NURS 3380 MODULE 5 RESPIRATORY CASE STUDY

NURS 3380 MODULE 5 RESPIRATORY CASE STUDY Bree Lively Module 5 – NURS 3380 Respiratory Case Study June 30, 2019 Scenario: RS has smoked for many years and has developed chronic bronchitis, a chronic obstructive pulmonary disease (COPD). He also has a history of coronary artery disease and peripheral arterial vascular disease. His arterial blood gas (ABG) values are pH, 7.32; PaCO2, 60 mm Hg; PaO2, 50 mm Hg; and HCO3-, 30 mEq/L. His hematocrit is 52% with normal red blood cell indices. He is using an inhaled ß2 agonist and theophylline to manage his respiratory disease. At this clinic visit, it is noted on a chest x-ray examination that RS has an area of consolidation in his right lower lobe that is thought to be consistent with pneumonia. 1.What clinical findings are likely in RS as a consequence of his COPD? How would these differ from those of emphysematous COPD? According to Stephens and Yew (2008), common findings among patients with COPD are a chronic productive cough for a minimum of three months, shortness of breath, ausculatory wheezing, use of accessory muscles when breathing, pursed lips, increased expiratory time, cyanotic, increased mucous production, and weak. Furthermore, research has shown a link between a higher risk for developing obesity in COPD patients due to the lack of physical activity and the limitations due to COPD symptoms (Franssen, Goosen, O’Donnell, and Schols, 2008). Emphysematous COPD consists of damaged air sacs within the lungs. These air sacs lose their elasticity, and therefore, hold onto trapped air, making exhaling very difficult and the patient feeling short of breath (Columbia Surgery, 2019). Studies have shown emphysematous COPD patients to be thin with a barrel chest, typically have little to no cough, and use pursed lips and accessory muscles when breathing. 2.Interpret RS’s laboratory results. How would his acid-base disorder be classified? What is the most likely cause of his polycythemia? This patient’s labs indicate respiratory acidosis and symptoms of hypoxemia and polycythemia from hypoventilation. The pH is acidic and the CO2 levels are increased due to inability to fully expire and CO2 being trapped. In an attempt to compensate, the kidneys would attempt to reabsorb bicarb. Being that bicarb is a normal level, this patient remains uncompensated (Open Anesthesia, 2019). Because the body is in a prolonged hypoxemic state, polycythemia has occurred. In the body’s attempt to compensate, an increased amount of hemoglobin is produced (Rosmarin, Schier & Tefferi, 2019). 3.What is the rationale for treating RS with theophylline and a ß2 agonist? Theophylline has been shown to relax smooth muscle through bronchodilation, and suppress the response of the airways to stimuli. ß2agonist, another bronchodilator, also works to relax muscles of the airway and improves breathing (Cazzola & Page, 2014). 4.What effects would his respiratory disease have on his cardiovascular function? COPD has been linked to cardiovascular disease and an increased morbidity and mortality rate (Quint, 2017). COPD is caused by smoking, which is known to also cause stress on the heart and vessels. Due to the heart working harder, the risk for heart disease, and in turn coronary artery disease and congestive heart failure are also a high risk to develop (AHA, 2018).