COPD Case Study Adapted from Lewis VCE Lesson 11, Emphysema & Pneumonia
Patricia Newman, 61 admitted with dyspnea at rest, cough, and fever
Smoker x 45 years; 2ppd
Multiple hospitalizations for pneumonia in past 2 years
Osteoporosis x 8 years
HTN x 15 years
Divorced x 15 years; 2 adult children live out of state
Mother d at 63 of MI; father d at 59 of stroke
Medications at Home:
Calcium carbonate 600 mg 4 times per day
Estrogen patch twice a week
Chlorothiazide 500 mg daily
Atenolol 50 mg daily
Sleeps on 2 pillows at night
Emphysema for 12 years
Frequent cough productive of moderate amount of yellow sputum
Short of breath when walking 20 feet
HTN well controlled on meds; no other known cardiovascular problem
Objective:
T – 101.1; B/P – 162/90; R – 26, regular, slightly labored; P – 108, regular
O2 sat 89% on room air
Lungs – coarse crackles throughout lungs; using accessory muscles to breathe
Mental status – alert oriented to person, place, time; cranial nerves intact; PERRLA
Abomen flat, nontender; bowel sounds active; pulse 2+ all extremities
Q1 Which of the clinical manifestations are abnormal and why? What would normal findings be?
Dyspnea at rest, cough, fever; T=101.1, BP=162/90, HR=108, O2 sats 89%; labored
respirations, coarse crackles, accessory muscle use
Normal finding would include unlabored respirations, clear lung sounds, patient’s baseline is SOB
when walking 20 feet. Afebrile, BP 120/80 or less, HR 60-100, sats>90% for COPD patient
Chest x-ray – right middle and upper lobe infiltrates, consistent with pneumonia; hyperinflation consistent with
emphysema
WBC 16,000
RBC 4.9
Hgb 15
Hct 45
MCV 90
Platelets 250,000
Glucose 78
Na- 140
K+ 3.2
Cl- 101
Creatinine 0.8
, BUN 18
ABG: PaO2 – 70; PaCO2 – 56; pH – 7.30; HCO3 – 26
Sputum for culture and sensitivity – pending
IV – 0.9% normal saline; add 40 mEq KCl to every liter of IV fluid
O2 per nasal cannula to keep O2 sat > 88%
Cefotetan 1 gram IV every 12 hours
Ipratropium bromide MDI – 2 puffs three times per day
Albuterol inhaler – 1-2 puffs every 6 hours as needed
Continue home medications:
Calcium carbonate 600 mg 4 times per day
Estrogen patch twice a week
Chlorothiazide 500 mg daily
Atenolol 50 mg daily
Regular diet; no salt
Ambulate 3 times a day increasing distance as patient tolerates
VS every 4 hours
Daily weights
I & O every 4 hours
Peak flow measurements every day
Physical therapy and occupational therapy consult
Q2 How long has Patricia been diagnosed with emphysema? What is emphysema, and how does emphysema
differentiate from chronic bronchitis?
Patricia has been diagnosed for 12 years. Emphysema is damage to the alveoli, which causes air-trapping
and impaired gas exchange. Chronic bronchitis is characterized by increased mucus production.
The nurse discusses emphysema with Patricia.
Q3 Which of Patricia’s clinical manifestations can be attributed to emphysema?
Respiratory acidosis, hypoxia, frequent cough productive of moderate amount of yellow sputum, short
of breath when walking 20 feet, hypertension, sleeps on 2 pillows at night, smoker, frequent
respiratory infection (hx of pneumonia)
Q4 What other clinical manifestations could be present with emphysema? What are the clinical manifestations
of chronic bronchitis?
Confusion or change in LOC, cyanosis, wheezing, low BMI/weight loss, barrel chest, clubbing
Patricia is taken to x-ray for a chest x-ray. Does she need portable oxygen? How will the nurse obtain this?
Q5 What findings on the x-ray are indicative of emphysema?
The patient is currently 89% on room air. The physician order is to keep sats >88%, however, it would be
safe to take oxygen with the patient in case she needs it; the nurse will get an oxygen tank to attach to
the bed or wheelchair for transport and a nasal cannula for patient necessity.
Patricia Newman, 61 admitted with dyspnea at rest, cough, and fever
Smoker x 45 years; 2ppd
Multiple hospitalizations for pneumonia in past 2 years
Osteoporosis x 8 years
HTN x 15 years
Divorced x 15 years; 2 adult children live out of state
Mother d at 63 of MI; father d at 59 of stroke
Medications at Home:
Calcium carbonate 600 mg 4 times per day
Estrogen patch twice a week
Chlorothiazide 500 mg daily
Atenolol 50 mg daily
Sleeps on 2 pillows at night
Emphysema for 12 years
Frequent cough productive of moderate amount of yellow sputum
Short of breath when walking 20 feet
HTN well controlled on meds; no other known cardiovascular problem
Objective:
T – 101.1; B/P – 162/90; R – 26, regular, slightly labored; P – 108, regular
O2 sat 89% on room air
Lungs – coarse crackles throughout lungs; using accessory muscles to breathe
Mental status – alert oriented to person, place, time; cranial nerves intact; PERRLA
Abomen flat, nontender; bowel sounds active; pulse 2+ all extremities
Q1 Which of the clinical manifestations are abnormal and why? What would normal findings be?
Dyspnea at rest, cough, fever; T=101.1, BP=162/90, HR=108, O2 sats 89%; labored
respirations, coarse crackles, accessory muscle use
Normal finding would include unlabored respirations, clear lung sounds, patient’s baseline is SOB
when walking 20 feet. Afebrile, BP 120/80 or less, HR 60-100, sats>90% for COPD patient
Chest x-ray – right middle and upper lobe infiltrates, consistent with pneumonia; hyperinflation consistent with
emphysema
WBC 16,000
RBC 4.9
Hgb 15
Hct 45
MCV 90
Platelets 250,000
Glucose 78
Na- 140
K+ 3.2
Cl- 101
Creatinine 0.8
, BUN 18
ABG: PaO2 – 70; PaCO2 – 56; pH – 7.30; HCO3 – 26
Sputum for culture and sensitivity – pending
IV – 0.9% normal saline; add 40 mEq KCl to every liter of IV fluid
O2 per nasal cannula to keep O2 sat > 88%
Cefotetan 1 gram IV every 12 hours
Ipratropium bromide MDI – 2 puffs three times per day
Albuterol inhaler – 1-2 puffs every 6 hours as needed
Continue home medications:
Calcium carbonate 600 mg 4 times per day
Estrogen patch twice a week
Chlorothiazide 500 mg daily
Atenolol 50 mg daily
Regular diet; no salt
Ambulate 3 times a day increasing distance as patient tolerates
VS every 4 hours
Daily weights
I & O every 4 hours
Peak flow measurements every day
Physical therapy and occupational therapy consult
Q2 How long has Patricia been diagnosed with emphysema? What is emphysema, and how does emphysema
differentiate from chronic bronchitis?
Patricia has been diagnosed for 12 years. Emphysema is damage to the alveoli, which causes air-trapping
and impaired gas exchange. Chronic bronchitis is characterized by increased mucus production.
The nurse discusses emphysema with Patricia.
Q3 Which of Patricia’s clinical manifestations can be attributed to emphysema?
Respiratory acidosis, hypoxia, frequent cough productive of moderate amount of yellow sputum, short
of breath when walking 20 feet, hypertension, sleeps on 2 pillows at night, smoker, frequent
respiratory infection (hx of pneumonia)
Q4 What other clinical manifestations could be present with emphysema? What are the clinical manifestations
of chronic bronchitis?
Confusion or change in LOC, cyanosis, wheezing, low BMI/weight loss, barrel chest, clubbing
Patricia is taken to x-ray for a chest x-ray. Does she need portable oxygen? How will the nurse obtain this?
Q5 What findings on the x-ray are indicative of emphysema?
The patient is currently 89% on room air. The physician order is to keep sats >88%, however, it would be
safe to take oxygen with the patient in case she needs it; the nurse will get an oxygen tank to attach to
the bed or wheelchair for transport and a nasal cannula for patient necessity.
