COPD Management case summary

COPD Management Submitted by Shannon Delite Leake The University of Texas at Arlington College of Nursing In partial fulfillment of the requirements of Advanced Pharmacology N5334 Mary Davis, DNP, MSN, RN, APN-BC, CRNP, ADM-BC November 5, 2017 COPD Management CASE SUMMARY: Mr. Dwayne Johnson, a 59-year-old male, presents with complaints of shortness of breath upon exertion that impacts daily living and decreases quality of living. He 1 COPD Management would enjoy being able to spend time outdoors with his grandchildren and gardening. He reports long term use of ibuprofen for pain caused by cervical radiculopathy and chronic cough. Medical history includes co-morbid diagnosis of cardiovascular disease with a myocardial infarction with stent placement seven years, and an additional stent placed 2 years ago. Patient has history of 40 pack-year cigarette smoking, had stopped smoking post MI, but currently is smoking about five cigarettes a day, and consumes about three alcoholic beverages daily. Familial history positive for COPD and CAD. Patient will receive flu and pneumonia vaccines, and referral for Pulmonary Rehabilitation. Population Health Nurse for health coaching for goal setting and to continue with in office education regarding dietary changes to improve respiratory and overall health, education on smoking cessation, education on cessation of alcohol consumption. Patient will discontinue use of ibuprofen for cervical radiculopathy pain and begin use of acetaminophen with referral to neurosurgeon and pain management specialist for evaluation. Follow-up appointment in four weeks to evaluate effectiveness of umeclidiminium and monitor for side effects. 5334 CASE SUMMARY TABLE 1. Symptoms: List two pertinent signs and symptoms Shortness of breath upon exertion Chronic cough with sputum production 2. Recommended Drugs: **Drug of choice – list at least 3 recommended drugs List recommended drugs as indicated for this diagnosis 2 COPD Management  Incruse Ellipta (Umeclidinium) (GOLD, n.d.).  TheoCron (theophylline) (Theophylline, n.d.).  Winipred (prednisone) (Vallerand, Deglin, & Sanoski, 2017).  Mucinex (guaifenesin) (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) 500mg one to two tabs every six hours as needed for pain (Vallerand, Deglin, & Sanoski, 2017). 3. Drug Categories and Subcategories: Identify the category of each recommended drug.  Incruse Ellipta (Umeclidinium) therapeutically it is a bronchodialator, pharmacologically an anticholinergic, and a pregnancy category C medication (Vallerand, Deglin, & Sanoski, 2017).  TheoCron (theophylline) is therapeutically a bronchodialator, pharmacologically a Xanithine (Burchum, et al, 2016), and a pregnancy category C medication (Theophylline use, n.d.).  Winipred (prednisone) therapeutically an antiasthmatic and corticosteroid, pharmacologically a corticosteroid, a pregnancy category B (Vallerand, Deglin, & Sanoski, 2017).  Mucinex (guaifenesin) allergy, cold, expectorant, cough remedy, and a pregnancy category C medication (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) therapeutically a non-opioid analgesic, an antipyretic, and a pregnancy category B (oral, rectal) medication (Vallerand, Deglin, & Sanoski, 2017). 4. Drug(s) of Choice: FOR THE MAIN DIAGNOSIS ONLY, provide the chosen drug(s) of choice for treatment. 5. Rationale: Provide rationale, clinical guidelines, or evidence for the selected 3 COPD Management drug of choice  Incruse Ellipta (Umeclidinium) taken daily it has shown to improve patient symptoms, effectiveness of pulmonary rehabilitation, and health status (GOLD, n.d.).  Tylenol (Acetaminophen) 6. Contraindications and or Risks, as appropriate: Identify contraindications and risks as appropriate  Incruse Ellipta (Umeclidinium) Severe, or acute symptoms of obstruction of airflow, hypersensitivity to milk proteins, or other ingredients, while using other anticholinergics, while breastfeeding; use with caution in narrow-angle glaucoma, urinary retention, hepatic impairment, bladder-neck obstruction, prostatic hyperplasia, pregnancy, safety not established in pediatric populations (Vallerand, Deglin, & Sanoski, 2017).  Tylenol (Acetaminophen) previous hypersensitivity; consumption of alcohol, aspartame, saccharine, yellow dye number five, sugar, tartrazine, active liver disease, hepatic impairment (Vallerand, Deglin, & Sanoski, 2017). 7. What Patients Must Understand: Identify at least 3 appropriate teaching points for the patient and/or family (HINT: 3 teaching points is rarely adequate for good patient care)  Side effects/Adverse reactions include: Incruse Ellipta (Umeclidinium) arthralgia, acute narrow-angle glaucoma, urinary retention, nasopharyngitis, cough, chest pain, paradoxical brochospasm (Vallerand, Deglin, & Sanoski, 2017).  Breathe out prior to placing lips on inhaler; breathe in taking a long, steady, deep breath; hold breath as long as you can while you remove mouthpiece from your mouth; close cover on mouth piece (Vallerand, Deglin, & Sanoski, 2017).  Do not stop taking without discussing it with primary care provider (Vallerand, 4 COPD Management Deglin, & Sanoski, 2017).  Do not use Umeclidinium for acute (sudden) breathing problems (Vallerand, Deglin, & Sanoski, 2017).  Notify office of increased breathing problems, increased need for short-acting rescue treatments (Vallerand, Deglin, & Sanoski, 2017).  Do not take any other prescribed, over-the-counter remedy, or herbal remedy without discussing this with our primary care provider (Vallerand, Deglin, & Sanoski, 2017).  Notify office of eye pain, halos around lights, blurred vision, eye swelling (Vallerand, Deglin, & Sanoski, 2017).  Notify office of urinary retention, painful urination, or any difficulty passing urine (Vallerand, Deglin, & Sanoski, 2017). Tylenol (Acetaminophen) agitation, headache, anxiety, fatigue, atelectasis, insomnia, difficulty breathing, hepatoxicity, hypotension, hypertension, constipation, nausea, increased liver enzymes, vomiting, hypokalemia, renal failure in chronic use of high doses, neutropenia, pancytopenia, trismus, Steven’s Johnson’s Disease, muscle spasms, rash, Acute Generalized Exthematous Pustulosis, Toxic Epidermal Necrolysis, urticaria (Vallerand, Deglin, & Sanoski, 2017).  Do not drink alcohol while taking or limit your alcohol consumption to less than three glasses if taking one or two doses of Tylenol (Acetaminophen) as this increases hepatoxic effects (Vallerand, Deglin, & Sanoski, 2017).  Do not take Tylenol (Acetaminophen) NSAIDs with this medication as this may further damage your renal system (Vallerand, Deglin, & Sanoski, 2017).  Do not exceed 2grams of Tylenol (Acetaminophen) daily to limit your chances of hepatoxicity (Vallerand, Deglin, & Sanoski, 2017).  Do not take Tylenol (Acetaminophen) longer than 10 days unless directed to do so by your primary care provider (Vallerand, Deglin, & Sanoski, 2017).  Stop taking Tylenol (Acetaminophen) if you develop a rash and call the office 5 COPD Management (Vallerand, Deglin, & Sanoskin, 2017).  Read all over-the-counter medication labels to determine if they contain acetaminophen to avoid taking more than your recommended daily amount (Vallernad, Deglin, & Sanoski, 2017).  Eat small, frequent meals to maintain protein (nuts, eggs) and calories (fatty foods and carbohydrates) in your diet and avoid being overfull, which may cause you to have more difficulty breathing (COPD, n.d.).  Avoid salt which can cause water retentions, which could make breathing difficult (Janchote, 2016).  Avoid dairy products if they tend to increase your phlegm (Janchote, 2017).  In the summer avoid going outside when the humidity and the ozone levels are high (Jovinelly, 2017).  Stop smoking and remain not smoking (GOLD, 2017).  Wear a scarf and breathe through your nose on cold days (Jovinelly, 2017).  Avoid chemical exposure to household cleaners and dust (Jovinelly, 2017).  Buy a dehumidifier if the inside of your home is humid (Jovinelly, 2017).  Change air filters often for your central air condition/heating unit, to control dust and pollen exposure (Jovinelly, 2017).  Utilize your air conditioning and fans to keep your home cool (not cold), as cool air aids in breathing (Bottrell, 2015).  Discontinue drinking alcohol. Alcohol can, cause glutathione deficiency (an antioxidant found in your lungs) which can increase your COPD symptoms; decrease your lung function; decrease your ability to clear phlegm/mucus from your airways; and interfere with medications prescribed for COPD, pain, and other conditions (Does, n.d.). 8. The Prescription(s)