Exemplar 15.3: COPD

You have a 50-year-old male that has just been told he has stage 1 COPD w/chronic bronchitis. He is unsure what exactly that means, and he asks you to explain it to him. Which of the following is NOT an accurate response?

You have 60 y/o female patient presenting w/COPD. She brings up a large amount of thick sputum every time she coughs, but brings up even more first thing in the morning. She has a blue tinge in her gums, lips, fingers, and toes. She has +4 pitting edema in both of her calves, ankles, and feet, and her jugular veins are distended. Upon auscultation, you could hear inspiratory & expiratory ronchi. Which symptoms are dominant in this patient's COPD case?

You have a 70 y/o female patient presenting w/COPD. She coughs a minimal amount, but when she does cough, she brings up very little sputum. She has dyspnea and tachypenia at rest that gets worse with even a minimal amount activity; therefore, she is not a very active individual. Despite her lack of activity, however, she is very thin. Her anteroposterior chest diameter is 1:1. She uses accessory muscles & purse-lipped breathing, and will generally sit forward with her hands on her knees. Upon auscultation, you hear diminished breath sounds & wheezes. When you percuss, you hear a loud, low-pitched sound. Which symptoms are dominant with this patient's COPD?

You have an elderly man that you are concerned might have COPD. You suggest that he undergoes testing for it, but he is apprehensive because he's unsure what that might entail. Drag and drop the correct test name for each description. [blank_start]Arterial blood gases[blank_end]: "We will draw some blood to see how much oxygen and how much carbon dioxide you have in your blood. [blank_start]Pulmonary function testing[blank_end]: "We will perform tests to test your total lung capacity, the amount of air in your lungs after you exhale, the amount you can exhale in one second, and the total amount you can exhale overall. These tests will establish a COPD diagnosis and how far the disease has progressed." [blank_start]Ventilation-perfusion scanning[blank_end]: "We will perform a test to see how much of your lungs are taking in oxygen and how much of that oxygen is getting into the capillaries." [blank_start]CBC w/WBC differential[blank_end]: "We will take some of your blood and test how much of each type of blood cell there is. An increase in the amount of red blood cells, or an overall increase in all blood cells, could indicate COPD." [blank_start]Exhaled carbon dioxide[blank_end]: "We will measure how much carbon dioxide you exhale so we can see how much oxygen is being exchanged for carbon dioxide in the lungs."

Select the medications that may be appropriate for the treatment of COPD (7 of these are right)

Administering oxygen without intubation or mechanical ventilation to clients with chronic hypercapnia can increase PaCO2.

You have a 71-year-old COPD patient taking ipratropium bromide, albuteral sulfate, and guaifenesin for his COPD. He is an active smoker, but he's trying to quit. He is reporting medications don't work as well as he'd like, so he's asking you for other ways he can help his COPD. Select appropriate responses you can give to this patient. (5 of these are right).

You have a 65 year old patient that has COPD with chronic bronchitis as the dominant symptom set. His SpO2 is down to 89% and he is becoming more tachypenic. His breathing also appears to be more labored. He is already on supplemental O2, running at 3 L./min via nasal cannula. His skin is not cyanotic, and his LOC is remaining stable. He is not bringing up as much sputum as he usually does.. Select the best intervention for this patient right now.

You have a 80 year old newly admitted patient that has severe COPD with emphysema as the dominating symptom set. She is very activity intolerant, requiring assistance for every activity except turning herself in bed. Eating is downright exhausting for her, so she routinely only finishes about 25% of her meals. Because of her inability to finish meals, she appears cachectic. Select appropriate interventions for this patient.

You have a 70 year old patient with moderate COPD, with chronic bronchitis as the dominating symptom set. She claims she has tried everything to quit smoking, but simply can't get the hang of it. You see that she has only one child, a son, that is married, and he appears to be her primary caregiver. He appears distressed by his mother's re-admittance to the hospital, while his wife looks annoyed. Select the worst intervention for this situation.