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).(answered 2022)

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. No, the heart rate is too fast they temp is very high (possible infection), High respirations (respiratory acidious? Would need lab values), The O2 is below 90%. Patient might be septic. Listen to lung sounds!! 2. Describe a plan for implementing these physician's orders. Diet as tolerated so check reg to make sure they’re not experiencing issues. Encourage them to always call for assistance when getting up. Encourage them to wear O2 at all times to keep O2 up (nasal canula 2L). Reg. check IV site to make sure it still viable ei. Once a shift. Hook them up to tele, call tele to make sure it is reading clearly. Have Labs done as ordered. Xray as ordered. Sputum culture as ordered. Upon admission make sure RT has come and seen the Patient for nebulizer treatment. Not in this order most important will be O2, call RT first, hook up to tele (keep an eye on the heart) while setting up x-ray. 3. What is the primary nursing goal at this time? To make sure they can breathe. Address the respirations and O2 levels. 4. Based on this priority, identify three independent nursing actions you would implement.