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NR 601 Week 2 COPD Case Study Part 1 (Initial post, Faculty and Peer responses)
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  • NR 601
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  • Chamberlain College Of Nursng

NR 601 Week 2 COPD Case Study Part 1 (Initial post, Faculty and Peer responses) J.D. is a 62 y/o Caucasian male that presents to the office today with the CC of persistent cough for the past 6 months with a recent onset of SOB. Cough is intermittent and frequent and is noted to be worse in the AM...

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  • July 6, 2023
  • 10
  • 2022/2023
  • Case
  • Susan brown
  • A+

Subjects

  • nr601
  • copd case study part 1
  • susan brown
  • week 2
  • jd

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  • Chamberlain College Of Nursng
  • NR 601
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Week 2: COPD Case Study: Part 1

NR-601 Primary Care of the Maturing and Aged
Family


Susan Brown


January 2020


J.D. is a 62 y/o Caucasian male that presents to the office today with the CC of

persistentcough for the past 6 months with a recent onset of SOB. Cough is intermittent and

frequent and is noted to be worse in the AM. Cough is productive. The sx are aggravated by

activity and are relieved by rest. Tx has been Robitussin DM OTC without any relief of sx.

Severity of sx; he is unable to walk greater than 20ft w/o stopping to catch his breath. Pt states,

“I routinely walked 1mile a day without difficulty.”


Upon ROS the patient denies fever, chills, or weight loss. Denies any sx associated

with HEENT. He denies chest pain and LE edema. However, he reports a persistent productive

coughwith white-yellowish phlegm; that is worse upon waking and SOB upon activity.


PMH is positive for primary HTN. He is currently taking Metoprolol succinate ER 50 mg

qd for HTN and a MV qd. PSH includes cholecystectomy and appendectomy. KDA PCN (hives).

He is married with 3 children and works at a risk management firm as a Senior accountant. He

isa former smoker with a 20 pack-year hx; denies ETOH or illicit drug use. FH is positive for

diabetes and HTN. Father deceased at age 59 of MI and CHF. Father was a smoker; pt quit

“coldturkey” at that time. Mother living and siblings all in good health.

, Upon PE, J.D. appears his stated age, is A&O x4, NAD, and is able to speak in full

sentences. T. 98.1, P. 66, RR. 20, BP 156/94., O2 sat 94 % on RA, Ht. 68.9 “, Wt. 258, with BMI

of 38.2 (obese). Cardiopulmonary exam reveals S1 S2 with no murmurs or additional heart

sound, BBS clear to auscultation with faint forced expiratory wheezes in bilateral bases. R are

even and unlabored. No BLE edema noted. PE otherwise normal and unremarkable.


Differential Diagnosis in order of most likely:

1. Chronic Obstructive Pulmonary Disease (COPD)

2. Asthma

3. Heart Failure

COPD:


COPD is a progressive disease of the lungs that is characterized by airflow limitation

related to chronic obstruction that impedes normal breathing; this process is preventable as

well as treatable (Berg & Wright, 2016). As a result of repeated exposure to pollutants and

inhaled irritants, pathological changes in the airways and alveoli occur due to an increased

inflammatoryresponse (Dunphy, Winland-Brown, Porter, & Thomas, 2019). The chronic

inflammatory response leads to irreversible structural changes, a narrowing of airways

passages, and parenchymal changes in the lung; the exaggerated inflammatory response in

some individual is thought to a certain degree to be related to a genetic predisposition.

Overproduction and hypersecretion of mucus is related to irritation of the goblet cells and

permanent damage of the airway specifically the cilia lead to chronic productive cough (GOLD,

2017). In the United States, COPD is the third leading cause of death and the fourth leading

cause of disability; and isassociated with exorbitant medical costs. 80 to 90 % of cases of

COPD are caused by cigarette

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