NUR 1211LCOPD Care Plan/; COMPLETE SOLUTION/ GRADE A GUIDE

NUR 1211LCOPD Care Plan/; COMPLETE SOLUTION/ GRADE A GUIDE NUR 1211LCOPD Care Plan Medical Diagnosis: Acute COPD exacerbation Subjective Data: Patient reports shortness of breath, fever, and productive cough “I can’ ...

NUR 1211LCOPD Care Plan/; COMPLETE SOLUTION/ GRADE A GUIDE NUR 1211LCOPD Care Plan Medical Diagnosis: Acute COPD exacerbation Subjective Data: Patient reports shortness of breath, fever, and productive cough “I can’t breathe”. Per his wife, he has not been able to speak in full sentences for the past day. Patient states been a smoker for the last 40 years with 1 pack of cigarettes a day. Patient reports drinking but only one beer at dinner. According to patient he ran out of his inhalers one week ago. Objective Data: BB is a 75-year-old male with long history of COPD for the past 15 years, smoker with 40 pack-per-year. History of hypertension compensated with lisinopril 10mg. Other medications: Advair Diskus, Ipratropium, and Proventil. BP 128/82, pulse 88, RR 26, SpO2 86% on oxygen 2 L nasal cannula, temp. 100.1 F, pain 2/10 (chest pain due to cough). CBS reported leukocytosis. Skin is flushed and diaphoretic. Barrel chest and inspiratory and expiratory wheezes auscultated. Productive cough with green sputum. Nicotine stained to right fingers. Strength 3/5 bilaterally. Alert and oriented x 4. Priority Nursing Diagnosis: Ineffective breathing pattern related to ineffective inspiration and expiration due to COPD as evidence by wheezes on auscultation in both lungs’ fields. Expected Outcome: Breathing pattern improvement within the next 4-6 hours. Action Rationale 1. The nurse will auscultate breath sounds every 2 to 4 hours as indicated. 2. The nurse will evaluate skin color, 1. Decreased breath sounds, crackles, wheezes, and rhonchi can be observed and must be reported promptly for immediate treatment. 2. Lack of oxygen will cause blue/cyanosis temperature, capillary refill; observe central versus peripheral cyanosis. 3. The nurse will encourage frequent rest periods an teach patient to pace activity. 4. The nurse will educate the patient or significant other about proper breathing, coughing, and splinting methods. 5. The nurse will educate patient about medications: indications, dosage, frequency, and possible side effects. Incorporate review of metered-dose inhaler and nebulizer treatments, as needed. 6. The nurse will place the patient with proper body alignment for maximum breathing pattern. 7. The nurse will provide respiratory medications and oxygen, as per doctor’s orders. coloring to the lips, tongue, and fingers. Cyanosis to the inside of the mouth is a medical emergency. 3. Extra activity can worsen shortness of breath. Ensure the patient rests between strenuous activities. 4. These allow sufficient mobilization of secretions. 5. This information promotes safe and effective medication administration. 6.A sitting position permits maximum lung excursion and chest expansion. 7.Beta-adrenergic agonist medications relax the airway smooth muscles and cause bronchodilation to open air passages. . NURSE NOTES I found that the patient has shortness of breath with inspiratory and expiratory wheezes, positive use of accessory muscles, RR 26, and SpO2 86% on oxygen 2 L nasal cannula. The patient is in a tripod position using bedside table support, his skin is flushed and diaphoretic. The patient received a 30-minute nebulizer treatment with Ipratropium and albuterol, and methylprednisolone 60 mg IV at 1900 in the emergency department (ED), however, his oxygenation is still poor. CBC reported leukocytosis, 12 lead ECG reported normal electrical conduction with sinus tachycardia at 105, and chest x-ray PA reported hyperinflation of lungs with flattened diaphragm consistent with long-standing COPD, focal consolidation in the right lower lobe suggestive of possible pneumonia. Background: Ben Bundy is a 75-year-old male farmer who has a long-standing history of COPD for the past 15 years, he is a smoker (40 pack per year), as per patient sometimes he drinks a beer with dinner. The patient was admitted to the hospital due to increased shortness of breath at rest, fever, and productive cough (with green sputum). His medical history also includes hypertension compensated with lisinopril 10 mg PO q AM, his medications also include Advair Diskus 1 puff q 12 h, Ipratropium MDI 2 puff q 6 h, Proventil MDI 1-2 puff q 4 h PRN for wheezing. Patient doesn't have any allergy; his code status is DNI. According to patient he ran out of his inhalers a week ago. Assessment: Most recent vital sings at 2000 are BP 128/82, pulse 88, RR 26, SpO2 86% on oxygen 2 L nasal cannula, temp. 100.1 F, pain 2/10 (chest pain due to cough). IV with fluids running, no infiltration. Skin: Warm, flushed, diaphoretic, intact with no lesions. Skin turgor appropriate for patient age. Nails: nicotine stained to right fingers. No clubbing noted. HEENT: Head with no visible or palpable masses, depressions, or scaring. Eyes: PERRLA, conjunctivae pink, sclerae white. Ears with no discharge. Nose with no discharge or polyps. Mouth with dry mucous membranes and a mild bluish tinge to lips. Neck: No visible lesions, scars or deformities, trachea midline, the patient is able to swallow without a problem. Full ROM. Cardiovascular: Regular rate and rhythm, no murmur, or S3 sound. Capillary refill to finger pad less than 3 seconds. Respiratory: Barrel chest, respiratory diaphragm excursion symmetrical, positive use of accessory muscles. Inspiratory and expiratory wheezes auscultated. Productive cough (green sputum) (culture sent) Gastrointestinal: Abdomen flat and symmetric, bowel sounds normoactive in all quadrants, no tenderness, masses, hernia, or organomegaly. Genitourinary: No masses or tenderness, no urethral discharge. Musculoskeletal: Strength is 3/5 bilaterally. No swelling or deformities on extremities. Neurological: A/O x 4, cranial nerve II- XII intact. Recommendation: I would like you to evaluate Mr. Bundy as soon as possible since he has poor oxygenation. Please let me know if you would like to order a mucolytic to help improve the wheezes. Meanwhile, the nursing staff will continue to monitor SpO2, and maintain oxygen therapy, as well as educate the patient about effective coughing techniques and encourage pursed-lip breathing.