O 2 88%. His admitting diagnosis is an acute
exacerbation of chronic emphysema. Vital Signs: BP 152/84, HR 124, RR 42, T 100.4F
Prescriber Orders
Diet as tolerated.
Out of bed with assistance
Oxygen (O 2 ) to maintain Sa O 2 of 90%.
Continuous ECG monitoring.
IV of D5W at 50 ml/hr
Arterial blood gases (ABGs) in AM.
Chest x-ray (CXR) q24h
CBC with differential, Basic metabolic panel (BMP), Sputum culture now
Albuterol 2.5 mg plus ipratropium 250 mcg nebulizer treatment STAT
Methylprednisolone (Solu-Medrol) 125 mg IVP q8h
Doxycycline (Doryx) 100 mg PO q12h × 10 days
Azithromycin (Zithromax) 500 mg IVPB q24h × 2 days then 500 mg PO × 7 days
Fluticasone/salmeterol (Advair) 100/50 mcg 2 puffs bid
Heparin 4000 units subcut q12h
Enalapril (Vasotec) 10 mg PO q AM
Albuterol 2.5 mg/ipratropium 250 mcg nebulizer treatment q6h
1. Are D.Z.'s vital signs and Sa o 2 appropriate? If not, explain why.
D.Z.’s vital signs are not appropriate. D.Z. is hypertensive, with increased heart rate, respiratory rate and
temperature.
2. What is your plan (in priority order) for implementing these physician's orders?
This study source was downloaded by 100000901307859 from CourseHero.com on 10-15-2025 22:38:23 GMT -05:00
https://www.coursehero.com/file/27067011/Emphysema-case-studydocx/
