Case study - Chronic obstructive pulmonary disease: Nursing

Nurse sma works on a medical surgical unit and is caring for Richard, a 75 year old male with a history of smoking, who was admitted for an acute exacerbation of chronic obstructive pulmonary disease or COPD.

Nurse. Sema goes through the steps of the clinical judgment measurement model to make clinical decisions about Richard's care by recognizing and analyzing cues, prioritizing, hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse sema recognizes important cues including Richard's vital signs which are a temperature of 99.6 °F or 37.5 °C heart rate, 98 BPM respirations, 28 breaths per minute and BP.

100 and 42/90 millimeters of mercury and oxygen saturation, 85% on room air. When asked about pain.

Richard reports a current pain level of zero out of 10 nurse sema notes that Richard's respirations are labored. He has expiratory wheezing and he's leaning over in a tripod position.

Next, nurse sema analyzes these cues. She reviews the electronic health record or EHR and notes Richard's arterial blood gas or ABG shows a low Pao two indicating hypoxemia.

She also recognizes COPD causes airway inflammation leading to obstructed airflow out of the lungs causing CO2 retention, making gas exchange difficult.

Nurse sema knows that richards hypoxemia, wheezing and tripod positioning indicate hes experiencing impaired respiratory function and needs effective respiratory management.

Now, using the information shes gathered, nurse sma chooses a priority hypothesis of impaired gas exchange. Then she generates solutions to address Richard's impaired gas exchange that will include pharmacologic and non pharmacologic interventions.

She establishes an expected outcome that after intervening, Richard will maintain an oxygenation saturation between 89 to 92% on 2 L, nasal cannula within one hour.

Nurse sema then takes action to implement these solutions. She places Richard on continuous pulse oximetry monitoring and applies 2 L of oxygen using a nasal cannula.

I am gonna put some oxygen in your nose and then administer a breathing treatment to make it easier for you to breathe. I can't catch my breath.

Ok, Richard breathe in slowly through your nose for two counts, keeping your mouth closed and then breathe out while pursing your lips as if you were going to whistle, this will help you exhale the air in your lungs and make breathing easier.

As Richard practices, pursed lip breathing nurse sma administers his prescribed breathing treatment according to the principles of safe medication administration.

After the treatment is complete, nurse sema raises the head of the bed to 45 degrees to assist with lung expansion and helps Richard to lie back.

She places the call bell in reach and exits his room. An hour later, nurse, Sma enters Richard's room to evaluate the outcomes of her actions.

She takes Richard's vital signs which are temperature 99.6 °F or 37.5 °C heart rate, 80 BPM, respirations, 22 breaths per minute BP, 100 and 32/73 millimeters of mercury and pain zero out of 10, his oxygen saturation is 92% on 2 L of oxygen.

She also listens to Richard's lungs and notes that expiratory wheezing is still present but airflow is improved. All right.

As a quick recap, nurse, a recognized and analyzed cues related to Richard's impaired gas exchange and prioritized hypotheses and generated solutions to address this problem.

Nurse. A then implemented pharmacologic and non pharmacologic measures to address Richard's COPD exacerbation and evaluated his outcomes comparing them to expected outcomes.

Since Richard's oxygen saturation goal was achieved, nurse determined that the planet care was successful.